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Hip pain

Back pain, Health, Hip pain, Knee pain

The Wall Sit – Beat knee pain

July 5, 2017 • By

The Wall sit is one of the most do-able exercises and is a brilliant strengthening exercise for anyone with back, hip or knee pain.

Who would benefit from would wall sits, otherwise known as wall squats?

  • Those wanting to avoid or prepare for knee or hip surgery
  • Most with hip or knee arthritis will get massive benefit
  • Those of you that struggle to get up from chairs
  • Anyone at all who wants to strengthen their back and legs from home

wall sit exercise for knee pain arthritisSo what is a wall sit?

It is simple a squat hold with your back leaning against the wall as shown in the video below. the key  things to remember are:

  • Your knees should no go out past your toes. Aim to keep your knees over your ankles or feet
  • Keep your chest up and back straight
  • Do not push into pain
  • Expect some burning in your thigh muscles (this is a good pain and shows your muscles are working hard)

Top tip: Lean into the wall with a Swiss Ball, foam roller, basketball or anything that rolls to minimize friction – this makes the exercise far more effective and comfortable.


The idea for the wall sit is not to repetitively go up and down but squat down and hold for a period of time.

Aim to hold until your muscles start fatiguing and then come back up again and repeat 10 times – over time your hold time will get longer and longer and your back and legs will get stronger! (1)

Tip: Only go down as far as is comfortable for YOU and don’t go past horizontal thighs.

Progression

The one-leg wall squat is often used as a test of lower limb endurance(2,3) and also makes for an excellent exercise when you want to push your leg strength further while still looking after your knees.

All you need to do differently for the one leg hold is lower yourself down, keeping your feet shoulder width apart and then carefully lift one foot just off the ground – hold as long as you can (without losing form).

Below is a table giving average times to gauge where you are at:

wall sit values

The wall squat is a great exercise and well worth persevering with whether you can just hold a double leg wall sit for 20 seconds or a one leg squat for 100! Make it a challenge every night for one month and notice the difference.

References:

 


Hip pain, Knee pain, Spine

How to Protect and Strengthen Cartilage

July 19, 2016 • By

strengthen cartilageWhat if I told you that to keep your joint cartilage strong you need to put load on your joints – Not bike and swim?

Your articular cartilage forms the smooth covering inside your joints and often when someone has degenerated cartilage they are told to decrease loading and get into non-weight-bearing exercise – such as swimming and cycling.

strengthen cartilageIn a way this makes sense in that if you want to preserve and strengthen your cartilage, you wouldn’t run and jump and lift weights, would you? But our body doesn’t work like that, it responds positively to the force we put through it and really lives by the use it or lose it motto.

Recent research shows that:

Through putting load (body weight) on our cartilage we actually promote Transforming growth factor beta (TGFbeta) gene expression which helps to maintain our articular cartilage strength – That is pretty awesome.(1)

So without going into boring detail – By doing exercise which loads and compresses your cartilage, you actually help to strengthen cartilage and maintain homeostasis.

So get out there and walk, run or lift to keep your joints healthy – whether it is your knees, hips, back or any other weight-bearing joint.


Back pain, Health, Hip pain

The Best Glute Stretch

August 25, 2015 • By

This is the stretch my patients rave about the most and about the only stretch they keep doing once injury free – because it makes you feel so much better – and gets results! So give this glute stretch a shot, it can really work wonders.

The great thing is that the title is not an exaggeration.

First of all I will show you the glute stretch and a video to make sure you are doing it right and then I’ll fill you in on why it is so good for your hips, knees shoulders and especially your low back.

 

The Best Glute Stretch:

What you’re stretching:

  • the best glute stretchYour glutes, hamstrings and other hip rotators. All of these muscles at the back of your hips get stretched out here to unload the pull on your low back and hips. This also increases the mobility of your hip joint by increasing the rotation – which is essential for something as simple as walking, but also for sports such as golf where hip rotation is crucial.

 

  • Lat stretchYour latissimus dorsi is stretched out when you bring your arm across your body as shown in the video. When tight the lats can pull your shoulder down and forward, so great to stretch out!

 

Try and do this stretch daily and make it part of your routine as it can work wonders, but as with other exercises, it isn’t a quick fix!

 


Health, Hip pain

Trochanteric Bursitis – The Best Exercises and Self-Treatment

January 25, 2014 • By

Trochanteric bursitis is a an all too common cause of hip pain throughout the population, from athletes to the elderly. In this post I will clearly explain, what trochanteric bursitis is, what causes it, and what the best rehabilitation exercises and self-treatment techniques that can be done at home to help you get back to your best!

Also often called: Greater trochanteric bursitis, trochanteric pain syndrome

  • Anatomical location/body part affected: Trochanteric bursa lies over the greater trochanter of the femur, deep to the tensor fascia lata-iliotibial band (ITB) and the attachment of the gluteus medius/minimus muscles.

Trochanteric-BursitisTFL_ITBandWhere is the bursa and what does it do: The bursa lies over your greater trochanter which is the bone you can feel on the outside of your upper thigh (right behind your side pocket). All bursa in your body (there are about 160 of them!) work to help all the structures in your body move smoothly. The bursa is like a small balloon of fluid – normally a very thinly filled one – and in this case it lies over the greater trochanter so your iliotibial band (as seen in the picture to the right) can glide over the bone smoothly.

What is the cause of trochanteric bursitis?

The two main causes are:

  • The most common cause is repetitive friction or compression of the bursa by the structures/tissue that glide over it. This is what I am going to tell you about in more detail below as there are some main contributing factors that lead to the excessive friction and compression on the bursa which have to be addressed to get long term results.
  • The other is direct trauma such as a fall on to you hip.

Both of these cause the inflammation within the bursa so that if is blown up by the inflammatory fluid like a balloon and the walls of the bursa thicken.

Contributing factors (lets find the real reason you get bursitis!): The simple mechanism of injury in cases without direct trauma is excessive friction/compression of overlying tissues on the trochanteric bursa. What leads to this excessive friction/compression is the important thing – if we find this, we can treat this very well!

  • Osteoarthritis – of the hip or low back
  • Tightness of the ITB – The iliotibial band crosses over the bursa, so if this is tight it will cause excessive compression and friction.
  • Leg length discrepancy – Causing a muscle imbalance and glute dysfunction in the pelvis.
  • Weak hip abductors (glutes medius and gluteus minimus) – These are the muscles that stop your leg going inwards while walking and stop your hip dropping – so if these are weak you will have poor hip stability and biomechanics – putting more pressure on the bursa.
  • Weak core
  • Tight or over active and tensor fascia latae – This muscle attaches on to the iliotibial band and so if this is working too hard (such as when your hip abductors are weak) it causes tension on the ITB.
  • Risk factors
    • Higher prevalence in women than men; 4 times more likely! This is due to decreased oestrogen post-menopause decreasing muscle tone and also broader hips and a narrow stance in women.

How do you know if it is trochanteric bursitis and what else could it be:

  • Presentation/signs and symptoms
    • The main complaint is aching in the upper lateral(outside) thigh. If acute/quick onset, pain can be sharp and intense. However, pain in chronic hip bursitis is usually dull and diffuse and may radiate down to or below the knee, mimicking low back radicular symptoms.
    • There is tenderness with direct pressure, such as when lying on the affected hip. Pain can disturb sleep and general mobility(walking). Painful activities include prolonged standing, squatting, and the first steps after rising from a chair. Pain increases with hip flexion and external rotation – as in crossing affected leg over the other while sitting. The main and most accurate test during physical exam is intense or sharp tenderness on deep palpation of the greater trochanter.

Glute med and minLateral hip pain is far too often diagnosed as trochanteric bursitis, even if there is no bursal inflammation. The primary (most common) cause of lateral hip pain is tendinopathy or dysfunction of the Gluteus Medius and Gluteus Minimus muscles(you can see in the image to the right that they attach straight onto the Greater Trochanter). In a new study where over 800 patients with trochanteric pain syndrome were scanned, 50% had gluteal tendinopathy and just 20% had trochanteric bursitis. So given that often gluteal tendinopathy is the primary cause of lateral hip pain it is important for long-term pain relief, rehabilitation exercises and correction of any biomechanical deficiencies (muscle imbalance, leg length discrepancy, poor foot mechanics etc) are followed through with and addressed.

 

So, because lateral hip pain can be caused by both trochanteric bursitis and tendinopathy – the following rehabilitation exercises and self-treatment will help both of these!

1. Glute strengthening:

  • Side lying Abduction exercise for hip and glut strengtheningSide lying hip abduction: Making sure to keep your top elbow down to stop your hips rolling back.
  • 3 sets of 12 repetitions

 

 

 

 

 

  • Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strengthClams: Top elbow down again, keep your ankles together, lift the top knee up about 20cm.
  • If you find it is too easy, roll your pelvis forward more.
  • If it hurts your hip then place a towel or small pillow between your knees
  • Your Goal is 50 repetitions, nice and slow

 

 

 

2. Advanced hip strengthening: This is for really getting the hips strong and balanced out and best to start when you are recovering well and pain free.

  • Bulgrarian split squat for hip stability and strength - trohcnateric bursitis and lateral hip painBulgarian split squat: Don’t get scared off by the name – you can do this! Just remember the back leg is just for balance – not to help you up and down.
  • Tips: Make the front leg work. Start a good distance out from the step/chair. Take it slowly and control it.
  • 3 sets of 8 repetitions.

 

 

 

 

3. Myofascial release of your tight TFL (tensor fascia latae muscle)

tensor fascia latae and itb myofascial releaseasis anterior super iliac spineIt is a great to loosen off this muscle as it can really add compression over the bursa. The TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!

Lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!

And remember, a bit of trigger point pain is expected here.

  • You can also check out this mobility WOD video  – The main bit I want you to do is the ball work from about 3 mins and 36 seconds. This is a great release to do and will give your awesome relief!

4. Footwear: Supportive footwear (with arch and heel support) is a huge plus – it stops your foot over pronating or supinating which would put your hip in a bad position (try standing in bare feet and rolling your feet in and out and notice what it does to your hip position). Alternatively you can go to the podiatrist and see if you need orthotics.

 

Maintenance and prevention – This is big, you cannot stop the exercises once the pain has gone – you can do them less, absolutely, but you need to persevere.

Steroid injections: If you get one for your bursitis, remember it takes away the inflammation but it does not fix out the things that caused it (such as hip stability) and there is a high chance it will come back if you don’t rehab it. Also it is important to get a clear diagnosis before injection as cortisone is basically poison for tendons (and remember  only 20% of lateral hip pain is actually Bursitis – a lot more are tendinopathies).

Back pain? Low Back Pain and dysfunction can have a big impact and even cause lateral hip pain so make sure you address this also.

 

For more reading on lateral hip pain – This is a good resource.

Check out this quick hip stability and balance test!

 


groin pain, Hip pain, Lower limb

Hip Arthritis: The best self-management exercises

August 15, 2013 • By

Hip Osteoarthritis affects 11.5% of men and women and can be an extremely debilitating Hip osteoarthritis self treatment, self help exercises to decrease paindisease for those of you affected. Clinical guidelines for best treatment recommend a combination of conservative non-drug treatment and drug therapies and in particular a focus on “self help and patient driven treatments”. This is what I want to give you today – the information, advice, tools and exercises that you need to decrease the pain and limitations from Hip Arthritis and feel great!

Article layout:

  1. Risk factors for hip OA
  2. Exercise program
  3. Physical activity and weight loss
  4. Physio benefits and self-help tools

Risk factors: Developing arthritis of the hip is due to a combination of factors that add up to increase the load through your hip joint and leading to increased degenerating and bone growth.

Below are the main factors leading to Hip OA:

– Joint shape and past injury

– Predisposition to OA: Gender, age, race, genetics

– Poor muscle function and stability surrounding the hip

Factors adding to OA pain and progression:

– Obesity

– Physical activity levels

– Co-morbidity

– Muscular function.

So: There are definitely some factors there such as joint shape, past injury and age, that we cannot alter, but there is A LOT that we can help with and improve, so in the rest of this post, that is exactly what we are going to do!

Goals of program:

– Unload the hip joint.

– Strengthen and stabilize muscles surrounding the hip.

– Address the contributing and aggravating factors.

Exercise Program:

birddog exercise to muscle coordinatin, glute activation. decrease low back and hip pain

Bird-Dog exercise

Goal: In order to increase muscle coordination and glute activation.

Action: on your hands and knees, slowly extend out your opposite arm and leg, hold for 5 seconds then lower down and repeat 10 times.

Tips: start with just one leg if this is too hard.

 

bridge - glute strenght, decrease back, hip and knee pain.Bridge exercise

Goal: to increase strength and activation of low back and hip extensor muscles.

Action: Lying on your back with knees bent, squeeze your glutes and lift your bottom and low back off the ground. Hold for 5 seconds, lower down and repeat 10 times.

Tip: to advance, cross arms over chest and keep one leg straightened out in the air.

Clam exercise plus - gluteus medius strengthening, pelvic stabilityClam exercise

Goal: to increase hip stability and balance and to reduce hip drop when walking.

Position: Side lying with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 30reps on each side.

hip flex 2Hip Flexor stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Action: In the position shown, reach up tot he sky, tuck your bottom underneath you and hold for 1 minute.

Tip: Add a cushion under your knee if sore.

 

 

glut and Lat stretch - Hip flexibilityGlute stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Position: starting on hands and knees, bring one knee in between your hands and straighten the other leg behind you. walk your hands out in front, first onto your elbows and then reaching out if possible.

Tip: take the back leg across to the opposite side.

Advanced exercise:

Single leg Squat, hip stability and strengthDouble and single leg squats: These exercises make the hip stabilizers work in unison and are great for those of you with mild OA.

Start performing Double leg squats and progress to 1 legged, making sure not to work into pain.

Tip: stick your bottom out like you are going to sit down.

 

Do all exercises daily and twice daily if you have the time!

Physical activity and weight loss

Increase load though excess body weight can cause increased pain and disease progression and is something we can definitely do something about! Having a graded exercise program where you gradually increase your activity levels can decrease, pain, increase quality of life and importantly reduce the need for joint replacement in people with hip osteoarthritis.

The best way to do this? set an achievable goal eg. Bike, 10km, walk 3 km, run 20 minutes, swim 500m etc and the time you want to do it in(eg. 2 months) then build slowly towards this! Not only will exercise help your hip arthritis but it will improve your peace of happiness and well-being over-all!

There is a lot of people out there saying to stay off arthritic joints but exercise has been proven to be very beneficial for arthritis so it is a matter of doing what your body can handle – swimming and biking are great as they put less load through the joints.

The Benefits of Physiotherapy:

The benefits of manual therapy are very real and can make a huge difference to your pain and movement. To help out with the great work to you do at home (see exercises above!) I fully recommend consulting a good hand-on Physiotherapist/ Physical Therapist and you won’t be disappointed.

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Quick Stability and Balance test

Glute activation: the missing link