- All right, Bob, hip pain.
Is it arthritis or bursitis?
We're gonna show you how to test for it
and how to treat it all at home.
- Very good.
- [Man] ♪ Bob and Brad ♪
♪ the two most famous physical therapists ♪
♪ on the internet. ♪
- Hip arthritis, or is it bursitis?
- Bursitis, right.
- Pain in the hip.
So we're looking at Sam,
he's gonna help us out today.
Here is the hip, the ball of the hip
and here is the greater trochanter.
Now arthritis comes from the...
- The joint itself.
- Yeah, exactly that.
- Ball and socket glenoid.
- Right, the cartilage becomes rough and irritated
and movement and weightbearing increases pain.
- Right.
- A big distinctive difference is bursitis
is more specifically out on this part of the bone.
Which is right here.
You can feel that.
- There's a fluid filled sack that is over the top
of the boney prominence here.
Which is a bursa.
- Right.
- And itis means inflamed,
so that bursa is inflamed.
And every patient I've ever had
that had bursitis of the hip.
I'll go and I'll find that bone.
And then I'll rub on it.
And within a half a second
they're letting me know in a painful way.
"Ouch that hurts, right there."
- By the way Brad,
I called this a glenoid fossa,
The glenoid is up here.
- (laughs) Yeah.
This is the acetabular.
- There you go.
I'm glad you caught that, Bob.
because there are gonna be people out there.
- They'll, they'll catch it
- They'll, chime in and they'll holler at us for that,
trying to catch us on every move.
So again, the symptoms are very similar.
When you walk or weight bear, they both hurt your hip.
But bursitis has that distinct tenderness over that bone.
- Right.
- So we're gonna tell you how to treat
that specific diagnosis first.
Here we go.
The first thing with bursitis, painful when you walk.
People don't wanna do this but get a cane out.
It's not a long term thing,
It's only until this bursitis...
- Stop prevent.
- Settles down.
Yes.
So pain is here, take the cane on the opposite side.
If you put your arm down, the handle will go to the wrist,
the crease of the wrist, and you walk.
And each time you walk, the cane goes with the sore hip
takes pressure off of it and will decrease pain.
Again, you'll only do that for a few days.
Get the pressure off.
While you're using the cane,
not exactly the same time, but during that day.
You're gonna lie down,
- You're gonna also do is use a cold pack.
- Right.
- And I put it right on the hip itself.
Now you can buy one or you can make one,
we have a video on how to do that.
- Right?
- You can also use an NSAID or I like ibuprofen.
- Right.
- Something that actually calms it down.
Next you're also going do non-weight bearing exercises like,
well let me show you.
- Yeah.
- Sideline hip abduction.
- So these muscle, this exercise
is working the muscles around that hip bursa
allowing you to strengthen these muscles
without irritating it.
- Now, if it, it does irritate it, don't do it.
- Right.
- Next one is clam shell.
- You actually put your knees together, your ankles together
and you're gonna work on opening the clam shell.
- Yep, open and close and do it slow like this.
Take your time 10 to 15,
or until you feel the fatigue in the hip muscle.
The next thing, by the time you've done this
for a few days, cold pack, use a cane.
You'll start feeling like,
I don't know if I need the cane anymore.
Then progressively start walking without it.
Continue the cold packs two or three times a day.
Continue the strengthening...
- Do it slowly though
- Exercises.
- Yeah.
- And progress through the walking as tolerated.
Don't overdo it.
Now we're gonna get into arthritis of the hip.
Okay arthritis of the hip.
You know you might find
some crepitus when you walk or move.
That's that grinding of the hip,
that's even a more clear sign,
that you've got some arthritis in there.
To treat it again, get the cane out
if it hurts when you walk.
If that right hip hurts the left cane,
just like we just talked about the same thing as bursitis.
- It's really gonna help.
- Right? Exactly.
The other big difference with arthritis
in my clinical experience, I think Bob's agree.
You can use either a cold pack
- or heat
- or heat.
- whatever you respond better...
- Upset fashion right.
So a cold pack again,
you can put it right on the hip itself.
You can go for 20 minutes, do a couple times a day.
For heat we like to use far infrared heat,
actually from Thermotex.
This does a great job.
And Brad, how far does this heat actually penetrate?
- Right? The big difference
between a regular heat pad and the far infrared
is heat pad, normal heat pad
goes about two or three millimeters skin deep.
- Right
- This goes 2.36 inches,
it gets down into that hip joint.
- Yeah. It goes into the joint itself.
- Absolutely.
- All right.
We have a whole bunch of stretches we can do to the hip.
We'll try first single knee to chest.
Brad you can do a seated,
I can do a supine or lying down my back,
laying in my back, lying it back.
- This actually gets the knee as well.
So it's kind of a two for the,
for the effort of one, two joints.
- All right.
How about a figure four?
- Yep.
- I'm gonna actually take my ankle cross it over my knee
and actually push down a little bit.
I could actively do it too.
Push down with the leg.
- Do the exact same stretch in the seated position.
- I can also bring the leg up like this
and I can even go further and go like this.
- And if you're seated, you can do the same thing.
Or you can lean forward, like this, push down like this.
- You can even grab the foot and give a little yank.
- You'll know you want these stretches to feel
like a good stretch, not creating any sharp pain at all.
Make sure you do both legs as well,
even the one that feels good. Make sure you get that one.
- Anything else, Brad?
- Well, Bob, we wanna move on to the next exciting...
Uh next thing is we wanna get this soft tissue.
In other words, the muscles are around that hip joint.
We wanna get those softened up and relaxed
increase blood flow.
A massage gun really works well for this.
I actually had this with a patient in the last year.
He's gonna get a hip replacement.
And for about two to three months
prior to the hip replacement
he would use the massage gun and work the muscles.
You don't go over the hip joint itself,
you work the muscles around.
Usually the ones on the back side,
on the butt area there.
But you can work over the top there's muscles there
and in front.
- And down into the thigh.
- Yep, exactly.
- Make a big, big difference.
- Probably like the ball one, the ball head
- Right.
- There's six heads with this particular one.
This is our Bob and Brad gun,
which we were really excited about, cause there...
- By the way, yeah, we're releasing it at Walmart
- They're excellent quality.
You will not find anything wrong with it.
And I really like it.
This has been great.
He really, this particular patient, his hip is replaced now,
but he really found this beneficial.
- So we'll have a list of stores
where it's being released at and the link below.
- Right.
- Because there's 500 Walmart stores.
- Right.
And you know, we also have our guns online as well.
But you know, if you like to do the old fashioned shopping
it's the way to go.
All right.
Next thing, Bob strengthening exercise.
- Sure.
All right, we're gonna strengthen the left hip.
The one that's on the top.
(Bob chuckles)
Go ahead and keep the leg straight.
This leg lower leg is bent, provides kind of a base
for doing the exercise
and I slowly bring it up and I slowly bring it down.
- 10 to 15 reps is probably adequate.
- Right
Then you could try a few clam shells
where you actually line up the ankle line up the knee
and looks it looks like a clam.
Doesn't it Brad?
- Right, open and close there.
- Right
- There you go.
Again, 10 to 15 of those as well.
You should probably do both sides.
- And this is a good time to mention
that you should not sleep on a painful hip.
- Right exactly.
I do wanna show standing exercises briefly.
It's easy.
You know, if this is my sore hip
I'm gonna do hip flexion like this 10 to 15 reps.
Hold onto a back of a chair to a cupboard,
something solid and safe.
Go out to the side like this.
Make sure you don't point your toe this way
but this way straight ahead 10 to 15 of those.
And then straight behind you,
not like this, don't let the knee bend.
Straight leg and that'll get that hip muscle,
hip joint more effectively.
10 to 15 of those.
And, and then you'll wanna sit down and rest.
- Right? The stronger the hip, the less pain you have.
- Absolutely motion is lotion.
So enjoy this video and Bob,
I think we should carry on with some kind of famous ending.
- We can fix just about anything, but...
- Except for a...
- Broken heart.
Yeah, we're working on that too
- For a long time.
- Yeah, yeah.
We don't get very far.