As we found out last week, lots can go wrong within the hips. And while figuring out the problem can be difficult, finding the right solution may be a little bit more simple. For many of the issues that we have discussed the solution may ultimately be a surgical or pharmacological intervention. However, today I wanted to go over some exercise interventions that may be worth a try. So let’s dive into some hip new ideas on dealing with that pain in the butt.
The Big Three
There are three main domains that are thought to lead to hip pain including sitting, muscular imbalances, and skeletal imbalances. Sitting for long periods of time can lead to the latter two issues, but in a more direct sense, it can cause problems all on its own. Primarily, sitting causes compression within the hip joint itself and can, in a sense, squish the muscles, nerves, and blood flow. If you have ever had a “dead leg” from sitting on your wallet too long or one leg crossed over the other then you will know how troublesome sitting can be. Muscular imbalances can be described as building strength in some muscles while neglecting others resulting in an unnatural amount of strain on particular muscles. Runners, for example, often ignore the muscles used to move the body from side to side. Finally, skeletal imbalances are the uneven stature or movement patterns that many individuals have due to things like genetic bone differences, old injuries, and leg-length discrepancies.
What Should You Do?
Every person and every issue is unique and deserves a unique solution. This is due to the fact that pain is complicated. Pain can be caused by the various tissues (sprains and strains), by the nerves (sciatica), and other issues that aren’t understood yet (fibromyalgia, chronic low back pain). More often than not, however, movement is paramount to success. So let’s take a look at what you need to do for the specific issues discussed in last week’s post!
Femoroacetabular impingement (FAI) – FAI is unique because it is a combination of bone structure problems and hip tissue problems (1). These issues are far from uniform so the specifics of what needs to be done to fix the problem will change from person to person. However, some keys to success include hip-specific function and lower limb strengthening, core stability and postural balance exercises (2).
Piriformis Syndrome, Trochanteric Bursitis/Snapping Hip – These issues are common among runner, and as you can guess, are generally thought to be caused by muscular imbalances. You can try to alleviate these problems by foam rolling the piriformis, quadriceps and IT-Band, statically stretching the piriformis, biceps femoris and hip flexors, and performing exercises such as leg slides, floor bridge, lateral tube walking and ball squats.
Sciatica – Because sciatica can be caused by at least 6 underlying issues, there really is no one true way to best treat it (3). For best results, skip the exercise and talk to your doctor about medication options (4).
Strains – When it comes to strains of the groin and/or hip flexor, the general recommendation is to regain full range of motion, and restore full muscle strength, endurance, and coordination. You can prevent these injuries by doing programs similar to the one seen bellow (5).
One of the best ways to avoid injuries of the hips is to strengthen the hips. Because we sit on our butts all day long, we tend to lose the ability to use our glutes. This can lead to all sorts of problems in the long run. This is why I recommend you start by strengthening the glute muscles. Here is a great resource for learning how to strengthen the glutes. If you’re looking for pain relief, your best chance of seeing results quickly is to consult your doctor.
1. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement
Br. J. Sports. Med. 2016;50:19 1169-1176
2. Wall, P., Dickenson, E., Robinson, D., Hughes, I., Realpe, A., Hobson, R., Griffen, D., Foster, N. (2016). Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med, 50:1217-1223 doi:10.1136/bjsports-2016-096368
3. Verwoerd, A. J. H., Luijsterburg, P. A. J., Lin, C. W. C., Jacobs, W. C. H., Koes, B. W., & Verhagen, A. P. (2013). Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. European Journal of Pain (London, England), 17(8), 1126.
4. Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., . . . Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: Systematic review and network meta-analyses. The Spine Journal : Official Journal of the North American Spine Society, 15(6), 1461-1477. doi:10.1016/j.spinee.2013.08.049
5. Tyler, T. F., Silvers, H. J., Gerhardt, M. B., & Nicholas, S. J. (2010). Groin injuries in sports medicine. Sports Health: A Multidisciplinary Approach, 2(3), 231-236. doi:10.1177/1941738110366820
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