Why does my hip hurt when I've strained my shoulder?

Ida Rolf - "where you think it is, it ain’t"

More on this later, but this is one of my favourite quotes about health and injuries. Elaine’s Question:

"I'm wondering what happens in a strain, what the connections are and why twisting my arm might trigger my hip more than shoulder?" Firstly we’ll go through what a Strain is. How, as a general rule, strains are treated

Why that might be wrong -

Why it could be linked to the hip Other possible solutions to assist healing

What is a strain?

It’s when a muscle or tendon is stretched beyond its normal capacity. A tear of the tissue could have happened.

Common symptoms that you’ve strained a muscle:

• Pain

• Redness/warmth

• Swelling

• Reduced movement

• Muscle cramps or spasms - excess tension in the area

• Muscle weakness

Your brain will do this to protect you from any further damage to the area. Pain is the signal that something is wrong (and it’s never more than that, it is rarely accurate). Redness is an indication of increased blood flow - your body is sending additional resources via the blood to help heal the damaged tissue. Swelling - your body floods the area with white blood cells to “clean up” the damaged tissues and take them away. Swelling is a symptom of the extra fluids being in the injured area. Reduced movement, muscle weakness and extra muscle tension - this again is the brain's way of protecting you from further damage and protecting the tissues as they are being repaired. Traditional treatment: RICE

• Rest

• Ice

• Compress

• Elevate
  

This, however, is less strictly followed nowadays. In the last few years, even after major surgery, people are encouraged to get moving as soon as possible post surgery to encourage healing - within reason. Movement, however limited, is usually encouraged so that fresh blood and nutrients can be sent to the afflicted areas and waste products (dead cells) are more easily removed. This greatly speeds recovery, reduces inflammation and swelling. Movement as a rule of thumb is a great pain reliever. This doesn’t always mean to move a strained joint - this could mean doing exercise with parts of the body that aren’t damaged. I.e if the shoulder is damaged you can still do exercises like walking. This will have an overall effect of decreasing pain sensitivity across the whole body. Ice, with chronic injuries, is recommended much less. It can reduce pain temporarily but it has the drawback of cooling the muscles down, decreasing blood flow, slowing lymphatic drainage and decreasing your ability to move the joint all of which are slowing down healing (however the temporary pain relief might be worth it with high levels of pain) Compression - without limiting the joints ability to move (unless it’s severely damaged) Elevation - this is aimed to help drainage of waste products from the area, depending on the injury site this might be easy or more challenging. Ideally the afflicted area should be held above the level of the heart. For legs ideally you’d be laying down with legs raised on cushions and for upper limbs sitting with arms raised up on cushions to shoulder height…..not convenient in most cases unless you’re bed ridden.

KEY POINTS

Move as often as possible within limits of pain - your brain and body LOVE movement.

Ice is a pain reliever and best used only in the first few hours/days of an injury - after that you may be slowing recovery down.

Why treating the injury area only might be the wrong option.

Your body is one organism, it is a whole. It isn’t Lego or a robot where if you break or take out one part all you’ve got to do is repair/replace it. Damage to one area of the body affects the whole body.

Imagine this

You’ve been walking all day in shoes that don’t fit quite right anymore. You just know that there’s a blister coming, big, fat and juicy. You’re already limping a little bit to avoid the pain of treading on that spot again and again. That blister is going to be with you for a few days. It’s going to continue affecting how you walk. So, to avoid the pain you turn your foot out a little bit, take shorter steps and look a bit more where you’re going so that you don’t aggravate it by stepping on a rock. Already your ankle is starting to feel a bit funny, a few days later you’ve got a bit of a hip pain. Now the blister is gone, it’s been 7 days but you’re still walking with your foot turned out (you don’t even notice it) And now for some reason, you’re getting a pain in the shoulder. It must be the stress at work that’s doing it and carrying your laptop bag and lunch (saving a few pennies for the fuel at the weekend) But whatever you do that shoulder pain isn’t shaking, swapping sides with your bag, moving your shoulder around regularly to release the tension. You’ve even learnt some trigger point work from YouTube to release tension across your shoulders. Ah, Pilates later, that will work to get rid of this shoulder pain. [goes to Pilates] OMG, that feels so much better, all the stress is gone, my shoulder feels great. *** walks to the car *** WTF man, it was just better, now I’ve walked to the car and it’s F’ing come back! Seriously!! This happens all of the time, all over our body. The problem is that our body is EXCELLENT at adapting to the circumstances. Changing how it moves and learning new patterns. Sometimes though, it forgets to forget that this was only temporary. Your body should forget the temporary adaptations to different stimuli in your environment (i.e. the temporary blister) and return to it’s fully functioning operations as soon as the injury has healed. Except, for most people, a lot of the time, it doesn’t. It can literally be as innocuous as a blister that could throw your body off for weeks, months or even years.

This is why an injury in one area of your body can trigger pain in another area of your body.

I can’t complete this story without talking about Fascia

Fascia

Not the stuff you have under your guttering at home. It is in fact the largest organ in the human body. It’s literally everywhere. It wraps around your bones, organs, under your skin, over ligaments and tendons, around muscles, arteries, veins…..everything! Research has shown that there are multiple layers of fascia all over the body.

They have been termed as fascial lines.

They move across the body in various ways and have been separated into these categories Superficially - close to the skin and surface muscles Deep - closer to the bones, organs deeper muscles Spiral - wrapping around the body, front and back, left to right. Laterally - across the body (finger tip to finger tip) Vertically - Head to toe (and back again!) Anteriorly - front of the body Posteriorly - rear of the body Even though there are multiple “lines” of fascia they all connect to each other somewhere along the way. Whether that’s in the gut, the Jaw, the lower back/hips. Any one of them can affect any of the others.

Fascia has some amazing properties too.

• It is elastic - but only if it’s healthy!

• Super Strong

• Full of nerve fibers - it’s highly sensory, sending vast amounts of information back to the Brain.

• It can be both highly fluid or thick like a gel

• It has a triple helix structure (DNA is a double Helix) making it durable, strong, flexible

• It is highly electrically conductive

• It is Piezoelectric (when you hit it or move it it creates an electrical current)
  

It’s been hypothesized that the Chinese acupuncture/meridian system is deeply linked with fascia. Many of the key acupuncture points in the body lay in areas where different layers of fascia connect and are close to the surface. Fascia can become “stuck” - when an injury occurs the fascia can get damaged too, not just the muscles or bones (or whatever got injured) As with anything that becomes damaged in the body, it’s repair process might not go quite to plan. The body may adapt to this stimulation and think

“i got damaged here, i must reinforce the area”.

Or it simply rebuilds in a less than perfect way - things go wrong sometimes. It may then “tie” the area together creating what a manual therapist might feel as a knot of tissue or muscle. It is most likely a tender spot too (fascia is FULL of sensory nerves) A lot of people describe fascia a bit like a big bed sheet. When you pull on one corner (an injury) the whole bed sheet gets stretched and tightened. A new pain or injury might show up along any of the areas that are linked with that tightness. Add in a few extra bed sheets underneath the top one and you can build a picture of this could affect anything, anywhere in my body (even how your organs function!) Some may link fascia with complex pain problems such as fibromyalgia or Chronic Regional Pain Syndrome. I would have to agree that there is almost certainly a link but not the whole story. To answer Elaines' question - why does turning my shoulder end up in a hip pain. The answer is most likely down to fascia.

Chicken or Egg?

Did the hip injury come first or was it the shoulder?

Sadly Elaine, we’ll never actually know. You may have experienced pain in the shoulder first but the problem may have been underlying in the hip before that (but not bad enough to be noticeable) - it may also have stemmed from a foot, a calf, a knee, your stomach, it’s very unlikely that we’ll find out for sure. Even though we don’t know it’s not doom and gloom but instead of being able to write you a nice simple 3-5 exercise program to rehab your shoulder it’s more of a case of get your whole body moving to stimulate the major pathways of fascia in your entire body. There may be some mechanical issues in the spine also which reduce flexibility further and won’t help the issue. Stiffness or tight muscles in any area of the body could be linked to the pain site.

How to treat fascia

Fascia loves movement, getting the body to move in different patterns, new ways, that perhaps it hasn’t done for a long time will go a long way to. A good, whole body, mobility or warm up routine will go a long way in treating fascial issues. Whole body mobility / warm up routine https://youtu.be/eWWrkt8hnvU

Other things that will help

Moving more and in different ways - dancing, gymnastics, parkour, martial arts, plyometric exercises (within reason)

Hydration - fascia is very “wet” - roughly 70% water. It is also full of electrolytes (nutrients) so a healthy diet with lots of fresh fruits and veg

Don’t focus on the painful area - the shoulder may hurt but the tightness in the fascia could be anywhere.

Massage - some massage therapists specialize in the treatment of fascia - these tend to be soft and gentle techniques (not sports massage which could tighten the areas up even further)

Acupuncture - true acupuncture not dry needling - they’ll understand that a pain isn’t where we think it is and through their own methods may deduce which meridian points will likely help to undo the damage faster

Surgery

If you’ve had surgery of any kind, that surgeon had to cut through multiple layers of fascia. Not their fault. They had to do the surgery (probably) - if the fascia hasn’t knitted itself back together neatly, able to glide over each other smoothly then this tightness can cause problems. Surgery to fix fascia, in my opinion, is highly unlikely to work (at this point in time) the skill and technology level is not there. However there are skilled surgeons and Drs working on this such as Jean Claude Guimberteau, a Hand Surgeon, who is a pioneer of this work and research into fascia. So, if you’ve had surgery it would be a good idea to gently massage and stretch the tissues near and around your scars to begin to release any “knotted” tissues there - even if that scar is nowhere near your injury it could be of great help. There are also specialist massage therapists who deal with scar tissue (they are most likely fascial massage therapists too - it seems to me to be practically the same thing) If the thought of doing all that work on mobility, stretching, hydration, nutrition sounds a bit long winded, yet another minefield of information to wade through. Here’s a bit of a short cut - my entire foam rolling library and the majority of my mobility exercises and routines Foam rolling and Movement video library - free access here https://www.retrainpain.co.uk/foam-rolling

There’s another solution

Book a 30 minute call with Pete right here at Retrain Pain HQ - often these types of problems are fairly quick for him to find and resolve (but the other stuff certainly helps too) - it’s likely that this type of problem will take between 1-4 treatment sessions to fully resolve The beauty of the work that Pete does at Retrain Pain is that because it works on the whole body and not just the pain areas you are likely to get additional benefits such as:

• Improved sleep

• Greater Energy in your Day

• Improved Outlook

• Calmer and more balanced Moods

• Mental Clarity and Focus

• Improved Relationships and Connections with other people

Book your free introductory call here to get started https://calendly.com/retrainpain/30min