On Canceling a Hip Replacement Surgery:
Why Health Care & Medicine Require
Soft Tissue Therapies, Massage, and
Yoga-based, Structural Bodywork
Hip Joint Pain & Compression Remedies
[NOTE #1: Yoga-based, Structural Bodywork refers to manual therapy (similar to some massage techniques) using “yogic” principles of body-mind integration as well as complex postural assessment to enhance results. … Clients and patients engaged in yogic mindfulness while participating in hands-on, manual therapy, as well as postural yoga therapy, achieve far deeper levels of relaxation and resolution of problems caused by excess stress and tension. … In-depth postural assessment provides more precise clues as to which neuro-muscular units are in most need of attention.]
[NOTE #2: This is an abbreviated version of a much longer, more complete article available on my website. http://www.letgoyoga.com/hip-replacement-cancelled/ … If you visit that article after reading this one, you can conveniently jump past the repetitive material with a hyperlink.]
Time For A SECOND Hip Replacement?
In The SAME Hip?
I was visiting a longtime friend and mentor in the mountains of Eastern Tennessee about twelve years ago. His approximately forty year old (at the time) son was there doing professional carpentry for a family building project.
His son had severe, chronic joint pain in his right hip, a big problem as he was doing moderately heavy construction work and carrying most of his own tools and materials, including a lot of heavy stuff like sheets of plywood, drywall and other construction materials. … He was very fit and not overweight at all.
He had already received one hip replacement for his hip joint pain at Johns Hopkins Medical Center, one of THE leading medical facilities on Earth.
Yet when I showed up at the family home in Tennessee, he still had hip pain, and had been scheduled for a second hip replacement on the same hip. An additional reason for the new surgery (besides the pain) was the artificial hip joint appliance was beginning to break through the joint surface (acetabulum) in the wall of his pelvis. (!!!) …
This had been observed on X-rays, similar to the one below. The red arrow indicates the direction of pull on the artificial femur head up and into the acetabulum.
That, of course, is not a good thing! Something was obviously very wrong.
Being a postural yoga and a hands-on muscle therapist (similar to massage with significant differences) for 25+ years at the time (2004), and very good and long time friends with his father, I offered to see if I could help his situation.
Assessing Where To Work
I practice an advanced version of what’s called Structural Bodywork, including a system of structural analysis & postural evaluation. Contrary to recent “opinions” that the bio-structural model of therapy fails much or most of the time, properly applied, we’ve found it quite effective in many, probably most, cases.
I assessed whether his hip joint pain was localized (meaning the cause of the pain was at or very near the location of pain sensation) versus transmitted from elsewhere, near or distant, via the musculoskeletal structure and/or nervous system.
This is a significantly variable phenomena. For example, another Client had severe pain in one hip. Yet severe joint degeneration, visible on X-rays, was in the opposite hip joint. Structural analysis revealed the most chronically over-shortened muscles were more likely in the degenerated hip, not the painful hip. Relieving excess muscle tension and lengthening the muscles in the degenerated hip eliminated the pain in the opposite, painful hip.
To understand some of our theories of how such “distant triggering” works, please read Spooky Pain At A Distance at the website.
In this case, however (back in Tennessee), there were no postural signs, nor reports from his history, indicating his hip pain was a reaction to something elsewhere in his structure. So I chose to focus directly on the localized area of pain, the same hip as the pain and metal appliance was.
The Most Urgent Task
Because of the potential breakage of bone, it was clear the most urgent task was reducing local pressure on his hip joint. It was also reasonably clear his chronically contracted and over-shortened muscles were compressing the space between bony structures of his pelvis and the metal appliance, causing the beginnings of breakage of the pelvic joint wall.
His gluteal muscles (thin red lines in illustration) were literally pulling the artificial femur head (the appliance) inward toward his pelvic joint (the acetabulum), vastly increasing pressure within the hip joint itself (thick red arrow).
It was also very likely his muscles were putting too much pressure on and irritating local nerve endings within his soft tissues, and that was what was causing most or all of his pain.
Pain Is Not “Within” Joints: Often unnoticed — but well documented in orthodox medical journals — are the many people with significant joint (hard tissue) degeneration, or loss of space within the joint, (visible on X-ray or MRI) and NO pain, and many others with NO degeneration of their hard tissues but LOTS of pain.
WHY? There are few, if any, pain sensitive nerves within joints or on joint surfaces. Proprioceptive nerves within joints (intra-articular) measure movement, angles, speed and torque of the joint, but not pain.
With no other opposing “structural indicators” to suggest starting elsewhere, as we soon discovered, high muscular tension levels in his right hip were pretty good confirmation they were indeed the primary culprits of both the hip compression and pain.
The Tension Release Process
I had him lie face down on a bed, clothing (blue jeans and Tee-shirt) still on.
When I touched his right gluteal muscles (his “butt” muscles) through the material, they felt almost as hard as a piece of soft wood! It was, to be honest, almost scary how tight his muscles were! And I had worked on a LOT of muscles over the twenty some years I had already been in practice.
That high muscular tension level was strong confirmation his local muscles were indeed the culprits, although not yet with 100% certainty.
I applied a steady, low level of finger pressure to one spot on the muscle, selected more or less randomly, as the muscle was, for the most part, uniformly tight all over. I did not move around at all. No “cross fiber,” no rubbing or gliding, just steady pressure in one spot.
We assert this steady pressure with minimal movement maximizes the neural response of the inhibitory (tension reduction) nerves that reduce muscle tension if affected correctly.
I also encouraged that he focus his attention (mindfulness) on the muscles where I was working, and keep me informed if the pressure was causing any increase in his pain. If so, his job was to have me back off to the point it was not painful, at all. Some intensity of sensation is oaky. But any intrusive sensation or pain is not.
For maximum relaxation in the muscles, the Client should not be tolerating any sensations. … They should inviting, not fighting, the sensations.
RE: Mindfulness … Telling a person to “meditate” on an area brings predictable results, as in they usually “can’t do it.” They think meditation means to “stop thinking,” which is not the best way to think about it. … Yet if you ask them to “feel their muscles,” or ask “what are you feeling,” they are by definition staying more present in the moment.
It’s a way of initiating a meditative, mindfulness process.
(I’ll be writing on this topic soon. Please let me know if I should give it high priority.)
We started with the very surface layers of muscle. I waited for the muscles to start relaxing, allowing my fingers to sink deeper as the muscles relaxed and softened. Then, as each layer relaxed, I gradually sank into deeper layers of muscle. The “trick” is to not push the release of tension, but follow it.
One of my Mottos is: “It’s easer to open the door before you walk through it; and you can’t peel an onion from the inside out.”
Not getting “ahead of” the tension release process is highly effective and more efficient in the long run. And if the client is in fear that you’re going to hurt them, that can keep them from relaxing as well.
It’s the Goldilocks Principle: Some is to heavy, some is to light, and some is just right.
That’s the yogic process of “Playing The Edge” of pain, fear and resistance. In this way, we end up able to work deeper than the so-called “deep tissue” therapists, and stay in the tissue longer, achieving more tension release.
Although it’s a somewhat subjective judgement, when I was satisfied there was sufficient relaxation of tension in one “spot” in one part of his gluteal muscles, I moved to another nearby “spot” in his muscles, repeating the process.
I kept doing that process repeatedly for about 90 minutes. That’s ALL I did treatment-wise, but we slowly covered the entire gluteal region of that hip.
Over the next week, I did a total of THREE similar treatments, about 90 minutes each in duration.
His hip pain went away that week. … A year later, the pain was still gone. …
He did not get the second hip replacement.
Unfortunately, he moved to Alaska and we lost touch, so we did not get longer term feedback on his hip pain. But a year of no pain with no further treatment is a pretty good result, especially being a carpenter. Yet this is quite typical a result for many cases. … Yes, more complex cases often take longer, but not always.
My cousin, one of the most highly trained orthopedic, medical doctors in the country, told me that even if the Client had to return periodically for a bodywork “tune up,” it would probably be better than getting surgery.
And although I am rarely surprised anymore, even I was at that time pretty amazed at how effective and efficient this relatively simple approach to healing pain and dysfunction can be, even in such extreme cases.
And in case you are wondering, this was not an isolated case. Although this was a more dramatic case than usual, I and many soft tissue therapists around the world see such results on a frequent basis. Unfortunately, the majority of massage therapists are NOT trained to the degree necessary, and usually do not see their potential abilities in such cases.
Would A Second Surgery Have Helped Him?
And How Long Do Patients Have To Wait To Get Better?
I had during that week of treatment asked this Client if the therapists at Johns Hopkins ever treated his muscles? … NOPE!
I asked him whether his physicians ever even talked about his muscles? … NOPE! …
Was there any talk or action about relaxing & lengthening the muscles to first take the pressure off his hip joint to see if that would help before doing more aggressive treatment with drugs or surgery? … NOPE!
All This Begs the Question
If my friend’s son’s trouble was indeed too much neuromuscular & myofascial compression on his hip joint and the installed appliance, and that compression of the joint was the result of chronic, excess muscle tension, would another surgery have done any good? …
Or would it have just been temporary? …
Or possibly made things worse? …
And was the FIRST surgery even necessary at all?
If the muscles were the real problem (and they were), why did the physicians not know that? Or if they did, why did they not take the muscular tension reduction approach first? Would they or their physical therapists have known how?
Why was the factor of structural compression on the joint by way of excess muscle tension not observed, let alone addressed? Or, was the underlying cause of the joint compression even considered or pursued at all?
The probable answer is, few, if any, in the orthodox medical system are trained to observe, let alone treat, the body in this manner. That might come as a surprise until you’ve spoken with enough of them, or their patients.
Yet many highly competent soft tissue therapists produce such results on a regular basis.
Do Most Massage Therapists Know Any Of This?
Unfortunately, the perspectives presented here are not, to my knowledge, usually taught in many massage schools. Therefore, the percentage of therapists who can produce such results is, admittedly, limited.
Currently, the only school I personally know of that does teach to the degree and depth I prefer are the Schools of Advanced Bodywork in Charlotte, North Carolina and Jacksonville Florida. They were founded by Kyle C. Wright. He is currently based in Asheville, NC.
I have worked with Kyle many times in the past, and he in great part designed his massage school’s curriculum based on the Core Principles he learned in my therapeutic training programs many years ago. That includes the principles of physical, mental and relational yoga as applied to how to work with the muscles, plus the structural analysis method for determining where to work. At the time, I called the work Psycho-Muscular Release & Structural Balancing. It is not called DSL Edgework.
Previously, Kyle was the original owner of the five Southeastern Schools of Neuromuscular and Massage Therapy in Florida and the Carolinas, founded in 1990. He trained well over ten thousand therapists in the methods presented here, with a very high pass rate on licensure exams, before selling the schools in 2007. His therapists consistently report above average results.
It is currently my objective to work with more individual therapists, clinics and schools to bring this kind of knowledge into their practices and programs. In the meantime, I’m teaching this work via in-person and on-line workshops and one-on-one training & coaching sessions to groups of twelve individuals at a time, maximum.
Clinics or hospitals interested in incorporating such approaches to therapy can reach me through my LinkedIn Profile.
Most likely, this article raised more questions than it answered. Please read the full article here.
Thank You for Reading!
David Scott Lynn