In this video I'm going to show you how to walk right? If you're suffering from bone on bone,
hip arthritis, people suffering from hip arthritis often come to the conclusion
that they're doing something incorrectly with their walking, because they're hurts
to be on their feet for so long. So they often ask us here in the clinic or online,
what am I doing wrong? And how can I make my walking better? Well, in this video, I'm going to
show you step by step what you need to do to walk better. So stay tuned and watch this whole video.
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 week.
Just to be clear, I'm talking about osteoarthritis of the hip. Now rheumatoid,
not psoriatic arthritis or juvenile arthritis, or we're talking about osteoarthritis. So the
type of osteoarthritis, it tends to come on, for people that are in their 50s 60s, usually 70s
70s, or 80s, or beyond, if you've been diagnosed with hip osteoarthritis,
then you probably have had an x ray where they showed your ball and socket joint of your hip
and you have a reduction in space in there. And they're probably they're probably telling you
that your cartilage is wearing away as well. And that you might have a bone on bone hips situation.
And in order to give you the best shot at avoiding surgery, if you can, which most people can,
even though they've been told they have a bone on bone hip arthritis situation,
you've got to learn how to walk correctly. If you're walking around, even if you're in pain,
if you're limping, if you're using a cane or a walker to walk around right now, you've got to be
using your muscles properly to make sure that you take the forces off the hip joint
that are causing the hip arthritis problem that bone on bone hip arthritis problem,
so that you can begin to allow that hip cartilage to heal and put yourself in the best situation to
naturally heal your hip arthritis and avoid a surgery or having to use the medical system in
general, further because your hip is feeling better.
Now a prerequisite or what you need to do first, before we talk about walking is we need to
make sure that you can use your butt muscles. I know this sounds kind of funny and interesting.
But a lot of people can't squeeze their butt muscles, their glute muscles
without tightening the front of their thighs. Let me show you what I mean by this.
So take a look down here what I mean is this muscle back here, the gluteus muscles,
gluteus maximus minimus medius. And there's other deeper glute muscles
to those, you need to be able to contract or tighten all of these muscles back here, apart
from the ones on the front of the thigh right here. So when people squeeze or bump muscles,
because that's triggered out to do with the walking, you need to keep
this relax. And as you can see my knees here. If you lock out your knees like that tends to fire
the front of the muscles, the front of the thigh muscles right here. So you have to think about
how can I tighten these muscles back here, while keeping these muscles right here on the front,
loose and avoid locking out your knees to tighten up the front. You don't want to be doing that.
So you have to think long and hard about when you stand up does can you tighten up back here
and tighten both sides first, without tightening up the front. If you cannot do this, and you've
got to stay here and just practice this, don't go on to walking until you get this straight.
If you can't separate that contraction between your glutes and the front of your thighs,
the quadricep muscles or quads for short, then do not proceed into walking because
chances are you're going to be using your quads too much when you walk.
The reason for avoiding using your quads and avoiding locking out your knees is that when you
lock out your knees like that it causes excessive compression or too much pressure at the ball and
socket joint of your hip and that's what feeds into the bone-on-bone hip arthritis situation. But
if you can use your glutes better than it puts you in a situation where you're taking that pressure
off the ball and socket joint at the hip. And if you can consistently take steps using your glutes.
Now you're in a position where walking is potentially helping you out rather than
hurting you. Versus if you're using your quads too much it's hurting your hip joints. And you want
to avoid walking until you get good control of those glute muscles apart from the quad muscles.
Now if you're in a position where you can fire your glutes apart from your quads, the next part
is I need you to be able to fire your glutes independently of the left to the right side.
So want you to stand up right now and think about squeezing both glute muscles as tight as you can
then see if you can just squeeze the right side alone you might need to lean your weight over to
that side, too. Make your work better, and then do the left side as well. And if you can tighten
the left and the right individually, then you're ready to go walking. If you can't tighten left
and right individually, don't walk, because you're going to be tightening up both sides.
When you walk, you have to have individual control of those of those glute muscles.
And apart from the quad muscles, of course, the next step is to be able to fire the glute muscles
at different intensities. What I mean by this is, if you stand up and squeeze both glute muscles at
100% intensity, you should feel them tightening up, they should start to get pretty stiff in
those muscles, that would be 100% of what you can do maximally then fire in about 50%.
There's no real way to measure this, we can't put a meter in you and say, Oh, that's 50%,
you just have to guess what 50% is for yourself, then go down about 25%. And
play with the percentages here about 2550 75 and 100%. The reason for knowing the intensity here
is because with normal walking, you want to be in about the 25 to 50%
intensity range. More on this in a bit. When we take you out into the hallway to walk with us.
What you want to avoid is tightening up these muscles 100% Every time you walk,
because you're just not going to last long, you're going to be more likely to compensate.
Usually when people have trouble separating their glute muscles from their quads, when
they tighten them up, is there, they're usually tightening way too hard. It's causing everything
to contract the same time. And so you have to be able to fine tune how much you're contracting
so that you can isolate muscles a bit better. Same goes for left to right, if you can fine tune
how hard you can track the muscles, then you can isolate left to right rather than squeezing both
intensely inadvertently because you're just squeezing way too hard. And the other reason is,
you need to be able to squeeze proportionately. In other words, if you're just doing simple walking,
like you're walking through your house, or to the bathroom or to the kitchen, or you're just walking
at a leisurely pace, casual pace to through the store, you need to despair at a low intensity
every time you're using these glute muscles. But if you're carrying something that's of
significant weight, or you're having to push or pull something like maybe a full shopping cart,
or you're having to exercise and use those glute muscles, then you do want to fire more intensely,
more like at 50 to 75, or possibly even 100% If you're doing something of maximum intensity,
right. So you should check now that you can fire your glutes apart from your quads, and that you
can fire your glutes left to right, and that you can fire your glutes at different intensities.
If you clear on all of those things. Now we can go do walking and it's going to benefit your hips. So
come on over with me. Now that we know you've got good control over your glutes, we've got to set up
your standing correctly. If you look down at your feet, and you point your toes straight forward,
and then think about tightening your butt muscles as hard as you can go 100%
Think about how that feels, how the muscles are tightening up, then point your toes out
of it just like this. And then squeeze the muscles there, they probably will contract a lot better,
you'll get a better contraction out of those glute muscles. And then if you turn your
feet all the way in, try to squeeze the muscles there and they probably don't contract as good.
The reason for this is because when your legs are turned out, it shortens the glute muscle a bit,
the more your leg rotates out, your glute muscle goes this way, and it puts it in a better position
to be used. So if your feet are coming inwards, then it stretches the glutes out and it puts
them in a worse position to be used. So what I want you to take away from this is that you need
to be walking with your toes a little more out than you probably have been.
If you have not had good glute strength. If you're dealing with hip arthritis, then you need
to be using your glutes more during walking and turning your toes slightly out is going to help
tremendously. Right now that we've done all that prep work, let's get to walking. When you take
your first step, of course toe doubt, I need you to think about as your body weight lines up over
your leg and you start to put pressure on that leg, tighten up the button muscle on that side.
Then as you take the next step, of course took out a bit. Body weight comes over this leg. Now
you got to squeeze the muscle on the left side on my left here. And then as you step with the other
leg, the left side the left side is going to relax and now the right hip muscle is going to tighten
up. So you're alternating glute contractions as you walk making sure to line everything up
correctly. So how it looks from behind here, stepping onto this side so squeeze this muscle
a bit 25% to 50% step with the other side. I'll squeeze this one and squeeze this one
So in real time, it should look like this. I'm squeezing, squeezing, squeezing
this side, this side, this side, this side.
If you try this out, and you realize that you're walking like a robot, that's normal, a lot of
people are having to think about their muscles and their bodies tipping all over the place. And
they're kind of doing this. That's very typical, that's okay, you probably have to go through that.
But what you need to do is make it more casual, and easier to walk into, make it more smooth. And
if you're using a walker, or a cane, you could be doing this in the walker or with the cane
as you're moving along the walker and the canes should help you to stay more balanced.
So you're not wobbling side to side very much. Now, the final piece of the walking is you've
got to stay straight in your spine as straight as you can, it's not going to ever be perfect.
But when you're taking a step, you don't want to lean your body weight a whole bunch over this way
or this way. And you also don't want your waist to slide oversight aside, a lot of people will
step this way. So what you got to think about is if you put a finger on your nose and a finger on
your belly button, that's about where your spine is in your body, try to keep everything straight.
As you're walking, using your glutes correctly, you can see I'm still moving a bit,
especially here at my waist. But when I am walking, I'm thinking about it a little bit
more because of this, because normally I might do like this, my waist is going side to side, you
need to keep your spine more straight when you're walking. So I'm going to do it one more time here
without talking just so you can pay attention, then we'll go back into the room to wrap this up.
And when you're doing this walking method, it's realistic to begin to do this for short
distances at short times that you're aware of where you can control your glutes like this. So
a great time is in your home, find the longest stretch within your home, maybe a hallway,
where you can just walk back and forth for two, three minutes, or five or more if you can.
And just thinking about using your glutes the way that we discussed turning your feet out
and keeping your spine up and down nice and straight,
then the next step would be to go for longer distances like around the block
at the park. And this is not a super difficult thing to do. Once you kind of get all the
components together, it might be challenging at first, especially if you have trouble
separating your glutes from your quads. But once you get over that party, you can get good
glue contractions, then the next part is to not let your mind wander. And if you're
walking with people, or if you're doing this at the store and you're shopping,
your focus is going to go on whatever that person is talking to you about or you're talking to them.
Or you're shopping, you're thinking about what you need. Or you might be
walking the dog and making sure your dog safe, you've got to still bring your attention back to
using those glutes consistently. What I always tell my patients here in the clinic is the goal
that you should reach is to fire your glutes at about 25 to 50% for just everyday walking, if you
can do that 80% of the time that you're walking. So for every 10 steps, if eight of them can be
good steps for using your glutes a little bit like we discussed, then you're going to be on
track to pressurizing your joints normally the way they're intended to be pressurized, and you're not
going to be using your quads excessively, that's going to put your hip joint in a great situation
to begin to heal so that you might avoid a hip replacement surgery. And this is normal walking.
This is how we're intended to walk. If you see children, most children, as long as they don't
have any issues that they were born with. They walk like this, their glute muscles will fire
appropriately, their feet will usually turn out a bit. And it's not perfect. You probably know
some kids that didn't do this. But if you look at the mechanics of the joints, and if you give this
a shot, and you can get all the components to work correctly, it does wonders for hip joints.
Now if you've got a severe stiffness in your hip joint, and you can't get your glutes to
work correctly, this walking is not going to be for you and you shouldn't be going to go walk
for exercise for your hip joint you needed first get more emotion out of your hip joint
and then get your glutes to work better before you could do the walking. Otherwise,
you're going to grind your hip a bit more. You're going to overuse the muscles that got you into the
hip arthritis because if you can't use your glutes and your you have to be using your quad muscles,
and that's just going to make the problem worse you're going to be feeding into the problem.
So if you're in that situation you probably need to be doing some other exercises that
focus on glutes. We've got a video link in the description here below that talks about
exercises to start. If you've got hip arthritis, go check that out if you're in that situation.
We've also got a playlist of hip arthritis videos. It's also linked in the description below. If you
thought this video was helpful, give us a thumbs up please and drop any comments or questions down
below and we'll get back to them as fast as we can. We'll see in the next video friends, bye