It’s a Continuum
In the sequel to my post, Moving Out of Pain that was about my recovery from neck and shoulder pain, I will now share my personal journey with hip pain. I have written about this here and here, but now that it has been five years since the injury, I thought I would revisit my hip adventures once again.
As with Moving Out of Pain, rather than focus on the difficulties of pain, this post focuses on what helped me. This is not prescriptive for everyone, but I hope that something here might be helpful to someone else with hip pain.
My Rehab Starting Point
My training program started with finding my “deep core.” The deep core consists of your diaphragm (which is also a breathing muscle), your pelvic floor (the muscles that also assist with bladder and bowel control), your transverse abdominis (the muscles that go around your center and are much more internal than the 6-pack abs) and your multifidus muscles (small muscles along your spine).
Connecting with my deep core meant breathing exercises. I know it may sound weird to address the muscles in my core with breathing exercises, but like many people, I had dysfunctional breathing patterns that were affecting the way my core supported me during movement.
The first breathing exercise was the Connection Breath— getting the whole deep core working together, expanding on the inhale and contracting on the exhale. See the video below for a demonstration.
The second breathing exercise was called lateral breathing, a process of breathing into the bottom area of the ribcage, where the diaphram sits.
After I felt comfortable with breathing and feeling when my transverse abdominis (TVA) muscles were working, my PT had me add Toe Floats, Toe Taps (see videos below), and other Pilates exercises to my program.
I learned that these core exercises shouldn’t feel like bracing your core to pick up a car or help a friend move a fridge— that’s far too much activation. Activation of the TVA is subtle, so subtle that you can’t feel it in the usual way. In fact, these exercises are mostly brain work. So if you’re attempting these exercises on your own, relax and reset if you start to feel ab contractions. Then start over.
Pilates Toe Tap
Movement and Strength Were (and Are) Key
As I shared in Recovery is a Wavy Line, in order to recover from the hip pain, I worked closely with my PTs and also really focused on strength training with my coaches.
My strength training focused mostly on my glutes— not just the big butt muscle, the glute maximus, but also the muscles we at Reimagym call “side butt,” the glute medius and minimus.
The glute exercises were designed to help my femur (the upper leg bone) center itself in my hip socket. My femur sat slightly forward in the hip socket due to leg lifting in my circus activities, and from sitting more often than I wanted to. The forward position of the femur in its socket was one of the main reasons I felt pain when I sat down.
The exercises were successful — the intensity of that pain no longer happens to me today, but when I sit too long I can feel a familiar discomfort creep in. In order to prevent the pain from returning, I do what I call my “Hip PT Routine” every day.
It’s All About That Base
My PT started with exercises for all my different glute muscles. Many of these were working on correcting the muscle imbalances around my pelvis. Below are videos for three exercises I find especially useful in the Hip PT Routine.
Side butt exercises: Clams for external rotation and hip abduction with leg in IR for internal rotation
Mini band lateral walks
Slow and Steady Wins the Race
It took a good amount of time before I could get back to doing more than just PT exercises for my legs and glutes. But I got there— eventually.
My PTs provided guidance about which exercises I was ready for, and they reminded me not to jump ahead too quickly, which would have set back my recovery.
Eventually, I was able to get back to my regular strength training activities. It required patience, because even though I am a trainer who understands exercise progression, sometimes as a human I am impatient with that progress. Although once I was given the “OK” from my PTs to begin holding weights again trying some of my previous exercise routines, it felt great to be back at it!
Over time I was able to actually pick up heavier weight than I had ever done before the injury, mostly because I now knew how to access and use my glutes properly. In this video I deadlifted a 50 kilogram (110 lbs) kettlebell, which was a personal best at the time. Now, I can easily deadlift 62 kilograms and I am working towards deadlifting my bodyweight.
Not without Setback Moments
I consider myself fully recovered from my hip pain, but still, it is not roses all the time. Every once in a while, I have a day or moment when something isn’t great with my left hip, but those moments are so few and far between. I’m grateful.
I know the things that make my hip angry. Too much sitting on the couch is definitely a way for my hip to tighten in the front, which triggers some pain, mostly femoral nerve pain, which is no fun. When this happens I usually need to foam roll, stretch and do some glute exercises to help pull the femoral head back more centered in the socket.
Too much active hip flexion also aggravates my hip, so I have to be really careful about how I schedule my exercises. An exercise program with too much leg lifting or active hip flexion is bound to result in pain for me later on.
This means that some of my strength training exercises are not paired together, some have to be adjusted and some I just can’t do anymore. I’ve learned to accept that.
The biggest culprit behind hip pain for me is too much sitting, which is something I can easily fix, for example by wearing a smartwatch that tells me to stand up if I’ve been sitting too long.
What I Learned
Movement is key. For me this is more than just making sure I am not sitting for long stretches of time, it was also the process of continuing to work on my hip strength and ranges of motion.
Making sure my core is positioned optimally (ribs over hips or diaphragm over pelvic floor) and working with my breath is instrumental to remaining pain-free.
Having strong hips and glutes is key for me feeling good. I have to keep doing those exercise even on days when I’m not working out.
Some exercises and movements I had to let go and I had to work through being ok with that.
I am happy to chat more if you have questions — please feel free to reach out. Until next time, friends.