♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi Folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on the internet.
- In our opinion, of course Bob.
- So what is causing your hip pain? Is it arthritis?
How to tell, we're gonna go through it step-by-step,
give you some hints on some really specific tests
you can do to determine whether or not you have arthritis.
- Right.
- So the first thing, what is arthritis?
You got damage to the cartilage,
you have a ball and a socket,
yep? - Right.
- And there's kind of a Teflon coating
that goes over the ball.
- Yeah, it's white, it's very shiny when it's healthy,
and very slippery.
- Yeah, and what happens after time,
just like on a frying pan, it's can start to flake.
- Yeah. - And start to wear away.
- Yeah. - And you,
- sometimes you hear that term bone on bone,
that's where the Teflon is wore off on the ball,
and on the socket too, and you're getting bone on bone.
- Yap, and it's like sandpaper grinding in there,
if you wanna think of it that way,
and you can hear it and feel it oftentimes.
- That is one of the signs-
- When it's severe.
- When you hear grinding, or clicking, or cracking,
it's just not smooth anymore, the Teflon.
- Yeah.
- It's wore out.
So, other signs are pain and stiffness,
increased pain with standing,
increased pain with lying at it, of which all...
Which all makes sense.
- Right, so if it's a right hip,
or you're laying on your right side.
- Yep. So what are the pain patterns? This really...
This I thought is really helpful Brad,
because a lot of people think their hip is back here.
- Yeah, or they think it's up here-
- Right.
- Where the pelvis bone is-
- The wicked point.
- It's really down here, you can feel it,
if you do this thing like this,
you can feel that greater trochanter, is way down here.
- Groin, greater trochanter is part of the hip,
it's a bony part that sticks out.
So typically, pain patterns for hip arthritis is-
- Yeah, what do you mean by pattern?
That's, just hold on and we'll get through this.
- Yeah, well,
that's normally where you'd find the pain, a pattern.
So like, you might find it on the front of the hip,
you might find it on the side of the hip,
very common in the groin.
In fact, I saw a couple of orthopedists say it, said Brad,
"If it's groin, I'm thinking hip
until it's proven something else."
It's very common to have it in the groin with the hip pain.
- Well, is the groin down here?
- Well, right here.
- Right in the femoral crease?
- Yeah, right in the femoral crease.
- Right there, right there. - Yeah.
Now, yes, you can also get, the pain can be here,
and can refer down the thigh,
to the knee, not any further.
It can also refer down the side of the thigh.
- Right. - From here to the knee.
Very rarely are you gonna find hip pain back here,
this is usually back problems or something else.
- Back or sacroiliac pain.
- Yep, same going down the back of the leg,
that's usually not gonna be hip pain,
that's not a hip problem.
Also, if you have pain that spreads down beyond the knee,
numbness, tingling, pins and needles,
very unlikely to be hip.
- Right, we can't say never. - Right.
- 'Cause I went to McKenzie course,
(chuckles) they talked about that one as the weirdest thing,
so, but 99% of the time, yep. - 99%.
Your hip may also, at times,
especially this happens a lot in knees, but hips too,
where it feels like it's locking up.
- Yeah, right, yeah, sometimes that'll.
- So, all right, let's get to some of the tests
you guys you could do.
So with osteoarthritis, and this is from the father
of orthopedic medicine, James Cyriax.
- Dr. Cyriax?
- Yap, he said there's usually often a pattern
of where you lose motion in the hip.
- Sure.
- So the one motion that you tend to lose the most of
is hip internal rotation.
So what you're gonna do is you're going to sit
on a higher bench like this, or table.
- So the foot's dangling- - Yeah.
- You can't touch the floor.
- And you're gonna bring your legs out like this.
I don't have great hip internal rotation, do I?
- You don't, let's see if I got, can you get this?
Just, so when you bring your feet out
with your knees standing still,
that's internal rotating the hip socket.
- [Bob] And what your specifically, a lot of looking at,
especially if you have hip pain in one hip,
is that hip pain worse, or that emotion worse,
than the other side?
- I think, typically, the further out you go,
the worse it would get, is that accurate Bob?
- [Bob] No, but I'm saying it's limited.
- Okay, right.
- Right, so like this, let's say this is my painful side,
it might only go this far,
and my good side goes way out here.
- Right, I can go there, and this-
- That's typically what we're gonna see.
Next one that you tend to lose is hip Flexion.
So even in a seated position, or standing, or lying down,
you just check how well does your hip bend up?
They're probably better to show lying down, huh?
- Yeah, I'm gonna show
in a seated position from the profile.
So, this hip flexion in the seated position is this,
if you're laying down, that.
- So if I go here and this one only goes this far,
but this one goes that far.
- Right.
- This could be the problem hip,
and that could be having the arthritis.
- So in a chair, you can do this,
but this one, oh, you know, same.
- Yeah, and probably what I have talked about
in the past always is what the feel is too.
Quite often, it looked the same to me,
I'll say, "Oh, those feel the same."
It goes, "But this one feels really tight."
- Yeah.
- And that's often what you'll feel first,
is like it feels tighter
even though it looks maybe about the same.
- Right, or like it called the end feel,
if it comes up and it's like it hits right there.
- Yeah. - A very sudden end range.
- Hitting a wall.
- Yeah, and the other one's like, "Oh, squishy."
And you can pull harder and that's normal,
but bump (grunts).
- That would be an arthritic hip.
- Yeah, yeah. - It could be.
The final motion that you tend to lose is abduction.
So you lie down, and you see how far out the one hip goes,
and you compare to the other side,
and you can see if one goes farther than the other.
Getting it might be dramatic,
this one only goes this far and this one goes way out here.
- [Brad] Right, and there'll be maybe pain
associated with that.
- Right.
- [Brad] If you're standing, it might be,
you can bring this one out here,
and this one only this far,
that's also hip abduction in a standing position.
- So that's all according to Cyriax,
that's the pain patterns.
Now, there was a study I saw also that showed.
Now, they're gonna give you five tests,
if you have four of these,
you have a 91% chance of arthritis.
- If you have pain with four of them?
- Yeah, if you have issues with four of them.
- Okay.
- So the first one is just squatting.
So if you squat and it aggravates it,
aggravates your hip, that's one sign.
- Make sure you're holding on to something steady
if you got questionable hip pain,
'cause we don't want you to squat and fall as a result of it
and then breaking your hip,
so make sure you're pulled onto a solid piece of furniture.
- You want to show you this next one standing Brad?
I'll show it's seated.
Is that just flexion, so if you flex your hip and it hurts.
- Just like we had mentioned before.
- Yeah, just like we had mentioned before.
- Similar test. - Yep.
- Hold on to something if you're standing,
or have someone by you.
- So squatting, flexion,
and this is an actual test that you have to do,
you lie down, I'm gonna test this one,
I bring it up to vertical like this,
I grab the knee,
and now I try to drive the knee-
- Straight down?
- Straight down, I'm pushing down.
While I do that, I go across like this.
This is kind of grinding the hip,
if this hurts, that's another sign that you have hip pain,
and you can do it on both sides.
- So, you got five of these,
you almost have to put it down on a piece of...
I would, because I wouldn't remember
necessarily which ones hurt her which didn't,
so then I could look back and say-
- Right, you could, after the...
Well, I had a little bit of pain with that one.
- Yeah? Well that- - That is my problem hip too.
- Yeah, yeah, well you're getting Bob.
- I am getting old. (both chuckle)
Number four, if you have increased pain
when you extend the hip,
do you want to show that one Brad?
- Yeah. - Just standing and extension.
- So your trunk needs to stay up tall and stationary,
and extension of the hip is straight back.
Even a healthy hip doesn't extend a lot,
a lot of people do this to make it go higher
but that's really not hip extension.
So this body, like there's a wall in front of you,
you can't go forward, and then check right to left.
- Sore.
- You may find that the sore one doesn't go as far back,
and it hurts when you do the other leg,
'cause the weight bearing is on it,
that's a common combination.
- So basically you do three, you can do three standing Brad,
you could do the squatting- - Sure.
- You could do the hip flexion, and the hip extension all-
- One, abduction too?
- No, not abduction, hip flexion.
- Oh sure. - Yeah.
And then hip extension.
- Yep.
That's three of the tests right there.
The last one is the one we mentioned before,
is hip internal rotation.
If your hip internal rotation
is less than 25 degrees is what,
what would you say that is about 25 degrees?
That Length is about 25.
- Yeah, I guess.
- Not much less than the more of that, is it?
- Uh, they don't mind.
- Yeah, they don't know.
So again, so if squatting aggravates it,
if you have increased pain with lifting the leg flexion,
if it hurts when you do that scour test,
if it hurts when you extend the leg,
or if it hurts when you, or if you lack the motion,
that's five of the signs you might have arthritis,
if you have four of them, 91% chance you have the arthritis.
- That was quite a bit...
- Oh yeah, there's a lot to it.
The reason why I don't mind
doing some of these tests Brad too,
it shows you if you're lacking the motion.
Later on we're gonna show you how to stretch those hips,
to try to regain some of that motion.
- Right, and bring the pain down,
'cause you can't treat arthritis, you can't cure it,
but you can make the pain,
not always, depends on the severity,
but improve the symptoms, make it last longer if you will.
- Oh, absolutely, I just saw some studies last night Brad,
this was on the hand now,
but I've seen similar studies on the leg,
is that they did test, they did x-rays,
and they did them 10 years later,
50% of the people were not worse,
10% of the people were better.
- Ah.
- So that shows you right there,
50% of the people did not get worse at all.
- Sure. - I mean, so,
arthritis is not a death sentence, and it does not mean
it's just gonna necessarily get worse and worse.
- Right, you gotta keep moving.
- Yeah, right. - There's no doubt about it.
- This video, by the way,
is a part of a series of videos on hip pain,
if you go to bobandbrad.com,
go to the 'Programs' section
and look for the "Hip Series".
- That's right.
- You'll see a whole series of videos on hip pain,
And with each video, we also do...
we add a PDF which you can actually print out
what we said here today. - Right.
- So this video, with all the tests we went through,
you can print it out and you can just look at it,
you can do the tests without having to watch the video.
- Right, so if you're not a computer person,
you're a little older or that,
find someone that knows
to see if you've got a printer in your house
and print it out, and it's a wonderful option.
- Yeah, it's free by the way too.
- Yeah, it is. - It's only no email, nothing,
so please check it out.
- Very good. - Thanks for watching.
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