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A 43 year old Ironman triathlete consulted us, complaining of extreme pain which started in the front of his right hip, but which after 3 surgical procedures now also radiates to the back of the hip and down the leg to the knee.

History

After competing in several Ironman triathlons in the past, he focussed for 5 years mainly on playing golf 2x a week. He then decided to run the ultra-distance Comrades Marathon in South Africa, which he completed with no pain or injury. Shortly after running the Comrades he started to experience pain in the front of the right hip. The pain did not respond to physiotherapy and the orthopedic surgeon decided to give him a cortisone injection, which took all the pain away. He started to train after 2 weeks and 2 weeks into training he suddenly felt a stabbing pain in the front of the hip and could not continue training. A MRI scan showed a minor labral tear and the surgeon suggested keyhole surgery.

He was referred to see his physiotherapist shortly after the operation for rehabilitation. The pain in the hip was however unchanged and 2 weeks after the operation increased dramatically. Tests showed that he had developed an infection in the hip, which only subsided after 2 more surgical procedures. Since the last procedure, which finally cleared the infection, he was placed on crutches for 8 months and now walks with a limp. The original pain is still the same and the hip joint has become increasingly inflexible. The surgeon is now considering a total hip replacement.

The Lyno Assessment

From the history, and thinking from a movement perspective, the only action that could have caused chronic wear and tear on one side, was  the golf. Coming from a ultra-distance triathlon background with no injuries, one would suspect that his body must have been perfectly aligned, strong and balanced. Golf, however, is a unilateral sport, where the body moves in spirals and all in the same repetitive pattern. As a fit sportsman, he was able to play at a high level, which often results in ‘locking’ of the connective tissue in a spiral pattern (the reason for most of the back issues amongst golfers). When after 5 years of spiral training, he took on an ultra event which requires bilateral strength, the impact of the locked spiral sling would soon result in wear and tear on one side. It was just a matter of “wait and see where”.

The Lyno Assessment involves an investigation of mobility and movement of the whole body, including all the different joints and muscles. Our assessment confirmed the following:

Limited medial rotation and flexion of the right hip
Limited movement of the right hamstring
Limited medial rotation of the right tibia on the femur
Anterior rotation of the pelvis
Limited movement of the medial rotators of the left shoulder and arm
Limited rotation of the lateral rotators of the right shoulder and arm.

The overall ‘locked’ spiral pattern matched his golf swing pattern which locked the body into opposite spiral slings in the legs and opposite spiral slings in the arms. This spiral lock left the right anterior hip unguarded and allowed chronic wear and tear of the soft tissue structures.

Conclusion

A functional assessment of the full body will always immediately show if the body is stuck in a pattern that may cause wear and tear, often in unexpected areas. Without undermining the importance of symptomatic treatment, it is purely logical that if the body remains stuck in the pattern that may be causing the symptoms, it becomes crucial to not only assess the body for dysfunctional movement patterns but also to restore neutral movement before or during symptomatic treatment.

Remarks

The client requested a Lyno session as ‘a last resort’, when the medical fraternity had nothing more to offer but a complete hip replacement. When looking at his injury history, the results of the Lyno assessment made complete sense. We followed the assessment with a session including fascia release of the specific locked spiral patterns. The client had immediate pain relief and at least 50% increase in mobility of the right hip.We will continue the fascia release until he shows full neutral mobility and then follow it up with the activation of neural pathways and functional training.

By removing the patterns that could have played a part in causing the original injury, the body will have a better chance to heal and he will most probably respond better to physiotherapy and rehabilitation.