I recently worked with a female, high school softball pitcher. She had been recruited and awarded a full college scholarship but due to recurring, painful hip flexor and shoulder pain (all on the right) was unable to play for several months. She could not sit in class for any longer than five minutes and sleeping was very difficult with pain keeping her awake all throughout the night.
Especially challenging for me was the fact that I’ve never played softball. She was a former ballerina so we had that in common. My initial visit and focus was to hear her goals, which was to return to playing as soon as the season began and reducing her pain. This was late March and her season would be starting in mid May. I told her I wasn't sure about the season start date and attaining her goal but I would get her back onto the field.
I knew before we began that there were some left to right sided imbalances caused from repetitive movement patterns practiced daily, weekly, monthly and in her case year after year.
We determined after a series of PRI (Postural Restoration Institute) tests and assessments that the patient lacked proper core strength. "Core" or her "Power Center" being defined as the pelvis internal and external muscles. She lacked rotation in her hips, crucial to pitching, throwing and batting. This weakness affected her ability to transfer power up the kinetic chain from proximal to distal.
She had a “Power Leak.”
The pelvis is the foundation of the spine. Asymmetry of the pelvic structure can lead to a host of compensations throughout the spine predisposing individuals to dysfunction and injury. In softball, maximum throwing velocity requires proper coordination from the leg drive to hip rotation to shoulder and trunk rotation to arm motion. If the hips rotate too late, the thrower cannot reach maximum potential velocity. This explained some of the issues with her shoulder pain which will get addressed in Part 2.
The complexity of pitching, the series of perfectly timed movements which have to be balanced along the kinetic chain leaves little room for substitution. As I observed her pitching over and over again, I realized all of the adjustments she needed to make to complete the task. In order to maximize her pitching velocity we had to stop the leak, which was an unstable pelvis which could not hold her in the correct position during this series of movements.
We realized that her hip flexor was literally holding her up and never relaxed. It was ON all the time.
I introduced her to three of the Postural Restoration Institute exercises which we practiced and she would continue at home 2x per day. I explained that lack of hip stability was causing her hip flexor to do alot of the work her other muscles were not able to, due to malposition. PRI works to REPOSITION, RETRAIN and RESTORE muscular imbalances and attain more symmetry bilaterally (on both sides). We were going after repositioning her pelvis through non manual techniques, facilitating her right gluteus maximus, left hamstring, left adductor and left gluteus medius. I was hoping to offer some pain relief so she could sit in class and sleep more comfortably.
I was having her perform these exercises in supine or in a side lying position to make sure her hip flexor would not and could not kick on. It would in standing and she wan't strong enough yet.
She performed the 90-90 supine hip lift, the left side lying right glute max and the right side lying left glute med. We practiced these three exercises until her position was perfect with no compensations. She was visibly shaking as we went through each, astonished at the weakness of the muscles mentioned above. In the supine and side lying position, other muscles cannot "help" so we repositioned, retrained and restored them to their intended function. I had her walk on the floor in between each exercise.
She had no pain in her right hip flexor. None. She said-'this is the first time I've had no pain in several months. I've always felt my hip. It's been less but never a "zero' like it is now.
The next series (Part 2) will continue the story of her rehabilitation back to the playing field
Above are the three exercises I introduced to her. (All photos courtesy of PRI, Lincoln, NE)