Category Archives for "Sacro Iliac Joint, Hip Pain"

Hip Injury Rehab – Squat Lunge Reach Ups

Having great functional mobility in your hips means also having great mobility in your middle and lower back rotation. Being able to move through your whole spine will greatly help the full functional rehab of your hip injury.

Start by lunging forward with your one foot and twist your body in the same direction while reaching straight up above your head with the same arm and hand. Keep your low back in neutral position and your inner core muscles below the belly button pulled in and engaged.

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. Avoid having your knee fall into the mid line of your body or going past the front of your toes. Push back up to the start with the front forward foot while unwinding the back and bringing the arm back down. Repeat this for 10 repetitions doing 3 sets for each side.

If you’re unsure about the exercise or have uncertainty about where you’re at with your hip injury, consult your local Physiotherapist before continuing. 

Anterior Hip Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, and they also have an office in Burnaby, BC, Canada. Multi award winning best physiotherapists in both locations, multi award-winning best physiotherapist in each location. And of course, today, we're going to talk about hip interior hip pain. What's interior hip pain?

Wil: Yeah. So anterior hip pain, which is pain in the front of the hip. And this is actually a quite common syndrome and dysfunction in the hip. So basically there's many causes of it. When we look at some of that comes in to the clinic that it has anterior, which is a hip pain, it can be caused by like bursitis. So bursitis is basically when you have an inflammation of the bursa SAC in the front of the hip. 

And then another common cause of that, it can be basically an overuse thing in the hip flexors of the hip. So that's more commonly called a hip flexor tendinopathy. So tendinopathy being that it's been more of a kind of a long-term thing. And so those are the two most common causes of hip pain that we see from, especially people who are really active in sports. You know, we treat a lot of sports injuries at our clinic and people were just generally active like hikers, bikers and doing a lot of field sports. 

So the other part of you know, aspect of anterior hip pain that doesn't really get looked at too much is it's something that's kind of more related to the bone and the structure of it. And so the terminology of this is called an FAI, which is femoroacetabular impingement. So basically what that is is there's a bony anomaly happening there, in one of the two bones causing impingement in that joint. And there's specific limitations associated with that on a clinical level when you assess it.

But all in all, when you either look at whether it's an FAI or if it's like a bursitis, overuse tendinopathy or even something that's more wear and tear where it could be a bit arthritic. There's usually a lot of imbalances in terms of the muscle structure around the hip. So a lot of weaknesses and a lot of stuff that's just too tight and not allowing the actual hip joint to basically move properly and optimally. 

Mark: So how do you diagnose that? 

Wil: Well, so with the bony part of it is, you know, like it's, through specific ranges and limitation, but you ultimately need to have some scans and imaging done, and that's usually not related to trauma. So it can develop sort of when you're growing in the bones and in terms of how the structure of the bone start to then get maybe a little bit thicker in certain parts of the femur or the pelvis. And then so when you look at other injuries like, so I'll give you an example. 

I had a woman that came into our clinic who went on a five day hike at the West Coast Trail. And she's also a rock climber too. So she does a lot of like, you know sort of fluxion movements where their hips and then she bikes a lot. So anyway, she went on this five day hike and then two days into it she started getting anterior hip pain. And so it's funny because she was attributing that specifically to the hike, but knowing her and the fact that she was so active. You know, this was all set up to happen before. And the other interesting thing is that as I was assessing her, I realized that she had other stuff going on too.

So it wasn't just like in her hip joint that she was having all these imbalances, but her sacroiliac joint, which is basically an adjacent joint to the hip, was really, really stiff. And you know, just in digging a little bit more about her history, she had like a snowboarding accident many, many years ago and just landed on her bum and she couldn't walk for a couple of days. And it was one of these things that she didn't even really think anything of, but I was just like probing about, have you actually injured that hip or anything like that before? Oh yeah, now that I think about it. Yeah, I used to snowboard and I had fell on it really hard once and I couldn't walk for a day or two and then she was fine. 

It turns out that after I worked on mobilizing that sacroiliac joint, that hip area adjacent to the actual hip you know, her limitation and her hip pain was completely gone. But what still remained though, was a lot of the weakness and a lot of the tightnesses in her hip flexors. So she's been having this sort of a issue with this adjacent hip proper issue with the sacroiliac joint. That then I think started building up with all these imbalances and she's very active to begin with, but a lot of her activities involve hip flection and her hip flexor muscles, even after mobilizing and getting that sacroiliac joint moving was so tight that she didn't even have neutral range into hip extension. And that was actually one of her biggest things that she was complaining about too, is that hip extension was painful, but hip flection was painful too, but after we mobilized it, you know, her movement wasn't painful anymore, but she was just stiff.

So basically what we had to do then after mobilizing the areas that were stiff, we had to actually start to loosen those muscles around there that were also really tight and binding. Because what happens and then it just causes this sort of vice grip in the joint still. And like you're still not getting optimal movement in actual hip joint.

And then as a result, because she's always used to those muscles being tight and other muscles were just super, one specifically like interior iliocapsularis, which is a muscle in the front of the hip. And then her gluteus medius, which is basically the butt muscles. And gave her some exercises start off with, but she was like, miraculously got off the table, I can walk after one session. But it doesn't end there because then the muscle imbalances need to be addressed. 

Mark: What's a typical course of treatment? How long has it take in a more normal situation to get more pain-free? 

Wil: Yeah, so anywhere between you know, depending on the kind of injury, if it's an acute injury, it can take a little longer anywhere between like four to six weeks. If it's like an acute strain in the hip flexor or maybe longer. If it's a bursitis, those things can settle down pretty quickly, but then it's really now addressing the imbalances. Because the thing is like with this client, she wants to get back to doing all of her sports and her activities. And, you know, they're at a recreational level, but she's operating not at an optimal way of moving her hip and she has to relearn how to use those muscles. And so our job is to help facilitate that and make sure that the range of motion in the adjacent segments and the joints are actually moving properly, continuing to move properly and to basically reinforce that optimal movement pattern.

Mark: Cool. You mentioned, like you had a second client who was having this kind of interior hip pain. Yeah. 

Wil: Anterior hip it. Yeah. So this person, we actually suspect that might have a little bit more of what I mentioned earlier, FAI, femoroacetabular impingement syndrome. He had no trauma. I mean, no trauma that he can recall. And he's young, like 30, I think he's 30 something, really active guy really fit, likes to ski, but like pretty adamant, no trauma, he's always been really careful and stuff. Just serve development with chronic hip pain and also I think part of his history, like he hasn't been really good at stretching and working on recovery and stuff like that.

But the thing is, as I started to test him, he had all the symptoms and all the clinical signs of femoroacetabular impingement and those ranges and those loss of ranges and the weaknesses too.  I think that's one of the biggest thing is that he developed this imbalance and so we want to try and work on fixing that. Ultimately I kinda told him, like we think it's this, we can only really know, like if we get some imaging, but that's really up to you. You haven't had any trauma.

And so he has been in a few sessions to see us and it's interesting because when he works on his exercises, he gets really good. He's pretty consistent, but then he goes in bouts where he'll go hard on mountain biking, he'll be a bit more sore for a few days. So it's really interesting, like how the muscle imbalance does play a really big factor, but then at the same time, you know, if it continues on and it's ongoing, then you want to address that a little bit more.

And one of the things that we did was we did some things to actually address the limitation of the actual hip joint proper. That actually helped a little bit, but it was obviously, if it's going to be something more structural and bone, then that's not going to really be a solution because it's going to keep pinching in on the cartilage and then causing a continued stress and strain and aggravation.

 If that's the case, then that'd be where I'd be wanting to refer them back to the family doctor and saying, yeah, let's get some imaging done. And let's just see. I know you haven't had any trauma and I know you're operating at a high level of like your sports and activities, but if you want more information and data on what's going on, then let's take a closer look at this.

Mark: Yes. Taking care of it sooner rather than later, if it's something like you don't want, like a cyst growing or arthritis, et cetera, whatever they possibly can do. 

Wil: Yeah exactly when it persists like that, and it just doesn't seem to get fully better. 

So, if you want some help with your hip pain, anterior, posterior, medial, I don't care where it is the guys to see are Insync Physio in Vancouver. You can reach them in Vancouver at 604-566-9716. Or you can book online@insyncphysio.com. They also have a Burnaby office. You can reach them at 604-298-4878. Same story. You can book online insyncphysio.com. Thanks a lot Wil. 

Thanks Mark.

Sacro Iliac joint Injuries – Torso Twists

Here’s a simple but effective exercise that can help with improving the rotation mobility in your spine in order to help with your sacro-iliac joint and pelvic injury rehabilitation.

Sit down on a chair with your feet flat on the floor & check your left and right arms into abduction like you’re making the letter “T”. Then check your hip and butt anchored to the chair with your hands.

Sitting with your legs wide and arms straight reach your hand down the inside of the leg to the ankle and reach your opposite hand up to the ceiling trying to create the letter “T” with your arms while your butt is anchored to the chair. Hold this position for 30 seconds doing 3 sets on each side 2x/day.

This is a great mobility exercise to do for the spine as a warm up and a warm down or for recoveries after you finished playing or training.

Hip Injury Management – Butterfly Hip Mobility

Do you have hip pain or stiffness? Do you play any running, cutting or lunging type of sports? If yes, then this might be a great exercise to help you improve your hip mobility.

Start by sitting down with the soles of your feet together drawing your heels as close to your body as possible. Make sure your lower back is nice and straight. Hold on to your ankles and feet with both hands and bend forward with your hips keeping the low back straight and push the knees to the floor with your elbows. 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’re doing consult a local physiotherapist before continuing. 

Sacro Iliac Joint Injuries – Gluteus Medius Big Ball Push Ups

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip. 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 strength in your pelvis after a sacro-iliac joint injury. If you have any pain and problems with this exercise or are unsure about what you’re doing consult your local Physiotherapist before continuing. 

Sacral Iliac Joint Injuries – Airplane Transitions

Start with one lower leg length away from the wall. Plant the foot on the ground with the standing leg. Hip hinge into the wall & make sure you hinge at the hip and not bending through the knee.

 Keeping your pelvis, navel, and the centre of your chest in a straight line & pivot through the hip, turning your pelvis over the standing leg.

You should be feeling it through the side of your hip, back of your gluteal muscles, and the upper part of your hamstring.

This is a great exercise to build more core strength to help with the rehab of your sacro-iliac joint injuries.

Sacro Iliac Joint Injuries – Monster Band Walks

Start with a resistance band wrapped above your knees with the slack taken up. Be in neutral spine posture with your inner core engaged and your lower back flat.

Then assume an athletic stance with your hips and knees bent with your butt sticking backwards and your upper body leaning forward and hands in front. Take a side step and straighten out your knees, hips and body as you land your weight onto the stepping foot.

Return to the athletic stance and repeat. Perform 2 reps on one side and then 2 reps on the other side doing this 5 of them on each side for 3 sets.

If you are doing this exercise in a gym or space that has more room then you can perform 10 side steps in a row and then switch to the opposite side doing 3 sets in total. This exercise is great for strengthening your gluteus medius muscles to help with the rehab of your weak and dysfunctional sacro iliac joint.

If you have any pain and problems with this exercise or are unsure about what you’re doing consult your local Physiotherapist before continuing. 

Sacro-Iliac Joint Injuries-Progressive Core Stability Strength Hand Side Plank Scissors

Lie down on your side, with your feet stacked on top of each other with your hand and outside foot supporting your body weight. Keep your low back straight, butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Raise the top leg up towards the ceiling and back down again ten times before lowering your hip back down to the ground to rest for 10 seconds. Repeat this movement pattern for 10 repetitions in total doing 3 sets per day on each side.

This progressive exercise helps build the strength in your gluteus medius and core stability muscles to help with the dynamic stability of your Sacroiliac joint injuries.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your Sacroiliac-iliac joint injury, consult your local Physiotherapist before continuing. 

Sacro-Iliac Joint Injuries: Progressive Core Stability Strength Forearm Sideplank Scissors

Lie down on your side, with your feet stacked on top of each other with your forearm supporting your body weight. Keep your low back straight, butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Raise the top leg up towards the ceiling and back down again ten times before lowering your hip back down to the ground to rest for 10 seconds. Repeat this movement pattern for 10 repetitions in total doing 3 sets per day on each side.

This is a more progressive exercise to build the strength in your gluteus medius and core stability muscles to help with the dynamic stability of your Sacroiliac joint injuries.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your Sacroiliac-iliac joint injury, consult your local Physiotherapist before continuing. 

Sacro-Iliac Joint Injuries: Progressive Core Stability Strength Big Ball Roll Outs

Kneel down with a big exercise ball in front of you. Keeping your back straight and your inner core muscles engaged, slowly roll down your forearms on the pinky finger side.

Straighten out your elbows and move slightly past them on the ball. Come back up with control to the start position. Repeat this for 10 repetitions, doing 3 sets per day.

This is a great exercise for your Sacroiliac Joint after an injury or if it’s just hyper mobile and retraining your core stability muscles to help them work better.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your Sacroiliac-iliac joint injury, consult your local Physiotherapist before continuing. 

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