I found a really cool article, quite by accident. I was leafing through an older copy of one of my favorite journals “Lower Extremity Review” and there it was. An article entitled “Athletes with hip flexor tightness have reduced gluteus maximus activation”. Wow, I thought! Now there is a great article on reciprocal inhibition!
What is reciprocal inhibition, also called “reciprocal innervation” you ask? The concept, was 1st observed as early as 1626 by Rene Descartes though observed in the 19th century, was not fully understood and accepted until it earned a Nobel prize for its creditor, Sir Charles Sherrington, in 1932.
Simply put, when a muscle contracts, its antagonist is neurologically inhibited. When your hip flexors contract, your hip extensors are inhibited. This holds true whether you actively contract the muscle or if the muscle is irritated in some manner, causing contraction. The reflex has to do with muscle spindles and Type I and Type II afferents, something I often talk about in my seminars.
How does this relate to needling? We can take advantage of this concept with treating the bellies of hip flexors (iliopsoas, tensor fascia lata, rectus femoris, iliacus, iliocapsularis) and extensors (gluteus maximus, posterior fibers of gluteus medius). This is especially important in folks with low back pain, as they often have increased psoas activity and cross sectional area, especially in the presence of degenerative changes.
There also appears to be a correlation between decreased hip extension and low back pain, with a difference of as little as 10 degrees being significant. Take the time to do a thorough history and exam and pay attention to hip extension and ankle dorsiflexion as they should be the same, with at least 10 degrees seeming to be the “clinical” minimum. Since the psoas should only fire at the end of terminal stance/preswing and into early swing, problems begin to arise when it fires for longer periods.
Can you see now how taking advantage of reciprocal inhibition can improve your outcomes? If something as simple as taping the gluteus can have a positive effect, imagine what some needling can accomplish! Try this today or this week in the clinic, not only with your patients hip flexor issues, but with all muscle groups, always thinking about agonist/antagonist relationships.
really cool article that started it all: In the moment: Sports medicine Jordana Bieze Foster: Athletes with hip flexor tightness have reduced gluteus maximus activation Lower Extremity review Vol 6, Number 7 2014
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Daniel Moon , MD, MS; Alberto Esquenazi , MD Instrumented Gait Analysis: A Tool in the Treatment of Spastic Gait Dysfunction JBJS Reviews, 2016 Jun; 4 (6): e1. http://dx.doi.org/10.2106/JBJS.RVW.15.00076
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