In this video I'm going to show you the top five worst exercises that you could
be doing if you've got painful bone on bone hip arthritis. The last exercise is especially bad,
and it's often recommended by healthcare professionals. If you've ever seen a doctor
or a physical therapist, you may have been given any one of these exercises.
And if you're still having hip problems despite trying to do exercises to correct the hip problem,
this may be the reason why your hip arthritis is getting worse. Despite doing exercises,
I've got a great video covering the best exercises that you should start doing right now if you've
got bone on bone hip arthritis, you can find the link to that video in the description down below.
My name is Dr. David Middaugh. And I'm a specialist physical therapist at El Paso manual
physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile,
while avoiding unnecessary surgery, injections and pain medications.
Please consider subscribing to our channel so that you don't miss out on any of the helpful videos
that we post every single week. Before we get into the exercises that you should not be doing.
If you've got bone on bone hip arthritis, let me give you one piece of information
that connects all these exercises and why they're bad for your hip arthritis.
You don't want to increase pressure inside your hip joints. I've got my skeleton here.
And here's a hip joint right here, let me get a little bit closer to the screen.
When the pressures increase in the hip joint where the ball gets sucked into the socket worse,
or it gets shifted forward or backwards in a direction that it shouldn't be because it should
be seated into the center of the socket, the ball should be right in the middle of the socket,
that's where it's going to be most congruent and where the joint moves the best.
But if you've got muscle imbalances, or muscles are too strong on one side of the body,
then it can cause excessive compression start to rub the cartilage in the ball and socket joint
inappropriately. And when this happens over time over the course of months, years or decades,
or that's when you develop hip arthritis. And if it gets bad enough,
then you might be talking to a surgeon about the possibility of having a hip replacement surgery.
But the good news is if you don't have your cartilage too far gone, if you can still do
certain things like you have some decent hip motion and you can stand and if you can be on
your feet and walk for a while, then you might be in good enough shape to do the right exercises to
progress your hip to be able to get back to normal again and avoid having hip replacement surgery.
But if you're trying to exercise is what I'm going to tell you next you don't want to be doing
the first exercise that you see in just about every physical therapy clinic for
any patient that's got a hip problem is marching, seated marching, especially.
So the way this exercise looks is you're seated in a chair just like so. And you're told to just pick
up your feet and march in place just like this. You might do for reps or for time, you might
go you know, 50 reps, 30 reps, or go for a minute or two, whatever is appropriate for
your fitness level. Let's see the problem with this exercise is you're using your hip flexor
muscles are the muscles that are on the front of your hip. And if we go back to the skeleton,
the hip flexors run from this part of the hip bone
over the bones here and the attached to your back and on the inside of the pelvis right here.
And when that muscle becomes dominant, it tends to pull the ball up into the socket
and rub the front edge of the joint right here. That's the most common reason for hip arthritis.
Some people also have hip labrum tears. It's a chunk of cartilage. It's on the outside of
the hip joint right on the edge of the hip joint right here. And that's because of that excessive
pressure right there from over dominant hip flexors. And now if you've got over dominant
hip flexors, then you probably don't have very good glute strength, but muscle strength,
and that's what will tend to pull that ball in the socket better so that it alleviates
your hip problem takes the pressure off and helps your arthritis heal.
Seated marching may feel good in the moment like many of these exercises will,
but in the long term, it's strengthening the wrong muscle group and is going to be feeding into the
problem. And it could be the reason why you still have hip pain despite trying to do exercises.
The second exercise that is just not good for your hips situation is knee extensions,
especially resisted knee extensions. The Extensions look like this, you're
straightening out your leg and you're trying to fire this muscle as hard as possible. And
sometimes you've got a weight on your lower leg down here, maybe an ankle weight.
Or you might even be on a machine where there's a pad right here and you're pushing that pad into
some resistance so that you strengthen both of the muscles in the front of your thigh.
The problem just like with the marching is that one of those muscles that are in the front of
the thigh crosses the hip joints and can add compression to that ball and socket joints. And
that's exactly what you want to avoid. In order to combat arthritis. You need to take pressure
off joints because they've been overloaded for too long, and so strengthening a muscle that
adds more pressure to the joint just is not good in the long term for that joint.
The third exercise you shouldn't be doing is technically a stretch. But I count as an exercise
because you can trick your body into firing the muscles while you're trying to stretch. So intense
stretching is what I'm talking about. The most common stretches done for hips are these three,
this one where you're pulling your foot back towards your bottom and
stretching out the front of your thigh. Or where you put your leg back this way, you
might do this one on the floor, or up on a bed, some surface like this, and you're pushing this
leg back to stretch the front of the hip on my left side of this case, a leg that's on the table.
And another common one that's done is a butterfly stretch where you're sitting
kind of like this, your feet might be together soul, the soul, you're trying to push your hips
down this direction to move it out. A fourth one that you do see
frequently as well, is where you cross a leg over this way, and you're pulling in this direction.
But here's the thing with these stretches, they're all okay stretches to do. But not intensely,
there's a special reflex in all of our muscles, you can Google this and look this up,
it's called the stretch reflex. There are little cells inside all our muscles that are
called muscle spindles. And in the tendons of these muscles are called Golgi tendon organs.
These cells are important for protecting the muscle, they keep the muscle from tearing
the tendon from tearing. And if you do a big stretch on any muscle, what happens is
it causes the muscle to contract a bit. So now you're exercising it when you intend to stretch.
If you cross a certain threshold, and those cells are activated, the muscle spindle, or the Golgi
tendon organ, then the muscles going to begin to activate, which is going to work it out and
potentially feed into the problem, especially on those stretches where you're stretching the
front of your thigh, you're going to technically be strengthening that muscle in the long term.
Now this might feel good in the moment when you do it because you feel more flexibility,
it might move your joints in a way that it hasn't been moving. And that generally feels good for
most people. But you're technically feeding into the problem by strengthening the muscle that's
adding compressive forces to the hip joint. So you want to avoid doing this on a regular basis.
A better solution is to do light stretching. And to give you an idea of what light is, compared to
intense stretching, if you just simply put it on a zero to 10 scale, like zeros, nothing, you don't
feel a stretch at all. And then 10 is like the most intense stretch you've ever felt you might
even hurt yourself, if you go 10.5 or further, you want to stick at like a two or three stretch
intensity, don't go any farther than three. And it's going to feel really like you might
even feel like you're not doing a whole lot, you're just on the edge of a stretch,
it's a mild stretch. But if you can stretch it, that intensity, then you actually do
good on your muscles where they start to lengthen gradually. There's tons of research to show that
low intensity stretches are much better for flexibility than high intensity stretches
because of the muscle spindle and the Golgi tendon organ reflex that I've been telling you about.
So watch out with very intense stretching, stretching, okay, but don't make it an exercise
for yourself that feeds into the problem. The fourth exercise that is just not good for your
hip arthritis is a lunges. Now this one's commonly given by more ambitious physical therapists, or
sometimes personal trainers out there that usually mean very well to try to work on your balance.
But if you had hip arthritis, and that ball and socket joint is just
not positioned very well and you're trying to work on your balance before getting the ball to center
into the socket, then you're spelling disaster for yourself, you're going to potentially rub the
joint inappropriately. So lunge looks like this. You're standing with your feet staggered,
one foot back, one foot forward, and then you're trying to drop your knee down in this direction
and back up. And you might walk and do this and take the next step. Or you might stay in
the same position and do multiple reps like this. Either way, this requires quite a bit of balance
quite a bit of strength. And if you find yourself wobbling and your hands are going over the place
and you're having to grab on to stuff, you need to back off that lunge exercise, because just picture
what's happening at your compressed hip joint. When you're doing all that wobbling to balance
yourself, your poor hip joint is just moving back and forth like this, it is not controlled,
and you're going to rub that joint inappropriately which is going to progress
your hip arthritis gradually over time if you keep this up. And the fifth exercise is
by far the worst exercise in my opinion. It is straight leg raises. And you see this exercise
all the time in physical therapy clinics. People love to do it and you let me just
explain the intent that I think most physical therapists have in anybody prescribing this
exercise to their patients or to their people that they're helping out with hip arthritis.
They're thinking of all the directions that the hip joint moves and now because it's a ball and
socket joint, you can move your hips forward, you know, you can go this direction, you can
move your hips backwards in this direction, you can go outwards and across your body this way,
and you also have rotation, inwards and outwards. And so what most healthcare professionals in
general are thinking is to strengthen all directions of the hip joint,
not fully understanding and appreciating muscle imbalances, and their influences on
that ball and socket joint and how they over compress the joint. And the number one muscle
that gives tons of compression to that hip joint tends to be those hip flexor muscles.
Specifically, the psoas muscle, that iliacus muscle which are typically grouped with
together the iliopsoas muscles, what it's called when it's grouped, and the rectus femoris muscle,
which is technically a quadricep muscle, it's a muscle on the front of the thigh.
But because of its attachment point, it crosses the hip joint and can very much influence the
hip joint into the muscle that goes along with those as a TfL or tensor fascia Lata muscle,
it can also act as a hip flexor, and that one can be very painful when it gets flared up.
But it compresses that hip joint and rubs the edges of it together. So the
straight leg raise looks like this. Typically, you're going to be lying down on your back.
And you're told to pick up your leg straight. It's a straight leg raise it is exactly what it sounds
like. And you'll be told to do several reps. And guess what you're going to feel the muscle
right on the front of the thigh, possibly on the side of the hip, like right here where the
front pocket is that's a TfL muscle right there. You're going to feel all those muscles working,
and you're going to get false feedback. What I mean by that is, is your healthcare professional,
whoever's overseeing you on this exercising told you to do it
is going to say, Do you feel it in your hip flexors? Do you feel a burn in that muscle?
And you're going to go Yeah, I feel it every time I pick up my leg, you know, rep 29, 30, 31.
As you keep going your reps, the muscle gets more and more tired. And so when your
healthcare professional seeing this tells you Good job, you burn the right muscle, then you
think you're doing the right thing. But over time, you're worsening the problem because that's the
muscle that got you here in the first place. Listen, we've got a whole playlist of hip
arthritis videos to help you out. It's got tips, advice exercises,
go check out the link for that playlist in the description below. And there's exercises
in there too, that you should be doing that are focused on the right muscles. You can test them
out for yourself and see if they're helping you out. You should feel like you're getting better
within a day or two after doing the exercises. If you thought this video was helpful, give us
a thumbs up and if you have any questions, drop it in the comments below and we'll get back to
it as soon as we can. Thanks so much. Have a great day and we'll see in the next video friends. Bye