Hip pain occurs in 1 of every 4 women over the age of 50.¬†Pain experienced on the outside of the hip and thigh is commonly caused by irritated tendons or the bursa. The bursa is a fluid-filled sack that acts as a cushion between the bone and surrounding tendons.¬†The gluteus medius tendon is the most common structure involved in people who experience pain on the outside of the hip.¬†Pain is increased when lying on the side, walking, or when climbing stairs.
Steroid injections are commonly used to treat pain originating from the bursa or tendons.¬†This often provides substantial short-term pain relief. Unfortunately, the pain is likely to return. Sometimes pain becomes even more severe than before receiving the injection.¬†Thankfully, the latest research shows exercise is extremely effective in the long-term for treating hip pain caused by an irritated bursa or tendon.
Research Shows Exercise is Effective for Managing Hip Pain
A 2018 study published in the British Journal of Sports Medicine investigated the effects of exercise, corticosteroid injection, or no treatment in people with hip pain.¬†The exercise program was administered by a licensed physical therapist during 14 sessions spread over an 8-week period. After one year, 79% of patients performing the exercise program were a treatment success. Only 58% of the patients who received an injection and 51% of patients who received no treatment were judged to be a treatment success after one year.
Exercise Program Basics for Managing Hip Pain
Exercise is prescribed only after an initial examination is performed by a licensed physical therapist with specialty training in orthopedics.¬† Initially, exercise is prescribed to target activation of the gluteus medius muscle and tendons.¬†Isometric exercises are ideal in the early stages of rehabilitation.¬†When performed properly these exercises cause little to no pain.¬†Dynamic exercises are integrated next, first in lying positions, and then in standing.
It is important that proper technique is always maintained.¬†Exercises are only progressed when certain goals or milestones have been reached. Gradual progressive loading of the injured tendons and muscles leads to resilience and an optimal long-term outcome. The following 5 exercises are examples of the types of exercises physical therapists prescribe for hip pain.
Isometric Hip Abduction in Lying
Lie on your back, with your knees slightly wider than hip width. Place a pillow under the knees and a belt around your lower thighs. Very slowly and gently start to push your knees apart against the belt, but only enough to just take up the slack in the belt. All the big muscles you can feel around your hips and thighs should remain soft and relaxed.¬†You should be aware of deep gentle tension at the side of your hips.¬†Hold the isometric contraction for 10 seconds and perform 10 repetitions.
Begin lying on your back with the hips flexed and the feet lined up with the shoulders.¬†Perform the bridge by lifting both hips from the floor.¬†A common mistake is to excessively arch the low back.¬†Be sure to achieve the bridge position by extending through the hips.¬†Hold the bridge position for 2 seconds then return to the starting position.¬†Lower the body back down in a slow and controlled manner.¬†Typically, 2 to 3 sets of 10 to 20 repetitions are performed.
Isometric Hip Abduction in Standing
Stand with your feet slightly wider than your hips.¬†Place your hands on the sides of your hips so you can feel the glute muscles activate.¬†Slowly and gently imagine you are going to slide your legs apart ‚Äď ‚ÄúImaginary splits‚ÄĚ. Think of a slow buildup of muscle activation, rather than a sudden movement. You should only be aware of deep gentle tension at the side of your hips. All the big muscles around your hips and thighs should remain soft and relaxed. If you are unable to relax your larger muscles, you can start this exercise leaning your back against a wall. Hold the isometric contraction for 10 seconds and perform 10 repetitions.
Stand with your feet hip to shoulder-width apart and your weight equally on both feet.¬†About 2/3 of your weight should be back on the heels.¬†The thighs and buttocks begin relaxed. Next, bend at the hips and knees, translating the hips backward, and the body forward, like when you sit down. Keep your knees facing straight ahead. Keep your back long and relaxed. Your physical therapist will tell you how deep to go ‚Äď usually, start at 1/3 or ¬Ĺ of the distance to a chair. Move slowly down, pause briefly, and then return slowly to standing.¬†Focus on pushing through your heels and feeling the tension in your buttocks. Typically, 2 to 3 sets of 8 to 12 repetitions are performed.
Lateral Band Walk
The lateral band walk is performed with an elastic band tied around the ankles standing in an upright position with the feet together.¬†During this exercise, the knees and hips are flexed about 30¬į.¬†The hands are placed on the hips. Sidestepping is initiated by leading with one leg over a distance slightly wider than shoulder width.¬†It is important to keep the toes pointing straight ahead and the knees over the toes throughout the exercise.¬†Tension should be maintained on the band so the feet do not touch.¬†Three slow steps are performed in one direction followed by 3 steps in the opposite direction.¬†Each cycle constitutes 1 repetition.¬†Typically, 6-8 repetitions are performed each set.
Hip pain involving the bursa or tendons can be debilitating.¬†You don‚Äôt have to suffer any longer.¬† These 5 exercises are only a small sample of the types of exercises that can help. Meet with your physical therapist and get started on the road to recovery.¬†Your physical therapist will continually assess your injury and progress your exercise program based on your goals.¬†The objective is to decrease pain and restore function as quickly and safely as possible.¬†Contact us today if you have hip pain or simply have questions about which treatments are right for you.
Hamstring strains occur at high rates in sports which require running and sprinting.One of every 3 injuries in soccer is hamstring strains.¬† Other sports with high injury rates include baseball, football, and track and field.¬†These injuries can be very frustrating for athletes because of the long rehabilitation time. Return to sport may take several weeks or 2 to 3 months based on the severity of the injury.¬†Also, nearly 1 in 3 hamstring injuries will recur and many of these happen within the first 2 weeks of returning to sport.¬† Thankfully, rehabilitation exercises can help athletes can back in the game and avoid re-injury.
The hamstrings consist of three muscles: the semitendinosus, semimembranosus, and the biceps femoris.¬†The three muscles originate from a common tendon on the pelvis.¬†The hamstrings cross the hip and knee joints attaching just below the back of the knee.¬†During high-speed running the hamstring muscle is commonly injured as the leg is swinging from a bent to an extended position in preparation for landing.¬†During this phase of running, hamstring muscle activity is extremely high to control the length of the muscle.
The Most Effective Approach to Rehabilitating Hamstring Strains
Research indicates there are 3 types of rehabilitation exercises which assist in recovery from hamstring strains.¬†Agility exercises which involve changes of direction simulating sport movements reduce re-injury rates.¬†These exercises can be initiated early after the acute injury. Trunk or core stabilization exercises are also effective at reducing risk of re-injury.¬† And exercises which lengthen the injured hamstring can speed up an athlete‚Äôs return to play.
The remainder of this article highlights 5 rehabilitation exercises for hamstring strains.¬† Three of these exercises are intended to progressively lengthen the injured hamstrings.¬† These are the active hamstring stretch, the ‚Äúdiver‚ÄĚ, and the ‚Äúglider‚ÄĚ. Lengthening exercises are performed slowly and through pain-free ranges at first.¬†Aggressive stretching can delay recovery.¬†As the athlete improves, the speed and range of motion of these exercises are gradually increased.
Trunk stabilization exercises are designed to strengthen the muscles of the spine, hips, and pelvis.¬†Strengthening the hamstrings and all surrounding musculature is important to reduce the risk for re-injury.¬†Keep in mind, the hamstring muscle group originates from the pelvis.¬†The position of the pelvis during running can influence the length and activity of the hamstring muscles.¬†Increasing strength of the injured muscle itself builds resilience and promotes a safe return to sport.
Active Hamstring Stretch
Lie on your back holding the thigh of the leg to be stretched. The opposite leg remains straight.¬†With the upper thigh maintained in a vertical position, slowly extend the knee.¬† Pause at the point where a mild stretch is felt in the back of the thigh.¬†The stretch should not be painful.¬†Gentle stretching of the hamstring is helpful for recovery. Aggressive stretching of the hamstrings can delay your recovery.¬†Hold this position for 3 to 5 seconds, and then lower the leg back down.¬† Perform 3 sets of 12 repetitions once per day.
Cook Hip Lift
Begin by lying on your back with your hips flexed and feet lined up with the shoulders.¬†¬† Pull the knee of the uninjured leg up to the chest.¬†It is helpful to place a small towel roll or ball in the crease of your hip.¬†Lift your toes off the floor and perform a bridge from the other leg.¬†Be sure to achieve the bridge position by extending through the hips, not the low back.¬†Hold this position for 2 to 3 seconds then return to the starting position.¬†Typically, 2 to 3 sets of 10 to 15 repetitions are performed on each side once per day.
Begin by lying on your back with your hips flexed and the feet lined up with the shoulders.¬† Perform the bridge by lifting both hips from the floor.¬† Hold the bridge position and alternately walk the feet out away from the body.¬† It is important to maintain a level pelvis throughout the exercise.¬† After 2 to 3 steps walk the feet back to the starting position. ¬† Lower the body back down in a slow and controlled manner between each repetition.¬† Typically, 3 sets of 6 to 8 repetitions are performed once per day.
This exercise resembles a simulated dive. Stand on the injured leg with the knee slightly bent. Bend forward at the hip while simultaneously stretching the arms forward.¬†The back should remain flat.¬†The opposite knee remains bent as the hip extends.¬†This exercise should be performed very slowly in the beginning. As a progression, the speed and range of motion can be increased. Typically, 3 sets of 6 to 8 repetitions are performed every other day.
Begin from a standing position with one hand holding on to a support. The legs are slightly split. All the body weight is on the heel of the injured (front) leg with the knee slightly bent. The motion is started by gliding backward on the other leg (wearing only a sock) and stopped before pain is reached. The movement back to the starting position is performed with the help of the arms, not using the injured leg. Begin slowly in a pain-free range of motion. Progression is achieved by increasing the gliding distance and performing the exercise faster. This exercise requires slightly more recovery between each session.¬†Typically, this exercise is performed 3 times per week for 3 sets of 6 receptions.
Getting Started with Exercise After a Hamstring Strain
Rehabilitation for hamstring strains should begin early after injury.¬†Pain-free agility and trunk stabilization exercise are initiated immediately.¬†Lengthening exercise can be safely performed soon after injury when supervised by a licensed physical therapist.¬†The progression of an athlete‚Äôs rehabilitation program is based on specific criteria.¬†Your physical therapist will continually assess your injury and progress your program.¬†The goal is to return the injured athlete as quickly and safely as possible.¬†Contact us today if you have had a hamstring strain or simply have questions about which treatments are right for you.