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.

Deadlift: Harmful or Helpful for Low Back Pain?

The deadlift is essentially a hip hinge with weight.  The hinge occurs by flexing your hips and maintaining a flat back.  The deadlift also involves some knee flexion but the majority of the movement occurs by hinging at your hips.  Hinging differs from stooping and squatting.  Stooping involves bending the low back more than the hips.  Squatting involves bending at the knees more than the hips.  When done properly, the deadlift is an exercise that resembles a safe technique for lifting.

Strengthening Your Backside

The deadlift is a great exercise to strengthen your backside.  The gluteus maximus, one of the largest and strongest muscles of your body, is the prime mover when performing the deadlift.  The quadriceps, hamstrings, and low back muscles are also activated at high levels.  Adequate strength in these large muscle groups is necessary for every day function and performing sports at high levels.  The deadlift also activates smaller the stabilizing muscles of your spine to a greater extent than low load exercises lying on the floor or a ball.

Don’t Fear the Deadlift

The deadlift sometimes gets a “bad rap”.  This is because many in the medical community have cautioned people with low back pain from performing any heavy lifting.  It is true that improper execution any exercise can result in low back injury.  However, when performed properly, the deadlift is an excellent exercise to strengthen your hips and low back.  Proper instruction and coaching of the exercise should always occur for anyone with low back pain.   Most people require the help of their physical therapist or coach to learn the exercise correctly.

Deadlift low back pain

Should People with Low Back Pain Deadlift?

The safe answer is it depends.  However, research proves the deadlift can be very effective for strengthening your low back muscles, decreasing your back pain, and improving your function.  Therefore, most people with low back pain can, and should, be instructed on how to hip hinge and perform some variation of this exercise.  This does not mean everyone with low back pain should attempt to pick up as much weight as possible from the floor.  There must be proper instruction, safe practice, and appropriate progression.

Hip hinge for back pain

A 2015 study in the Journal of Orthopedic and Sports Physical Therapy showed both low load exercises and deadlift training resulted in similar improvements in low back pain, back muscle strength, and disability.  It was later found that people with better low back muscle endurance and lower pain levels were more likely to benefit from deadlift training.  Therefore, a wise approach is to begin with low load exercises on the floor or a table.  Once pain levels decrease and muscle function improves, progressing to deadlift training can be started.

Exercise Progressions

It may be challenging for you to learn how to properly hinge at  hiyourps without bending your back.  Physical therapists use different corrective exercise approaches to teach the proper movement pattern.  Only after mastering the movement pattern is weight added.  The basics of the set up include a hip-width stance, soft slightly bent knees, your shoulder blades back, and your chest up.  Your chest should be slightly above your hips, and your hips above your knees.  The movement is initiated by extending the hips with a flat back.

Below are 5 exercise progressions for you.  There are many others which are considered when designing an individualized program.  The specific exercises prescribed depend on your strength, mobility, and goals.

The Deadlift and Back Pain: Closing Thoughts

Your will never fully function in your everyday life without lifting objects from the floor.  It is unreasonable to never lift anything from the floor.  Physical therapists can teach your how to properly lift.  Deadlift variations are ideal for this purpose.  Research shows people with low back pain can safely and effectively perform the deadlift.  For many people with low back pain, the conventional deadlift is not the best choice.  Most people require modifications.  Your physical therapist can perform a physical examination and then prescribe the exercise which is best for you and your goals.  Contact us if you need help getting started.

Hip Manual Therapy Improves Low Back Pain

Research shows range of motion restrictions of the hip are associated with low back pain.  People with low back pain have less hip rotation range of motion compared to people without low back pain.  It is also common for people with low back pain to have side-to-side differences in hip rotation range of motion.  For example, one hip may rotate a total of 75 degrees, and the other hip only 60 degrees.  Hip mobility restrictions can be due to stiffness in the joint capsule or muscles which cross the joint.  Restricted hip mobility due to joint stiffness is best treated with manual therapy performed by a physical therapist.

Hip internal rotation restrictions are closely linked to low back pain.   This movement involves rotating the thigh inward towards the midline of the body.  This hip must internally rotate when the leg is behind the body during the normal gait cycle.   If this motion is unavailable at the hip, the movement must then occur at the spine.  Hip internal rotation must also occur when performing any type of pivot or change of direction when walking.   Many sports activities, such as swinging a golf club, require large amounts of hip rotation.  If the motion is not available at the hip, the spine must compensate.  This often results in abnormal movement and stress to the structures of the low back.

Proven Benefits of Hip Manual Therapy

A 2017 study published in the Journal of Evaluation in Clinical Practice investigated the effects of providing manual therapy and exercise targeting the hips in people with low back pain.  Half of the participants received treatment to the spine only.  The other half received treatment to the spine and hips.  The group who were treated with manual therapy and exercise targeting the hips were more satisfied with their treatment.  They also reported greater improvements in pain and disability compared to the group who only received treatments to the spine.

Hip Manual Therapy Techniques

Three hip joint mobilization techniques were utilized in the previously mentioned study.  Examples of these techniques are included below.   Manual therapy techniques are individualized based on findings from the physical examination.   All mobilization techniques are performed without pain.  Only a mild stretching sensation is felt by the patient during these treatments.  Immediate improvements in hip range of motion occur in most cases.  However, in order for these improvements to be sustained, home exercises are prescribed.

Closing Thoughts

There is no one magic treatment for low back pain.  Abdominal and low back strengthening exercises can be effective.  However, the best results usually occur when multiple treatments are combined and patients are taught to self manage.  Treatment focused only on the spine is often only partially effective.   The low back and hips are very closely linked.  Outcomes are improved when treatments are also directed to the hips.  In order for results to be sustained, an exercise program targeting hip mobility and hip strength are also included.

 

 

Hip Weakness Contributing to Your Back Pain?

Have you tried all types of low back exercises for your lingering back pain?  You might want to have your physical therapist take a look at your hips.  Your hips and low back are closely linked through multiple shared muscles.  Therefore, motion at the spine, pelvis, and hips occur together.  Poor movement at one of these areas creates compensations at the others.  This is because of the common muscle attachments.  Often, rehabilitation exercises targeting the abdominal and low back muscles result in only partial resolution of low back pain.  The missing piece may be addressing weakness of your hip muscles.

Proof There is a Link between Hip Weakness and Back Pain

Weakness or poor endurance of the glutes has been associated with low back pain in athletes and non-athletes.  Women with persistent back pain have smaller glute muscles compared to those without back pain.  Female athletes with back pain show side to side differences in hip strength.  This predisposes them to poor movement patterns and injury.  Chronic back pain in men is associated with weakness of the glutes, elevated body weight, and tenderness in the low back region.  Weakness of the glute muscles is often present in people who are limited in their ability to stand because of low back pain.

It is unclear if hip muscle weakness is the result of disuse or a cause of low back pain.  In either case, exercise targeting the hips is required to restore strength and proper movement.  Many people with weakness of their hip muscles overuse their low back muscles.  Overactive low back muscles leads to fatigue, pain, and abnormal movement. This results in a viscous cycle where abnormal movement results in more pain; and more pain worsens the poor movements.

LBP hip weakness

A 2015 study in the Journal of Physical Therapy Science compared the effectiveness of low back and hip strengthening exercise to low back exercise only.  The group of people who exercised both the low back and hip muscles showed significantly greater improvements in back strength, balance, disability, and pain.  Another study in the Journal of Back and Musculoskeletal Rehabilitation also showed better outcomes in people who performed exercises for both the low back and hip muscles.  The following 5 exercises were included in the study. Try these to get you started.

Clamshell

The clamshell strengthens your gluteus medius muscle.  Begin by lying on your side with your hips bent.  The knees are also bent and your feet are kept together.  A resistance band can be placed around your thighs just above your knees.  Start by rotating your top hip to bring your knees apart.  Hold this position for 2 seconds and then return to the starting position slowly.  Remain lying completely on your side with one hip stacked on top of the other.  Allowing your pelvis to roll backwards is the most common mistake.   The clamshell is a great exercise to start with because it requires minimal activity of low back muscles.

Side-Lying Hip Abduction

Hip abduction strengthens both the gluteus medius and maximus.  Begin by lying on one side with your bottom hip and knee bent.  Your top knee remains straight.  Maintain your top hip in a neutral or slightly extended position with your toes pointed forward.  Point your toes forward to orient your hip in slight internal rotation.  This increases gluteus medius activity.  Initiate the movement by lifting your top leg about 30 degrees.  Hold this position for a count of 2 seconds and then slowly lower your leg to the start position.  Ankle weights can be added for resistance once 15 proper repetitions are performed.

This exercise activates the gluteus medius to a greater level than the clamshell.  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 backwards during the movement is the most common mistake.  Also, as the muscle tires, your leg will drift forward into hip flexion.  It is important to maintain your leg lined up or slightly behind your trunk and upper body.

Quadruped Hip Extension + Knee Flexion

Begin on your hands and knees.  Position your shoulder directly over your hands.  Position your hips directly over your knees.  Maintain a neutral spine position throughout the exercise.  Initiate the movement by bending one knee to 90 degrees.  Next, lift your heel up towards the ceiling keeping your knee bent.  Hold this position for 2 seconds then return to the starting position. Lower your leg back down before repeating another repetition on the same side.  Avoid arching through your low back.  Complete the desired number of repetitions on one side before beginning with the other leg.

Cook Hip Lift

Begin lying on your back with your hips bent and feet lined up with your shoulders.   Flex your hip by holding one knee 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 one leg.  Avoid excessively arch your low back.  Be sure to achieve the bridge position by extending through your hips. Hold this position for 2 seconds then return to the starting position.  Lower the body back down before repeating another repetition on the same side.  Complete the desired number of repetitions on one side before beginning with your other leg.

The positioning of your hips during this exercise facilitates a neutral pelvis and low back position.  This is helpful for people with low back pain.  However, this also increases the challenge to your glute muscles compared to a standard bridge. Raising your toes makes you press your heel into the ground as you lift your hips. This facilitates the glutes and hamstrings.

Lateral Step Down

The step down exercise begins with your hands on both hips standing with one leg on the side of a step or 8-inch high box.  Maintain balance on 1 leg and slowly squat to lower your heel of the other leg toward the floor.  Gently tap your heel and return to the starting position.  Maintain your trunk in an upright position.  Avoid leaning to the side or waving your arms.  Your knee should not move forward past your toes.  Also, your knee should remain over your toes so it does not cave inwards.  Perform 8 to 10 slow and controlled repetitions before switching sides to your other leg.

Closing Thoughts

It is important to exercise your abdominal, low back, and hip muscles to fully recover from an episode of low back pain.  These muscles do not function in isolation.  Not addressing muscles imbalances often leads to recurrent episodes of pain.  These 5 exercises address common hip muscle imbalances in people with low back pain.  Exercises should be individually prescribed based on a physical therapist’s examination of your movement and strength.  Additional individualized exercises integrating multiple muscles with functional movement patterns are often beneficial to help you achieve their goalsContact us if you would like help getting started.