Wednesday, June 27, 2012

The S.E.R.F. Strap by DonJoy to correct internal hip rotation

I guess I used to sit a lot like this when
I was a kid. It is not a good way to sit!

I am started to try something new with my running, that someone who has a similar biomechanical stride may want to try. I realized post labral tear surgery that my body is still not symmetrical. No matter what the PT shows me to do, I still maintain my same running movement patterns I had prior to surgery. My problem is two-fold according to many doctors: tibial torsion on my left side that has my foot pointed to the side as well as femoral anteversion on the same side that has my femur and knee pointing in to a knock-kneed position. I am told I was probably born this way and you can't change it. I have a hard time believing I had two problems both on only one side. I have noticed that the PT does not help me with the internal rotation of my hip. I started wondering is this a problem I was born with or a compensation for my everted foot because when I point my foot straight, my knee knocks in? I am primarily concerned because the internal rotation of the hip seems to give me a pinching problem where the adductors join the hip, plus the glute medius problems I keep getting when running and I am tired of these problems and just want to run. I am willing to try anything at this point.

I found a strap last week called the DonJoy SERF Strap that is supposed to limit the internal rotation of the hip as you move. I have often wondered if someone could make a product to do that and lo and behold they have.
Developed in conjunction with Dr. Christopher Powers at the University of Southern California, the S.E.R.F. Strap™ is the FIRST patellofemoral brace designed to treat patellofemoral pain stemming from abnormal hip motion(s). The S.E.R.F. Strap™ utilizes a unique 3-point hip-leg anchor to treat patellofemoral pain caused by excessive hip internal rotation, adduction, and/or knee valgus. Made of thin Breathe-O-Prene®, the S.E.R.F. Strap™ is lightweight, breathable, and designed to be worn underneath clothing. The S.E.R.F. Strap™ can be used to control abnormal hip motion during leisure/sport activities and as a training tool in the clinic.

I ordered the DonJoy SERF Strap and tried it out as soon as I got it. I wrapped it around my knee and pulled it tight and wrapped it around my waist. It is a lot of strap, but it wasn't uncomfortable. I ended up doing my longest run since February at 45 minutes. The next day I did 42 minutes. I took a day off and went 49 minutes on a real running route (not just laps around the neighborhood) and then yesterday I jumped into the Mine Falls 5K Trail race just to see what would happen if I ran at a slightly faster pace. First off, I don't get the pinching feeling in my adductors and hip joint after my runs. I think the strap rotates my leg to straighten it out a bit and also pulls my femur out to the side a little also so that it doesn't pinch. It seems like me foot no longer tries to point straight, but goes out to the side, but I think this is good if the knee is tracking straight with the hip because that is the way my body is built. There is a lot of adjusting that my body and muscles have to do. I note that after runs, the muscles around the outside of my hip (or the greater trochanter) are sore and tired, but it is muscles that are sore and not my hip joint for a change. So far the strap is doing something.
Patella Femoral Syndrome can be caused by many thing in the body including muscle weakness, tightness, and/or biomechanics. Depening on the cause of your injury the S.E.R.F strap could help. It basically acts as a cue for you gluteal and hip muscles to fire when they are supposed to. It will not weaken the muscles you are trying to strengthen and can be a good tool to help with proper mechanic at your hip and knee while running and doing your strengthening exercises. (from SERF strap website)
Whether it leads to another injury, I don't know. It doesn't seem to be a permanent thing, but more like a tool to retrain your muscles and stride. I don't even know if I am putting it on correctly or at the correct tension, but it is an interesting experiment. Yes, I notice it as I run, but more-so because it alters my leg movement patterns. It is not really distracting otherwise, more interesting, I would say.

 At the last moment, I decided to run the 5k race just to get moving with the running crowd again. I have done very limited running over the past few months, so I was just hoping to jog through the thing and I figured I would do it between 25-30 minutes. I ended up running my second slowest 5k in 38 years (last Thanksgiving I ran a few seconds slower in a post-surgery turkey trot). I ran to the level of discomfort and kept the same pace throughout the race and finished in 24:25. It actually felt pretty good, despite running about 5 minutes slower than I was doing just 2 years ago with the bad hip. It is a good beginning point to start a slow year long build up to the place where I can run quickly again.

I wished I had this strap before my surgery as I saw one review where someone mentioned it helped with their pain.
I really really really really really liked this! you can wear it underneath clothes and it really truly works! I used mine because I had a labral tear in my hip and I guess the doctor said it would strengthen a muscle that would make my pain go down. It definitely did! (from SERF strap website)


Martha Peterson said...

Hi Jim,

If you're still feeling asymmetrical after your labral tear surgery I cannot recommend more emphatically how much you need to go to a series of one on one clinical sessions in Hanna Somatics. You've got two really good practitioners near you. They're no more expensive (and perhaps even less expensive!) than Rolfing.

While the SERF strap might help with proprioceptive "nudges" to your internal rotators, the overall trauma reflex pattern (the lats, obliques, abbdominals, adductors/abductors) isn't being addressed. Same with the Rolfing. I personally love Rolfing - came very close to becoming one myself, until my hip pain was actually exacerbated by Rolfing. I found Hanna Somatics and the rest if history.

Go here for help. I wouldn't steer you wrong:

All the best,

Ivy said...

Hi Jim -- I had brought info on this strap to my PT last year and she didn't like the idea of pulling anteverted femurs into an unnatural position. I am not sure if she was right about that as you point out that the strap just helps train the right muscles to activate, so I'll bring it up with my new PT. Btw, you annotate your childhood photo showing you sitting in "W" as not a good way to sit. Many movement specialists (such as Shirley Sahrman) believe just the opposite - that its perfectly ok for someone with anteverted femurs to sit in a position most comfortable as thats how the body is built. Therefore, they emphasize that one should not try to sit lotus-style if its uncomfortable or try to make feet point straight. Here's a good blog about this:

Jim Hansen said...

Thanks Martha,
I am hoping that the benefit of the strap is just for the nudges that you mention. It seems to have gotten rid of the pinches in my adductors. I even did an 8 mile run yesterday for the first time since February and it was pain-free. The last two weeks I have done much better with the somatics. I have moved from just following along on the DVDs to using the book and going at my own pace with the movements that seem to work best. I am really concentrating on the lengthening and relaxing the muscles after the contraction in the movements. Great stuff and thanks as I really value your knowledge and opinion.

Jim Hansen said...

Thanks Ivy,
I am sure my last PT wouldn't have liked it either. He didn't like anything that didn't come from his own repertoire, which was mainly about strengthening exercises to get me batter at doing the strengthening exercises-although his hip mobilization work was good.
I do hope that the strap is only temporary and that it does help with proprioception.

Thanks for the link to the Eric Cressey blog. I have not seen that article before, even though I have ready many of the articles on his blog. That is interesting about sitting. I was talking about that just yesterday with my wife. I teach elementary school and kids are often asked to sit cross-legged style for long assemblies and I mentioned how some kids are very uncomfortable like this and I try to find a chair for them if I can. Maybe we should let them sit the way they prefer instead of correcting them. My daughter tries to sit this way too! Let me know what your new PT thinks about the strap.

Ivy said...

Hey Jim -- I asked my current PT about the strap this afternoon and she said its ok to try as it could help, as long as I don't get "dependent" on it. She noted that I could always stop usng it if it wasn't helping or hurting me ;) So, I think I may just order it -- I have so many discarded "tools" piling up at home though that didn't work for me - wish I could rent for a week first ;) Yes, re. sitting I was always being coerced into sitting cross-legged by my teachers in elementary school and constantly found it really hard. Now I know why. Better to allow kids/adults to sit in a way thats accomodating to how they're built. Glad you found that blog post ineteresting too and that you hadn't read it yet. Keep us posted about your progress with this strap!

Jim Hansen said...

Ivy, Thanks for letting me know what your PT said. My hope is that it works in the long run and that it is only temporary. There is a 90 day money-back guarantee from the place I bought in from (link in the post). I hear you about all the tools. I have more tools and equipment then most PT offices! If it is out there, most likely I tried it. The good thing is that post-surgery, I have kept away from all the rollers, balls, and other things and have relied more on retraining my movement patterns such as Somatic exercises like Martha teaches. My hope is that this just shifts things away from the patterns I have so deeply ingrained. If you get the strap, let me know how it goes.

Anonymous said...

Hi Jim -- just checking in to see how the SERF strap has been working out for you...? I did not order it back in June becasue I had been making some improvement, but I've been going downhill (figuratively) lately, so am about to order it. I wish more individuals had reviewed it on the site or on Amazon.

- Ivy

Jim Hansen said...

Hi Ivy, I used it about seven to ten times, then I moved away from it. I think it gave some guidance for postitioning of my femur. It also gave me a bit of a spring in my stride on that side from the elastic bands. I was never sure how tight to make it and sometimes I think I had it too tight. I stopped using it last week when I attempted to run 10 miles on the one year annivesary of my hip surgery, but my hip joint was too tight and I only made two miles even with the strap. I did have a cortisone shot in my hip a few days earlier and after a week it kicked in and I ran 13 miles without the strap. I think the strap helped give me better proproception concerning the positioning of my femur and that the springy nature of the strap helped some days with my muscles trying to move the tight hip joint. I am keeping it for any days that I feel that knee knocking in more than it should. It is hard to tell what helps and doesn't help as I change things up a lot, but I think the strap did provide a temporary benefit that I hope with other changes will stick. Sorry to hear things are going downhill, let me know if you get the strap and how it works for you.

Anonymous said...

I have just talked to my PT about this, as I've been working at strengthening and stabilization exercises for 6 months and continue to have femoral rotation and knee pain. Just checking in to see if things are going well for you. Hope so!

Jim Hansen said...

I haven't felt the need to use this for awhile. A cortisone shot relieved a lot of stiffness in the joint. I have a lot of muscle tightness to deal with, but for now that part seems to be OK for now. It definitely was not something I became dependent on after it served its purpose.

Anonymous said...

I'm a PT who's had some training from the gentleman who created the strap. It can be a great tool as a sort of stop gap until you gain the proximal stability in your hips and other weak areas to do without it. Its relatively new and a lot of PTs may not be familiar with it.

Jim Hansen said...

I think you are right. It was just a temporary thing for me. It did its job for a short while until I could do without it.