The Physical Therapy AdvisorHip Pain – The Physical Therapy Advisor

Advanced Techniques on How to Treat Hip Impingement

benshatto@yahoo.com — Wed, 13 Oct 2021 16:20:11 +0000

Hip impingement pain is commonly felt in the groin, front of the hip or sometimes the side of the hip or deep in the buttocks. Like many lower extremity injuries, hip impingement is often multifactorial stemming from muscle strength imbalances (often due to weakness in the deep hip external rotators) and/or hip mobility imbalances. These mobility imbalances combined with muscle strength imbalances lead to altered hip biomechanics and ultimately, pain and inflammation in and around the hip labrum. These issues can be accelerated or started by a traumatic event or an overuse situation. The biomechanical imbalances cause the labrum of the hip to become inflamed and painful. This inflammation makes the biomechanical issues causing the impingement worse which just perpetuates the problem. Addressing these muscle imbalances can lead to the permanent resolution of your pain and symptoms.

In a previous video, Treating Hip Impingement: Basic Techniques, I addressed the basics of how to self-treat hip impingement syndrome. In this video, I go over advanced techniques of how to utilize a EDGE Mobility Band or a pull up assistance band to help self-mobilize the hip and very quickly eliminate your hip impingement.

CLICK HERE TO WATCH NOW

If you work on your deep hip external rotation strength (as demonstrated in this video) along with the mobilizations you are likely to see results even faster.

If you’re interested in a more thorough guide along with other videos on how to self-treat lower extremity injuries and pain, check out the Resilient Runner Program. This is the perfect guide to help you take control of your health and fitness as well as self-manage common aches, pains, and injuries. Even if you’re not a runner, this program is appropriate for those who love to stay active and want to enjoy a healthy lifestyle.

If you have a question that you would like featured in an upcoming video or blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by following The Physical Therapy Advisor!

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Basic Techniques on How to Treat Hip Impingement

benshatto@yahoo.com — Wed, 15 Sep 2021 11:00:40 +0000

A common reason for anterior hip pain, groin pain or even side of the hip or deep buttock pain can be hip impingement. Hip impingement, like most hip pain, is often multifactorial stemming from muscle strength imbalances (often due to weakness in the deep hip external rotators) and/or hip mobility imbalances. These mobility imbalances combined with muscle strength imbalances lead to altered hip biomechanics and ultimately, pain and inflammation in and around the hip labrum. These issues can be accelerated or started by a traumatic event or an overuse situation. The biomechanical imbalances cause the labrum of the hip to become inflamed and painful. This inflammation makes the biomechanical issues causing the impingement worse which just perpetuates the problem.

In this video, I go over the basics on how to treat hip impingement. I discuss what to stop doing immediately and what you can start doing to eliminate your pain in order to get back to activity quickly without surgery or painful injections.

CLICK HERE TO WATCH NOW

Be sure to check out my other video, Treating Hip Impingement: Advanced Techniques.

The post Basic Techniques on How to Treat Hip Impingement first appeared on The Physical Therapy Advisor.

How to Perform a Key Lower Leg Stability Exercise

benshatto@yahoo.com — Wed, 16 Sep 2020 12:00:25 +0000

Weakness in the deep external rotation muscles and poor lower extremity single leg balance are commonly associated with many lower extremity overuse injuries. A simple and effective exercise to improve strength, balance, and general stability of the deep hip external rotator muscles is the clock exercise (also called the star drill).

The important points to remember in this exercise are to keep the stance knee unlocked (the leg you are standing on) with the patella (knee cap) slightly externally rotated (usually pointing towards the 3^rd or 4^th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators needs to be the primary focus.

Slowly touch the ground very gently with the opposite leg. The amount of pressure touching the ground should be so slight that if there were a package of crackers taped to the bottom of the foot the crackers would not break. Performing the drill on a balance pad will significantly increase the difficulty level of the exercise.

In the following video, I demonstrate how to use a balance pad to perform the clock exercise, a key lower leg stability exercise for treating knee pain, hip pain, and foot and ankle related issues as well as balance.

CLICK HERE TO WATCH NOW

For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

For prevention strategies and to learn more about on how to self-treat the most common lower extremity overuse injuries, be sure to check out the Resilient Runner Program, which is designed to help YOU meet YOUR training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.

Have you performed the clock exercise before? If so, what was your experience like? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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How to Perform a Key Hip Stability Exercise

benshatto@yahoo.com — Wed, 02 Sep 2020 12:00:41 +0000

Hip pain, knee pain, and even foot pain (such as plantar fasciitis or posterior tibialis syndrome) can have an associated hip external rotation weakness. An important yet often overlooked component to proper lower extremity stability is how the deep hip external rotator muscles need to work along with other hip external rotators and hip abductors, such as the gluteus medius, to insure proper lower extremity positioning when the leg is in full weight bearing. Particularly, in a single leg stance position during walking, running, skipping or landing from a jump as the leg accepts full weight bearing while the opposite leg is in swing phase.

The deep hip rotators, also known as the short external hip rotators, are a group of muscles consisting of the superior and inferior gemelli, obturator internus, quadratus femoris, and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

Weakness in these muscles is often associated with many of the more common lower extremity overuse injuries:

Foot injuries: Plantar Fasciitis, Achilles Tendinitis, Posterior Tibialis Syndrome
Knee injuries: Patella Femoral Pain Syndrome (PFPS), Iliotibial Band Syndrome (ITBS)
Hip related issues: Piriformis Syndrome, Hip Bursitis, Hip Impingement

A simple and effective exercise to improve strength of these muscles is the standing hip 3-way exercise. The important points to remember in this exercise are to keep the stance knee unlocked and in a “soft” stance with the patella (knee cap) slightly externally (laterally) rotated (usually pointing toward the 3^rd or 4^th toe). The rotation must come from the hip, NOT the ankle. The stability of the hip and activation of the deep hip external rotators should be the primary focus.

In the following video, I demonstrate how to use an exercise band to perform the standing hip 3-way exercise, a key hip stability exercise for treating hip pain, knee pain, and foot and ankle related injuries.

CLICK HERE TO WATCH NOW

For additional videos on my recommended exercises to increase hip strength and stability, be sure to check out:

Do you suffer from hip, knee or foot pain? If so, hip external rotation weakness may be part of the reason for the ongoing pain as you overload and overuse other structures trying to gain extra lower leg support. Additional discussion can help others to manage this condition more effectively. Please leave your comments below.

The post How to Perform a Key Hip Stability Exercise first appeared on The Physical Therapy Advisor.

The Clamshell: A “go to” Exercise for Treating Foot, Hip, and Knee Pain

benshatto@yahoo.com — Wed, 06 May 2020 12:00:26 +0000

Do you suffer from foot, hip or knee pain? If so, hip external rotation weakness and poor single leg balance may be part of the reason for the ongoing pain as you overload and overuse other muscle groups in order to gain extra lower leg support. Weakness in the deep external rotation muscles is commonly associated with many lower extremity overuse injuries.

Injuries commonly associated with hip weakness include:

Foot/ankle injuries such as plantar fasciitis, Achilles tendinitis or posterior tibialis syndrome.
Hip related issues including piriformis syndrome, hip bursitis, and hip impingement.
Knee injuries such as Patellar Femoral Pain Syndrome (PFPS) and Iliotibial Band Syndrome (ITBS).

The deep hip external rotator muscles need to work along with the hip abductors (such as the gluteus medius) to insure proper lower extremity positioning when the leg is in full weight bearing. (Particularly, in a single leg stance.) One leg bears the full weight while the opposite leg is in the swing phase while walking, running or skipping.

The deep hip rotators (also known as the short external hip rotators) are a group of muscles including: the superior and inferior gemelli muscles; obturator internus; quadratus femoris; and the piriformis. This group of muscles is extremely important for stability of the body, pelvis, and leg as the leg/foot initiates full ground contact.

The clamshell exercise is a commonly prescribed exercise designed to target the hip abductors and hip external rotators. However, this exercise is often performed incorrectly or ineffectively.

In the following video, I demonstrate my preferred method of performing the clamshell exercise in order to insure optimal effectiveness.

In order to engage the deep hip rotators, you should feel the muscles working deep into the buttocks and directly behind the greater trochanter (the hard bone that pokes up at the top of the hip).

This exercise should be performed very slowly. I advise a count of 5 seconds up, a 5 second hold, and then a 5 second slow return to the starting position for at least 10 repetitions.

If you aren’t feeling the deep hip rotators activate, then you may need to reposition your legs. Usually, repositioning the knees and moving them up toward your head into a more fetal position will do the trick.

CLICK HERE TO WATCH NOW

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3 Causes of Hip-Pain Unrelated To Injuries

benshatto@yahoo.com — Wed, 08 May 2019 12:00:05 +0000

We’ve all been there… our hands clutching at our thighs in the hope of relieving hip-stress as we get up or sit down; a grimace on our faces as we try to grapple with what we think are signs of aging while easing into the bath; a frown as we get out of the car, straining to carry the weight in our legs, not our hips. Hip pain: most of us have experienced it, and if you’re reading this, you’re probably still suffering from its tell-tail discomfort. And yet, for most of you reading this, your pain isn’t related to any sort of injury you can think of – it just arrived and has decided to stay. The good news is, though its origins are unknown, hip-pain can be treated and alleviated. In this post, we’re looking at some of the reasons you might be suffering from hip discomfort – and better still – some of the ways in which you can become pain free, right now.

I know what you’re thinking – you haven’t fallen, tumbled, or tripped recently. In fact, you tend to take fairly good care of your hips in so far as you know how. And that’s great! The truth is, though, for the majority of us, joint health is something we don’t really consider in our daily activities. In other words, when it comes to our hips, we often don’t realize that small irregularities in our postures, habits, and routines, can affect the health of our hip joints in the long run. That having been said, take a look at some of the most common reasons you’re experiencing inexplicable pain in your hip area.

Sitting All Day
It’s possible you’ve already considered the fact that a largely sedentary lifestyle might be contributing to your hip pain – if so, you’re on the right track. Sitting for numerous hours a day will eventually lead to stiff, tight muscles, the presence of which will result in pain. Your hip joints are incredibly important when it comes to mobility – not moving or stretching them throughout the day will cause a decreased ability to move with comfort, hence the pulling, stabbing, or dull ache your feel when you leave for home or get out of bed in the mornings.

No Exercise
Your muscles and joints need to be lubricated, stretched, and strengthened in order for them to maintain their flexibility and functionality. And the best way to do this is… yes… you guessed it: exercise. Excluding exercise from your daily routine is a sure-fire way to end up experiencing hip-pain. If you don’t use your muscles often, they weaken and lose their ability to add structural support to your joints; in this way, then, weakening hip muscles can lead to damage in the hip joint, thereby causing and aggravating hip-pain.

Repeated Exercise Routines
Though exercise is a great way to keep your hip-joint healthy, the continual repetition of one single exercise, stretch, or routine can actually cause breakdown within the muscle, thereby aggravating hip-pain instead of alleviating it. Constantly focusing on one single type of activity places continuous pressure on one group of muscles, and so places stress on them whilst weakening those around them: this is the point at which injury, and thus the possibility of serious damage, may occur.

If you’re doing one, two, or even all of the above, don’t fear – your hip-pain can be dealt with. Fortunately, there are ways in which you can tackle and alleviate your pain. Take a look:

Stretch
Doing stretches which target your hip area can be very helpful in loosening and lengthening tight, stiff muscles which may be causing you discomfort. Find the time to hit the mat and stretch out your hip muscles, even if it means getting up 10 minutes earlier.

Varied Exercise
Having realized that a sedentary lifestyle is causing you discomfort, it’s time to begin making some changes. Start by incorporating some exercises in the office: get up every 15 – 20 minutes, and walk for 2 minutes every 30 minutes. In addition, try adding some extra activities to your daily routine. Why not try walking for 30 minutes a day, or cycling along the promenade or in the park? Getting those muscles moving is essential for your recovery and pain-free life. Remember, though, vary your routine as you go along.

Physical Therapy
Physical therapy is by far the fastest and safest way to get rid of your hip pain, right now. If you’ve never considered physical therapy, or have misunderstood the benefits of this therapy, it’s time to reconsider. With the help of a hands-on, qualified, and dedicated physical therapist, you’ll not only be rid of your hip-pain once-and-for-all, but you’ll finally be given the information you’re looking for, thereby gaining peace of mind in the process. Unlike other forms of treatment which offer temporary, often harmful solutions for your pain, physical therapy tackles the root cause of the problem safely and non-invasively, thereby giving you permanent relief from your hip discomfort. In addition, a hands-on physical therapist is able to offer you tailor-made exercises and stretches to suit your needs, thus allowing you to maintain a pain free life and finally gain access to the lifestyle you dream of.

Hip-pain doesn’t need to be a precursor to a life of immobility: it can be overcome and you can gain access to the active, mobile, healthy lifestyle you dream of. By following the above tips, and by contacting a professional, hands-on physical therapist, you’ll be saying goodbye to your surprising discomfort in no time. Don’t waste even a moment more puzzling over the cause; find the answers you’re searching for – and take the actions needed – right now. To learn more about physical therapists or find one in your area, visit the American Physical Therapy Association (APTA).

The post 3 Causes of Hip-Pain Unrelated To Injuries first appeared on The Physical Therapy Advisor.

Why You Won’t Heal – Part 1

benshatto@yahoo.com — Wed, 22 Feb 2017 14:00:24 +0000

You’re Getting the Wrong Treatment for Your Condition

As a physical therapist, I have the opportunity to work with individuals who suffer with chronic disease, cardiovascular conditions, neurological disorders, and of course, my specialty: musculoskeletal and orthopaedic conditions. A person’s rehabilitation process can be highly variable even within those who are recovering from the same type of injury. While most of my post rehabilitation clients have been able to move forward and live successful lives, there are other clients who took significantly longer to heal. Unfortunately, there are some who were never able to recover to any significant degree.

The reasons why a person may not recover are vast and complicated. However, I have identified six categories of common reasons why a person will not fully heal and recover or take an extended time.

6 Categories of Common Reasons Why You Won’t Heal:

You’re getting the wrong treatment for your condition.
The injury or condition isn’t capable of healing.
Physiological and social conditions are affecting your healing.
Poor nutrition.
Poor sleep quality.
The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

In Part 1, treatment for the condition is addressed. In subsequent posts, I will cover the other categories in addition to providing you with methods and strategies for recovery to insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

You’re Getting the Wrong Treatment for Your Condition:

Sadly in today’s health care environment, it’s not uncommon for individuals to get the wrong treatment for his/her condition and/or inappropriate care which can affect the recovery process. As a physical therapist, I continue to see countless examples of individuals getting wrong and/or ineffective treatments to manage a particular injury or medical condition.

Sometimes this is deliberate as part of some newest and greatest product scam that is touted as curing this or that condition, but most of the time, it’s done inadvertently. This problem isn’t just in one medical profession. It’s throughout the entire healthcare system.

The following three examples illustrate what happened to some of my prior physical therapy clients. Unfortunately, this list could be very long if I included every example I have witnessed.

Example 1: Total Hip Replacement

The client presents with apparent hip and leg pain. The client has undergone a total hip replacement in an effort to eliminate the pain only to have it still be present. Upon further examination, the cause of the hip and leg pain was an undiagnosed lumbar spine injury. Once the lumbar injury was managed appropriately, the pain in the hip and leg resolved. Although the client had arthritis and deterioration in the hip to justify the hip replacement, it wasn’t the real cause of the pain. In this case, the client never needed the hip replacement in the first place.

Example 2: Low Back Pain

The client complains of ongoing low back pain (LBP). Although there are many reasons why one may experience LBP, the pain is of mechanical origin in the majority of cases. This means that something in the musculoskeletal system is the pain generator. The client should be able to establish movement patterns that can help to determine if the pain is improving or worsening. This directional preference helps me as a physical therapist to guide treatment decisions.

Extending the spine makes the pain improve, but the client’s previous physical therapist has him performing primarily flexion (bending forward) exercises as part of the rehabilitation protocol. This treatment is not only ineffective, but it significantly slows the healing response as the client continued to aggravate the injury by moving repeatedly in the wrong direction. Upon stopping the flexion based exercises, the client’s LBP improved and fairly quickly went away.

Example 3: Chronic Headaches

The client sees a neurologist for assistance managing what appears to be a case of chronic migraine headaches. The client is given prescription medications which are taken on a regular basis in order to help manage the migraines. Although the medication helps to reduce the length of time of suffering, the client continues to experience migraines on a regular basis. The treatment may not be wrong, but it certainly isn’t overly effective. Worse yet, there is the potential for multiple side effects from taking the medication.

In this particular case, the client had a cervical alignment issue which caused mechanical neck pain that would trigger a migraine. Together, we were able to correct the alignment issue, and more importantly, fix the chronic poor sitting posture that lead to the alignment issue. This eliminated the headaches completely and the need for the migraine medication.

I tell these stories from past clients to illustrate the point that wrong and/or ineffective treatments can lead to a significantly longer than necessary recovery time. These clients were fortunate because the true cause for the pain was identified and recovery occurred.

There are a countless number of people who continue to suffer with an incorrect or ineffective treatment therapies. The key to successfully rehabilitating and recovering from a condition is to direct the right treatment plan for the condition. This includes how the actual injury or condition is being handled as well as addressing other risk factors or precipitating factors that directly affect the condition.

How to Identify an Incorrect or Ineffective Treatment Therapy:

You aren’t experiencing any relief in pain or symptoms from the treatment.
Your symptoms continue to worsen.
You have been using the same treatment for weeks or months without resolution. In the case of chronic disease, management of the condition hasn’t been effective.
The treatment and why it’s effective cannot be logically explained.
You haven’t been given any tools or education on how you to help improve or manage the condition, the rehabilitation or disease process, and its symptoms.
You are told that there are no other options.

If you are unsure whether or not the treatment you are receiving for your condition is helping, then it’s up to you to be proactive and seek a second opinion. Although you should be cautious in researching for medical information online, there are reputable websites that can help to educate you about symptoms and possible causes for your condition.

If you suspect that your treatment course is incorrect, discuss your concerns with your medical provider. Don’t be afraid to seek a second (or even third opinion) if necessary. There are many options, and help is available. Don’t give up!

Have you experienced an incorrect treatment or ineffective medical treatment before? What did you do in order to resolve it? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

The post Why You Won’t Heal – Part 1 first appeared on The Physical Therapy Advisor.

Q & A: How to Increase Hip Strength and Improve Mobility

benshatto@yahoo.com — Wed, 08 Apr 2015 16:30:09 +0000

Q. Hi. I have been noticing that even with my current strength training I’m pretty weak in my hip area. I’d like to work on strengthening this area, so I don’t have problems when I’m older. Can you recommend a few exercises that I can add to my routine? Thanks, I love your posts and utilize the information as often as I can. -Amy

A. Thanks, Amy, for this fantastic question! It’s wonderful that you are aware of this particular weakness and you’re being proactive now versus experiencing potential issues later. Maintaining adequate hip and pelvic strength is important for many reasons. The hip muscles control or influence most of the lower leg mechanics, including the hip, knee, and foot. They also play a role in lumbar stability and mobility. Both hip strength and mobility is vital to insure proper lower extremity movement.

Weakness and/or poor mobility in the hips can lead to potential problems including:

Hip pain
Knee pain
Lumbar pain
Abnormal gait patterns
Increased fall risk
Early development of osteoarthritis in the hips and knees
Iliotibial band syndrome
Hip bursitis
Shin splints
Plantar fasciitis

Many other conditions and pain can also be attributed to poor hip strength and mobility. This is by no means an all-inclusive list. I have written specific blog posts regarding many of these conditions. In each case, one of my recommended tips is to improve both hip strength and mobility. Many of the hip muscles are located deep in the pelvis and buttock area. They are not necessary large, but they are critical. These hip muscles can also be responsible for pain, particularly when spasming. Piriformis Syndrome occurs when the piriformis muscle (a deep hip rotator muscle) spasms. The spasm can cause buttock pain. Due to its proximity to the sciatic nerve, it can also cause radiating pain down into the leg known as sciatica.

How to Increase Hip Strength and Improve Mobility:

Squat. The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates muscles in the hips, the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. For more information on squatting, please refer to 7 Reasons Why the Squat is Fundamental to Life.
Target the hip muscles. Many of the muscles of the hip require specific exercises to insure that the correct muscle is activated. Please refer to Hip Strengthening Exercises for detailed descriptions and photos of my recommended exercises.

Improve your mobility. Tightness and restrictions in the hip and pelvic musculature are often associated with pain in the legs and low back. Please refer to Hip Stretches and Mobilizations for detailed descriptions and photos of specific stretches for the hip and pelvis and how to self-mobilize by using a foam roller and lacrosse ball. Tightness and restrictions increase your risk of injury due to improper mobility. For example, tightness in the hip internal rotator muscles causes the hip and lower leg to roll in, which is associated with Patellar Femoral Pain Syndrome (also known as runner’s knee). For more information on this condition, please refer to How to Self-Treat Patellar Femoral Pain Syndrome.
Self-mobilize. Using a foam roller is an excellent method to decrease pain and improve mobility throughout the hip and pelvis. For more information on how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
Walk more frequently. Walking is a critical component to healthy aging. Walking on various surfaces and terrain is an excellent way to improve your health, fitness, and hip strength. To discover other benefits walking, please refer to Why You Should Walk, Not Run.

Maintaining adequate hip and pelvis mobility and strength is an important strategy in avoiding many lower extremity orthopaedic conditions. Being aware of a particular area of weakness and being proactive now could save you from experiencing pain in the future. Thanks, Amy, for your question!

Which strategy will you use to increase your hip strength and improve mobility? It could be as simple as using the foam roller or walking. Most importantly, just get started! Please leave your comments below.

Looking for that exercise or book I mentioned in a post? Forgot the name of a product or supplement that you’re interested in? It’s all listed in the Resource Guide. Check it out today!

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