Hip pain? Trouble Squatting? Consider your ribs (aka Thoracic Rings)

During the recent seminar I ran, we met Nicole. Nicole has given me permission to write this blog because of the beautiful illustration of how various parts of the body interact and can cause pain.

Nicole has been chasing her pain around for a while. It started with some ankle soreness which became back pain which became right hip pain. Looking down the barrel of an MRI for a labral tear…but no incident or accident. She couldn’t squat or move well because of the pain. The standard hip tests seem to indicate pain in the anterior hip like a labral tear.

But what I do is a bit different. I look to see how she squats and what moves well and what doesn’t…and I discovered that her ribs aren’t working well…don’t know why yet, just that they aren’t working properly – we were in a seminar remember, not in a consultation πŸ™‚

Anyway, I found where her movement first deviates from normal…and it was in the left side of her ribs…The term “Thoracic Ring” was coined by Linda-Joy Lee (www.ljlee.ca), probably in a similar way to how the pelvis is called the “Pelvic Ring” – if you think of the 2 ribs and 2 spinal bones and the breastbone or cartilage the ribs join onto, they form a ring…what you do to one side affects the other side. But most people know what ribs are so I still persist with that when speaking with the general public πŸ˜‰

So back to Nicole…

When she squats, you will see that the first 2 squats show her shifting off her sore right side. When she “corrects” the rib on the left, she squats better and accepts weight onto the right side. There is a bit of a pause in the video because I am asking her to squat “evenly” – the fact that she can’t tells me that there is a bit more work to do to unravel why she is doing this.

What you don’t see in the video is that by **THINKING** about supporting that rib, she can take that pain in the right hip away. When she lay down to do some “quadrant testing”, her pain was there without the “correction” and when she or I “corrected” the rib, the pain went away. So to my way of thinking, is it really a torn cartilage? I didn’t even touch the hip itself!

There aren’t that many people who can assess this way…I was luck to be among the first in Australia back in around 2006/7…there are a few more now since then…but, as always, the proof is in the results…

I also like to show videos like this because quite simply, I expect results like this every day I am with my clients. I love the challenge and the pressure to “get it right”.

So the take-home message is this: Just because something hurts, it doesn’t have to be the REASON why it hurts. Nicole’s hip hurts but there isn’t something “wrong” with the hip…it seems like there is something wrong with the coordination in her ribs!

If you have an interesting story to tell, please let me know below.

Nicole’s Squat Correction

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About Antony Lo
Antony Lo is an APA Musculoskeletal Physiotherapist based in Sydney. His website is www.MyPhysios.com.au. He specializes in the management, treatment and prevention of pain and dysfunction, particularly of the pelvis and ribcage. His sub-specialties include Crossfit and Exercise Performance Optimization, Ante-Natal and Post-Natal Care and difficult cases that have failed treatment elsewhere.

12 Responses to Hip pain? Trouble Squatting? Consider your ribs (aka Thoracic Rings)

  1. Lynn says:

    How interesting..! So amazing how not only trigger points can have a pain (far) away from the “real” problem source… Thanks for the video and I truly appreciate it if you upload videos and comment them. That’s something that was absent in our physio education program and it’s very helpful when you share your “detective eye” with us, thanks.

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    • Antony Lo says:

      Hi Lynn. Thanks for the feedback.

      I am not sure if it a trigger point. I could get her to think about the correction and it works. If it was simply a trigger point, then massage would solve it. Also, you would have to ask “why” was there a trigger point there (there wasn’t by the way πŸ˜‰ )

      I will try to upload more as I get time. This was a particularly good example of what I do – I don’t always get to video them πŸ™‚

      Like

      • Lynn says:

        Oh, english is a difficult language (I speak german), it was not my intention to suggest it was a trigger point in nicole’s case (Ireally dont think so!), but the triggerpoint pattern of having a source there and the pain somewhere else reminded me of this case; pain/problem with hips and problem solving with the rib movement…

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        • Antony Lo says:

          Fair enough Lynn. You are doing far better than I. I respect anyone that can speak 2 or more languages!

          Also, I wasn’t commenting specifically about you but because others might read the comments so I want to be as accurate as possible πŸ™‚

          Like

  2. Fran Moore says:

    You could be describing me right now, this is absolutely uncanny. An MRI did not show a labral tear though when I saw a sports orthopod that is what he thought MUST be wrong because those were my symptoms. This is me, down to shifting my weight when I squat. Wow. I am really blown away.

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    • Fran Moore says:

      I was booked for surgery on the 30th of October and decided against it because doing certain things like glute activation work before squatting helps somewhat and 12 weeks off after surgery is not something I could mentally handle right now. I’d be really interested to see if this is my issue.

      Like

      • Antony Lo says:

        For sure Fran. The surgery will always be there. Obviously you have to consider your case with your treatment providers – if they you must, there has to be that consideration…but hip pain is usually not life or death, you know?

        Find someone to assess that hip pain and see if it is being driven from somewhere else.

        I used to get hammered for talking like that in my specialization training…find out if there is another region that is the major contributing factor πŸ˜‰

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        • Fran Moore says:

          I live in a regional area so pickings are slim, even the orthopod up here referred me to someone in Brisbane. I have a great physio and he was never convinced it was a tear, and did often do other work with me so I’m going to send him your article and see if he has some thoughts. Thanks.

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  3. Shandy Sawyer says:

    Very cool! What signs pointed to the ribs being the issue in the first place? Also which side of her thoracic ring is she pressuring to make the correction?

    Like

    • Antony Lo says:

      Hi shandy.

      First, I asked her to squat a few times. It was very painful and not very deep as you can see, no matter where her arms were.

      Then I put my hands on her hip joints, sij, lumbar spine and thorax with a squat or two for each region. Have to be careful if they are super irritable. She was ok. Same pain, no ramp up or increase in pain each time. Looking for the region that exhibits non-optimal movement first.

      Thorax shifted left at around ring 5 or 6 on movement initiation. This was earlier than the observed L/S rotation, SIJ unlocking and hip anterior translation. She looked to move from above over her foot so I didn’t think her lower leg was driving the problem.

      I supported various rings looking and feeling for the shift and preventing the shift. Found the best one which to me means controlled lateral shift, deeper squat, no pain.

      Was able to progress into a thought cue with single arm movement with a light weight. Squat got down to ATG (a$$ to grass) and earlier restrictions appeared to be fear of the pain rather than physical restriction.

      Still have to properly assess her to see where she needs to release and down train over active muscles which were maintaining the problem. As you can see, she is improved but the new squat isn’t perfect. Because it was a seminar, I didn’t have time to do a proper subjective and objective assessment.

      To get that result took about 3mins. To retrain other patterns took about 5mins (thought cue with 2kg weight)

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