♪ Bob and Brad, the 2 most famous ♪
♪ Physical therapists on the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist,
and Brad Heineck, physical therapist,
- Did I catch you off guard? - Yeah
- And together we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- Napoleon has lost a leg, Brad.
- Wow, sad Napoleon Bone Apart.
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- There you go.
- Let's get in today's topic, Brad.
We're talking about hip impingement, the causes,
we're gonna show you a test you can do,
the treatment.
But I wanna say right here at the outset, Brad,
that I think a lot of people are misdiagnosing this,
especially young people,
they think they have hip impingement,
which is actually femoral acetabular syndrome.
- Oh, now we're getting into the big words-
- I know,
as we move along here, you'll see the difference.
- Sure.
- So at the end of the video
I'm gonna talk about what I think most people have,
which is more of a rectus femoris tendonitis.
So again, big words,
I'm gonna show you
there's different ways to treat these things
they're completely different things.
- You may call it hip flexor tendonitis.
- Hip flexor tendonitis, right,
but it's not hip impingement.
So, alright,
what is hip impingement or femoral acetabular impingement?
First off, let's talk about how this develops spread.
- Yep. You want me to hold his arm?
- Yeah. Hold his arm.
- Shall we dance?
- If you are somewhat bow-legged.
- Here, let's get this, there we go.
Yeah. I'm gonna put this in here, actually, Brad.
- [Brad] Yep.
- Now, instead of
the forces normally going up, right into the hip,
where they normally do- - Mm hm.
- Now they're gonna, the forces are gonna,
because they're like this,
the force is gonna come out up here
and it's gonna hit the outside of the hip.
- So it just puts it at an abnormal alignment.
- Right. - So.
- And if that abnormal forces go on for year after year,
after year, what does the bone do?
The bone reacts, doesn't it?
- Right. It's going to calcify in that area
to help make it stronger,
which builds up, kind of like the way a bone spur will,
but this is not a bone spur.
- Right. - Similar concept.
- What, it's Wollf's law,
bone, when it gets forces on it,
it actually gets stronger or bigger or it reacts to it.
- Right. - So-
- It's really part of the growing process
in the normal human body,
but this is just an anomaly of it.
- So what happens,
let's get, we're gonna get a little closer Lonnie now
don't get frightened.
- Oh yeah.
- So one of two things,
or one of three things can happen with this Brett,
Brad and Lonnie.
Can you see this okay, Lonnie?
- All right.
You, this is the acetabulum, or the socket for the hip.
- Mm hm.
- Here's the hip bone itself,
the round part of it.
And normally again, it fits in here,
and just smoothly glides like this.
But again, if you start getting forces
on the outside of the hip here.
- Yeah, right in through here.
- You're gonna get an extra bone growing here.
And why is that a problem?
Well, you have also a socket here,
I mean a seal, that they call the labrum,
helps hold the hip in,
you see that orange?
And if this bone grows out too far
when this bone comes up in there, it can actually pinch it,
and it can actually destroy it after a while.
- [Brad] Right.
So, so the labrum is actually kind of
like a cartilage more material?
- Right. - As you say,
and if we start to pinch it and deform it,
it's gonna cause problems and pain, and it's not good.
- [Bob} Right. And that's why quite often
I would say femoral acetabular syndrome
is not a problem, Brad
unless it, it starts to de destroy something.
- [Brad] Sure.
- [Bob] If it destroys the labrum
or if it destroys the surface,
the cartilage that's on top of the articular cartilage
on top of them.
- [Brad] Yep. On the ball of the femur.
- [Bob] So it can grow, it can grow here,
it can also grow right here, Brad,
it can form right here and form a big bump right here.
- [Brad] So it can either be on the ball
or on the pelvis area.
- [Bob] Right. So either one,
either one is a bony thing that you can't change.
- [Brad] Sure.
- [Bob] I mean-
- [Brad] you're not gonna exercise it away.
- [Bob] Right, right,
I've seen some other YouTube videos
where people were taking bands and stuff like that,
and doing kind of looks like they were doing molds with this
and I just don't know how that's gonna change bone.
- Sure.
- So again, if they, you know, do an x-ray
and they find this on you, and you're pain free,
there's absolutely no reason to do anything about it.
- Right. And I don't think the orthopedic doctors
is gonna say, "You've got this problem,
we're gonna do surgery,"
if there's no symptoms, and no pain,
it's just like your body adjusted to it.
- Right. It's a, you know, again,
a pincher and a cam is what they call the two names,
pincher meaning it pinches probably?
Right - Sure.
So, and if you do have a torn labrum,
that's gonna be between, you know, you and your surgeon
whether or not you're gonna repair that or not.
- Sure.
- But the first thing that you might try
is some therapy and you say well, therapy doesn't help,
well, it can help calm things down.
- Sure.
- The first thing I would suggest, Brad,
is that just take some weight off the area,
- Mm hm.
- You know let's see if we can get,
maybe it's a little inflamed,
let's see if we can get it to calm down,
so just use a cane.
- Sure.
- You got a cane, Brad?
- Oh, sure.
So if walking is an irritant,
and it clearly irritates it
every time you put weight through that side,
get the cane out,
use it on the opposite arm, and walk with the cane.
That's gonna unload and take pressure off
that irritated area, giving it a chance.
- That's a good point, Brad.
A lot of people aren't gonna understand that,
but we don't have the time right now
to explain biomechanically why that works
but it's better to have the cane
on the opposite hand of the painful hip.
- Sure. Right.
- Do you wanna show that proper height for a cane, Brad?
- Sure. If you're standing there, let your arm hang down,
when you put the cane here,
the handle should come right to the wrist crease,
right there.
If it's down here, it's too low,
if it's up here it's too high,
you know, make your adjustments.
Usually aluminum canes are easy to adjust,
if it's a wooden cane, you can cut it shorter
but you can't cut it on.
- All right. Yeah. Thanks Brad.
The other thing you may wanna try
is some of the NSAIDs, non-steroidal anti-inflammatory drugs
- Ibuprofen-
- Ibuprofen, and we actually have a video
on how you might try to dose that don't we?
- Sure. Yep. Nice one.
- The other thing is you wanna make sure
you are keeping as much range of motion
in the hip as possible.
- Mm hm. - You know,
a simple one that we do, Brad,
is we have people lay down,
and if I'm working this hip, you know,
you can work in the flection this way, flexion, extension,
and you can do rotations this way, too, Brad.
- Sure, yep.
- I got tissues falling out my pocket, Brad.
- Yeah. - Making me cry.
- So again, with these exercises,
they shouldn't irritate it,
there may be a little stretch involved
maybe a little irritation
but the more you do it, it should feel better.
So if it hurts and it starts getting worse, as you do more
you're aggravating it and you need to stop.
- Yeah. And the other thing is with pain,
I'm staying in this position for a reason, Brad
I'm not just trying to look stupid,
(Brad chuckles)
with pain, quite often the muscles start to get a bit weak,
and that throws things off even more,
wouldn't you say Brad, you know?
- Sure. Right.
- So it wouldn't hurt to strengthen that hip either.
- Sure.
- And one easy one to do is what we call four ways.
- Okay.
- So you just lay on your side,
I'm gonna strengthen this one,
I'm putting this one bent,
just to kind of give me a little bit of a base,
and you can start doing hip abduction.
and I'm keeping the toe straight forward on that, Brad.
I'm not going this way.
- Don't point it up.
- Or I'm not going that way.
- Straight ahead.
So we're working this hip abductor muscle, right in here.
- Okay.
And then I can go onto my back,
and I can do hip flexion.
- Why don't you- - Do this one?
- Yeah. - Switch.
- So it's really good idea to keep this knee up,
like here,
gives your back and your pelvis some support,
it's easier to do.
- We can do hip adduction.
So I'm going up like this now,
and I'm strengthening the inside of the hip here.
- Sure.
- Same thing now, I don't turn the foot up,
I don't turn the foot down,
I keep it right in the middle.
- Yep.
This one's a kind of awkward to do.
- It is an awkward one.
Still good to do though, Brad.
- Sure. You bet.
- And then you can do hip extension.
So you're just gonna work on lifting up like that.
- And you notice how Bob keeps his leg nice and straight,
works out better that way.
That really works out posterier hip well.
- So now, really, we're gonna talk about now
rectus femoris tendonitis, Brad.
And that's where we think a lot of times
people are having trouble.
You have a muscle here that comes down off the pelvis here,
and off the A-S-I-S,
and it goes down and attaches into the femur.
And there's a tendon there,
and that one is, if you are laying,
why don't you lay down, Brad, one's flat.
I'll give you a pillow.
- Yeah, please. (Brad groans) A pillow.
- So if you, if you're tender, when you go like this,
- Knee to chest.
- Ow, it pinches!
- Yeah, it pinches.
That's more likely to be due to a femoral,
the rectus femoris.
- Right.
- Now, if it's acetabular syndrome, Brad,
what we do is we go into flexion,
a little bit of abduction
and then internal rotation like this.
- Right.
That's kind of hard to see 'cause Bob' in the way.
So we'll do it again.
- I'm going, I'm bending it,
I'm bringing it towards the other leg a little bit.
- Over there.
- And now I'm bringing the ankle out.
I'm turning the leg.
- Sure.
- If that hurts, that tends to be the first thing
we were talking about that-
- The true impingement.
- Yeah, the true impingement.
- Okay.
- If you just go straight up like this and that pinches.
- Yep.
- That may be more like, you know,
I'm thinking of that rectus femoris,
that muscle that may be more of a problem.
- Often come, hip flexor tendonitis,
- Hip flexor tendonitis.
If you flip onto your stomach, Brad.
And I'm testing this one right here,
and I have 'em push down,
just push down, this way.
- Oh yep.
That would be also, if that hurts,
that could be the second thing we're talking about again,
the hip flex or tendonitis.
- [Brad] Sure.
- Why don't we sit up Brad, real quick.
(Bob laughs) I didn't mean-
- I said quick.
- So if you wanna try, you know, to see
if that's actually the problem,
generally if you find the A-S-I-S,
the anterior superior iliac spine-
- That boney part.
- Wanna show it on here.
- Sure.
- So it's right there.
- [Brad] It's right around the belt line.
- Yep. You find it's the biggest bone sticking out there,
right?
- [Brad] Yeah. Yep. It's pretty easy to, to palpate.
- Yeah.
So you go about eight centimeters below that,
what is that in inches Brad, about 2 and a half?
- Right.
- About two and a half inches below that,
and rub right there.
That's where that tendon is.
And if it hurts right there
and it's hurting that in that area,
that's more likely that you have the hip flexor tendonitis.
- Sure. Yeah, because that's quite a distance away
from the impingement we're talking about.
- Yeah.
And that's actually a treatment you can do, Brad.
- A friction massage.
- Yeah. You can get yourself in a relaxed position,
and you can rub that area aggressively.
- Sure.
- For, you know, minutes at a time,
and that'll help break up that scar tissue and calm it down.
- Sure.
Then we got a video on that,
dedicated to that as well.
- Yeah. If I remember I'll
I'll try to hook that up at the end of yourself.
- Okay. Sounds good.
- All right, remember Brad,
we can fix just about anything.
- Oh yeah, except for-
- A broken heart.
- There you go.
That's pretty good, Bob. You remembered that.
You're getting older. (Bob chuckles)