Anterior Hip Pain and Weakness: Hip Flexor Strength Straight Knee

Maintain a flat lower back with your knees straight and legs on the ground. Engage your inner core muscles below your belly button. Start by slowly raising one bent knee up to your chest and then return it to the start position by straightening out the knee and leg back down to the ground. Ensure that your lower back remains flat and the opposite knee and leg remains still.

Repeat this movement for 10 repetitions, doing 3 sets on both sides.

This exercise is a great progression to the Hip Flexor bent knee to address hip impingement pain with muscle imbalances and weakness coming from your hip flexors.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Post-Race Recovery

A proper warm-up prior to a run is important to increase the heart rate, blood circulation to the working muscles, and joint efficiency. However, cooling down is an essential component of the training process and should be completed at the end of every exercise session. It is important to cool-down after a run to transition the body back to a steady, resting state by decreasing the heart rate, breathing rate, and body temperature. Cooling down also returns the muscles to their optimal length-tension relationships and returns blood from the extremities back to the heart. Skipping a cool-down or performing it incorrectly can cause your muscles to become sorer and stiffer which may lead to unwanted injuries.

The following is a guide for optimal post-race recovery:

1. Slow jog or walk
Immediately at the end of a run, it is ideal to slow your pace down to a jog or a brisk walk to gradually lower your heart rate. Ending your run abruptly may cause blood to pool in your legs instead of returning it to the heart and brain. This can lead to a risk of fainting or feelings of lightheadedness. Jog or walk for approximately 5 to 10 minutes. 

2. Hydration
Exercising will cause more sweating and loss of fluid in the body which may lead to dehydration. Restore fluid levels in your body by rehydrating with water. It is important to stay hydrated to help manage your body temperature, remove waste from your body, and protect your tissues and joints. 

3. Total Body Stretching
a. Pigeon Pose:

Begin in 4 point position on a yoga mat. To stretch the right posterior hip, including the Piriformis muscle, straighten out the left knee pushing the left foot back. Then bring the right knee forward towards your chest while supporting yourself with your hands in front. Making sure that your left and right pelvises are level with each other, bring your right foot across turning it to the left side. Then reach forward on the mat with your hands bringing your elbows towards the mat while keeping both sides of the pelvis level and down. Hold for 30 seconds and do 3 sets on each side 2 times daily.

b. Hip Flexor Stretch:

Kneel down onto your left knee. Then rotate it about 45 degrees past the midline of your body. To keep your posture nice and tall imagine there’s a string pulling your whole spine upwards from your pelvis, right up your entire back and neck and up to the top of your head. Then engage your inner core muscles tight below your belly button and keep your low back flat. Next, bend the right knee forward and keep your posture nice and tall without leaning backwards. Then reach your left arm up pointing the fingers towards the ceiling nice and high and point your right finger tips to the floor. Hold this stretch for 30 seconds and repeat 3 times for each side.

c. IT Band / Lateral Quad Stretch:

Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. Then, bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. Pull the heel back towards the bum while keeping the core engaged and the low back flat. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.

d. Lat Stretch:

To stretch the right lat, place the back of your right hand to your left side in front of you while clasping it with your left hand. Reach forward to your left and keep your elbows straight. Keep your knees wide apart and the back of your feet flat on the mat. Reach forward and lean to the right arm pit. Hold for 30 seconds, do 3 sets. Repeat on the opposite side if it’s also tight!

e. Shoulder Stretch:

To stretch out the right side, reach your right hand up and down your back keeping your right elbow pointed upwards. Avoid arching the back by keeping your spine in neutral. Pull the right elbow towards midline with your left hand while keeping the right elbow pointed upwards. Hold this for 30 seconds doing 3 sets on each side daily.

f. Rolling out the Hamstrings:

Put the roller on the ground and bring your hamstring onto it. Roll up and down onto your Hamstring muscle while supporting yourself with both hands. Find the sweet spots (or the areas that hurt in a good way) and continue to roll over these areas for 3-4 minutes in total. Do this 2-3 times a day just before you stretch out the hamstring.

g. Rolling out the Calf Muscles:

4. Additional Measures
Take a 5-10 minute cold water bath to reduce swelling. Allow 1-2 days post-run to allow the body to recover before massaging any tight muscles.

Hip Pain and Weakness – Hip Flexor Bent Knee

Maintain a flat lower back with your feet in the air and your knees toward your chest while you keep your inner core muscles engaged below your belly button. Start by slowly lowering one bent knee down to allow the foot to reach the ground, and then return it to the start position above ninety degrees.

Ensure that your lower back remains flat and the opposite knee and leg do not move. Repeat this movement for 10 repetitions, doing 3 sets on both sides.

This exercise is great if you have hip impingement pain with muscle imbalances and weakness coming from your hip flexors. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Running Injury Prevention

Running is a great way to improve aerobic fitness and cardiovascular health. Running not only burns calories, but can contribute to one’s mental and physical health. However, a large percentage of individuals who run are exposed to a wide range of running-related injuries, most of which are due to overuse. Up to 80% of the injuries occur in the lower extremities with the knee found to be the most commonly injured body part (Callahan, 2018). Patellofemoral pain, medial tibial stress syndrome (shin splints), achilles tendinopathy, iliotibial band syndrome, plantar fasciitis, and stress fractures are the most common diagnoses. 

RISK FACTORS
In the majority of cases, pain may arise in the lower extremities due to intrinsic factors such as being overweight, having weak core and leg muscles or with changes in foot type such as having flat feet. Extrinsic factors such as poor footwear, not stretching, or an unbalanced diet may contribute to running-related injuries. The main risk factor to running-related injuries was due to having a previous injury in the last 12 months. It is important for your physiotherapist or coach to be aware of all previous injuries that you may have sustained.

TREATMENT
Acute treatment includes stretching the posterior structures, massage, ice, activity reduction, taping, corticosteroid injection, or orthotics. Long-term treatment includes strengthening the intrinsic foot, ankle and hip. New footwear, night splints, or surgery may be indicated if conservative treatments are unsuccessful. Consult your physiotherapist or coach for the appropriate treatment. 

RETURN TO RUNNING CHECKLIST
Ensure there are no signs or symptoms of inflammation and you have gained the full ability to weight bear through your legs and feet. You should be able to hop in multiple directions on each leg and should be able to walk at a speed of at least 5.6 km/h (or 3.5 mph). Toe dexterity, or precise control of the toes, should be present in each foot and you should be able to balance in a wobble-free manner for more than 30 seconds. 

Below are some key exercises to stretch and strengthen muscles essential to improving running performance and reducing the risk of running-related injuries:

CORE ACTIVATION
A) Wall Squat

The exercise shown above can help with the retraining of the core stability, hip, leg and ankle muscles.

  1. Wrap a closed loop resistance band around the thighs just above the knees. 
  2. Position yourself so that your low back is fully leaning up against the big ball on the wall. Keep your posture nice and tall but don’t arch your low back when leaning upright against the big ball. 
  3. Engage you inner core stabilizers by contracting your pelvic floor muscles and pulling your transverse abdominal muscles below your belly button inwards, hugging your spine. Remember to keep breathing. 
  4. Leaning your weight on the ball slide downwards doing a wall squat while you maintain static isometric pressure against the resistance bands. Keep your knees over your ankles and in alignment with your second toes. 
  5. Hold the wall squat for 10 seconds. Repeat this for ten repetitions doing three sets daily.

B) Psoas March

The exercise shown above helps increase hip flexor and core strength.

  1. Being by lying flat on a mat so there is no arching of the lower back. Place your hands just below the belly button to cue engagement of the core muscles.
  2. Bring both knees up to approximately 90 degrees and wrap a band around your feet.
  3. Hold one knee stationary while pressing down the opposite leg. Then bring the extended leg back to the starting position.
  4. Repeat with the other leg while maintaining core activation and controlled breathing.
  5. Complete three sets of five repetitions on each side. Progress to sets of 10 repetitions for more difficulty.

MUSCLE STRENGTHENING & STRETCHING
A) Bridging Hamstring Curls

The exercise shown above helps strengthen the hamstrings, glutes, and core stability muscles to help protect the ligaments of the knee. 

  1. Lie on the ground with the stability ball under your heels with your legs straight and your toes pointing up. 
  2. Engage your inner core muscles below the belly button. Then extend your hips by squeezing your butt and lifting it off the ground. 
  3. Bring the ball in towards you by flexing your knees and hold for a second and then straighten your legs back to the start position while keeping your butt up and hips extended. 
  4. Keep your inner core engaged the entire time. 
  5. Start by doing 3 sets of 10 repetitions and then progressing it to 3 sets of 15 to 20 repetition 4 times per week. 

B) Step-Ups

The exercise shown above helps strengthen the hip, quad, and core muscles to prevent leg injuries.

  1. Start with a tall posture and your inner core engaged below the belly button. 
  2. Bring the opposite arm up while using your glute muscles to fully extend the hip up as you step with one foot onto a step box.
  3. Keep your thigh strong by preventing the knee from buckling inwards, as well as keep your knee over the heel so it doesn’t go over your toes. 
  4. Do 3 sets of 10 on each side. 

C) Wall Plank Resisted Knee Highs

The exercise shown above helps reduce anterior hip pain and weakness that may contribute to running-related injuries.

  1. Place a closed loop light resistance band around your feet. Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture. 
  2. Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then slowly lower it back down with control. 
  3. Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets, 10 repetitions for each side. 
  4. A progression of this exercise is to perform the knee lift twice as fast but still lowering the leg and foot back down with control while you keep your core muscles engaged and maintain core stability control throughout all repetitions and sets.

D) Lateral Quad Stretch

The exercise shown above is particularly helpful if the Iliotibial Band is tight due to stiffness in the lateral quadriceps muscle. Overuse knee pain can be caused by excessive running. 

  1. Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. 
  2. Bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. 
  3. Pull the heel back towards the bum while keeping the core engaged and the low back flat. 
  4. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. 
  5. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. 
  6. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.

References:
https://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity

Anterior Hip Pain & Weakness: Wall Plank Resisted Knee Highs

Place a closed loop light resistance band around your feet. Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture.

Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then slowly lower it back down with control.

Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets, 10 repetitions for each side.

A progression of this exercise is to perform the knee lift twice as fast but still lowering the leg and foot back down with control while you keep your core muscles engaged and maintain core stability control throughout all repetitions and sets.

If you’re having anterior hip pain or weakness with your everyday functioning, then this exercise may help. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Hip Pain & Weakness: Wall Push up Knee Highs

Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture. Going into a plank position on the wall, bring yourself down into a push up while you lift one knee up in a straight line up towards your chest and then lower your leg back down as you straighten up with the push up.

Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions on each side to start. Perform a total of 3 sets of 10 repetitions for each side.

If you’re a runner or do sports that involve running & experience anterior hip pain or weakness, then this exercise may help.

If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Anterior Hip Pain & Weakness: Wall Plank Knee Highs

Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture.

Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then lower it back down. Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets of 10 repetitions for each side.

If you’re a runner or do sports that involve running & experience anterior hip pain or weakness, then this exercise may help. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Why is There Numbness and Tingling in my Arms?

Causes:
There are many possible causes of numbness and tingling in the upper or lower limbs. Some of these causes may include: nerve injury, prolonged sedentary position, pressure on the nerves due to a herniated disk, enlarged vessels, or tumors, shingles, abnormal levels of salts and minerals in the body, or congenital conditions. Other medical conditions such as carpal tunnel syndrome, diabetes, or strokes may lead to numbness and tingling. 

Local pressure on a nerve may cause distinct patterns of numbness that may also be associated with weakness or spasms. Compression of the ulnar nerve at the wrist may cause numbness and tingling of the little and ring fingers. Compression of the same nerve at the elbow may present numbness on the back of the ulnar side of the hand. Likewise, compression of the radial nerve just above the wrist may cause numbness on the back side of the thumb and index finger. Compression of the median nerve just below the elbow joint may present numbness on the palmar side from the middle finger to the thumb. 

Median Nerve At The Wrist Physical Exam Of The Hand - Hand - Orthobullets - EDUCATIONS OF HUMAN ANATOMY

​​​​Self-Care:
If the cause of the symptoms has been determined, ensure to follow the necessary steps as prescribed by your doctor to reduce or eliminate the condition. Certain exercises may be recommended to alleviate pressure on the peripheral nerves causing the numbness and tingling. Control blood sugar or vitamin levels with the appropriate daily dosage. Do not take large doses of any vitamins or supplements until discussion has been made with a medical professional. Large amounts of vitamins or supplements may result in nerve toxicity which can cause numbness and tingling.

Further testing may include X-rays, MRI, nerve or blood tests to help diagnose or treat the appropriate condition.

Exercises to Reduce Numbness and/or Tingling:
1. Ulnar Nerve Flossing

Begin in a seated position with tall posture and shoulders down. Then create a circle with your thumb and index finger and bring the elbow and forearm up while pointing the heel of the hand upwards forming a mask over your eye with the circle. Hold this for a second and then return the arm and hand back to the starting position. Repeat this for sixty seconds, doing five sets three times per day. The progression of this exercise is to first start with the head rotated away, then bringing the thumb and index finger over the eye. The duration is also for 60 seconds for 5 sets, three times per day.

2. Radian Nerve Flossing

Begin by extending the shoulder and arm with the elbow straight behind you while flexing the wrist and the hand out to receive a “low - five” from behind you. Return the arm and hand back to neutral position by the side and repeat this for up to thirty seconds when you initially start to get the hang of it and then increasing it to sixty seconds. Do five repetitions each time three times per day. The progression of this exercise involves the rotation of the head and neck to the opposite side first and then reaching back with the arm and hand for the “low-five” and then return the head and arm and hand back to the neutral start position. Do this for 60 seconds for 5 repetitions three times per day.

2. Median Nerve Flossing

Begin by placing your left hand on your right shoulder & look away to the opposite side. Abduct the shoulder to 90 degrees and together extend the elbow, wrist and fingers fully. Then turn your head to the right side and release the whole right upper extremity by flexing the fingers, wrist and elbow together. Repeat this again by looking to the opposite side and extending the entire right upper extremity again. Do this for 60 seconds for 3 sets 3 times per day.

When to See a Medical Professional:
Go to the hospital or call 911 if:  
· You are unable to move or have weakness in the body
· You do not have control of limb movement
· You have a loss of bladder or bowel control
· You are disoriented (confused) or have a loss of consciousness
· You have difficulty walking, talking, or a change in vision
· You notice signs and symptoms of a heart attack or stroke


References:
https://www.massgeneral.org/ortho-hand/conditions-treatments/numbness_and_tingling.aspx
https://medlineplus.gov/ency/article/003206.htm

Anterior Hip Pain: Femoral Nerve Glides Sidelye

If you have a dull ache, tingling, loss of sensation in the front of your hip area or weakness into your knee, this exercise may help. 

Lie on your side with the affected hip on top. Have your low back in some extension at the start in the rest position. 

Then, flatten the lower back by reversing the extension and flex the knee by bringing the heel closer to the butt and extend the hip back while you extend the neck backwards. Then release with performing this continuous motion throughout the exercise. 

This will help mobilize the nervous system with an emphasis on the femoral nerve. Do this continuous movement for 60 seconds for 4 sets daily. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Roll it Out! Full Body Ball Workout

Change up your gym routine by using various gym equipment such as dumbbells and bands. Use a Swiss ball for a full body work-out. Performing different types of exercises on the Swiss ball can help improve your range of motion, balance, and coordination. Engaging the core muscles while exercising on a large, unstable object such as an exercise ball is essential to performing the movement correctly and preventing injury. Try out the exercises below:

Push-Ups:

  1. Place both hands on a Swiss ball with your feet together to form a straight line from the top of your head to your toes.
  2. Engage the core and maintain a neutral spine. Keep your elbows close to your body and slowly lower your torso to the ball.
  3. Push up from the ball back to the starting position.
  4. Repeat for 3 sets of 10-15 repetitions.

Ab Roll-Outs:

  1. Place both of your forearms on a Swiss ball to form a 90 degree angle at the elbow.
  2. Keep feet and knees together on the floor.
  3. Engage the core muscles and maintain a neutral spine.
  4. Slowly roll forward by extending your arms and pushing the ball away from you. Make sure the knees and feet remain in contact with the floor.
  5. Slowly bring your body back to starting position by engaging the core muscles and pushing from the elbows up.
  6. Repeat for 3 sets of 10-15 repetitions.

Wall Squat:

  1. Wrap a closed loop resistance band around the thighs just above the knees. 
  2. Position yourself so that your low back is fully leaning up against a big exercise ball on the wall. Keep your posture nice and tall but don’t arch your low back when leaning upright against the Swiss ball. 
  3. Engage you inner core stabilizers by contracting your pelvic floor muscles and pulling your transverse abdominal muscles below your belly button inwards, hugging your spine. Remember to keep breathing. 
  4. Leaning your weight on the ball slide downwards doing a wall squat while you maintain static isometric pressure against the resistance bands. Keep your knees over your ankles and in alignment with your second toes. 
  5. Hold the wall squat for 10 seconds. Repeat this for ten repetitions doing three sets daily.

Hamstring Curl:

  1. Lie on the ground with the stability ball under your heels with your legs straight and your toes pointing up. Engage your inner core muscles below the belly button. 
  2. Extend your hips by squeezing your butt and lifting it off the ground. 
  3. Bring one knee towards your chest and hold it there.
  4. Bring the ball in towards you by flexing your other knee and then straightening it back to the start position. 
  5. Keep your inner core engaged the entire time. Do 3 sets of 15 repetitions, 3 times per week.

Reach Outs:

  1. Keep your posture tall and your inner core engaged by pulling the muscles below the belly button inwards toward the spine. 
  2. Wrap a resistance band around your upper back. With your belly on the ball stay on your hands and feet. 
  3. Secure the band on the floor with your opposite hand. Reach your index finger forward, with the thumb up towards the wall on a slight angle out, and then come back down.
  4. Repeat this 10 times for 3 sets on each side.  
  5. To progress the functional core strength, reach your index finger forward while extending your opposite leg and heel back at the same time. Keep the hips and pelvis level. Repeat this 10 times for 3 sets on each side.

Plank Walk-Outs:

  1. Start by pulling in your inner core by making your waistline skinnier below the belly button.
  2. Then roll out into a plank position on the ball in full control with a flat spine. 
  3. Lift one leg off of the ball with full control while keeping your hips level with each other. Try to keep your toes pointed to the floor as much as possible and lead with your heal. 
  4. Do 3 sets of 5 repetitions holding for 5 seconds on each side to start. 
  5. Then progress to 3 sets of 5-10 repetitions holding for 10 seconds when stronger.