Refresh your understanding:
- Chronic overuse of the adductors leads to their degeneration, which we call Osteitis Pubis.
- Biomechanics (the ways you move) are at the heart of Osteitis Pubis.
- The OP mechanics are over pronation/supination, knocked/bowed knees, hip drop, an Anterior Pelvic Tilt/Sway and a locked SIJ/Pelvis.
- Fixing OP means altering/correcting these OP mechanics to stop overloading your adductors and allow them to heal.
- All the OP mechanics are connected so isolating and correcting one at a time is not an effective strategy.
We understand that it’s your OP mechanics that cause you to over rely on your adductors for stability. Why do you have the underlying faulty firing patterns that lead to your hip drop, anterior pelvic tilt, knocked knees, locked SIJ and over pronation? What are these faulty firing patterns? Why did they develop and most importantly, how can you reverse them?
Poor firing/activation patterns: your muscles aren’t working together
OP mechanics are not isolated biomechanical issues.
- If you over pronate your tibia will internally rotate, increasing the likelihood of having knocked knees.
- The arch muscles which stabilize the foot connect muscularly/fascially to the stabilizing muscles in the pelvis. When your arch muscles collapse during over pronation so do the pelvic muscles leading to an anterior pelvic tilt/shift.
The amount may vary, but almost every OP patient presents with some degree of all 5 OP mechanics, a set of pinball reactions that leave the adductors trying to stabilize your entire lower body.
Individual Muscles aren’t weak…. They are uncoordinated!
Functional and muscular weakness are different.
Muscular weakness is familiar to us; in isolation exactly how big/small and strong/weak is a particular muscle or muscle group.
Functional weakness is how effectively you can use a muscle/fascial group in conjunction with the rest of your body.
When we talk about weak glutes, weak arches or a weak core we aren’t talking about muscular weakness; we are talking about functional weakness. Your OP mechanics are caused by the lack of timing, coordination and skill to efficiently use your muscles together. You are ‘functionally weak’.
OP patients are usually strong… in isolation
We’ve tested hundreds of OP patients. A lot of them could hold a 2 minute plank or smash 100 glute bridges. They had strong, powerful muscles when each muscle is tested individually.
The story changes once we move onto functional testing. Functional testing challenges your body’s ability to connect and coordinate your muscles and fascia during movement. It tests the efficiency, balance and coordination of your body. It tests your ‘real world’ prowess, how you perform fundamental human movements. OP patients do well with manicured, controlled strength tests. They perform poorly with real world, functional tests.
They struggle to maintain good alignment and knee tracking during a body squat. Standing on one foot isn’t relaxed. OP patients grip the floor violently with their toes, losing their balance after a couple of seconds. Timing is off, so each muscle fights each other, grasping and bracing as they lurch clumsily through movements. This is the cause of the OP mechanics.
Each muscle is strong enough on its own but they have no idea how to work together. Every movement is an arm wrestle, a battle to hold on to control.
Timing and coordination: why OP patients ‘move clunky’
Coordination and timing of movement patterns are ‘off’.
Your arch muscles might work, but they fire after you’ve already over pronated. Therefore your knee drops in, encouraging you to over contract your adductors to regain control. Unfortunately this inhibits your glute stabilizing muscles, preventing your hips from rotating smoothly.
This is the nature of OP mechanics. You’re constantly playing catch up, grasping and bracing to try to control the ‘whiplash’ of your over pronation/supination, knocked/bowed knees, anterior pelvic tilt/sway, locked SIJ and hip drop.
You could do hundreds of clams and build the strongest glute medius in the world to fix your hip drop. You could do thousands of planks to build a bulletproof core. You could do a million calf raises, making your arches as high as a sprinter’s…
But if your glute medius fires after you’ve dropped your hip, or if your core switches on after your pelvis anteriorly tilts, or your calves switch on after you’ve pronated, you’ll always be fighting a losing battle. Isolated strength training simply doesn’t work. You need to train to coordinate the actions.
A simple test?
Stand on one foot and close your eyes. You should be able to maintain your balance without shaking too much for 10 seconds. Seems easy but it isn’t if you have OP. Most OP patients will find themselves touching the ground regularly.
You need to develop and improve the coordination and timing of your core muscular and fascial systems. You must stop moving ‘clunky’ and stop your muscles from fighting each other. Start moving with grace, coordinating the muscular and fascial systems in your body.
The Deep Front Line and the 6 functional systems that fail in Osteitis Pubis
If individual muscles are not the issue, what is?
The ‘core muscular/fascial chain’ stabilizes your entire body. This chain is called the Deep Front Line (DFL) and is the foundation of our body. Spanning from our head to our toes, it ensures our posture, alignment and stability during all movements. When it collapses/distintegrates you overload your adductors and get OP. The 6 functional systems are connected to this Deep Front Line.
The DFL is a Web
Consider the DFL a web, a long set of interconnected muscles and fascia. When you pull on one part of the web it communicates with and changes the entire structure. This allows load to be evenly distributed through the entire DFL rather than isolated in one area (such as the adductors). A functional DFL allows load to be dissipated across the entire body, from head to toe.
OP= The collapse of the DFL
Rehabilitation is about strengthening the coordination and connections between these systems, not isolating and focusing on each system individually. Balanced coordinated firing and activation of each of the 6 functioning systems will ensure even and efficient distribution of load and stability across the body, de-loading the adductors and allowing them to heal.
Obviously fixing OP means reactivating and strengthening the DFL to stop overloading your adductors.
The 6 Functional systems: what’s wrong with them?
In OP patients, the functional systems that lend the DFL its strength are weakened. Whenever one of these systems fail, others do too and it’s usually your adductors that kick in to compensate.
Your arches are made up of a set of muscles called your ‘deep toe flexors’. Since your feet are the base of your body, an unstable dysfunctional arch makes it impossible for the other 5 systems to work effectively.
Your core can be divided into the deep and superficial core. The deep core is responsible for providing the majority of pelvis and lower spine stability/support. A poorly stabilized spine/pelvis prevents your glutes from firing and contributes to the locking of the SIJ.
The glutes play a key role in generating movement (gluteus Maximus) and stabilizing the hip (lateral rotators). If the glutes fail to fire the body will engage the oblique chains and other compensatory patterns to replace the glute max activation.
Locked SIJ/Pelvic Floor
The sacroiliac joint (SIJ) plays a vital role in pelvic rotation during walking/running. The pelvic floor is responsible for controlling the SIJ. In OP patients this is locked, that is, each side of their pelvis is stuck to the sacrum. Instead of rotating each pelvis in a different direction (forward and backward with each step) the whole pelvis rotates, causing twisting/excessive rotation.
Weak Oblique chains
OP patients present with poorly coordinated and often over active oblique chains (a supplementary system to the ‘deep core’). The oblique chains cross from one side of the rib cage to the opposite leg, contributing to whole body twists, rotations and scliosis of the spine.
Weak Vestibular/Proprioceptive system (poor balance):
The unspoken, unseen system, your balance, is vital to the function of every muscle in the body. Proprioception is the spatial awareness of your body. It allows you to move in good alignment and posture, dissipating load evenly across the body. OP patients present with decreased proprioception, leading to increased bracing and tension. Their movements tend to be clunky and rigid, creating more friction and force through the lower body.
Whenever one of these systems fail, it’s usually your adductors that kick in to help compensate.
Fixing OP = Whole body functional rehab
If the DFL/6 functional systems are intricately interconnected, then the only way to fix your OP is to strengthen and correct them all at once with functional rehab. Functional exercises mimic real world movements demanding the activation and coordination of each of the 6 functional systems. Functional rehab prepares you for what you will be facing in your normal life so you don’t return to the track/field only to find your OP waiting for you.