5 Easy Exercises for Your Hip Replacement Recovery

Hip replacement surgery relieves pain for hundreds of thousands of people each year.  However, some are disappointed because of persistent weakness and trouble walking.  Early after surgery we hear “be patient” or just “take it easy”.  Or, “all you need to do is walk more”.  This approach to hip replacement recovery is just not good enough if you want your quality of life back.

By working closely with your physical therapist, you can do better.  An individually tailored exercise program will speed up your recovery.  Perform the exercises at home or in the clinic with your physical therapist.  Both methods are effective.  They key is that you are performing the right exercises based on your deficits and goals.

Exercise is Proven to Speed Up Your Hip Replacement Recovery

 A 2013 review of clinical studies proves that exercise leads to better outcomes after hip replacement.  Stationary cycling improves quality of life during the first 3 months after surgery and 2 years later.  Early strength training during the first 2 months after surgery results in the greatest functional improvements.  After 8 weeks, weight bearing exercises (examples included below) are best to improve your function.

A more recent review of the research suggests both at home or supervised exercise improves outcomes after surgery.  Patients who attended supervised physical therapy did slightly better.  However, both approaches improve strength, walking, and reduce pain after your surgery.

The decision to exercise at home or under the direction of your physical therapist is not universal. Both approaches work.  It is best to discuss this with your physical therapist, surgeon, and family.  Develop a plan that fits your needs and adjust as you go.

A Sample of Easy Exercises for Hip Replacement Recovery

Whether you exercise at home or with your physical therapist, they key is that you are performing the right exercises.  This is determined by your physical therapist after your initial evaluation.  Everyone who has a hip replacement doesn’t do the same exact exercises.

In general, start with low intensity exercises lying down.  After a week or 2 your pain and stiffness will improve.  Then you will transition to more challenging exercises.  This includes weight bearing exercises done in standing instead of lying down.

Below are 5 examples of some of the common exercises we prescribe.  They emphasize muscle activation and strengthening of your glutes and quads.  These exercises are safe to perform whether you had your surgery through the front (anterior approach) or back of your hip (posterior approach).  Perform them once per day.  We recommend you do 2 to 3 sets of 8 to 12 repetitions for each of them.

1. Prone Glute Squeeze

Isometrics are done by contracting the muscle without joint movement.  This makes the isometric glute squeeze an exercise you can do early and often.  Start with gentle contractions.  Increase the intensity as your pain decreases.  If you have trouble lying flat on your stomach put a pillow under your abdomen.

2. Bridge

The bridge strengthens your glutes and core.  It also helps restore hip extension mobility.  Be sure not to arch your back too much.  Concentrate on squeezing your buttocks.

3. Clam Shell

The clam shell strengthens your gluteus medius.  This muscle is important because it stabilizes your hip and pelvis when you walk.  Weakness will cause you to walk with a side to side lean.  If you are struggling with this exercise you can modify it.  Lie on your back, instead of your side, and place a band around your thighs.  Pull apart with both legs.  When you get stronger, go back to doing it on your side.

4. Sit to Stand

Start by doing this exercises with a few pillows stacked on a firm chair.  The higher you make the chair, the easier it will be at first.  As you get stronger, remove the pillows or find a slightly lower chair.  Don’t over do it at first.  You want to make sure the exercise is challenging but not painful.  Also be sure not to lean away from your involved side.  Your body is really good at compensating.

5. Single Leg Balance

Ok, this exercise is going to be tough for you.  Modifications will probably be needed at first.  Stand close to a chair or counter.  Use 1 hand to assist with your balance.  Over time, slowly decrease your dependence on the chair or counter.  The better you get at this exercise, the better your walking will become.

Start Early for Your Best Hip Replacement Recovery

Don’t delay getting started.  If you are stiff and sore, do the glute squeezes and modify the clam shell.  Work the other exercises in as you feel better.  Also, don’t underestimate the power of getting outside and doing a short purposeful walk every day.  Keep moving but don’t overdo it.

Delaying your rehabilitation will lead to poor habits.  Your body is great at figuring out how to compensate.  So if you develop a poor walking pattern it will be very difficult to correct this later on.  This is why working with your physical therapist early can save you time and aggravation down the road.  If you need help getting started call our office and schedule an initial evaluation with your physical therapist.

 

Lunge Exercises: How to Modify the Lunge if You Have a Knee Injury or Pain

It can be frustrating when knee pain or an old injury interferes with your workouts.  This is especially true when knee pain prevents you from exercising your lower body.  Some people give up and avoid exercising all together. However, there are ways for you to exercise and move without pain.  This article shows you how to modify lunge exercises so you can keep training.

The lunge exercise is a great way to train your lower body muscles from your glutes all the way down to your lower leg.  The lunge is closely linked to everyday walking, running, stair climbing, and balance.  Lunge exercises also help train athletes for changes of direction common in sports.  Just about everyone will benefit from doing some type of lunge exercise.  This article will teach you how to modify lunge exercises so you can have a great workout without pain.

The Basic Mechanics of Lunge Exercises

Lunge exercises involve coordinated movements between your hips, knees, and ankles.  Also, control of your trunk position influences how your lower body joints will move.  The greatest amount of joint movement occurs at your knee.  However, during the lunge the greatest muscular demands are placed on your glutes.  Therefore, performing lunge exercises in a way that increases your glute muscle activation will theoretically reduce the stress on your knee.

muscles during lunge
Lunges are primarily a glute dominant exercise

The lunge is a movement pattern that many people struggle with.  It is a challenge for some people to control the position of their trunk.  We see people leaning or falling to their left of right all the time.  It is important that you maintain a relatively upright and stable trunk throughout the lunge.  Don’t add any weight or resistance until you can master this important part.

Just as important is the position of your knee relative to your hip and ankle.  When your knee is bent during the lunge it should not collapse towards the middle of your body.  Instead, keep your knee in line with an imaginary line from your hips down to your second toe.  Think about pushing your knee out (not your foot) as you move up and down during the lunge.  Learn more about this here.

Lunge Regressions and Progressions

The exercises that follow are part of a simple progression. Start with the basic split squat and go from there.  Many people also benefit from performing other corrective exercises to strengthen their gluteus medius and maximus.  These corrective exercises are based on your physical therapists examination of your strength, mobility, and movement patterns.

Split Squat Exercises

The simplest way to minimize knee stress to your knee during the lunge is to control the depth.  Deeper knee bends increase stress around your knee cap and within your joint.  Deep squats or lunges increase stress to your meniscus, ligaments, and joint surfaces.  Controlling the depth of your lunge is easy to accomplish when you are starting from a static position like in the split squat.  We recommend starting without any weights or resistance.  Instead focus on maintaining balance and control of your trunk.

The split squat also allows you to adjust the position of your feet. A good starting point is to begin with your feet split about 60% of your total height.  This distance places the greatest demands on your hip muscles.  For more challenging variations that require greater knee flexion try the rear-foot elevated split squat.

Reverse Lunge Exercises

The reverse lunge involves a backward step instead of the more traditional forward step.  The reverse lunge loads the hip more than the knee.  Therefore it is a more knee-friendly option than the traditional forward lunge.  This makes it an excellent option for people with arthritis or those with a recent knee surgery.

Lunge exercises
TRX Assisted Lunge

Begin with both feet together holding a suspension trainer in each hand.  This will help maintain your balance during the exercise.  Step back and lunge down into a comfortable depth.  Keep a neutral spine with good upper body posture. Think about pushing up with your glutes and extending through your front hip.  Finish with both feet together. At first it will be easier to perform all repetitions on one side first.  As you gain confidence, alternate steps with each leg.  Perform 2 to 3 sets of 8 to 12 repetitions.

After you are able to perform the assisted exercise with good technique you are ready to progress to a traditional reverse lunge. Another progression is the deficit reverse lunge.  This exercise uses a small step of 4 to 6 inches.  The elevated position will load your hip and glute muscles more.  It will also increase your available knee range of motion.  This increases the training effect to your quadriceps muscle.  But it also adds to the knee joint load.

Forward Lunge Exercises

After mastering the split squat and reverse lunge, you are ready to progress to the forward lunge.  This requires greater balance and control of your trunk.  And if performed poorly, will increase the stress on your knee.  Remember; focus on your technique before getting fancy with weights, bands, balls, or balance devices.

There are an endless number of variations that can be incorporated into the forward lunge.  Some include the use of external loads (dumbbells, kettlebells, and other weights).  Other variations utilize technique modifications to unload or load certain parts of the body.  We will focus on a few of these types of lunge exercises.

Allowing the front of your knee to move past your toes will increases stress to your patellar tendon.  In the early phases of rehabilitation or when pain is severe, this should be avoided.  Instead, in these instances perform the lunge with your knee staying behind your toes.  In most cases, this is your best approach.  However, if you are bothered by chronic patellar tendinitis, (AKA “jumper’s knee”) controlled stress or load to the tendon may be a good idea.  Your physical therapist will help you decide if this is the right approach for you.

Additional Ways to Modify Forward Lunge Exercises

  • Hold a light medicine ball out in front of you to act as a counterbalance. This will make it easier for you to maintain proper trunk position.
  • Add an external load or weight to increase the demands on your hip muscles and ankle. However, adding weight will have less of an impact on your knee joint.
  • Hold a dumbbell in the hand opposite to the side you are lunging with to increase glute activation.
  • Slightly lean your trunk forward to further increase glute muscle activation (instead of keeping a perfectly straight trunk).

Final Thoughts on Lunge Variations

This article outlines some key points about progressing lunge exercises for people with knee pain or injury.  You can achieve great benefits from sticking with the split squat and never progressing to a traditional lunge.  Other people will be able to modify and progress through these exercises.  After mastering the forward lunge, you may want to experiment with lateral or transverse lunges.  These exercises are more challenging and require impeccable form.  The doctors of physical therapy at BSR are experts who can help you move without pain.  If you want a little extra help to get over the hump, contact us and schedule your initial evaluation.

 

 

 

Sports Hernia Exercises to Get You Back Playing

Are you an athlete experiencing deep pain in your lower abdomen or groin when you exert yourself?  Sports hernia is common in athletes who do repetitive kicking, twisting, or turning at high speeds. This includes athletes who play soccer, football, basketball, baseball, tennis, and hockey.  Many athletes miss significant playing time due to ongoing pain.  This article describes what a sports hernia is.  We also highlight 6 exercises to help you get back to playing after a sports hernia.

What is a Sports Hernia?

sports hernia treatment

The injury is called a “hernia”.  However, hernia means a body part or tissue squeezes through a weak area of muscle or fascia.  With the common inguinal hernia, part of the intestine pushes through the injured lower abdominal wall.  With a sports hernia this rarely occurs.  There is injury or tearing of the inguinal wall.  The injury is to the fascia, muscles, or tendons of the abdomen and pelvis.

With a sports hernia no organ pushes through the injured tissue.  This is why the preferred term is now “athletic pubalgia”.

Proven Treatments for Sports Hernia

Once diagnosed, rehab is recommended for at least 3 to 6 months.  If you do not improve with rehab you are a surgical candidate.  A 2014 study looked at 100 cases of sports hernia treated with rehab or surgery.  In people undergoing surgery, 94% successfully returned to their pre-injury sport or work.  In the conservative group, 93% returned to their pre-injury levels.  Therefore, both rehab exercises and surgery are effective treatments for sports hernia.

Phase 1: Starting Exercise 

Early rehab exercises focus on flexibility, core stability, and hip strength.  You should be able to perform these exercises with minimal or no pain.  Most exercises involve isometric contractions (static holds) of your lower abdominal and pelvic muscles.  Emphasize a neutral spine and slow controlled movements.  To start, perform dead bugs, bridging, and plank variations.  Also consider other abdominal and hip strengthening exercises.  Within a few weeks you will be feeling better and stronger.

Perform the initial exercises with special attention to proper technique and building endurance. These exercises lay the foundation for more advanced exercises to come.  We recommend 2 to 3 sets of 12 to 20 repetitions for each exercise.  Perform them daily.

Phase 2: Exercise Progressions

After you have adequate core stability and hip strength, you are ready to progress.  The next phase of rehab involves rotational movements.  This is because sports hernia injuries often result from pivoting or twisting.  Examples are kicking a soccer ball or swinging a baseball bat.  Single-leg exercises are also very important during this phase.  Lunges, split squats, single-leg dead lifts, and single-leg squats help prepare you for return to your sport.

Balance, control, and endurance are important aspects of these exercises.  Perform 2 to 3 sets of 10 to 12 repetitions.  Perform them 3 to 4 days per week.  You can continue performing any stretching and phase 1 exercises on alternate days.  Also, prior to returning to sport your physical therapist will put you through agility and plyometric training.

Final Thoughts on Exercises for Sports Hernia

Core and hip strengthening exercises are proven treatments to get you back playing after a sports hernia.  The 6 sports hernia exercises in this article are a sample of many effective options.  You will also benefit from receiving manual therapy performed by your physical therapist.

As always, your symptoms and goals dictate the approach that is best for you.  So commit to these exercises for at least 6 weeks. If you would like help getting started, call our office to schedule an initial evaluation with your physical therapist.

Hip Impingement Exercises

Hip impingement results from excessive contact between the ball and socket of your hip joint.  Bony changes or deformities compress or pinch your bone, cartilage, and other joint structures.  This has the potential to lead to tears of your labrum and early hip arthritis. Surgery and physical therapy are the most common treatments.  This article describes our preferred approach to prescribing hip impingement exercises.

People with hip impingement report clicking, catching, stiffness, and even locking of their hip.   You will experience pain in the front of your hip, groin, the outside of your hip, or in your buttock.  It is also common to experience low back pain at the same time.  Deep squatting or twisting movements bring on your pain.  Sitting in the car or low chairs also bring on your pain.

A Proven Approach to Exercise

A 2019 review in The American Journal of Sports Medicine investigated the effectiveness of exercise for people with hip impingement.  The review included 5 clinical trials with over 100 patients.  Based on this research, exercise supervised by a physical therapist was best.  Also, exercise programs that include strengthening exercises for the hip and core muscles lead to the best overall improvements.

Core Strengthening Exercises

The position of your pelvis influences the bony contact and joint mobility of your hip.  An anteriorly tilted pelvis, seen in people with arched lower backs, exacerbates hip impingement.  Therefore, exercises that facilitate a neutral or slightly posteriorly pelvis is preferred.  Your lower abdominal muscles are responsible for maintaining proper pelvic and spine positioning during physical activity.  Early basic exercises emphasize proper pelvic alignment.  The basic exercises must be mastered before moving on.

After proper pelvic positioning and abdominal bracing is achieved, you are ready to progress to more challenging core exercises.  This includes exercises such as the dead bug, rollouts, and plank variations.  Perform all exercises with a neutral spine and pelvis.  Also, emphasize high repetitions to develop trunk muscle endurance and strength.

Hip Strengthening Exercises

Weakness of the glute muscles is common in people with hip impingement.  Restoring glute muscle activation, strength, and endurance is important to alleviate compression and pinching in your hip.  Start with basic floor exercises to activate your gluteus medius and gluteus maximus.   Clam shells, hip abduction, and a bridging progression are excellent places to start.  Remember, emphasize proper form and high repetitions like 15 to 20 per set.

After adequate training of your core and glutes, you are ready to progress standing and dynamic exercises.  It is important to maintain balance and good alignment of your trunk and legs during these exercises.  Do not allow your upper body to lean to the side.  And avoid allowing your knee to cave inwards.  Both of these compensations will increase compressive stress to the front of your hip.  Lateral band walks, l-leg RDLs, and 1-Leg squat variations are great exercises to implement in this phase.

Final Thoughts on Hip Impingement Exercises

Core and hip strengthening exercises are proven forms of treatment for your hip impingement.  The 9 hip impingement exercises in this article are a sample of many excellent options.  As always, your unique presentation and goals will dictate the approach that is best for you.  Commit to these exercises for at least 6 weeks.  Remember to emphasize proper form with slow and controlled movements.  If you would like help getting started, call our office to schedule an initial evaluation with your physical therapist

6 Strength Training Exercises for Hip and Knee Arthritis

If you are one of millions of Americans bothered by hip or knee arthritis, this post is for you.  And if you would prefer not to rush into popping pills, having injections, or pursuing surgery, this post is really for you.  The following paragraphs are for people who want to take back control of their health and quality of life.  You may be thinking, “But there is no cure for arthritis.”  We disagree.  The Cambridge dictionary defines a cure as something that makes someone who is sick healthy again.  A cure refers to making you, a whole person, healthy again not correcting or reversing some change in your joint.  With this definition in mind, there is no better cure for your hip and knee arthritis than exercise.

There are many different types of exercise which have been proven to be helpful for arthritis.  Aerobic exercise, stretching, yoga, tai chi, aquatics, and balance training are all proven forms of exercise.  This post goes into detail about one of the most effective forms of exercise for people with hip and knee arthritis: strength training.

You may be thinking, “But my knee [or hip] hurts too much to exercise.”  Or someone may have even told you,” Exercise will make your arthritis worse.”  These claims are flat out wrong!  If you accept them as true, you are playing the victim.  Victims wait around for their lives to change.  Successful people create the changes they want in their life.  If you don’t to be a prisoner to your arthritis pain, now is the time do get moving with an exercise program.

A Proven Approach: Strength Training for Arthritis

When we look at the entire body of research done on arthritis it is clear that strength training is beneficial.  A 2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with hip and knee arthritis.  These were aerobics, mind-body exercise (yoga or tai chi), strength training, and stretching.  A regular strength training routine was proven to be beneficial for decreasing pain, improving function, and restoring quality of life.

In 2016, a panel of medical experts across the world reviewed the best evidence looking at exercise for people with hip arthritis. Compared to all other forms of exercise, these experts found strength training to be the best for decreasing pain, improving function, and regaining mobility.  Recommendations include performing one to three 45-minute sessions each week.  You can use exercise equipment at a local gym or fitness center.  For most people, it is more practical to start strength training at home without all the fancy equipment.  The 6 home exercises that follow focus on strengthening your core, hips, and thigh muscles.  They are a great starting point for you.

Band Knee Extension

The quadriceps muscle or “quads” on the front of your upper thigh is crucial for walking, climbing stairs, and standing up from a chair.  The quads of people with hip and knee arthritis are weaker and smaller than people without arthritis.  Weakness places additional stress through your arthritic joints.  Stronger quads reduce joint stress and decrease your pain.  Band knee extension is a great exercise to start working your quads.

Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Sit up nice and tall with good posture.  Extend your leg straight to activate your quads.  Do this quickly.  Once you have your knee fully extended pause 2 to 3 seconds.  Then slowly lower your leg over a 5 second period.  To review, raise the leg fast, hold 2 to 3 seconds, and then lower it back really slow.  This will give you the best results.  Perform 10 to 15 repetitions for 2 to 3 sets.

Band Knee Flexion

The hamstrings in the back of your thigh are also critical for balance and walking.  Stand to perform this exercise.  Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Keep a nice tall posture.  Bend your leg behind you but keep your knee directly under your hip.  All movement occurs at your knee.  No movement occurs at your hip.  Bend the leg fast, hold 2 to 3 seconds at the top, and then lower it back really slow.  Perform 10 to 15 repetitions for 2 to 3 sets.

Partial Wall Squats

Many people cringe at the word “squat”.  In fact, you may have even had another healthcare professional tell you to never squat.  Unfortunately, it is impossible to go through life without squatting.  Every time you sit down or get into your car you are squatting.   You might as well get better at it and learn to do it in a way that minimizes stress to your joints.

Stand with your back against a wall.  Place your feet 12 to 18 inches out from the wall.  With your arms crossed over your chest, slowly squat to a depth you are comfortable with.  Start small and as you get strong you will be able to go a little deeper.  Be sure your knees stay in line with your hips and ankles.  Don’t allow your knees to cave in.  Hold the down position for 2 to 3 seconds, and then push up fast back to a standing position.  Perform 8 to 12 repetitions for 2 to 3 sets.

Bridge

Your glutes are the key muscles that extend your hips to stand up or climb a flight of stairs. The bridge is a great glute exercise to start with.  Begin by lying on your back with the hips bent and your feet lined up with your shoulders.  Perform the bridge by lifting both your hips from the floor.  A common mistake is to excessively arch your low back.  Hold the bridge position for 2 to 3 seconds then return to the starting position slowly over 5 seconds. Perform the lift fast but lower your body back down in a slow and controlled manner.  Perform 10 to 15 repetitions for 2 to 3 sets.

Clam Shell

Your abductor muscles on the outside of your hip are important for stability when you walk, run, or climb stairs.  When these muscles are not working properly, you will walk with a side to side lean or lurch.   This will increase joint stress and increase your risk for falls.

Lie on your side with your hips and knees slightly bent.  Keep your feet together.  Pace a resistance band around your thighs just above your knees. Start the exercise by rotating the top hip to bring the knees apart. Hold this position for 2 to 3 seconds and then return to the starting position slowly over 5 seconds. Be sure to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake with this exercise. Perform 10 to 15 repetitions for 2 to 3 sets.

Hip Abduction

Lie on your side with the bottom hip and knee bent.  Keep your top knee straight.  Your top hip is maintained in neutral or slight hip extension with the toes pointed forward.  Point your toes forward to orient your hip properly. Initiate the movement by lifting your top leg about 30 degrees.  Hold this position for a count of 2 to 3 seconds and then slowly lower the leg to the start position over 5 seconds.  Perform 10 to 15 repetitions for 2 to 3 sets.  For those who struggle with this exercise, try doing it standing instead of lying down.

This exercise activates the gluteus medius to a greater level than the clam shell.  However, it is also more challenging to perform correctly.  Similar to the clamshell, it is important to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake.   Also, as your muscle tires, your leg will drift forward into hip flexion.  It is important to maintain your leg lined up or slightly behind your upper body.

Hip and Knee Arthritis: Get Started with Strength Training

The hardest part to any exercise program is getting started.  Commit to performing these exercises a few times each week.  You will see small changes after a few weeks.  Expect to see the best results after consistently exercising for 6 to 12 weeks.  If you don’t feel like you can do it alone, give your physical therapist a call.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health and quality of life.

 

 

 

 

Hip Pain: 5 Exercises to Help You Manage

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 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.

2-Leg Bridge

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 – “Imaginary splits”. 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.

2-Leg Squat

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 – usually, start at 1/3 or ½ 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°. 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.

Final Thoughts

Hip pain involving the bursa or tendons can be debilitating. You don’t have to suffer with pain 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: 5 Important Exercises for Recovery

Hamstring strains occur at high rates in sports that require running and sprinting. One of every 3 injuries in soccer are hamstring strains.  Other sports with high injury rates include baseball, football, and track and field. These injuries can be very frustrating for athletes.  This is 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 get you back in the game and avoid re-injury.

Your hamstrings consist of three muscles: the semitendinosus, semimembranosus, and the biceps femoris. These 3 muscles start from a common tendon on your pelvis. The hamstrings cross your hip and knee joints attaching just below the back of your knee. Hamstring injuries commonly occur during high speed running.  This occurs as your 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.

Hamstring Injury

The Most Effective Approach to Rehabilitating Hamstring Strains

There are 3 types of rehabilitation exercises which assist in recovery from hamstring strains. Agility exercises involve changes of direction simulating sport movements.  These exercises reduce re-injury rates.  Always initiate these exercises early after your injury. Trunk or core stabilization exercises are also effective at reducing your risk of re-injury.  Finally, exercises that lengthen your injured hamstring can speed up your return to play.

The remainder of this article highlights 5 rehabilitation exercises for hamstring strains.  Three of the exercises progressively lengthen your hamstrings.  These are the active hamstring stretch, the “diver”, and the “glider”.  Perform lengthening exercises slowly and through pain-free ranges at first. Aggressive stretching delays recovery. As you improve, gradually increase the speed and range of movement.

Trunk stabilization exercises target your spine, hip, and pelvic muscles.  To reduce your risk of re-injury, it is important to strengthen your hamstrings and all surrounding muscles. Keep in mind, your hamstring muscle group originates from your pelvis. The position of your pelvis during running can influence the length and activity of your hamstring muscles. Increasing the strength of your injured hamstring itself builds resilience and promotes a safe return to sport.

Active Hamstring Stretch

Lie on your back holding your thigh. Your opposite leg remains straight. With your upper thigh in a vertical position, slowly extend your knee.  At the point where a mild stretch is felt pause and hold. The stretch should not be painful. Gentle stretching of your hamstring is helpful for recovery. Aggressive stretching of your hamstring will delay your recovery. Hold this position for 3 to 5 seconds, and then lower your leg back down.  Perform 3 sets of 12 repetitions once per day.

Cook Hip Lift

Begin lying on your back with your hips bent and feet lined up with your shoulders.   Pull your knee of the uninjured leg up to your 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 your other leg. Be sure to achieve the bridge position by extending through your hips, not your 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.

Bridge Walk-Out

Begin lying on your back with your hips bent and the feet lined up with your shoulders.  Perform the bridge by lifting both hips from the floor.  Hold the bridge position and alternately walk your feet out away from your body.  It is important to maintain a level pelvis throughout the exercise.  After 2 to 3 steps walk your feet back to the starting position.   Lower your 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.

Hamstring “Diver”

This exercise resembles a simulated dive. Stand on your injured leg with your knee slightly bent. Bend forward at the hip and simultaneously stretch your arms forward. Your back should remain flat.  Your opposite knee remains bent as your hip extends.  Perform this exercise very slowly in the beginning. As a progression, you can increase the speed and range of motion. Typically, 3 sets of 6 to 8 repetitions are performed every other day.

Hamstring “Glider”

Begin in a standing position with one hand holding on to a support. Your legs are slightly split. All your body weight is on the heel of your injured (front) leg with your knee slightly bent. The motion is started by gliding backward on your other leg (wearing only a sock).  As always, stop just before pain is felt. The movement back to the starting position is performed with the help of your arms, not using your 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.

Get Started Soon

Your rehabilitation after a hamstring injury should begin as soon as possible. Initiate pain-free agility and trunk stabilization exercises immediately.  Also perform lengthening exercise soon after your injury, but be gentle.  It is best to perform these under the supervised of a licensed physical therapist. The progression of an athlete’s rehabilitation program is based on specific criteria. Your physical therapist will continually assess your injury and progress your program.  Our goal is to get you back 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.

Hip Arthritis: 5 Helpful Exercises

Hip arthritis is a condition where the protective cartilage of your joint surfaces break down.  Cartilage serves as a pad or cushion to your bone beneath it.  Arthritis can occur on the end of your thigh bone (ball), pelvis (socket), or both.  This exposes  bare bone within your joint. Physicians use the phrase “bone on bone”.  However, this sounds much worse than it actually is.

bone on bone

Hip arthritis does not always lead to pain.  Also, “severe” arthritis viewed on x-rays may cause you only mild pain.  Likewise, mild arthritis may result in more pain.  The experience of pain is more complex than simply “bone on bone”.   Joint inflammation, joint stiffness, muscle weakness, muscle tightness, and changes within your nervous system can contribute to pain experienced from hip arthritis.

Symptoms of Hip Arthritis

Hip arthritis typically affects people over 50 years of age.  Common symptoms include stiffness early in the morning or after you begin walking after a long period of sitting.  You feel pain in your groin.  You can also have pain in the back of your hip, the side of  your hip, or radiate down your thigh towards your knee.  Your pain is generally worse with weight-bearing activities (e.g., walking, standing, or twisting).  Most people experience “flare-ups” of increased pain and stiffness interspersed with periods of little or no pain.

Physical Therapy for Hip Arthritis

Recent research shows several types of exercise are effective for improving pain, function, and quality of life in people with hip arthritis.  This includes aerobic exercise, mind-body exercise, strengthening exercise and stretching.  Manual therapy performed by your physical therapist is also a proven treatment.

Common forms of mind-body exercise are tai chi and yoga.  These exercises are low to moderate intensity with slow movements.  Emphasis is placed on an intentional awareness (mindfulness) of your breathing.  Physical therapists incorporate these principles when prescribing exercise for people with hip arthritis.  Those seeking more concentrated instruction in these forms of exercise are referred elsewhere – Hot or Not Yoga and the Bay Avenue Community Center.

Research supports aerobic exercise for people with hip arthritis. Regular walking for 30 minutes five days per week is recommended.  Continuous walking is preferred but if you are unable to perform one 30-minute walk, multiple shorter walks totaling 30 minutes are fine.  Your physical therapist will help you begin and progress your individualized walking program.  Cycling, swimming, and other forms of aerobic exercise are also very beneficial.  However, walking programs show the greatest improvements.

Muscle strengthening exercises are very important for people with arthritis.  The gluteus maximus and gluteus medius muscles are often targeted.  These muscles are important for walking, climbing stairs, and transferring from sitting to standing.  Weakness of your hip muscles results in increased forces through your hip joint.  Also strengthening the core muscles will improve your ability to function in every day life.  Common exercises prescribed includes bridging, the clam shell, and hip extension exercises.

3 Strengthening Exercises for Hip Arthritis

Stretches for Hip Arthritis

Hip arthritis leads to stiffness of your hip joint capsule and ligaments.  Your surrounding muscles shorten further limiting your range of motion.  Stretching exercises to improve hip extension and rotation range of motion are important to restore your normal walking patterns.  Common exercises prescribed include hip flexor stretching and self-mobilizations for hip internal rotation.

Exercise for Hip Arthritis

Hip arthritis does not have to be disabling.  Exercise will improve your pain, function, and quality of life.  Many people are unsure how to start and what type of exercise is best for their personal goals.  Meet with your physical therapist to develop an individualized exercise program that meets your needs.  Call us and get started.

References

1.  Goh SL, Persson MSM, Stocks J, et al. Relative efficacy of different exercises for pain, function, performance, and quality of life in knee and hip osteoarthritis: Systematic review and network meta ‑analysis. Sports Med. 2019;49(5):743-761.

Kinetic Chain Exercises Linking the Shoulder and Hip

Overhead activities such as throwing require proper sequencing of different body parts.   The lower body, trunk, shoulder, arm, and hands are considered links in a chain.  If any of these links are not functioning properly, the chain is broken.  Effectively using the body as a kinetic chain maximizes overhead athletic performance and reduces injury risk.  Shoulder rehabilitation programs now integrate the kinetic chain theory for a broader approach versus focusing only on isolated muscles.

Why Involve the Kinetic Chain?

Exercises targeting the shoulder muscles receive a great deal of attention in overhead athletes and rightfully so.  The rotator cuff and scapular muscles are important for dissipating high forces created during throwing.  However, most of the energy created during throwing occurs from the lower body and trunk.  Weak links in the lower body leads to additional stress to the shoulder and elbow during throwing.  Therefore, including exercises that incorporate all links of the kinetic chain are beneficial.

lower body strength throwing

 

Lower body exercises such as the squat and lunge can be integrated with common shoulder rehabilitation exercises.  Total body exercises which incorporate resistance bands or tubing are ideal for integrating links of the kinetic chain.  This article described only 3 exercise examples.  However, there are many other variations which can be developed based on the athlete’s profile and goals.

Overhead Squat with “Y”

Stand holding a resistance band in both hands with your shoulders flexed and elbows straight.  Perform an overhead “Y” by raising both hands with your elbows straight. Maintain this overhead “Y” position as you perform an overhead squat.  Try to reach a maximum depth of the squat without compromising your upper-body position.  Maintain the overhead “Y” until completing your set.  Perform 8 to 10 repetitions  eachset.  This exercise integrates the gluteus maximus, rotator cuff, low back muscles, and trapezius.

Lunge with “T”

Stand holding a resistance band in both hands with your shoulders flexed and elbows straight.  Perform a “T” with both arms by pulling your hands and shoulder blades back with your elbow straight.   Once in the “T” position, perform a reverse lunge with one leg.  The “T” position is maintained until one alternating repetition is performed on each leg.  Reset the “T” before completing your next repetition.  Perform 6 to 8 slow and controlled repetitions on each side.  This exercise activates the gluteus medius, gluteus maximus, lats, and trapezius.

Lateral Band Walk with “W”

Perform an exaggerated sideways walk with a resistance band just above your knees. Remain in an athletic position keeping your toes pointed straight ahead.  It is important to push the knees apart against the resistance band in order to activate your hip muscles.  Your shoulder blade and rotator cuff muscles are activated by using a second resistance band in your hands.  Make a “W” with the elbows in order to achieve scapular retraction.  Take 3 steps to the right followed by 3 steps back to the starting position.  Also, think about pulling the elbows to your opposite back pocket.  Perform 6 to 8 slow and controlled repetitions to each side.  This exercise activates your gluteus medius, gluteus maximus, rotator cuff, and lower trapezius.

Closing Thoughts on Kinetic Chain Exercises

Combining lower body exercises with traditional shoulder rehabilitation exercises is beneficial for overhead athletes.  Muscles throughout the entire body function in a coordinated sequence during baseball and softball throwing.  Resistance bands have gained popularity in the baseball and softball communities as part of pre-throwing routines and strength and conditioning programs. These shoulder-focused exercises train only a limited number of links in the kinetic chain.  A wise approach is to integrate upper body resistance band exercises with dynamic, full-body exercises.  Talk to your physical therapist  or give us a call if you are unsure about which exercises are best for you.

 

 

5 of the Best Hip Mobility Exercises

Hip stiffness leads to many painful conditions in and around your hip.  In older adults, limited hip mobility is associated with hip arthritis, spinal stenosis, and knee arthritis.  In athletes, hip stiffness is linked with hip impingement, labral tears, groin pain, low back pain, and knee pain.  This article highlights 5 hip mobility exercises that will help you move with less pain.

Hip Joint Basics

Your hip joint is a large ball and socket joint similar to your shoulder.  Unlike your shoulder, your hip socket is much larger than the ball.  Therefore, less mobility is available at your hip in comparison to your shoulder.  In addition, further loss of hip motion is due to bony changes to the femur or pelvic bone.  This occurs with aging.  Also common, restrictions are due to muscle and joint capsule tightness.

Hip Mobility Exercises

Hip mobility exercises

Manual therapy soft tissue techniques and various forms of stretching will improve your hip mobility.  In order for lasting changes to occur, manual therapy is combined with self-mobilization exercise.  Self-mobilization exercises are performed in your home with minimal space or equipment.  The exercises which follow in this article are basic self-mobilization techniques that  easily you can easily perform in your home or local gym.

Prone Figure-4 Hip Self-Mobilization

The figure-4 self-mobilization is helpful if you have limited hip external rotation.  This is the right stretch for you if you experience difficulty putting on your shoes and socks.  It will also improve  your hip extension which can translate into improved walking or running ability.  When performing this exercise it is important to activate your abdominal muscles to avoid arching your low back.

Quadruped Hip Internal Rotation with Lateral Distraction

Limitations in hip internal rotation are characteristic of many hip problems.  Any sport that requires squatting, pivoting, planting and cutting require hip internal rotation.  By using a belt or band to distract your hip joint, greater hip internal rotation is available.  Be sure to place the band or belt deep into your groin to optimize the stretch.

Quadruped Rock Back with Hip Posterior Glide

Rock backs promote a posterior glide of your femur and stretch the back of your hip.  With this exercise we like to keep the hip flexion passive.  This is because passive motion alleviates the influence of your hip flexor muscles.  By using a belt or band to distract your hip joint, greater hip flexion is available.

Kneeling Hip Flexor Self-Mobilization

Limited hip extension flexibility is one possible cause of an increased anterior pelvic tilt and low back arching during walking or running.  This pattern stresses the structures of your low back and hip.  Combining this self-mobilization with abdominal strengthening exercises alleviates low back and hip pain.

Standing Posterior-Lateral Hip Self-Mobilization

Tightness in the back of your hip can lead to pain in the front of your hip or groin.  Stretching this region will help.  By using a belt or band to distract your hip joint, greater hip motion is available without pain.  If you do experience pain, adjust the height of the step or shift more weight onto your opposite leg.

Closing Thoughts on Hip Mobility Exercises

Hip mobility exercises are best performed after a dynamic warm-up.  Elevating your body temperature and activating your nervous system will lead to the best results.  Ideally, mobility exercises will result in a mild to moderate stretching sensation. Muscle re-education and strengthening exercises always follow once new range of motion has been gained.  Finally, it takes consistency and time to achieve lasting gains.  If you would like help from your physical therapist, give us a call.