Category Archives for "Hip Pain"

Hip Pain Running Injuries with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. He's the clinical director. He's the big cheese, the chief cook and bottle washer. He's the chief joint manipulator. Maybe that's even better, at Insync Physio. And we're gonna talk about something that's a little tricky. Hip pain running injuries. How you doing Wil? 

Wil: Hey I'm doing really good, thanks, Mark. Yeah. Actually, funny enough, I used to be a chief bottle washer at a restaurant when I was growing up, and in some ways I still am at home with the young babies. Yeah. Yeah. So this is actually a really good topic to talk about because you know it, this is definitely peak running season with the weather that we're having.

You know, it's cooler, which is perfect. And it's prime running season too, cuz it's not rainy. And so people are getting out and what I'm seeing is a lot of people coming in with hip pain from running. And one in particular is a woman, a client who came in to see her physio team.

And you know, we do share the caseload here. And this one patient had a pain going on her hip and she started up running in the fall and then did a couple races and I think she ended up doing Turkey trot or whatnot just as a sort of like a training race. And she was having trouble just like even like sitting for more than 15, 20 minutes and the pain was going down basically right into the outside of her bum cheek area and then referring a third of the way down her thigh, on the backside.

So, a lot of the times when you kind of start having that stuff coming on and if it's like after a run or during a run, you know, can be a little bit troublesome or a little bit worrisome. And then after the run, it doesn't go away, then you should try and do something about it. I mean with this particular client, she was trying to do exercises to relieve it that she found online and she was just trying to do some self massaging on it and nothing really worked. 

So we ended up assessing her and it turned out that she had, what's called a thicker iliac joint or SI joint dysfunction happening. On further questioning, it turned out that she has had a couple kids and because of that, she's got some hypermobility in that whole SI joint and pelvis. And then when we looked at things a little bit more, there's a lot of imbalance going on. And this is someone that's also quite an avid runner.

And at one point she has done quite a handful of half marathons, a few marathons. So she's not like new in the game. And she was having this kind of ongoing hip issue, and it was getting worse and worse. And then I think she ended up going on a trip and she was away with her family for a couple weeks and then it got really bad and then she came back, sat on the plane and, you know, and she was like, Oh, I could barely move the next day. 

So that's usually, you know, the presentation that we see people finally like, this is sort of the cherry on top, I can't take anymore, and you know, the straw that breaks the camel's back.

When we looked a little bit more closely at what was going on, there was a lot of imbalances. And in addition to looking at what's going on with SI joint, there was some ligament instability. She could walk and all that stuff okay, relatively easily, but the main issue was running hurt it. She started in the first like five minutes was kind of okay, then it started getting worse. And then sitting for more than 15 minutes was bad. So she was quite rotated out of alignment. 

And so we were looking at why she was like that. It turns out that it was because she had this instability in through there, all these ligaments that were really loose, probably from her pregnancies before in the past. Her kids are like 10 and 7 or something like that. And then she has these imbalances where a lot of things are just so tight. And then that tightness was just not allowing other things to actually activate and turn on. 

So these imbalances were affecting her actual running pattern or what we call her running gait. And so when we looked at it, we were like, Oh, you're totally not activating this. And then when we actually went in there specifically, look at how strong she was, it was astonishing for her where her one side where she was getting the pain, it was like she was failing. It was like 40%. Like she could barely hold that up.

And then on the other side, she didn't have any problem. They were like, Oh, wow, that's crazy. So we looked at why that was going on and we had to like do some adjustments to kinda get things aligned and it was affecting our whole back, all the way up into her lower back. And so we assessed that obviously, and it wasn't coming from her lower back or upper back in terms of the main cause.

So we think that that unstable SI joint had been trickling up and everything's just been seizing and everything was sort of like, I guess lack for better word, stuck, in the thoracic segment of the mid back area. So we essentially did a bunch of adjustments first and kind of realigned things that in itself kind of helped her, but that wouldn't sustain it, and I'll tell you why in a second.

So we did all these adjustments and then her strength where she was failing went from like 40%, to like 70%. And she was like astonished at how much of a difference that made. But then that bringing it up from 70 and keeping it even at 70 to bringing it up to 90 and potentially up to 95, maybe a hundred, possible, is only possible if we actually prescribe the right exercises.

So we assessed her and looked at, this is totally like this. It's not actually opening up. The mobility is actually not great when it goes into an extension and as a result you're not able to activate certain things. So what we ended up doing was reinforcing certain things. We had to do a lot of soft tissue releasing as well, and then suggesting certain other modalities to release that soft tissue.

So whether it being massage therapy or other forms of deeper releases like IMF or just working on some more active relief stuff with other therapists, that was important. Make sure we gained that mobility and then reinforcing it by working on opening up those areas that are tight and strengthening. So we call that up training. The areas that are not actually turning on that are down trained. And then those areas that are up trained that are just on too much, we gotta settle those down. 

So we sent her on her way with a bunch of prescribed exercises specifically for her, and she was doing great. I said, You know, like you can check in with me if you want. And she was pretty functional, but I said, You can check in with me in about a week, or you know, a couple weeks or something like that. And she was doing really great. But then she stopped her exercises and she ended up having to go away somewhere and she didn't do her exercise for a week and then came back and she was frustrated.

Because she didn't have enough time, she was only able to do them for like four or five days, and then because she didn't have time to do exercises, it came back, same thing. And then that physio basically treated her and got everything going again, and she's good again now. She's really on top of her stuff. That's the homework, so to speak. 

And she's looking at running another half marathon as sort of a training run before she does the the BMO next summer. And that's her goal. She hasn't really been running in a while and she wants to get back into that running routine. So that's been two weeks since we last saw and we haven't heard from her. And we said check in with us in about two, three weeks. So I think the physio is seeing her next week. 

Mark: So it's an important part, and we've mentioned this before, an important part of your healing process is to, I don't know, I keep thinking repattern or retrain the proper firing of muscles. Once they've loosened up, once you've rebalanced and readjusted everything so that things are firing in the right order, the right way they should be doing. And that takes practice, basically. You gotta have some reps in so that you rewire your neurology to work right. Is that a fair assessment? 

Wil: Yeah, absolutely. And I think the other key factor here is knowing what ones to do. Of course. Because I mean, she was trying to do all this stuff before she saw us on her own and she didn't know what to do and she was just like, Oh yeah, I'm tight here. And then trying to do stuff that was almost there, but just little tweaks that maybe she wasn't getting right.

And then also when you're so stuck, and use this quotations, stuck and out of alignment, that it doesn't matter how much you're even doing the exercise correctly, you gotta give yourself a fighting chance. What I mean by that is that you're gonna be on good neutral ground where everything's all on alignment now. Then we can actually have a fair fight.

Mark: Yeah. Let the healing grow from a place where the soil has been tilled a little bit and is ready to take that seed of the exercises. If you're having some running issues, if you've got some hip pain or even back pain, from ramping things up cuz suddenly it's running season. The guys to see are Insync Physio. You can reach them on their website, insyncphysio.com. They have a North Burnaby office as well. And to call the Vancouver office, (604) 566-9716 to book your appointment. You have to call and book. They're always busy. Thanks Wil. 

Wil: Thanks, Mark.

Hip Pain Cartilage Injuries with Wil Seto

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. He's the head clinician, the expert, the guy many time voted best physiotherapist in Vancouver. Of course his clinic has also been voted the best physiotherapy clinic a number of times. And we're gonna talk about hip pain today. How you doing Wil? 

Wil: Hey, I'm doing well, thanks Mark. Yeah, hip pain. More specifically cartilage related type of hip pain. 

Mark: So what kind of symptoms, I mean, it's pain in your hip, but how would you know that it's the cartilage versus arthritis or a growth in your hip or, or? 

Wil: Yeah, no, those are good questions. So the technical term, when we talk about the cartilage in the hip we refer to it as the labrum. So quite often, if you get an injury or a tear in the cartilage of your hip, we call it a labral tear. And you're right about like how do you know that it's not like a tumor because it could be right. And that's one of the causes and actually. 

I'm glad that you actually brought that up because we had a patient that came in to see one of our physios, this is a while back now, a few years ago. And he was having hip pain that just wouldn't go away. And these are the kind of things you wanna look for, like there was no trauma and he didn't do any sports or any exercise in particular that brought this on. And I remember one of our physios who was treating him, you know, was telling me about him. And he brought me in to kind of take a look at it and and I was like, yeah, like, this is interesting. It's strange. Because there was no real mechanism of injury, number one. And when I say that, there was no trauma and there was no like acute trauma and there was no like repetitive type of trauma and there was no incident. And so we said, you know, go see your doctor and get some scans and get it checked out.

So he did that and it turned out that he ended up having a tumor, the size of a baseball in his hip. And so I'm glad that you brought that up. So it could be that, but I mean that was very rare, like that happens probably less than 1% of all hip pain and these type of cartilage type of errors that we see.

But that's what we thought it was initially because it was acting a lot like a cartilage tear, like a labral tear. And you know, we get the classic symptoms of it catching and clicking but you can imagine finding a tumor the size of the baseball, of course, things are gonna pinch in there. You know, of course things are gonna not move right in there. 

So some of the other symptoms, if there is more of a tear in the labrum, that cartilage portion, then there'd be specific movements that cause it like if you ended up getting in a car accident. And that can cause sort of the shearing force and you're already in this you know, flex position or something like that, and it can damage sort of the back top side versus the posterior superior portion of that labrum. Or if you're in a hyperflex position, if you're just doing a lot of stair climbing and for some reason the stats show that the Asian population tend to have a lot more of that.

I don't know if it's because you know, they tend to squat more or something like that. So doesn't have to be an acute trauma. It can mean it's sort of this repetitive thing. And so they found that they have more of that tearing on that posterior superior side. But then they also found that the highest incidences seem to be related to kind of more in the anterior superior, which is on the front top part of that hip labrum. And so anything that involves twisting compression, in terms of the mechanism of an injury. 

So on a repetitive and on longer sort of chronic scale and maybe even things like, okay, let's say I do a lot of training and I suddenly add stairs to it. And then I just start to feel a little bit of a low grade ache and that builds. So it can start up as a small injury, a small tear and start to build into a bigger tear and then escalating into a bigger one and then causes a lot more symptoms and eventually dysfunction where you can't even walk. And so you experience pain whenever you try to run and even walk and even just standing. And even bringing up your knee in hip flexion, try to put on your pants, put on your socks. 

We have a couple physios that are seeing a couple of patients that have that exact problem right now. An older gentleman that came in, very active, likes to swim. Took some time off. Didn't feel comfortable going in the pool during this whole pandemic. It's been a long stretch. Went back in January for the first time in like, you know, year and a half or whatever. And started swimming four days a week. And it was actually kind of a funny injury. He tried to, you know, prop himself out of the pool, like mantling pulling out of the pool and put his right hip into this hyper hip flexion and tried to get himself outta the pool with his leg up. Felt a little tweak. He thought he just pulled the muscle kind of went away. 

So this is sort of how it starts. It went away and then he tried to do the same thing again the following week. And then it got worse and felt even sharper. And then it started clicking more. We haven't sent them in for scans yet, but our physio team sees a lot of this.

And what ends up happening is that you know, for quite a majority of them, there's stuff going on in the labrum, at the cartilage area. That's usually the presentation. There's some kind of trauma, whether it's like an acute type of trauma or some kind of micro trauma or repetitive type of trauma. 

And another cause is if you have like, so related to trauma, let's say you injure the hip and you don't injure the cartilage and you have a hyper mobility. So there's all the laxity in there. Or maybe a little bit of laxity. And because of that, then it's more unstable. And then the hip joint, so you have sort of like, it's a ball and socket, and so what ends up happening is that ball portion, because more unstable, then as you twist and turn in a ball and socket type of joint, then it can cause some injury in that hip, if it's more unstable. 

If there's a lot of multiple imbalances, like we were talking before then yeah you add that to the mix. Then that can cause more compression. And then you go to try and get into the range that you're used to for flexion or extension. Then you will tear that labrum. 

So there's also certain conditions that you're born with. Let's say you have what's called, like when you're a child, you have certain diseases in the hip where it's just more lack or congenital hip dysplasia where you know, when you're born, your hip kind of gets dislocated and gets put back in. That can be something of an issue that can cause a type of labral tears.

But there's also like the degeneration component, like as you get older, it's just tends to wear a little bit more and you're more prone to having it wear out. If you have other preexisting injuries to maybe your back or, you know, things that are related to the function of your hip.

Obviously we know how the back is really connected with that hip. So if you've had, you know, certain back issues or certain back conditions and that can affect the hip and usually the symptoms are right in your hip joints from the front. We call that the anterior right to the lateral, and it feels like it's deep inside and it feels like there could be like a locking and catching type of pain. And it can be from like a constant diffuse ache to a sharper type of pain sensation in there. And usually that will progress a little bit more as that degeneration occurs more and more. 

Mark: So what kind of things do you do to diagnose this? 

Wil: Well, it's kind of tough to actually say that it's a labral tear, but we can always say that it's like probability that it is. And there's certain things that we do in our examination procedures to look at it's the probability is likely that it's this, based on these different tests that we're doing. And quite often people will think, oh, like when they have this especially in the initial stages, that they might have pulled the hip muscle.

And so we obviously wanna rule out any of the muscles if they've been sprained. And then we also check out whether or not if there's a hyper mobility or instability natural joint. Because like I said earlier, like that laxity and that hyper mobility can play a factor in this.

And then sometimes there's like, there's a condition called Ehlers Danlos syndrome where you're just sort of locked through all the ligaments in your body and not just ligaments, but through other parts of your body that can also lead to issues with the labrum. And some people have gone on living into like, you know, their fourth or fifth decade of their life, not knowing that even had Ehlers Danlos syndrome. So it can be mild to more severe.

And so these are things that you do specific testing, you go back to the doctor, but you know, it's sort of these genetic markers that you look for that can add to that. So these are all things to consider. 

Mark: And how bad does it get to be before you are, or when's it the best course of action, is to refer someone to the doctor for scans and whatever treatment the medical doctor might provide. 

Wil: Yeah. So basically, we are seeing patients sort of like first line. So what that means is that we see them before they've even gone to the doctor, quite often. We have about like 25% of the patients that will see a doctor first because you know, they're not really sure. And they go to their family physicians who they trust. But usually we see them first and we'll diagnose it or we'll look at what's going on based on the tests.

And then we wanna treat that. And we wanna treat it, especially if we think it's an orthopedic thing. If there's other sort of signs that if it's really obvious, like, oh, that sounds like it might be something more going on on that initial assessment. Then we will refer you back to see your doctor and to get more testing done. Because I think that it's important to work with your family physician to really solve and get at the root cause of your aches and pains of what's going on in your hip. Because there could be more going on. 

Even though we may be suspecting that it could be like a possible labral thing, but if there's other things going on, like there's unrelenting pain. And pain that's like a 10 outta 10 without any relief with any kind of positioning or movements, you know like there should be some kind of relief, if it's biomechanical issue. Unless it was just a fresh injury. 

So those are really sort of warning signs right away like if it was like a gradual thing, like there was no true mechanism of injury. But they're having this 10 outta 10 or 12 outta 10 pain. That's a huge warning sign that something else might be going on. And especially like, there's no lead up to this. 

Mark: And let's say it's not that bad, and so you're moving forward with treatment. What is a typical course of treatment? 

Wil: Yeah, really addressing if there's a hyper mobility or instability, stabilizing the joint. And that also means that looking at okay, well what's imbalanced. Because usually if there's instability, there's also an imbalance in the muscles, but let's say if there's no instability, we wanna look at what's not working properly.

So we want to start to address the movement to function. So quite often the hip flexors are super tight and not functioning properly and they're not allowing the extension mechanism to work properly. But it becomes a bit of a dilemma because let's say like I was saying earlier that it's the anterior top portion, which is the anterior superior portion of that cartilage that usually gets damaged.

And usually what happens is, it's a hyperextension compression type of injury. But then quite often you need to activate those muscles in that range. Like your glutes, because they're not activating properly. So then what happens is we gotta start to address the movement function of it. So we have to look at how do we get your hip moving better without aggravating it?

Because even the act of getting it moving, if we produce pain, that's gonna shut everything down because pain will also cause things to not work properly. Swelling will also cause things not to work properly. So we wanna address those things. We wanna settle it down, if it's acute. Take the swelling down. Do whatever it takes for that part of it.

And then now we wanna start addressing okay, the mobility issues. And then we can start addressing the strength issues and then kind of doing that together maybe. And then the functional mobility. So now we've gotta work on the core aspect in getting what is overactivated and what is underactivated.

And then part of that is addressing, okay, well can we walk on this now? Can we go upstairs? Can we even just put on your pants? Can we even put on your socks first thing in the morning? So those kinds of things.

Mark: Does it change when someone's had a hip replacement?

Wil: So that's a good question because slightly different. It does change because there's a lot of positions that you want to avoid. And when you have a hip replacement you essentially have like automatic instability. And so usually with the hip replacement, the cartilage is all worn out. So there is no cartilage. And so you're not really looking at rehabilitating the hip with respect to a torn cartilage that you're trying to maintain and keep intact. Cause now there's basically no cartilage there. And now you're just replacing it with a total new hip or partial hip or whatever you decide to choose. And now you're looking at strengthening and trying to maximize function and avoiding certain positions and letting the postoperative part of it heal first.

Mark: So if you're having hip pain, the guys to see are Insync Physio. You can reach them on their website at insyncphysio.com. You can book for either office. You can call the Cambie office at (604) 566-9716. Or the North Burnaby office, you can reach them at (604) 298-4878. Get in there, find out what's going on with your hip, and if there's more going on, then they can look after it, they'll refer you to your doctor. Or they'll get you started on the path of recovery and get your hip working properly again. Thanks Wil.

Wil: Yeah, you bet, Mark.

Hip Injuries and Adductor Rock Backs

For tight groin muscles caused by hip injuries, you might want to give this exercise a try.

Start in 4 point position on a mat with your legs as wide apart as possible as if you are trying to do the splits. Then push your butt backwards towards your heels and hold this position for 30 seconds. Perform 3 sets each time, 2 times per day.

This is a simple exercise that can help with improving the mobility of your groin adductor muscles. If you have any abnormal pain or problems doing this exercise, please consult your local physiotherapist before continuing.

Anterior Hip Pain – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip to help with your anterior hip pain. Have the back of your ankle and heel pushing back on the front low side of a big ball against the wall. In side lying, make sure that your torso is not too far back or bent too much forward to avoid your hip being in a flexed position.

With your spine and hip in neutral position push the back of your ankle and heel up to the top part of the ball maintaining contact on the ball the entire time. A few key things to look for is to keep the toes pointing forward and towards your own nose so that you’re not rotating the hip and the toes upwards while you push the ball upwards. Bring the ball back down and repeat this 10 times for 3 sets on each side.

This is a great exercise to build more functional posterior core strength to help offset the muscle imbalances that contribute to anterior hip pain. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing.

Hip Injury Management – Adductor Longus Muscle Mobility

This is a great mobility exercise for the hips to help improve what we call the motion of abduction so that you can move the lower extremities more into the outward direction.

Start by securing a belt or a solid strap around something solid and unmovable like the leg of a couch. Check your position by starting with your knees open wide in a “V” and bent. Make sure your lower back is nice and straight.

Next, hold on to the strap and gently pull yourself forward to take up the slack of the belt to reach the barrier of your hip flexion while you maintain a straight low back. Then begin to straighten the knees to the floor and gently pull yourself forward on the strap by flexing at the hips even more until you feel a more moderate but comfortable pulling on the inside muscles, or the Adductor Longus Muscles, of your thighs.

Hold this for 30 seconds doing 3 sets 2x/day. If you have pain that doesn’t feel like a stretch, or are unsure about what you are doing consult a local physiotherapist before continuing.

Hip and Buttock Pain: Self Ball Release

Place the release ball on the Gluteus Medius muscle located just below the superior aspect of the pelvic bone called the Iliac crest. Then roll on to the ball and bring your forearm to the ground.

Go back and forth with partial weight and then to progress it with full weight on the release ball. Go slow and relax into it while you roll it out for up to 3 minutes in a couple of different points in the muscle.

This is a great self ball release technique to ease up stiffness and pain into the hip area. If you’re experience abnormal pain or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Hip Pain Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly. He's a physiotherapist at Insync Physio in Vancouver. One of Vancouver's favourite physiotherapist clinics, many time winners of best Physio in Vancouver. And Simon is going to talk to us today about frontal hip pain. Hip pain. This is really common. So what causes this kind of hip pain in the front of your joint? 

Simon: Hi, Mark, thanks for having me. Yeah. I'll just talk about hip pain sort of a little bit globally. And again, I might bring in a certain client that I saw recently as well, like a case study. But yeah, there's a couple of things that can cause hip pain to be honest Mark.

So this guy in particular, just came in and had pain in front of his hip. No real specific injury as such kind of came on more gradually. So we dug into the history of like how it came on and then he said he had it, I think mid November. So that would have been two months ago from when we recorded this video, he took a break.

He was actually doing a lot of Nordic cross skating, which I wasn't really aware of what that was, but it's almost like you're on the little wheels. Like you're kind of skating, but on ground as you maybe you know what that is Mark? But I never heard of it being from Ireland, but he explained it in good detail, but he was doing a lot more of that and he was in a lot more rowing he was telling me. 

And then he did feel the pain coming on, but he just kind of continued for awhile and he stopped and then the pain didn't go away and he landed in my office here, or in my clinic here. So, you know, the first thing, like, because it was more gradual in nature, you wouldn't be sort of thinking more like a groin strain. It might be overworked or chronic use of the groin, but we have  to kind of rule out the groin, which we kind of do in clinic where you squeeze the knees together. And if there's no pain on that, you kind of pretty sure it's not a groin, but even the mechanism of injury it's unlikely to be a groin. You know, you usually get that in lots of changing of direction.

He does have a bit of changing in your direction in that actually. He further made it more detailed in how this classical, where you just kind of go straight, these wheels are, there's kind of more lateral as he described. So the lateral movement was really making it worse according to him. So that was kind of interesting to see why that was worse for him.

So he came into clinic. We had a look at the front of the, he kind of pointed to the front of his hip, not to the side of his hip and it was more painful that at night time when he was laying on that side. So that's kind of how he presented. So we cleared the groin. Obviously we did the squeeze test where the knees were squeezing together. That was all clear. 

And then we kind of checked his hip flexors. So iliopsoas, that's the name of your hip flexor and then you have rectus femoris, which is actually one of your quads that also crosses the hip joint and it assists in hip flexion as well. So in the clinic here, he had a little bit of pain when he was completing that movement on hip flexion.

And when we started to palpate the front of the hip, you kind of have two bony nodules on the front of your hip. Just a little bit below that, he had a lot of pain in there. So he was also stiff in his hip as well. And he was a little bit older, he's 50 years old. So he has a bit of stiffness in his hip, but this is definitely, I think an overuse injury of the muscle called rectus femoris.

And just from lots and lots and lots of hip flexion. It was a lot of hip flexion. And then he was trying to alternate to something else which was rowing, which was also a lot of that hip flexion. It also was stretching the life out of his hip flexors as well.

So the muscle was really getting no time to kind of recover or heal, so I think he just needed a bit of education really.  I think he was concerned. It hadn't gone away in two months. So my job is to get out the aggravating factors. Just tell him, stop rowing, stop, stretching the life out of his hip. And just maybe cool down at Nordic cross skating just for a week til I settle it. So that's what we done just to start. 

And then we obviously just loaded up to the hip and a little bit more, but more gradually. And because it is chronic, it wasn't specific and some of the chronic stuff can take a little bit longer to heal, like it is a chronic tendinopathy. So you're probably looking at maybe, sometimes take two to three months. But if it's done right, we can introduce it a little bit earlier. So we load it up as hip flexors and we did a couple of exercises just to build up that muscle on the hip, we avoided sort of a lot of this aggravating factors for two or three weeks, and then we started to add it in gradually.

And he's actually after making a pretty good recovery now and he's happy that it's not hip osteoarthritis. So he's back doing his Nordic cross skating. Now I think he's back up to three or four times a week so with no pain. And so that was great. 

Mark: Well, hopefully he puts the skis on and gets out on the snow, which is really what that's training for. I've had this injury from cross country skiing. But it was from wax failing, going uphill, hard uphill and over stretching the rectus femoris. And so, did he have any crepitus in his hip? 

Simon: He didn't actually no, he had no crepitus in his hip. He was very tight in his hips now. And I'd imagine we all know you get a little bit of osteoarthritis as you get older, but certainly he wasn't symptomatic or had no clicking or popping or crepitus. That was good. I think that really eased his mind. I think he kind of thought it was the start of hip osteoarthritis. So he was kind of relieved that it was, I say, just that muscle it's important, but maybe it is better not to have hip osteoarthritis as well. 

But you're right, Mark, you can get more of the acute injuries. His was more chronic from lots of hip flexion, somewhat a more, acute injuries, you know, snowboarders, when they lean back, they can really over that muscle. Kind of like what you were saying when you're really doing a lot of uphill and stretching back, you injury it that way too, for sure.

Mark: Yeah. So what was the treatment protocol? What would be more of a typical thing if somebody had this kind of overuse injury to the rectus femoris or their front of their hip? 

Simon: Absolutely Mark, yeah. So what we do with him, actually, we, a lot of the time it can be just tightness in the quad muscle actually. So we just worked out that muscle with a lot of massage, some needling like IMS treatment or dry needling, it's called that because there's nothing in the needle obviously, but we just reset the muscle and make sure it's long enough. And really, again, it's all about education and just, you're overloading this muscle just too much in the amount that you're doing.

He really wanted an alternative, something alternative to do. He couldn't do it the Nordic cross skating because obviously he's probably training. Someone who does, this is usually really eager to get onto the snow and he didn't want to lose any sort of cardiovascular stuff as well. So I mentioned a little bit of biking to him and a bit of cross trainer if he could, but just really tried to limit, I avoided rowing as well, there's too much hip flexion in that.

I think he was just going to aggressive, a weekend warrior type character. So he was happy to just do a bit of bike for awhile but it was hard to reel him in to avoid the rowing and that cross skating. And then, yeah, we just loaded him up here in clinic as best he could. And yeah, he has no pain at nighttime now. And he's back doing his Nordic cross skating now. And he's looking forward to getting back into the slopes, he can do that now too.

Mark: Absolutely. So if you've got some hip pain, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver at the Cambie Street office. You can call to book your appointment (604) 566-9716. Or check out the website insyncphysio.com. Real easy to book right there online. 

If you're in Burnaby, they have a Burnaby office, (604) 298-4878. Same thing you can book online there. Pick from whichever physiotherapists you want. You can choose Simon, he's busy and he's good at what he does. Inphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thanks very much.

Hip Impingement

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapist office in Vancouver. And we're talking hip impingement. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. Basically it's when the head of your femur or your femur bone basically pinches up against that part of the socket of your pelvis, which is called your acetabulum. So what they normally refer to it as FAI. Which is femoroacetabular impingement. And there's a few different causes to that. 

There's definitely, you know, like sort of structural genetic component where if you're pelvis and your hips are aligned in a certain way and the neck of your femur is not proportioned, or if it's shorter then you have an increased risk of having this type of impingement happening. 

So aside from looking at sort of the congenital factors, we're looking at more of the other secondary issues of like, imbalances that you develop from sport and activity, to specific injuries. Then you can run the gamut of like, you know, having issues that are caused by like the sacred iliac joint that shifts the alignment of the whole pelvis, which then causes a movement issue in the actual hip. So that's huge because I see that quite a bit too. To where you have like, in your hip, you have cartilage that's called your labral. And so you can sometimes experience sort of an injury into there. And then if you have sort of that kind of stuff going on and that can definitely give you changes in terms of the actual motion and movement of the whole hip. 

So when it comes down to the true FAI, there are a lot of different causes to this. And I think you really want to address what are the biomechanical factors.

So biomechanical factor being like, you know, what are the things that are affecting the way that this joint is moving. Assuming that you account for all the structural issues and that, all that stuff is normal. And you don't have that aspect with regards to that getting in the way. And then you're looking at muscle imbalances. So you have like your lower back joints maybe, your spinal joints maybe contributing to all that. 

Mark: So how would I know? How does this show up when somebody comes into your office, what are they complaining about? 

Wil: Yeah, it's like basically a pain in the front part of your hip. And it's primarily you know, you feel weak in there as well, weak and painful. And it's interesting because I had a fellow who was an avid rock climber recently who had been doing a bit more driving, I guess, just you know, driving around sort of getting to different rock climbing gyms now that there's the winter season and also he's a skier too. And he noticed that he was getting some more hip pain. And he was driving a standard, so he was using that left side. He was getting an impingement on that left side. And that was getting even more trouble as he was like sleeping. And then he was noticing that it was referring down to his knee.

That's when he finally thought he had to get checked out by me. It was when he started getting the increasing in symptoms and it just wasn't going away. So basically that's the biggest symptom right there. It's really that sort of like, you can put your palm of your hand or just your fist on the front part of your hip and that's the area of pain. And especially trying to bring your knee towards your chest and you start to elicit a sharp pain and then if you try and rotate it out, the knee coming outwards, and then that can also elicit a painful response into that interior part of your hip.

Mark: So that's how it shows up. You can't maybe put your socks on as easy without pain. So when you're diagnosing it, what are you looking at? You talked about muscle imbalances and all kinds of other things. How are you diagnosing it exactly to find what's going on? 

Wil: Yeah. So quite honestly, there's marked weakness in that hip. So weakness marked with pain. And then also just in terms of the movement of the joint. So when we get in there and looking at the joint, there's like the kinesiological movement or the anatomical movement of how it's supposed to move. And there's usually a restriction and extension, but then with that extension restriction, you have that accompanying weakness with the fluxion, which is bringing the knee to the chest. With pain. And there's always like, sort of this pinching sensation. And also coming out into the, what we call like an abduction fluxion motion, where you bringing the knee outwards and upwards kind of thing because that puts more sort of a closing in aspect of that hip joint. And then that brings in more of that impingement.

So that's sort of the primary part of it, like, Oh yeah, that's the hip impingement. And then we really look for well what's causing that. And aside from like, you know, the structural and the congenital parts of what I talked about before, you know, then you're really starting to look at, okay, so is this now really like an issue with the sacroiliac joint that's driving this. And then also quite often, in addition to that, you know, we talked about the weakness. You also want to just really work on strengthening specific muscles in that hip flexor area. 

Because strengthening that area helps to support the normal moving patterns in that hip again. Because when it's really weak, then it basically, you know, all the other muscles that are really tight started to take over and then you get all this imbalance and it basically spits it to the front. Spits that joint to the front. And then you can imagine as it does that, then you go to like, bring the need of the chest. If you've got to bend over and you have that motion of fluxion pinching even more when you're having all that imbalance happening. So those are the things that we're looking at addressing is those imbalances, but then primarily, you know, what's driving it. Is it, you know, the sacroiliac joint.

So with this specific client who actually had a sacroiliac joint injury, it was definitely driving that hip impingement. And then now we're also in the process of looking at helping them strengthen his core. Now it's hard to tell, was his core already weak, and then it caused the sacroiliac joint to shift. It's hard to say, but we definitely know that he had this issue with his mobility and his SI joint or a sacroiliac joint. So now we're in the process of trying to help him with his core strengthening and also his hip flexor strength. And I've only really seen him three times. He comes in like he's still really active, still climbs.

And in those three sessions, you know, the first time he came in, he was getting constant pain. You know, it was like nine to 10 on the pain. And it went from nine to 10 out of the pain to like a three to four out of pain out of the second session. And that was like a month later. And, you know, we gave him some exercises, reinforced the stuff that I did manually and doing the releases that we did and all the things that we worked on to try and really restore a more normal movement pattern in that hip.

And then I saw him for the third time, like a month after that. So this has been a span of like almost three months. And he's like at times where he's pain free almost, and he feels it mostly with climbing. And then when he's still driving a little bit, when he's clutching with that left foot.

Mark: Anything else you wanted to say about hip impingement? 

Wil: Well, I think you know, the big thing is that if you're trying to stretch it out, it's not just about trying to stretch things out in there. Like it's, I think the biggest misconception is that I got this really sharp hip pain, you think, Oh, I just stretch it and it's okay.

Sometimes it may be, sometimes it might help, but like if you're stretching and you're noticing very little returns and gains in that, then you want to get it checked out because then you want to get at the root cause of what's actually driving that. And you know, something as simple as like, you know, figuring out that alignment issue and what's causing that and addressing that, you know, can really make the difference of like, like you know, from experiencing a constant nine to 10 out of the pain to making life a little bit more enjoyable. Making your sports and activities a little more enjoyable. And finally being able to pursue the things that you really want to be able to do again. 

Mark: Bottom line. If you want to feel better, if you're tired of being in pain, the guys to call in Vancouver are Insync Physio. If you're in the King Ed, Cambie area, Mount Pleasant, et cetera, et cetera, they get people coming from all over the place actually. They're that good. The Vancouver office is (604) 566-9716 to book your appointment, you got to call and book ahead. They're busy. Or in North Burnaby, there's another office (604) 298-4878. Give Insync Physio a call they will help you out. 

If you want to check out the website, Insyncphysio.com. You can book online there as well. And you'll see there's lots of videos on there for all kinds of types of exercises and stuff that will help. Whatever, if you've got a minor issue that you need to work on, maybe that'll help, but if you want expert help and getting better and moving freer, give them a call. Thanks Wil. 

Wil: Thanks Mark.

Chronic Hip Pain Strain- Forward Lunge Reach Ups

Progressively strengthening your core stability muscles after a hip injury can help you become functionally stronger.

Start by lunging forward with your right foot and reaching up with the opposite arm and hand high up above your head while keeping the low back in neutral position. When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Don’t let your knee fall into the middle or go past the front of your toes and the opposite arm reaching straight up without deviating past the midline or off to the side. Push back up to the start with the forward foot and repeat this for 10 repetitions doing 3 sets for each side.

This exercise is great for returning to activities and sports that require a lunge and reaching motion. If you’re unsure about the exercise or have uncertainty about where you’re at with your hip book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out. 

Preventing Cycling Injuries – Hip Flexor Strengthening

Hi, this is Simon Kelly, physiotherapist in the Cambie Village clinic here, Insync. And today I’m just going to show you a simple exercise to really focus on your hip flexors while you're biking.

So I am just going to bring my right leg forward, nice straight back if you can. It’s good to keep your elbows a little bit bent as well when you're biking as well. So obviously the bumps in the road aren't going through straight arm, so I usually keep my arms a little bit bent in this as well just to get kind of re-enact exactly what you're doing on a bike.

So I usually do this maybe 12 sets and that's a nice burn on the right iliospasoas, your hip flexors here. Try to be as steady as possible, bringing the knee up, good! A little bend in the elbows and you would be doing that as I said 12 times, three times a day. Cheers!