- Today I'm talking about hip pain.
Now maybe you have hip pain
and your concern is that your pain could be arthritis
or some other joint problem.
So in today's video
I'm gonna explain everything I can about hip pain.
So by the end of this video
you can leave it knowing exactly how to test
and what you can do about it
to help relieve some of your pain.
Quite often people come in saying they have hip pain
and their concern maybe like yourself,
is that it could be something to do with the joint.
But there's three places
that people often say they have pain.
So if I just show you on my spine,
so this is a human spine.
As you're looking at it right now, this is the front.
So the stomach would be here.
This is my right side
and then as I come around this way this is towards the back.
So people will either feel pain towards the front side
of the hip, the outside
or towards the back in towards the sort of buttock region.
Now this is kind of the structure of the hip joint.
So this here is the socket, this is where your hip joint is.
So it's known as a ball and socket joint.
So if I put that down and pick this model up instead,
this is a hip joint.
So this is the right leg.
So as you're walking, this is how it would look.
So as I come...
This is the outside here.
So as you're walking, this is how it moves.
So this is your pelvic bone here,
this is the front and this is the outside.
As you can see, there's a lot of movement
that can happen through this joint.
These blue structures here
this is called the joint capsule or the labrum.
So the labrum is just in there
and then the joint capsule goes around it.
All of these red markings that you can see here
this is where the muscles start.
This is where muscles start from
and then they come down
and attached to where all of these blue markings are.
So as you can see,
there's a lot of muscles that attach to the femur,
your thigh bone.
So if we just talk about the three different locations
that people feel pain, the first is at the front.
There's a few different things that can happen
if you feel pain at the front.
This is where you would most likely feel pain
if you had a joint problem such as arthritis.
So just to clarify
that would be more towards into the groin.
So as you're looking at me here
that pain where you would feel in the groin.
So if you have groin pain
there's a chance that it could be joint related.
If it's not, then it could be your joint capsule
or the labrum that goes around the joint itself
or it could be your hip flexor muscles.
So you've probably heard the term hip flexors a lot before.
Not many people actually know what that means.
So I've now added in the hip flexors.
So I'm just...
You're still looking at this from the front.
So this is still the right side here.
This is the inside of the pelvic bone.
And just to be clear, that's here.
So that's inside of this here.
So the muscles that we commonly refer to as the hip flexors
are two muscles
collectively known as the iliopsoas.
So it's made up of two muscles,
one is the iliacus and the other one is the psoas.
Now this muscle here
actually comes up and attaches onto the spine
but it's obviously being cut.
So this muscle comes down
and attaches to the inside of your thighbone just here.
So it's quite common that if you have a hip flexor strain
or any other muscles on the anterior, so to the front side,
that can cause you groin pain.
So if you feel pain at the front, that could be muscle,
it could be the joint capsule or the labrum
or it could potentially be arthritis.
Now, the second place that you could feel pain
is more towards the outside here.
So if I show you on my model again.
You could feel pain on the outside of the hip.
Now, whenever anyone comes in saying they have hip pain
and they tell me it's on the outside here
where this bony bit is, you can feel it.
As you run your hand down, you can...
So there's pelvic bone there.
As you bring your hand down you can feel a bump,
a bony bump, that's this part of the bone here.
So anytime someone comes in they say,
they've got hip pain and they refer to this outer part,
I know for a fact that it's not the hip joint.
What it most commonly can be is a tendon or a bursa.
So just to clarify, if I add in some of the muscles.
So now I've added in your glute.
These are called...
People refer to these as glute muscles.
So these are your gluteus minimus and medius.
So there's two muscles here.
As you can see, they take up quite a lot of space.
They come down and attach to the outer part
of this bone here.
So now you're looking at it from the back,
they attached to the outer part of the bone.
Now people can be very tight through these muscles.
This is primarily due to just the way we move.
We're always sitting
or we're just very rarely stretch out these muscles
so we can get very tight.
And then something happens such as a repetitive movement.
Let's say you've gone for several long walks in one week
or you've started training
and you started doing more running
or you've just generally just started moving
or even stretching more than usual whatever it is,
it tends to be that you've done more of something.
People will then feel pain around this outer part.
So you're looking at it right now from the back.
Quite often, people can feel pain anywhere
from the back part to the top part of this bony bit
round towards the front.
So it tends to be the whole kind of semicircular area.
So where these muscles attach this is tendon.
Now, obviously it's red here
but tendons have like a more of a whiter appearance.
So I see quite a lot of people with pain here.
Moving further round to the back.
So this is now still the right hip
and you're looking at it more from the back side.
You can see that there's now more muscles
that I've just added.
These muscles are your rotators of the hip.
So they help to externally rotate your hip, your thighbone.
Again, many of these attach to the thighbone
and they can also become very irritated.
There's also a nerve that comes out here
and runs down the back of your thigh
this is called the sciatic nerve
and this can become very irritated in people as well.
So people with sciatica
have an irritation of this big thick nerve.
This muscle here is called the piriformis.
Many people have heard of the piriformis.
Anytime they have pain in the backside
they say that could be
because it's their piriformis is in spasm
or the sciatic nerve is being pressed on by the piriformis
and yes, that can be true.
The sciatic nerve comes out around here
but what could...
But it could be that
but it also could be any of these other muscles
that come around this area too.
So it might not just be that piriformis.
Anyway regarding hip pain, I'm not gonna talk so much now
about the backside of the body.
We're only gonna focus on the outside and the front.
So now I'm gonna show you a couple of tests that you can do
just to differentiate between hip joint
or muscle and tendon.
So the first thing you can do to test if it's your hip joint
is bring the bad side foot.
So if it's my right hip that's caused me pain
I'll bring my right foot up above my knee
and then with this, the bad side knee
I'm gonna drop down towards the floor
and what we're looking for is either pain
through the hip joint
or for the knee to be able to come
almost parallel to the floor.
If you find your knee is up here or it's causing you pain
from anywhere from this point to horizontal
then the chances are that could be your hip joint itself.
So now if we want to test
whether it is the soft tissues such as,
a tendon or hip flexors.
So we bring the good side up towards the chest
and what we're looking for here is, does this bad side,
the leg that is straight, is that lifting up off the floor.
If you are...
If you bring in the good knee up towards the chest
and then you're seeing that this knee is lifting off
then that indicates that there's a shortening
of the hip flexors.
So that could be spasm
or it could be just some kind of overall muscular tightness.
So ideally you wanna be able to keep your knee down
as you bring your good side up towards your chest.
Now, if you move on to the side of the hip
one of the most common tests the I use on people
and you've probably seen this
in some of my other videos as well,
is this one here.
So if you're sitting on a chair
bring the side that you want to test up.
So bring this foot up, place that on your knee
and what we're trying to do
is to see how low this knee can drop down.
Now, this in itself is difficult for many people.
Some people haven't even got the flexibility
to bring that foot up onto their knee.
In which case it's highly likely
that the pain on the outside of your hip
is due to muscular tightness.
If you can get into this position
then push your knee down as far as it will go.
What we want to be able to see
is to get that shin bone horizontal,
get that parallel to the floor.
So if you do have pain in the outside of your hip
this would most likely cause you some discomfort
or a sense of stretching.
And of course, the other thing we can do
is just simply press into the bone or just above the bone.
Quite often when I do that there's very tender
in a lot of people.
That tenderness simply just means
that there's inflammation or tendonitis.
There is a possibility that it could be some inflammation
of the bursa as well.
It doesn't matter whether it's a tendon or bursa
if you're pressing there it's causing pain.
The point is that the muscles above are too tight
and need to be relaxed.
So as well as that being a test
you can also use this as a stretch.
If you can get your leg up here, then that's great.
Hold onto your shin to stop your foot falling off your knee.
You can either use your hand to push that knee down
or you can use your elbow.
If you want to intensify that stretch
then what you can do is lean forwards.
Also, what you could do is adjust the height of your seat.
The higher the seat is
the less intense that you're gonna feel it in that hip.
As you lower it you're starting to bring this knee up,
so it causes more movement through that hip joint
and so you feel that stretch is a lot more intense.
If you're using this as a stretch,
I would hold for 20 seconds
and build it up to 60 seconds over time.
You could do this every day
as long as it's not causing you pain.
So for example, if you're doing it every day
and you're feeling like the pain is getting worse
then just ease up.
Do maybe every other day and see how that feels.
If it's still painful
then just maybe once or twice in a week
but you wanna just keep that joint moving,
keep those tendons moving
because through here there's gonna be inflammation.
So the last thing you wanna do is
repetitively move those tendons or put load through them.
So keep everything very minimal
in terms of the amount of movement or the amount of stress
but keep them moving.
So cycling on a stationary bike with very low resistance
can be really beneficial, swimming or just walking
but for no more than 30 minutes at a time.
So if you wanna stretch your hip flexors
or you wanna stretch the muscles at the front of your hip,
let's say you are able, you...
Let's say you are able to kneel down on the floor.
What you're gonna need is a towel,
unless your floor is padded
but mine is obviously a hard floor so a towel.
The hip that you are trying to stretch
that knee goes on the towel,
from there the good side you step forwards.
Now this bit is really important,
with your hips what you don't wanna do
is be sticking your bum out
because that's going to shorten this muscle
and it's gonna take away that intensity.
So just start kneeling on the floor,
tighten up your abdominals
and tuck your tailbone underneath you.
It's like you're trying to push your hips forwards.
So keep that tension through here.
Don't let anything slack off and don't let your hips...
Don't let your bum stick out the back.
So tighten up here, big step forward with the good side
and then lunge forward
keeping that tension through here.
What you should feel is a stretch going through the front
and possibly down the thigh.
This is just the quad muscles stretching
or the tendons up here of the hip flexors.
So I would do that for 20 seconds
over time you can build that up to one minute.
I would say, do that every other day.
That's quite an intense stretch.
So the last thing you wanna do is push that too much
and cause any more tendonitis.
So just to reiterate, this is for your hip flexor muscles.
So if you have any sort of joint pathology,
such as arthritis,
this is not what you wanna be trying to do.
You wanna be only doing this to stretch the muscles,
the hip flexor muscles.
So if you find that you can't do that stretch kneeling down
'cause it hurts your knees you can do this standing up.
Find a wall just for stability
and the side that you want to stretch.
Take that foot back as far as you can.
Now you can keep your heel off the floor.
You don't have to have it fixed onto the floor
'cause you might not have the flexibility in your calf
or your ankle.
So either heel up or heel down doesn't matter.
From there just holding onto the wall,
tuck your tailbone under, engage your abs
and then push your hips forwards.
So what you're not doing is leaning back.
You're keeping your spine nice and stable
and just pushing your hips forwards.
So from here you should feel a bit of a stretch
trough the top of your thigh, maybe into your groin
but you shouldn't feel any pain
or compression through your spine.
So again, abs tight, bum squeezed, hips forwards and hold.
So now that we've been through those stretches
and been through those tests,
hopefully you have a better idea
of what could be causing your hip pain.
So my suggestion is go and try those stretches,
go and try those tests.
Stick with those stretches.
If you decide that it is muscular
that's causing your problem,
then stick with those stretches for at least a month.
Maybe every other day for at least a month.
As it starts to improve
the next step will be to start to strengthen it
and that will be something we'll touch on in another video.
But in the meantime, if you do have anything like back pain
or you wanna see some more hip stretches
then go and have a look at these videos
that I'm showing you on the screen right now.
So stick with it and I will see you in the next video.
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