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This article was originally published in Positive Health issue 55 – August 2000
Mézières was fond of saying that the primary problem is never where it is felt (pain) or seen (deformation). It is always at some distance, in a pain-free and discretely distorted part of the body. This remark was made in connection with the Antalgic Reflex a Priori (ARAP), her name for the mechanism by which an organism escapes a painful stimulus provoked by hypertonic muscles by distortions or other compensatory behaviour. I spoke of ARAP in more detail in two recent columns.
Hip arthritis is a prime example of how this complex mechanism works. Although they can vary, according to the different stages of the disease, symptoms indicative of osteoarthritis of the hip joint are clearly visible: thigh slightly flexed, externally rotated and somewhat adducted, knee often flexed, foot everted with toes a little pointed… Pain inevitably accompanies these deformations; and pain in the hip-joint (coxalgia) is not the only one – the groin, the knee or the inner side of the knee and sometimes even the foot can often be painful too.
All these symptoms encourage the therapist to treat what appears to be the seat of mischief: the hip joint. Manipulation and mobilization are conscientiously tried but without success. Finally, the patient is compelled to visit the surgeon – as a last resort. However, this extreme outcome could be avoided in most cases. According to Mézières, it is useless to treat the hip joint directly as it is only a victim; the hip is diseased, but from causes remote from it. Unfortunately, the primary cause of hip arthritis usually passes unnoticed, obscured as it is by the conspicuous symptoms from the hip.
With the exception of congenital and accidental causes, or advanced cases where the disease has fused the joint, according to Mézières, all cases can be successfully treated by addressing the primary cause. (Although this is true in principle, it has to said that when the joint has been seriously damaged by the disease, the condition is so painful that few patients would be willing to go through the difficult and lengthy Mézières’ treatment.) But, if the cause is not in the hip, where then is it hiding?
In 1947, when Mézières made her primary discovery about the muscular chains, with their tendency to become hypertonic and to distort the body, it was as if scales had fallen from her eyes. Scrutinizing her patients with this altered vision, she was able to develop a new science of body mechanics and to discover the muscular cause and the treatment of many orthopaedic conditions which had been previously misun-derstood. She realized the importance of shape in relation to function. This led her to adopt a standard, a template of perfect shape as a guide during the treatment of her patients since any departure from this ideal could be seen as a recipe for pain and malfunctioning. With her new outlook she was able to discover that the first and most significant distortion to make its appearance is an abnormal inward curvature of the spine (hyperlordosis). Hyperlordosis is the primary cause of many musculo-skeletal complaints, including arthritis of the hip joint. Hip arthritis is, therefore, a back problem, not a hip problem per se.
In some individuals, hypertoned back muscles over-arch the lower back and compress it so much that the lumbosacral joint becomes locked. As long as its fixity is unchallenged no pain will be felt in this area. Unfortunately, subsequent hip movements are bound to disturb the ‘frozen’ but painless lower back. For example, normally, when one bends forward with straight legs, the pull from the hamstring muscles forces the lower back to lose its concavity, via the backward tilt of the pelvis. In the case of a locked lumbosacral joint, the body instinctively ‘knows’ that a normal range of hip movements would provokes pain by flattening or rounding the lower back.
To avoid this unhappy consequence, the pelvitrochanteric muscles (from hip to pelvis) go into contracture to limit the amount of hip movement which would flatten or round the lower back. It is as if the hip joint is sacrificed for the sake of the lower back.
Movement is life and is necessary for healthy functioning. With its mobility seriously restricted by such contracture, the hip joint starts to dry up as the normal flow of synovia lubricating (fluid) is interrupted. Under these conditions, the fate of the hip is sealed: cartilage and bone degeneration, narrowing of the joint space and osteophytes are on their way. Although this sounds painful, Mézières is convinced that the pain in the hip comes from the contracture of the pelvitrochanteric muscles, and in the groin from the adductor muscles, but not from the degeneration of the joint itself. She goes as far as to say that when there is pain, there is always hope of recovery, whatever the degree of deformation of the joint surfaces. When the bones have fused together (ankylosis) the pain disappears and it is too late for a Mézières’ treatment.
Recovery, as usual, consists in removing the cause, in other words, in restoring the normal elasticity of the tight muscular chains. There is no single blueprint for success as treatment has to be tailored to individual idiosyncrasies. One thing we all have in common, however, is that our muscles will put up a good fight to escape the stretch. Once their ‘grip’ is released, the body can start its healing process. The therapist provides the conditions of health and the body ‘cures’ itself.
If you suffer from coxalgia, wise up these little known discoveries made by Mézières and they will allow you to make an informed choice between various therapies. And hip hip hurray to Mézières!