- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- All right, Brad,
today we're gonna talk about bone on bone,
hip arthritis, and just because you have,
it doesn't mean that you have to live with the pain.
I think we can knock the pain down a little bit.
- Right.
- If you try some of these things.
Now, first off, what are we talking about
when we have bone on bone arthritis?
- The cartilage is wore off and we're going-
- Right.
- bone to bone in the hip joint itself.
- Yeah, and what you're going to find,
I'm going to come a little bit closer Lonnie,
are you right there?
Now, this bolt isn't in your hip,
you don't have that by the way.
But this is the smooth surface of the the femur
that fits into the socket over here.
You want to just spin that Brad?
- Yep.
- There's a socket right up in here.
And on this smooth surface, actually what makes it smooth
is a thin cartilage that's very slippery,
very strong, hyaline cartilage, but after a while,
it starts to wear off as you age.
- Right.
- [Bob] And Brad described it as being
almost like it's rusting.
- Right.
- [Bob] And it's flaking off,
and eventually you have pockets
and divots and it's actually just gonna be all wore away.
- Right. So you got that ball and socket,
and it was smooth, and slippery, and gliding-
- Right. - and quiet,
and all of a sudden it starts making noises,
pain associated with it.
So how you're gonna deal with that before,
you know, you don't wanna have surgery,
and how can you manage the pain.
- Right.
First off, what you should understand about this is,
the pain tends to flare up and it tends to calm down.
- Mhmm.
- So if you're in a flare up,
the one thing you're wanna gonna try is using a cane.
- Right.
- Brad, you want to go ahead and demonstrate?
- Sure, so here we go.
It's got the, the left hip is the problem here.
You're gonna take the cane in the opposite hand.
- Right.
- A lot of people will think it's in the same leg,
but you go the opposite. Okay.
And they've done studies on that and why it works,
and just believe us, that's the way it works.
- Right.
- But you need to walk when the cane goes forward,
left leg goes forward and that's the natural sequence
of the arm in the leg anyways.
So I'm taking weight off of this hip
by going through this cane.
And it gives you better balance as well.
- It's amazing how this makes a,
I would think of all the things we're gonna recommend today,
this is the most important.
- Right.
- Because if you get it calmed down,
you can get rid of the cane again.
- Right.
- But I always get a kick out of Brad,
a lot of people say, "Well, I'm not gonna use a cane.
It makes me look old."
- Right.
- But instead they'll walk like this,
Yeah.
They're limping around,
which works looks much worse than using a cane.
- Right.
Yeah. That gives you a little look of distinction.
- That's right.
All right, the second thing
you're gonna wanna do is actually,
we're gonna do some hip stretches Brad.
And the reason we're gonna do these stretches is,
a lot of times with arthritis,
the hip becomes tight, - Mhmm.
- and it's not moving as well.
And so now, instead of the forces being spread out
throughout the entire ball here,
it's just working on a small part of the ball.
- Right.
- And that's getting worn out faster.
- Right.
- So you want to make sure you keep the hip
stretched out as much as possible,
and make sure your knee's
not falling off either, (laughing)
because that's not gonna help.
- This is interesting, Bob, because actually,
just yesterday, I worked with a patient, hip arthritis
and we're gonna be doing these same stretches on her.
- Wonderful.
Well do you want be the stretcher? Stretchee?
- Sure.
- She'll lay down and-
- You bet, let's-
- And I'll...
- Right there Bob, on your back.
- You want me to, I thought you were going to be this.
Oh, you're going to- - Ohhhh.
- All right. We're ready.
Okay. Probably just hip flexion, right?
- Sure.
- So you're gonna go ahead, and just go ahead
and bring it up, and give it up a little yank.
- Now the woman I have yesterday,
she can get up about to here.
She's so tight. - Right.
She cannot get past 90 degrees.
So we're gonna work on that gently.
- So you grab around the knee
or you grab under here- - Right, mhmm.
- if you can't get, get that far. Okay?
- Okay.
- How about a hip rotation?
And you can do rotations
by rocking back and forth- - Right.
- like this.
But you can also do, and this is a good one
to do every morning when you wake up.
Just start getting the hip moving before you-
- And it works the low back a little bit too.
- Yeah, low back too.
- Mhmm.
- You can do the figure four stretch.
- Yeah.
- Now you can do that in a number of ways,
but one, you could just cross over like this,
and a lot of people aren't gonna have much motion
in this one. Are they Brad?
- Yeah, and it might be painful.
So you have to, it should not be any sharp pain.
Stretch pain is all we're looking for.
- If you are somewhat mobile,
you might even try putting it up like this
and stretching it down- - Right, right.
- and pushing a little bit with your hand.
But most people are gonna probably be up like this.
- I did have, just recently, he was 87 years old
and he could do this and we could actually
help his hip out by that.
So, sometimes it works on mobile people.
- All right.
How about a hip extension stretch?
This is one where you'd actually go to the edge of the bed.
Please don't fall off.
- Right.
- And you're gonna bring one leg off,
and you're trying to stretch the leg
down this way a little bit.
- Right. So you're getting that stretch right up in here.
- Then to make it even worse,
you pull this one up at the same time.
- What he means, just more aggressive on the stretching.
- That's right.
- If you got a lot arthritis,
you might have to start with someone holding this.
- Right.
- And working it gently.
- All right. Any other stretches Brad?
- Yeah, there's one that,
this has worked really well with this person.
Same person.
Both are bad ones, a lot worse than the other.
Just get yourself straightened out Bob.
You're kind of crooked there.
- Oh this- - There you go.
- Yeah. - Yup.
And this is something you can do.
Just take the leg and you have a family member, a friend,
and gently pull.
And the only reason you're going to do it is because,
Bob or the person that's having the treatment is gonna say,
"oh does that feel good. Just hold that."
And if it doesn't feel real good, you don't do it.
- Right.
- It's very clear.
You pull and it's not very hard.
And they say, "oh, just hold it for another",
you hold it for about 30 seconds.
You get tired, and then you give it a break.
- That stretch that capsule a little bit,
give a little traction to it.
So, alright.
The third thing you're going to want to do.
Joints love movement.
- Mhmm.
- What happens is you start having hip pains,
so you move less, right? - Mhmm.
You stop walking as much.
You stop moving as much, totally.
So what you want to do is try to find a way
to get some movement without weight bearing.
- Sure.
- Or little weight bearing.
Ane thing that's great is biking.
- Mhmm.
- Another one is,
- Swimming.
- If you got a pool and you like to get in the water,
that is wonderful.
- Another thing we've shown in some of our other videos is,
you can take, what it's called the E1000 elliptical.
- Mhmm.
- It's this little machine, and it's a pedal machine
and you can actually sit down and pedal.
- You can sit right in your dining room chair
and put it out, and it gets those hips moving.
It's not a lot but- - Yeah.
- it gets them moving.
- And gets a little more nutrition to the joint.
- Right.
- And gets a little more blood flowing to the joint.
- And as far as biking, Bob had mentioned biking.
Outside bike, possibly, but a stationary bike,
or a recumbent bike, where you sit in in a chair like this.
You have to spend the little money, or if you belong
to a fitness center- - They all have them.
- the YMCA.
- Right.
- And you're sitting there, and you're peddling like so.
- Wonderful for the hip.
- Right.
- All right.
Last thing you're going to want to do is,
you're going to want to strengthen the hip.
- Mhmm.
- So, and the easiest way to do that is,
what we call straight leg raises times three.
- Sure.
- So you start off, you're in the bed.
I gonna be strengthening this one right here.
You wanna talk more Brad,
so that- - Sure.
And it's important to have this leg up like this.
It takes stress off the back,
and it makes it little easier.
And you're gonna lift up.
Now, this is more aggressive, it's harder than you think.
- Yes, it is.
- Yeah. So if that's too heavy,
you might have someone help.
Or you might go here, and it's a little less,
and just bring the knee up.
- Right. Just to start off that way.
- Right.
- Because-
- Especially when you got long legs, like me,
this is a lot of work.
- You better believe it.
- So hold it for 10 if you can,
or 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
About seven seconds- - Sure.
- or eight seconds.
- And you might start out with just doing the motion
without holding it, and working your way up
to that asymmetric hold.
- And then you can lay on your side.
I'm gonna switch to this one, Brad.
- Yep.
- And I can bend this leg.
- Yeah, and this is a nice one for that hip abductor.
This one can help that waddling,
from becoming less when you do this exercise.
So it's up, and then down.
And the same thing, you may only go up and down,
and as you get stronger-
- You can bend the knee- - Sure.
and go like this to start off with.
- Yep.
- Okay. And how many reps Brad, would you say?
- I like to stick around 10 reps.
- Okay.
- You could do less, or you could do a little more.
And if you're stronger, you're getting pretty good.
You can bring that up higher as well, okay.
Just don't kick anybody in the head. (laughs)
- The Chuck Norris kick.
- Yeah.
- All right, last one.
You can actually lay on your stomach, and lift up this way.
- And Bob would normally lay flat-
- Yeah, microphone, I didn't wanna...
- but his microphone would get squished.
(laughing)
- I didn't wanna squish my microphone.
A standing one, real quick Brad,
would be a good one for the hip abductors
to hold onto a chair, and just work on doing these.
- Right, sure.
- Throw these into your repertoire.
And you don't have to suffer from pain
with bone on bone hip arthritis.
At least you can knock it down a bit.
- Let's- - Right.
- improve it.
- You better believe it.
Keep on moving and things are gonna keep feeling better.
- Thanks.