I apologize for the lag in posts as of late. Life, as you know, can get quite busy sometimes and this has been “one of those times”…

I found an article quite by accident. I was leafing through an older copy of one of, if not my favorite journals “Lower Extremity Review” (1) and there it was. An article entitled “Athletes with hip flexor tightness have reduced gluteus maximus activation” (2). Wow, I thought! Now there is a great article on reciprocal inhibition!

What is reciprocal inhibition you ask? The concept, was 1st observed as early as 1626 by Rene Descartes (3,4) 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 (5) certainly spurned by his previous landmark paper “ The integrative action of the nervous system” published in 1906 (6). The concept is also called “reciprocal innervation”. Simply put, when a muscle contracts, its antagonist is neurologically inhibited, So when your hip flexors contract, your hip extensors are inhibited. This holds true whether you actively contract the muscle or if the muscles sarcolemma or nerve innervation is irritated, causing contraction. The reflex has to do with muscle spindles and Type I and Type II afferents which I have covered in an article I wrote some time ago (7). 

We can (and often do) take advantage of this concept with needling the bellies of hip flexors (iliopsoas, tensor fascia lata, rectus femoris, iliacus, iliocapsularis) and extensors (gluteus maximus, posterior fibers of gluteus medius). One technique for the psoas, which I often teach, has been recently described in another FREE FULL TEXT paper (8) and text (which also teaches the side lying technique) (9) that I found embedded in yet another online article on needling the psoas (10). The lower portion of the muscle can also be needled at its insertion, similar to the procedure for iliopsoas bursal injection (11), another technique I teach in seminars. 

So, what does this have to do with muscle length and strength? Needling appears to increase muscular strength (12-17) and range of motion, i.e.. length (18-23). We can take advantage of these concepts during our treatment of patients and clients. 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 (24). There also appears to be a correlation between decreased hip extension and low back pain (25-28), with a difference of as little as 10 degrees being significant (25). Take the time to do a thorough history and exam and pay attention to hip extension and ankle dorsiflexion (29) as they should be the same, with at least 10 degrees seeming to be the “clinical” minimum (29,30). 

Can you see now how taking advantage of reciprocal inhibition can improve your needling outcomes? Try this today or this week in the clinic, not only with your patients hip flexors, but with all muscle groups, always thinking about agonist/antagonist relationships.

Take care and keep on needling

Dr Ivo

1. 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
2. Mills M, Frank B, Blackburn T, et al. Effect of limited hip flexor length on gluteal activation during an overhead squat in female soccer players. J Athl Train 2014;49(3 Suppl):S-83.
3. Ciuffreda KJ, Stark L.  Descartes' law of reciprocal innervation. Am J Optom Physiol Opt. 1975 Oct;52(10):663-73.
4. Jacobson M Foundations of Neuroscience Springer Science and Business Media, Plenum Press, NY 1993 p 277
5. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1932/sherrington-bio.html
6. Sherrington CS. The integrative action of the nervous system. New Haven, CT: Yale University Press; 1906
7. https://thegaitguys.tumblr.com/post/9708399904/ah-yes-the-ia-and-type-ii-afferents-one-of-our
8. Electroacupuncture as a complement to usual care for patients with non-acute pain after back surgery: a study protocol for a pilot randomised controlled trial BMJ Open 2015;5:2 e007031
9. Dommerholt  J, Fernandez de las Penas J Trigger Point Dry Needling 1st Edition An Evidence and Clinical-Based Approach  Churchill Livingstone 2013
10. http://acupuncturemedical.net/blog/dry-needling-the-psoas-major-why-should-we-bother.html
11. Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip. Blankenbaker DG, De Smet AA, Keene JS. Skeletal Radiology 2006:35(8);565-571
12. Hübscher M, Vogt L , Ziebart T, Banzer W  Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial European Journal of Applied Physiology September 2010, Volume 110, Issue 2, pp 353–358 
13. Banzer W, Hübscher M, Pfab F, Ziesing A, Vogt L (2007) Acute effects of needle acupuncture on power performance during stretch–shortening cycle (Article in German). Forsch Komplementmed 14(2):81–85 
14. Dhillon S (2008) The acute effect of acupuncture on 20-km cycling performance. Clin J Sport Med 18(1):76–80
15. Huang LP, Zhou S, Lu Z, Tian Q, Li X, Cao LJ, Yu JH, Wang H (2007) Bilateral effect of unilateral electroacupuncture on muscle strength. J Altern Complement Med 13(5):539–546
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19. Koppenhaver S, Embry R, Ciccarello J, Waltrip J, Pike R, Walker M, Fernández-de-Las-Peñas C, Croy T, Flynn T. Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome. Man Ther. 2016 Jul 21;26:62-69. doi: 10.1016/j.math.2016.07.009. [Epub ahead of print]
20. Mendigutia-Gómez A, Martín-Hernández C, Salom-Moreno J, Fernández-de-Las-Peñas C. Effect of Dry Needling on Spasticity, Shoulder Range of Motion, and Pressure Pain Sensitivity in Patients With Stroke: A Crossover Study.J Manipulative Physiol Ther. 2016 Jun;39(5):348-58. doi: 10.1016/j.jmpt.2016.04.006. Epub 2016 May 7. PMID: 27167369
21. Boyles R, Fowler R, Ramsey D, Burrows E Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther. 2015 Dec;23(5):276-93. doi: 10.1179/2042618615Y.0000000014.Braz J Phys Ther. 2015 Jan-Feb;19(1):34-43. doi: 10.1590/bjpt-rbf.2014.0066. Epub 2014 Nov 28. 
22. Aranha MF, Müller CE, Gavião MB. Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial.
23. Shin BC, Lim HJ, Lee MS. Effectiveness of combined acupuncture therapy and conventional treatment on shoulder range of motion and motor power in stroke patients with hemiplegic shoulder subluxation: a pilot study. Int J Neurosci. 2007 Apr;117(4):519-23.
24. Arbanas J, Pavlovic I, Marijancic V, et al MRI features of the psoas major muscle in patients with low back pain. Eur Spine J. 2013 Sep;22(9):1965-71. doi: 10.1007/s00586-013-2749-x. Epub 2013 Mar 31.
25. Roach SM, San Juan JG, Suprak DN, Lyda M, Bies AJ, Boydston CR. Passive hip range of motion is reduced in active subjects with chronic low back pain compared to controls. Int J Sports Phys Ther. 2015 Feb;10(1):13-20. Erratum in: Int J Sports Phys Ther. 2015 Aug;10(4):572.
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29. Lewis CL, Ferris DP. Walking with Increased Ankle Pushoff Decreases Hip Muscle Moments. Journal of biomechanics. 2008;41(10):2082-2089. doi:10.1016/j.jbiomech.2008.05.013.
30. Nodehi-Moghadam A, Taghipour M, Goghatin Alibazi R, Baharlouei H. The comparison of spinal curves and hip and ankle range of motions between old and young persons. Medical Journal of the Islamic Republic of Iran. 2014;28:74.