Correcting Hip Adductor Asymmetry

[Progressive Overlord]

Dealing with pain on my left hip joint, irritation/pain in the left gluteus muscles and the sacroiliac joint, and impingement issues on the inside of the left hip for a long time. I finally figured out what is wrong. It seems obvious that I have some kind of functional leg length discrepancy (could also be anatomical). Left leg is more externally rotated, left hip adductors are weak (adductors on the right are visibly much bigger), generally shifting weight to the right leg. My search for adductor asymmetry even came up with the fancy more global diagnosis of "Left Anterior Interior Chain (AIC) pattern". I spare you the videos but you can see this pattern in my BS, DL, BP and P.
The starting point for fixing this seems to be to strengthen the left hip adductors to pull the femur around a bit in the acetebelum.
Starting Strength Philosophy is suggesting to not do any isolation work, shim the right foot and fix your squat etc.. I fooled around with bodyweight and weighted squats, trying to consciously mirror my asymmetry (pushing with the heel of my right leg, putting the right leg in more external rotation, bringing the left leg in less external rotation, trying to pull weight to the left side with my adductors etc.). On the plus side this has improved mechanics and motor control and squat looks symmetrical from the back now. BUT I dont have the feeling this really works the adductor on my left very hard. I have almost no doubt that correcting my squat etc, will take care of the adductor asymmetry over long time. BUT I really want to get rid of this fucking hip pain as fast as possible. So here is what the Physios suggest:

Right Sidelying Left Adductor Respiratory Pullback - YouTube

and a little more in depth analysis of the problem:

CLINICAL APPLICATION OF THE RIGHT SIDELYING RESPIRATORY LEFT ADDUCTOR PULL BACK EXERCISE

The exercise in the video works the proximal adductors like nothing I know.
What is your take on the problem and do you have any better advise. Thanks.

[Tom Campitelli]

Oh, dear lord. That video is special. I only skimmed the article because life is entirely too short to subject oneself to such things without being paid. I did like the first line in the conclusion, however:

Despite the Right Sidelying Respiratory Left Adductor Pull Back's use for a variety of musculoskeletal dysfunctions, there is little data published on the efficacy of the exercise.

Let's think about this from the perspective of Stress, Recovery, and Adaptation. How the fuck can these exercises produce any meaningful stress? How can this stress be quantified and incrementally increased? What is the adaptation that will result?

We are also assuming you have diagnosed yourself correctly, which, if I had to place a bet, I would say is incorrect. Let's see a video of you squatting. Please read the sticky for instructions on how to do that.

[Progressive Overlord]

Oh, dear lord. That video is special. I only skimmed the article because life is entirely too short to subject oneself to such things without being paid.

Thank you very much for taking the time.

I did like the first line in the conclusion, however:

The disussion part sounds more promising:

Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described.

Let's think about this from the perspective of Stress, Recovery, and Adaptation. How the fuck can these exercises produce any meaningful stress?

We are talking about weak muscles, that should respond to any kind of new stress. The stress is produced by maximum voluntary contraction.

How can this stress be quantified and incrementally increased?

It's quantified as the maximum voluntary contraction you are able to perform. The muscle will get stronger after the stress of maximum voluntary contraction. Then you perform again this voluntary contractions.
Another effect is that after using and feeling the relevant muscles you are able to better utilize this muscle during training and every day life.
Im not telling you that this exercise is really strengthening the whole adductor group. The main target here are the proximal adductors that are able to pull around the head of the femur in the acetebelum of the hip socket because they have the best angle to do so.

What is the adaptation that will result?

Excessive external rotation and abduction of the left Femur is reduced resulting in a more symmetrical hip and movement patterns.

We are also assuming you have diagnosed yourself correctly, which, if I had to place a bet, I would say is incorrect.

It's not really that hard to tell. I have a very thick right Adductor group (in fact the adductors are so tight I cant fully extend my right knee). The left adductors and hamstrings are weak and "long" and knee extension is not restricted. Left leg externaly rotates much more than right leg. And I could go on and on how this pattern shows in my torso, ankles and shoulders. Im pretty sure Im not far off with my diagnosis.

Let's see a video of you squatting. Please read the sticky for instructions on how to do that.

Thank you for the invitation. My last working set of today was directly filmed from the back and you cant see the feet. First working set of today is a 45° angle from the back (but I'm fooling around in the bottom position by consciously pulling my self to the left with my adductors). I could upload them but its probably better I give you a 45° from the last set of my next session doing normal squats.

Anyway I started doing the above mentioned exercise and variations of it. I did a lot of bodyweight squats mirroring my asymmetries (rotating the hip in the other direction, pulling more with the left leg etc.). I also did this to a lesser degree in the weighted squats. I used two bike rides to work the left adductors in an unfamiliar way. I reversed my movement pattern during walking etc.. As a result in less than one week the pain from impingment in the left hip is almost gone. Pain from bursitis/overstreched left hip capsule is almost gone (I had this pain for 1,5 years on and off). ROM in hip flexion has increased tremendously. Mechanics feel over all much better. Im pretty convinced that you can reposition an overly externally rotated femur with the above exercise and that it works quick. Video is coming.

[Tom Campitelli]

We are talking about weak muscles, that should respond to any kind of new stress. The stress is produced by maximum voluntary contraction.

If you can squat 135 pounds, that will almost certainly require more muscular force to be produced than anything lying in the fetal position and barely moving could do. The correct answer would be, it would produce almost no meaningful stress. Exceptions might be for people who have been wheelchair bound for a long time.

It's quantified as the maximum voluntary contraction you are able to perform.

This would also be incorrect. It cannot be quantified in any way, shape, or form. Please provide magnitude and units. It cannot be done. A squat, however, provides such metrics very nicely.

It's not really that hard to tell. I have a very thick right Adductor group (in fact the adductors are so tight I cant fully extend my right knee).

It is this kind of stuff that further cements my impression that you have misdiagnosed yourself. Only one of the adductors even crosses the knee joint and it is pretty much never mentioned as a knee flexor because it does so little in that regard. If you cannot extend your right knee, the adductors are almost certainly not the cause.

The left adductors and hamstrings are weak and "long" and knee extension is not restricted. Left leg externaly rotates much more than right leg. And I could go on and on how this pattern shows in my torso, ankles and shoulders. Im pretty sure Im not far off with my diagnosis.

I do not share your certainty. Lots of people are able to convince themselves that they have various imbalances that must be corrected via all manner of time wasting activities. There are legions of physical therapists and other body workers that serve to encourage this kind of thinking. It does not make it correct, however.

Anyway I started doing the above mentioned exercise and variations of it. I did a lot of bodyweight squats mirroring my asymmetries (rotating the hip in the other direction, pulling more with the left leg etc.). I also did this to a lesser degree in the weighted squats. I used two bike rides to work the left adductors in an unfamiliar way. I reversed my movement pattern during walking etc.. As a result in less than one week the pain from impingment in the left hip is almost gone. Pain from bursitis/overstreched left hip capsule is almost gone (I had this pain for 1,5 years on and off). ROM in hip flexion has increased tremendously. Mechanics feel over all much better. Im pretty convinced that you can reposition an overly externally rotated femur with the above exercise and that it works quick. Video is coming.

The one week cure for bursitis via two bike rides and walking differently? Man, this is getting weird. I am getting close to tapping out here.

[Progressive Overlord]

If you can squat 135 pounds, that will almost certainly require more muscular force to be produced than anything lying in the fetal position and barely moving could do. The correct answer would be, it would produce almost no meaningful stress. Exceptions might be for people who have been wheelchair bound for a long time.

More muscular force must be produced by the hole system during the squat, but that doesn't mean you can't produce higher activation of single muscles with silly exercises. Btw. the Squat doesn't produce that much activation in the adductors if we trust EMG-research (DL seems to work them harder).

This would also be incorrect. It cannot be quantified in any way, shape, or form. Please provide magnitude and units. It cannot be done. A squat, however, provides such metrics very nicely.

Not sure I misrepresented the goal of the above exercise in my previous posts but it's not really meant to be a strength training program. It is a measure to reposition the head of the femur in the acetabulum. For this purpose the body is put in a position where the medial adductors/internal rotators (tiny muscles like in the rotator cuff of the shoulder) have the best angle to reach maximum activation and produce maximum force to rotate the head of the femur (to reposition it in the hip socket). Keep in mind the head of the femur is connected to the hip with the strongest ligaments the human body has to offer. This ligaments will help keeping the hip joint in the new position. For the femur to keep this position medium to long term you have to strength train of course and change the movement patterns that are engraved in your neuromuscular system.

It is this kind of stuff that further cements my impression that you have misdiagnosed yourself. Only one of the adductors even crosses the knee joint and it is pretty much never mentioned as a knee flexor because it does so little in that regard. If you cannot extend your right knee, the adductors are almost certainly not the cause.

You are right. It's probably tight hamstrings. To my excuse the adductors can facilitate knee flexion if you are riding a bicycle and your shoes are fixed to the pedal with cleats (similar to the lombard's paradox). But I don't think because cycling screwed a bit with my understanding of human anatomy my self diagnosis is total bogus. My hip is/was definitely rotated clockwise if you look from the top and the right leg internally rotated, left leg externally rotated. Its not really that hard to spot. Functional leg length discrepancy are not that rare. Jordan referenced a study in another thread putting its prevalence at >30% of the population. Even if I choose this diagnosis at random I would be right 1/3 of the time.

The one week cure for bursitis via two bike rides and walking differently? Man, this is getting weird. I am getting close to tapping out here.

I never said it was a cure for bursitis and my left hip still has some pain (just a lesser degree). And of course I have to consciously change movement patterns in everyday life (btw. cycling feels greater than ever when I rotate my hip in a symmetrical position.) Hope you are still up for a video of the new and improved squat coming tomorrow after my training session.

[Tom Campitelli]

More muscular force must be produced by the hole system during the squat, but that doesn't mean you can't produce higher activation of single muscles with silly exercises.

Please provide any data that supports your conclusion, particularly with respect to the adductors.

Btw. the Squat doesn't produce that much activation in the adductors if we trust EMG-research (DL seems to work them harder).

One of the many reasons to be extremely suspicious of EMG data and exercise science in general. Your statement above is badly flawed. How in the world does a properly done squat fail to "activate" the adductors when they eccentrically elongate on the way down and concentrically shorten on the way up? The deadlift certainly uses the adductors, but they probably change length less than they do in the squat and are not the primary hip extensors in the movement. Lastly, there is nothing out there showing that EMG data accurately record motor unit recruitment, either. None.

Not sure I misrepresented the goal of the above exercise in my previous posts but it's not really meant to be a strength training program. It is a measure to reposition the head of the femur in the acetabulum.

Good luck with this. If your femoral head was out of position in the acetabulum, do you know what that is called? Hip dislocation. It is considered a medical emergency and generally requires something like a car accident or a fall from a great height for that to happen.

For this purpose the body is put in a position where the medial adductors/internal rotators (tiny muscles like in the rotator cuff of the shoulder) have the best angle to reach maximum activation and produce maximum force to rotate the head of the femur (to reposition it in the hip socket).

The exercise you linked to puts the adductors in as shortened of a position as they can get unless you were to cross the body's center line. When a muscle is already shortened, it cannot produce much more force. Muscles produce the maximal amounts of force when they are at their resting length. I am sorry, but you are wrong about this, too.

Keep in mind the head of the femur is connected to the hip with the strongest ligaments the human body has to offer. This ligaments will help keeping the hip joint in the new position.

Your ligaments won't do anything differently because they are inelastic, your femoral head isn't in any new position, and you have done nothing to change anything. This is good. Dislocating your hip is probably excruciating.

For the femur to keep this position medium to long term you have to strength train of course and change the movement patterns that are engraved in your neuromuscular system.

I am just beating a dead horse by this point.

You are right. It's probably tight hamstrings.

Probably not. If you cannot extend your knee while standing up straight, it probably has something to do with your knee joint unless you have pathologically tight hamstrings, in which case you would have trouble walking or really doing any kind of normal activity.

To my excuse the adductors can facilitate knee flexion if you are riding a bicycle and your shoes are fixed to the pedal with cleats (similar to the lombard's paradox). But I don't think because cycling screwed a bit with my understanding of human anatomy my self diagnosis is total bogus. My hip is/was definitely rotated clockwise if you look from the top and the right leg internally rotated, left leg externally rotated. Its not really that hard to spot.

You need to stop reading on the Internet about how we are all terribly screwed up and imbalanced.

Functional leg length discrepancy are not that rare. Jordan referenced a study in another thread putting its prevalence at >30% of the population. Even if I choose this diagnosis at random I would be right 1/3 of the time.

That is very comforting. Why are we talking about leg length discrepancies?

I never said it was a cure for bursitis and my left hip still has some pain (just a lesser degree).

Hmmm... It sounds that way from this quote below:

As a result in less than one week the pain from impingment in the left hip is almost gone. Pain from bursitis/overstreched left hip capsule is almost gone (I had this pain for 1,5 years on and off). ROM in hip flexion has increased tremendously.

And of course I have to consciously change movement patterns in everyday life (btw. cycling feels greater than ever when I rotate my hip in a symmetrical position.)

You probably don't because there is probably nothing wrong with you.

Hope you are still up for a video of the new and improved squat coming tomorrow after my training session.

I think I need a drink after this post.

[Progressive Overlord]

I think I need a drink after this post.

Before you get a drinking problem I better stop the discussion and would like to request a form check on my Squat. I need 30 seconds to get the weight out of the rack (in case you want to skip). Thanks for taking the time.


Backsquat-6*82,5Kg - YouTube

[Tom Campitelli]

You were doing something different on almost every rep, which makes giving you good cues more difficult. I can tell you that most, if not all, of your squats were too high. Go deeper. Narrow your stance slightly. Stop arching your back and lifting your chest. Look down, chest down, drive your butt up. Don't stop at the bottom. Come right back up.

[Bill Been]

Dr. Been has a great deal of fresh information to assimilate and incorporate due to this epic thread and that astonishing video. Thanks are given across all modal and temporal domains.

[Tom Campitelli]

Dr. Been, anything we can do here to advance your scientific inquiries is both a privilege and an honor.