“They come at night, mostly” my client Kim quipped, quoting the famous line from Aliens (one of my top ten movies).
She’s referring to the pains down the side of her left leg that regularly wakes her up at night.
This vicious pain pattern is ubiquitous. Gyms are full of people foam rolling their lateral thigh/ IT bands.
Trigger point referral patterns to the lateral thigh come from quite a few muscles – the main culprits are gluteus medius, minimus and tensor fascae latae. Mmm – all abductors of the hip. There’s a clue here!
These muscles fall into the phasic category and tend to be weak/inhibited. Bursitis and tendonitis of the muscles that attach to the greater trochanter is rampant. (Quadratus lumborum refers right into the greater trochanter often mimicking GT bursitis.)
Here’s a paradigm I’ve used in eliminating and/or reducing that pernicious “aBducted by aliens” painful lateral thigh syndrome
- My top three assessment tests for this condition are: High Iliac Crest; Pelvic Rotation and Pubic Bone Misalignment. If you only have time to do one, check the pubic bone. When that bone is misaligned it wreaks havoc in the adductors
- Restore length-tension relationship between adductors and abductors. Adductors tend to overly-facilitated and abductors inhibited.
- Adductors: Myofascial release and trigger point therapy followed by assisted stretches using antagonist/agonist contract.
- I prefer to work with the adductors in the sidelying position. It’s the best position to get these excitable muscles to turn-off. Most therapists work on the adductors in the supine position with the leg abducted and externally rotated putting the adductors on a stretch. Ouch! They are stubborn and will fight your work.The top hip is flexed, knee bent. Bottom leg is extended leaving the adductors in a good position to work on. Use the Pin and Rock technique first to soften the tissue, followed by Pin and Move. End with long, lengthening strokes from hip to knee.
- Abductors: while your client is sidelying you can work with the IT band, TFL, Gmin and Gmed and even the QL. My preferred was of working on the lateral thigh/IT band is gentle cupping. The collagen fibers that make up the IT band are heavy-duty – some of the strongest in the body. The fascia tends to get glued. Cupping allows you to lift, separate and rehydrate the tissue awakening the sensory aspect of the IT band that helps us to coordinate and stabilize our standing, walking and running. Make sure to check if there’s bursitis or tendonitis. Cupping over those areas would likely irritate the tissue. If cupping is too painful or you’re not a “cupper” perform slow, patient cross-fiber friction working hip to knee. Grasping, lifting and gently shearing the tissue anteriorly and posteriorly is also an effective technique.
- Since the abductors most likely are weak/inhibited I suggest several exercises to my clients. Keep in mind that the hip is a ball and socket joint and has a rotator cuff of sorts. Check out the one below that targets all the external rotators of the hip joint.
- At home stretches for the adductors.
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Final thought – this is a way not the way to treat this pernicious pain syndrome. I’m a firm believer in not getting married to any paradigm!!
