Training through a Serious Hip Problem

I just got a 12 year old right handed pitcher as a client. He has a left slipped capital femoral epiphysis in addition to right knee pain and a positive left shoulder impingement………..I was wondering if you had any training recommendations……….He had a left(1)-right(2) asymmetry in the active straight leg raise and a 1 in trunk stability.

Probably going to need to get this fixed.

This individual needs to be referred out. With 3 major painful issues in addition to being 12 years old, where perceptions of pain may be challenged in their authenticity, this is going to be a tough nut to crack.

If there is resistance, and you can’t tag out of this one in the short-term, the first thing to consider is if this has been repaired surgically previously, or is going to be repaired.
I don’t know that the SCFE can be tolerated without surgical intervention, but I suppose it’s possible.
If he has not had surgery, at least make sure it’s cleared for movement and certain ranges. You can definitely make this worse if you crank around on something that shouldn’t be moving.

In terms of ASLR, you should only be here in this case if MSF, DS, or SLS is your DN. DS will not be if there is knee pain, and MSF correction should come before SLS if you are in the SFMA model.

The TSPU score of 1 is useless here if there is shoulder pathology. You have no idea if whatever is going on in the shoulder from the positive impingement is affecting the pushup, or it’s just a poor stability pattern, or both. So throw that out for now and return to after the shoulder pain is resolved.

The ASLR score should be broken down with MSF and 1-leg MSF. If this is repaired surgery, the 1-leg MSF should be revealing and consistent with your ASLR screening score.
Where we go with the ASLR breakout is the PSLR. That is how you are going to know if this hip is going to move or not, if it should be pushed or not. Again, this is probably best assessed in the hands of a medical professional, but you are looking for end feel here. Is it muscular? Springy? Capsular? Or hard? The end feel will yield your treatment approach.
Is the PSLR hugely different than the ASLR? Then this is a stability issue, and we should go to, in this case, segmental rolling and 1-arm (the non-painful side) chops and lifts in half-kneeling, left side down. Of course this position can not provoke the knee, which it shouldn’t because it’s the other side.

If the end feel is bony, you can still work hard on stability. Mobility and stability are just relative. If you have very little mobility in the hip, you just need adequate stability to work with it above and below.
Also persist in single leg techniques as long as there is an asymmetry.  Symmetrical lifts like DL and Squat with an asymmetrical ASLR will throw torque into the body at some location to make up for the asymmetry grounded through the floor.  The compensation has to go somewhere.
The SFMA always allows you to train very hard around injuries and run corrections concurrently.  The bigger the problem, the more creative you may have to be, but even in this complicated case, you can see how the guiding process works.  This message transcends this SCFE example and applies to all issues tracking to stability/motor control deficits, soft tissue restriction, or joint dysfunction.

This could be complicated, and a young child with developmental challenges can be very psych-driven in terms of complaints.
Bottom line, get the painful stuff checked out. Find out the above information from the right person, and let the kid play. The above information I think should be useful, but not always for a 12-year old. The ultimate goal is to let him move freely in 3 planes with variable loads and enivornments, and let him learn physically and honor the corrective process.  Just don’t be a slave to it.
Physical education is the answer as this young man’s motor system can learn and improve. Just know what you’re working with the start with.

Probably still screwed.

  • August 22, 2011

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