For the PT guys - Scar tissue in Hips/Psoas

chedapalooza

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So I found an awesome doctor who was knowledgable enough to recognize my symptoms and notice my pelvic tilt and rotation.

The muscles in my hips (psoas, piriformis, iliopsoas) all have become extremely tight over the years and developed large amounts of scar tissue and caused my pelvis to rotate to the left as well as anterior pelvic tilt. There is a large degree of nerve entrapment and overall blood flow to the region has been diminished for some time. He is confident he can remove the scar tissue with active release therapy and was able to level my hips almost completely in one treatment (noting that it will take several visits for the effects to stay "permanent" with lifelong maintenance and care)

-My post is regarding deadlifting-

Years of young invincibility and football ego in the weight room led to this injury... It's been 4 years since the first symptoms popped up (2010 was last year i played in college)

I have bruises all up and down my hips from the release therapy yesterday lol. Anyway..

Unfortunately it looks like I won't be breaking my 300 x 2 dead lift any time soon or at all. I cut down to 165lbs for summer (from 175) and this dr told me he wouldn't suggest going much over 225lbs for a dead lift at my body weight. He said if I wanna pull more i should be 185+. Any truth?

Deads are the only lift I really like to program and challenge myself at so I am sad for sure. I keep my squats and bench at a light average weight for maintenance.

Is there any reason to believe I can't continue (once I take care of this issue) to increase my weight with the deadlift? Is there any point? I don't compete... It's really just a competition with myself- and at what point does the risk out weight the benefit?

I actually found the video I had my gf take to check my form of my 300 x 2 pull. There are some noticeably flawed movements that are not in all of my other videos. I would love to send to anyone interested in watching. Only a day or two following this session I started to develop bad bladder and testicle pain as well as frequent and urgent urination symptoms along with some residual incontience after urinating. That is what prompted me to begin seeking treatment
 
Gutterpump

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You can keep deadlifting while taking care of the issue. But once you do take care of it, there's no reason why you shouldn't progress. As your form improves, so should your #'s
 
kjetil1234

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A tight psoas isn't a problem in dead lift or squat (unless you're gonna compete). Just start with your back a little bent.

If the problem is in the bottom of a squat, that's the pectineus which is causing the problem. The reason it hurts in the same spot is that they glide over the same bursa (bursa illiopectineus)

What he said about the weights regards to pulling is complete bull****.
 
braskibra

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idk at 5'7 165 is decently filled out, I mean I wouldn't go as far as calling the guy out like the above poster nor offer my own contradictory diagnosis, but i suspect nerve entrapment (paresthetica meralgia?????) isnt being caused by bursitis. BTW i dont think he even mentioned having symptoms in the inner groin near the pectineus? Or are you having femoral n. symptoms? Urination and testicular pain don't sound good, did you get cleared by a physician?
 

chedapalooza

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idk at 5'7 165 is decently filled out, I mean I wouldn't go as far as calling the guy out like the above poster nor offer my own contradictory diagnosis, but i suspect nerve entrapment (paresthetica meralgia?????) isnt being caused by bursitis. BTW i dont think he even mentioned having symptoms in the inner groin near the pectineus? Or are you having femoral n. symptoms? Urination and testicular pain don't sound good, did you get cleared by a physician?
Yes. I got ct scans and ultra sound and blood and urine ... All was clear. I do have nerve entrapment that was his diagnoses. Pain runs from behind testicles up into lower abdomen and obliques and all the way down to just above the knee, as well as around to top of butt cheeks. The whole area is just a swollen tight mess with really bad nerve entrapment. It is being worked out and I am foam rolling the hell out of it, taking hot baths, using joint force and arnica and getting the active release therapy twice a week while limiting my cardio and lower body work... Any ab work i do I am sure to keep hip flexors neutral. Most of the scar tissue is in the psoas and groin areas (inner upper thigh)
 
kjetil1234

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Walk like a duck? Externally
Rotates feet? Could be femoral
Nerve impingement, could also be the obturator (makes more sense, from what your symptoms are)

If your hip flexors are tight and you have shooting pains, could definitely be femoral nerve. But I think it's strange that you're not feeling it down the leg, in such a case.

How do you reproduce the pain?
 
kjetil1234

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idk at 5'7 165 is decently filled out, I mean I wouldn't go as far as calling the guy out like the above poster nor offer my own contradictory diagnosis, but i suspect nerve entrapment (paresthetica meralgia?????) isnt being caused by bursitis. BTW i dont think he even mentioned having symptoms in the inner groin near the pectineus? Or are you having femoral n. symptoms? Urination and testicular pain don't sound good, did you get cleared by a physician?
Well it didn't make sense to me, as the femoral nerve is short when pelvis is flexed. So why would he have problem during dead and squat due to a tight psoas unless only at the top? And none of this have anything to do with the weight used, which led me
To call bull****.

I think the symptoms were vaguely talked about, but I agree that shooting pains in the abdomen are not related to groin bursa as I speculated (simply because it is a very common problem)
 
Gutterpump

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A tight psoas isn't a problem in dead lift or squat (unless you're gonna compete). Just start with your back a little bent.

If the problem is in the bottom of a squat, that's the pectineus which is causing the problem. The reason it hurts in the same spot is that they glide over the same bursa (bursa illiopectineus)

What he said about the weights regards to pulling is complete bull****.
A tight psoas causes anterior pelvic tilt and thus an unstable spine / lower back. A neutral spine is required for maximum power, and to prevent injuries / pain. This applies to almost all standing lifts with a barbell.
 
kjetil1234

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A tight psoas causes anterior pelvic tilt and thus an unstable spine / lower back. A neutral spine is required for maximum power, and to prevent injuries / pain. This applies to almost all standing lifts with a barbell.
Only when standing, hence my advice of stopping before vertical.
 
Gutterpump

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I'm confused. I've never heard of a deadlift or squat where people don't stand :06:
 
Gutterpump

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Even when bent over forward though, an unstable spine is going to cause big problems. Excessive lumbar curve (hyper-lordosis) will cause lack of power and pain in any position, regardless of being/stopping vertical or not. There will still be excess strain in the lumbar region and far too much emphasis on the spinal erectors. The aim is a neutral spine in all of these lifts.
 
braskibra

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Yeah bro bro its all good, I agree it could be an obturator issue or one of the roots prior, (genitofemoral etc)
 
braskibra

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I think in regards to nerves being shortened position, the spine is loaded in all these lifts, in addition looking where the f nerve travels hip flexion certainly can cause compression under the inguinal ligament, however I suspect the clinician is on the right path with scar tissue and possible compression of the iliohypogastric nerve or genitofemoral nerve, OP have u tried injection of the nerve?
 

chedapalooza

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My right foot turns out when I walk (over pronation)
 
kjetil1234

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Even when bent over forward though, an unstable spine is going to cause big problems. Excessive lumbar curve (hyper-lordosis) will cause lack of power and pain in any position, regardless of being/stopping vertical or not. There will still be excess strain in the lumbar region and far too much emphasis on the spinal erectors. The aim is a neutral spine in all of these lifts.
You do realize that he psoas is attached to the femur right? Tight doesn't necessarily mean unstable. Why would the curve be excessive when he's not fully extending?
 
kjetil1234

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I think in regards to nerves being shortened position, the spine is loaded in all these lifts, in addition looking where the f nerve travels hip flexion certainly can cause compression under the inguinal ligament, however I suspect the clinician is on the right path with scar tissue and possible compression of the iliohypogastric nerve or genitofemoral nerve, OP have u tried injection of the nerve?
Hip extension you mean? Hip flexion would release the pressure on the nerve.

What good would injection of the nerve do, when it's acting up due to tightness of a muscle ?
 

chedapalooza

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Hip extension you mean? Hip flexion would release the pressure on the nerve.

What good would injection of the nerve do, when it's acting up due to tightness of a muscle ?
No. One treatment session so far and it was very successful. Seeing him again Monday and wed.

The genitofemoral nerve is what he thinks is the one being affected I believe
 

chedapalooza

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I am putting two videos on YouTube

1 u will see my good form at 225x5
2 u will see the exact rep I injured myself on 300x2

300 for two was a PR for me lol so I had my gf film it so I could check my form. Coming in handy now as all the nerve symptoms began one to two days after the lift
 
braskibra

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Its a diagnostic measure to provide knowledge if it is actually irritation of the nerve, quit coming off like u know everything. Hip flexion in conjuction with trunk flexion will decrease space in the femoral canal. Elongation of the nerve could potentially cause symptoms as well. See difference between phalens test carpal tunnel, v median n. Tension test. Both test the same nerve but in different manners
 
braskibra

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If u have the injection of the nerve and it provides relief then you have diagnostic information that it is the nerve causing pain, if you experience little relief then further examination and testing is required
 

chedapalooza

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If u have the injection of the nerve and it provides relief then you have diagnostic information that it is the nerve causing pain, if you experience little relief then further examination and testing is required
Isn't that gonna cause damage? I'm not familiar w any of this really learning as I go

Here is the video where I am confident the injury took place... Watch hips and lower back compress on a flawed second rep as I finish the pull

http://youtu.be/JJVrbx56ZTE

Here is the video from June 6 with good form at 225

http://youtu.be/vzI9GvRf9VI
 
Sean1332

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I'd kick those shoes off and go barefoot. You seem to get onto your toes a lot. I'd also set up with the bar against your shins when you're standing there and sit back/down until your hands get to the bar. Then, make sure you squeeze your glutes hard to lock it out instead of overextending your back. Making sure you're breathing properly should help with that. too. - IMO

No idea about your condition. My psoas gets tight. I've incoporated this stretch that Rodja recommended, with a forward distracting band sometimes:
http://youtu.be/iEbvVwuBnzg
 

chedapalooza

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I'd kick those shoes off and go barefoot. You seem to get onto your toes a lot. I'd also set up with the bar against your shins when you're standing there and sit back/down until your hands get to the bar. Then, make sure you squeeze your glutes hard to lock it out instead of overextending your back. Making sure you're breathing properly should help with that. too. - IMO

No idea about your condition. My psoas gets tight. I've incoporated this stretch that Rodja recommended, with a forward distracting band sometimes:
http://youtu.be/iEbvVwuBnzg
Thanks very much
 
kjetil1234

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No. One treatment session so far and it was very successful. Seeing him again Monday and wed.

The genitofemoral nerve is what he thinks is the one being affected I believe
Awesome!

Its a diagnostic measure to provide knowledge if it is actually irritation of the nerve, quit coming off like u know everything. Hip flexion in conjuction with trunk flexion will decrease space in the femoral canal. Elongation of the nerve could potentially cause symptoms as well. See difference between phalens test carpal tunnel, v median n. Tension test. Both test the same nerve but in different manners
Sorry, wasn't meant like that! Yeah I agree. Stretching vs. impingement, good point. However I don't see any reason that drugs (injections) should be attempted as a first try "just to check". If the nerve is stretched rather than pinched, the muscles that possibly grip the nerve needs an assessment, agreed?

Femoral canal compression makes sense due to the restricted blood flow, but then again, his femoral nerve is not showing any symptoms, nor did he have any symptoms before this rounded back deadlift, as far as I understood. Suppose it could also be a hernia or hematoma pressing the canal.

If u have the injection of the nerve and it provides relief then you have diagnostic information that it is the nerve causing pain, if you experience little relief then further examination and testing is required
Shooting pain to the groin and abdomen is a good sign that it's some kind of nerve problem. Cortisone would either way not give permanent relief in a condition like this, as far as I can see. Now, if indeed scar tissue is gripping the nerve, then hip extension would make it hurt.

Isn't that gonna cause damage? I'm not familiar w any of this really learning as I go

Here is the video where I am confident the injury took place... Watch hips and lower back compress on a flawed second rep as I finish the pull

Jul 2, 2014 - YouTube

Here is the video from June 6 with good form at 225

Jun 6, 2014 - YouTube
So you have significant rounding of the back when lifting, which absolutely puts it at risk for injury, like a slipped disk. The one with good also to some degree, as your hip shoots up and you finish with back erectors(lumbar flexion). Either way a herniation very often WILL result in nervous pain symptoms... The weight is too heavy for you to properly execute the lift (firste rep aswell), as I see it. If the treatment doesn't give the results you were hoping, I'm betting there's a herniated disk in your back.
 

chedapalooza

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Awesome!

Sorry, wasn't meant like that! Yeah I agree. Stretching vs. impingement, good point. However I don't see any reason that drugs (injections) should be attempted as a first try "just to check". If the nerve is stretched rather than pinched, the muscles that possibly grip the nerve needs an assessment, agreed?

Femoral canal compression makes sense due to the restricted blood flow, but then again, his femoral nerve is not showing any symptoms, nor did he have any symptoms before this rounded back deadlift, as far as I understood. Suppose it could also be a hernia or hematoma pressing the canal.

Shooting pain to the groin and abdomen is a good sign that it's some kind of nerve problem. Cortisone would either way not give permanent relief in a condition like this, as far as I can see. Now, if indeed scar tissue is gripping the nerve, then hip extension would make it hurt.

So you have significant rounding of the back when lifting, which absolutely puts it at risk for injury, like a slipped disk. The one with good also to some degree, as your hip shoots up and you finish with back erectors(lumbar flexion). Either way a herniation very often WILL result in nervous pain symptoms... The weight is too heavy for you to properly execute the lift (firste rep aswell), as I see it. If the treatment doesn't give the results you were hoping, I'm betting there's a herniated disk in your back.
Thanks for all the feedback. It was too heavy.. I was all jacked up on EC stack lol :( I leaned my lesson to check my ego now. I just really wanted to break 300.. Anyway. No back pain, doubt it's anything regarding a disk.. There is a small lump deep in my groin on the hard tendon that Connects pubic bone + hip it is very tender and sore when massaged even lightly. Not sure what that is.. Hematoma?
 
kjetil1234

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Thanks for all the feedback. It was too heavy.. I was all jacked up on EC stack lol :( I leaned my lesson to check my ego now. I just really wanted to break 300.. Anyway. No back pain, doubt it's anything regarding a disk.. There is a small lump deep in my groin on the hard tendon that Connects pubic bone + hip it is very tender and sore when massaged even lightly. Not sure what that is.. Hematoma?
Hope it stays that way bro, good attitude but watch your back.
Hematoma is a collection of blood, basically a bruise. Hernia in this case, is pretty much the intestine breaking through the deep abdominal wall. Although the 'small lumps' you talk about sound more like the lymphatic nodes.

Wish you the best recovery man, good luck!
 

chedapalooza

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Hope it stays that way bro, good attitude but watch your back.
Hematoma is a collection of blood, basically a bruise. Hernia in this case, is pretty much the intestine breaking through the deep abdominal wall. Although the 'small lumps' you talk about sound more like the lymphatic nodes.

Wish you the best recovery man, good luck!
Got it. I don't think hernia pain is way down since beginning to stretch and massage efficiently and daily... Bowels greatly improved as well. So will just take some time!
 

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