Hi guys! This video is about hip flexibility and how to improve it when you've got osteoarthritis
in your hips. So, what we're going to look at is: why osteoarthritis can make your hips tighten up;
how to get rid of that tightness; why you need to time your exercises right, because if you do them
at the wrong time of the condition then it can be actually making it worse; and then lastly,
I'll demonstrate some movements that you may use to improve your hip flexibility. So,
my name is Maryke. I'm the physiotherapist from sports-injury-physio.com, where you can get online
physiotherapy assessment as well as treatment for your injuries. So, have a look at the description
of this video if you want the link to my website. Excellent! So, why does osteoarthritis cause your
hips to become stiff? Most of us, as we get older, will have a little bit of osteoarthritis
in our joints. And how much you have of it or how severely it's affected can vary quite dramatically
from person to person; and it depends on things like your genetics, your lifestyle,
other illnesses you have; if you've had previous injuries, for instance, you may find that you've
got osteoarthritis in one hip and not the other; and it can be because of things that you've done
to it. But when you have osteoarthritis, it affects your cartilage and your joint and the
capsule and everything. Now, one of the biggest reasons why the joints become stiffer is that it
thickens the capsule – so, the capsule surrounds the joint, so it pulls the joint together – so,
you get a decrease in your joint space as well, so it's not as easy for the joint to move. Then,
you can have little bony bits that grow out of the bones and out the sides of the joints, and
if these stick into each other or into the joint when you move it, that will restrict your range
of movement; sometimes they grow into directions where you don't even know about it and it doesn't
affect you at all. So, it just depends on which direction they decide to grow. And then lastly,
it's often also because of a lack of movement. So, the more painful your joint becomes, the less you
move it; or maybe it's lifestyle, that you've got a quite sedentary lifestyle with work and
things like that, that you don't actually move your hips through your full range of movement;
and then, because you've got the osteoarthritis in there, it becomes stiffer and tighter more quickly
than somebody who doesn't have it. So, how do you get rid of it? Movement is the main way that you
can get rid of it. You may not be able to get your hips fully flexible if you've got osteoarthritis,
because there may be changes that you can't reverse, but your best chance of improving
your flexibility and keeping your movement is by moving it often. Now, it is important
to time your exercises right, and this is because osteoarthritis has kind of like active periods and
dormant periods. And during active periods, you can get active inflammation in the joint capsule,
the lining, and other bits that surround the joint; and if you're going to do stretches and
strong movements or exercise during that period of time, you can make your symptoms worse. But then,
once it's flared up a bit, it may calm down again, it usually calms down again. And at that point,
you may just have a bit of a niggle, and it may just feel really stiff, and that's the time that
you can do stronger stretching movements and kind of push the exercises a little bit more,
but always with caution. So, important: If you've got a red, swollen, painful joint,
that's the time to do gentle movements; repetitive movements can help for that,
but no strong stretches. But if it's just a niggly joint and it just feels a bit stiff, then
you can do slightly stronger stretches and stuff; you've just got to test what works for you. Okay,
so what things can you do to improve your hip flexibility? I'm gonna explain a few things that
you need to watch out for first. Let me just just get this up again, because otherwise I'll forget.
Repetitive movements are often a better option than strong, sustained stretches. And the reason
for this being that often, when you take the joint into positions, you may feel that as you take it
in - and I'll demonstrate the per exercise as well - you feel a restriction there; and it can
be those little bony points I spoke about, or growths that you get, the osteophytes, and if
you keep on squashing that really hard, you can actually irritate it and cause inflammation. So,
it's much better to just gently stretch things and take it out of the position and see how it feels.
Also, the joint can be quite sensitive because it's got osteoarthritis in there; so, another
reason why it's better to use dynamic movements rather than strong, strong stretches. Then also,
I find, even if I ask my patients to do a stretch really gently, they tend to get frustrated with
how stiff the joint is, and they tend to really pull on it, and that can irritate it. So,
be really gentle with it at the beginning. Get to know your joint, get to know what it likes;
and often you'll see better results if you just take it to the first bit of restriction but repeat
that movement. Then also, something that people don't realise often is that you can actually get
really good strength gains through ... or range of motion, movement gains through doing strength
training, because there's quite a bit of research out there to show that eccentric muscle action,
where the muscle lengthens as you contract it, brings about better changes in your muscle length
and stuff over time, so, better flexibility. But we're also looking at joint capsules here,
so we do want kind of slower movements in and out, just repetitively throughout the day would
be useful as well. Good! So, we're gonna look at four main directions for the hip to move:
forwards, backwards, turning in, turning out. Now, usually when a joint becomes stiff through
hip osteoarthritis, you lose your internal rotation first ... or most ... most of that;
that's most restricted. Then, external rotation as well, extension, and flexion is the one that
usually stays with the best range of movement there. So, I think ... Which one will be easiest?
Let's demonstrate extension first, because I don't have to shift so many things, I think. So, let me
bring the camera down a bit … and you can see me ... perfect. Okay, so when we talk about extension
of the hip, it's how well it moves backwards. And for me, one of the easiest things, or the best
ways to do this, is this kneeling stretch that you can do in this position. If your knee doesn't like
you being on it, you may have to do it in standing or just place loads of soft things underneath it,
but please don't go and irritate your knee so that you've got a sore knee and hip in the end. So,
what we want to do is, we want to stretch the front of the hip joint with this. So, you're
essentially just going to lean into the stretch until you feel the movement there. And remember,
we spoke about repeating a movement rather than holding it for a very long time. So, we're gonna
hold it for about 10 seconds or so, and then come back out, and then just come back in for about 10
seconds or so. Now, watch out that you don't extend your back as you do that, because then
you won't feel as much of a stretch. So, keep your tummy muscles in, don't allow your back to extend,
and just move the hip forward – so, this bit – and feel the stretch kind of over this area. So,
that's a really handy one to do for the front of the hip. Let me just show you how to do
it in standing as well. So, if give me a moment, I'll shift this back, then you should be able to
see more of me. That's better, yes. Okay, so if we're doing it in standing, you'd have one
leg in front of the other, and I'm stretching this hip. So again, exactly the same thing;
you kind of lunge forwards and then you push your hip forwards. So, that's a really good one,
and you can, even if you bend the hind leg, you can just ease into that stretch a bit more if you
wanted to. But yeah, you can play with it there; that's essentially the movement that you want to
be doing for it, okay. So then, if we look at the opposite movement: So, we've stretched the front;
now we want to stretch the back of it. So, the easiest one there is really in lying. Start with
it, and just taking ... Come on camera, focus; here I am. There we go! So, you'll have your one
leg flat - I want to stretch this one - and we'll just pull the knee straight up. Now,
often, for hips that have osteoarthritis in it, this position, you could feel a squashing in
your groin. So, don't force it; just take it to where you want to, where you can feel it gently,
and we're looking for a stretch over the back of it. So, if you're finding that really squashes in
the front, and you're not feeling much at the back, then you don't really need the stretch
because then these things are flexible enough. So, that's one way that you can improve your hip
flexibility. So again, it's about movement in that position, okay; that's the type of thing you do;
and then the other side as well. But if you wanted to do this in standing, a typical exercise that
can help you improve your hip flexibility that way, would be actually a squat, to be honest;
because if you look at this; if I go down into a squat, we're getting a lovely flexion,
so it's the same as if I've been pulling that up. So you, by doing repetitive squats,
you can also improve that range of movement. Now, the next one is … Let's do external
rotation first, so, turning the leg out. And I'm actually gonna change my position that I lie in,
that you can see from this angle. so, let me just see what's the best. Okay, so ... With this one,
I want you to be really, really gentle. The first step is literally just to place the leg onto
there. Now, if you've got a really stiff knee, it may actually be sticking there, that it doesn't
even want to go out, but the aim is to just gently get it out there. Now, often, my patients find,
if they just bring it into the position, that already pulls a lot. If that's the case,
there's no need to go pushing it out, because you're already getting a stretch there, and you
may actually over-stretch if you're going to go push it out quite hard. But what you could do is,
you leave it there for a few seconds, change over and do the other side, and come back and do this
one. And this is one that I often get people to just, if it's already tight just in that position,
I just get them to lie there for about 30 seconds or so before they change over. So, this one I do
do as a static stretch. If you don't feel much like that, you could just increase the stretch
a little bit like this, by moving it with your arm. But again, don't kill yourself off. And if
you comfortably can get to that position, then I would say, go into the full stretch and see if you
can actually bring that leg up as well. But now, if you put your leg on there and you're like this,
and you're really struggling with it all, honestly, there's no reason why you should
be lifting this bit up. Then first work on this to become more comfortable, otherwise you'll just
over-strain. So, that will stretch or help your leg to turn out in this position. But now, we
also have to turn it in through that position. And for that, the easiest is actually to do it on your
stomach. So... I'm gonna turn a little bit this way; let's see if this works without showing you
all my underwear. OK, so in this position, all you do is, you let your legs drop out. And it's quite
a nice one, because you can just lie there and repeat this a few times; and then you can allow
it to hang down there for a bit. But again, don't let it lie there for about 30 seconds or so, it
will be too sore when you come back. Rather just go for shorter holds, so, five to ten seconds,
and use movement to do this. So, that will help or can help to increase your range of movement
for your internal rotation. If it is putting on your socks that's your main issue, that you can't
reach your feet because ... to put your socks and your shoes on, then the two movements that's
most important is improving how well your hip can come up as well as that external rotational one,
because those are the two movements that really allow you to get down to your feet. Let me know
if you've got any questions. And if you want more help with your injury or you would like
to have more detailed descriptions of how you should do your stretches, you're welcome to
consult me via video call – link to the website is in the description of this video. Take care!