Guest Post by Dr. Caroline Withall
It’s hard to believe almost two months have passed since a very fruitful and productive second visit to Dr. Ginger. One of the reasons I skipped a blog post last month was I wanted to really measure the results of the trip before writing again, and I’m absolutely delighted to report a steady upward trajectory. My Fitbit activity log illustrates how much more I am moving and exercising now, far better than words.
After years of roller coaster ups and downs, I am now progressing consistently. During my visit with Dr. Ginger, we spent a full two days working intensively. This time digging deep into fascial and neural issues that have been troubling me and this led to some really significant findings and my exciting success! As a result of re-tailoring my program I am finally getting stronger and experiencing less flare ups. I think we have finally hit upon the “secret sauce” as Dr. Ginger would say!
I am excited to share my experience and these findings, because they could be very relevant to other hip arthroscopy patients who are struggling to recover.
Dr. Ginger’s methods take a very different direction to traditional rehabilitation methods. If you have continually tried and failed to strengthen your way out of recovery, this type of approach could be really helpful, as it has been for me!
Dr. Caroline Withall, PhD
Uncovering the Truth about my Gluteus Medius
Regular readers of this blog may recall I have continually had difficulty in trying to strengthen my glute med, it did not matter how I tried, or how gently I paced myself, it always resulted in terrible flare ups.
So it was deeply satisfying, as well as fascinating, to finally uncover once and for all the reason why – not to mention completely vindicating to know it was not due to lack of effort or ability.
It turns out that there is absolutely nothing wrong with my glute med. Actually, it works perfectly, although perhaps a little on the weaker side due to everything that has happened. But with more investigation, we determined that the muscle can function absolutely fine – if it is allowed to! The real problem is that the fascial layers surrounding the muscle were compressing it so much, it was stifled from performing.
How on earth do I now know this?! It’s all because of Dr. Ginger’s inexhaustible investigatory skills.
I have spoken before about how forensic she is, and one of her key tools to detect and solve issues is with ultrasound imaging. My situation was not an easy issue to identify. Initially in a lying down position, things appeared to be normal. However, Dr. Ginger can also use imaging to assess what is happening during everyday movements. Once I was in a standing position and replicating the motion of walking, it became very clear on the screen that the glute med was quite severely restricted.
It was a real light bulb moment, and quite shocking for us to see! This knowledge was critical to forming a new rehabilitation approach, as now we had proof that although I sometimes have neural symptoms from the glute med, it was not because the actual motor patterning of the muscle was off, but entirely due to fascial compression.
Game Changing Treatment Update
Armed with this information, Dr. Ginger set to work with lots of manual therapy – including dry needling and myofascial release – and the results were astonishing. We retested the movement after the treatment by re-imaging it, and there was no compression at all and an entirely normal glute med function in standing/walking. It was a game changing discovery and treatment!
It’s important for me to say that It was not something that could be resolved overnight though – the compression soon comes back with activity. Ordinarily you might have a course of needling and myofascial work over successive weeks to coax it to release, however I was only in the US for a few days, so Dr. Ginger showed me how to use a gua sha tool to continue the encouragement at home. Most importantly, armed with this information she was now able to figure out a different way for me to try strengthening work and create a new program – time to move everything horizontal!
Dr. Ginger also introduced me to the Pilates Reformer as a way to progress rehab. For someone in my situation this is ideal, as it is a non-weight bearing approach. You exercise lying down on the reformer carriage, and in many of the exercises your feet use the bar. Not only does this allow me to strengthen my glute med, but it includes another critical component of movement. With the pilates reformer, I can work on strengthening the muscle while lengthening it at the same time! We discovered this is the magic formula for me to help address the fascial restrictions currently centered around my glute med.
The reason I was not getting results with traditional strengthening exercises, such as bridges or squats, is because there was simply too much fascial compression on the gluteus medius. Contrast that with the last two months, as working both the muscle and fascia together has proved a dramatic change, and my activity levels have nearly doubled as a result.
Every time I am done with a reformer session I feel that lengthening effect, and it feels soooo good. To keep this up back in the UK, I have purchased my own reformer and I am now steadily progressing both on my own and with Dr. Ginger’s help.
I can honestly say the new program is working great and I would urge anyone struggling to seriously consider the fascial aspects of recovery.
Reflections after the Game Changing Visit
Of course, I have still had some ups and downs, but I’m happy to report they are less frequent. I have to exercise caution with the reformer because if I do too much, I can bring that compression right back onto the area, or set off the pudendal nerve, a separate issue I can still struggle with. It’s a fine balance between doing enough to progress, but not so much as to cause a bit of a setback. Before and after every session I gua sha and cup the glutes and abdomen religiously.
As ever, you won’t be surprised to hear I did cause myself a mini flare-up; the third time I did a session on my brand new reformer, I got carried away and did too much for a novice. I’ve been very strict with myself since, doing it twice a week for about 30-45 mins, and building up slowly the amount of exercises I do; but I have increased from 4 exercises to 8 and that’s just in the space of a month, so it gives you some idea of how I have been able to progress the work. I have still kept some elements from my old program too – there is always a place for the deep front line releasing sequence, which I still practice several times a week, especially during flare ups. Closed chain exercises, such as the warrior wall twist, are still part of my regular routines.
Other aspects of manual treatment from this trip have had a profound effect on my stellar progress. Dr. Ginger did some Maitland joint mobilizations on my hips to treat capsular adhesions and assist with my body’s tendency to twist forward on my right side, the legacy of years of compensation. I feel in so much better alignment, and my right knee now moves very freely and doesn’t get locked in a position. And on top of all of that, I have also found greater ease in doing the vital screw home position.
Previous compensatory patterns had also led to the left side coccygeus muscle taking more than its fair share of load, essentially stabilising me. Dry needling was really transformational in erasing that pain, and two months later it hasn’t returned. I attribute this not only to the needling, but also as testament that the new program is working. The right side is getting stronger and able to take more share of the load. I still have issues with the genitofemoral and pudendal nerves getting triggered by abdominal fascial restrictions, but again myofascial work followed by performing gua sha myself is helping me manage those much better, and a tight right QL muscle can cause havoc at times.
My old friend the obturator Internus still flares, but no longer on a daily basis. Again, I’m attributing that to finally being able to strengthen all muscles towards operating optimally .
As a result of the March trip to see Dr. Ginger, my daily step count has dramatically increased. I can now comfortably do 10,000-13,000 steps in a day. Sometimes even on consecutive days, which I could not even contemplate doing this time last year.
Dr. Caroline Withall, PhD
There are days when I’m venturing out without my trusty seat cushion, as I’m so much more confident about sitting. Don’t get me wrong, I still seek out restaurants and cafes that have decent seats. I think that will remain with me for the rest of my life, but now if I have to sit on a bad seat, as long as I don’t sit for too long I’m not as worried.
There is still some way to go, particularly with the abdominal neural issues, so I have planned another trip in the summer which hopefully will tackle the final few pieces of the jigsaw. I am getting closer and closer to the centre of the onion, and we certainly peeled a few more layers in the Spring! I feel full of hope that by the end of the year I will have reached the core.
Not getting the results you had hoped after your hip arthroscopy and therapy for hip labral tear, repair, and/ or hip impingement or dysplasia? Are you also female and wondering if hormones or GI function is related to your pelvic pain?
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