♪ Bob and Brad the two most famous ♪
♪ physical therapists on the internet ♪
- Hi folks I'm Bob Shrupp, physical therapist.
- Brad Heineck physical therapist.
- Together we are the most famous
physical therapists on the internet
- In our opinion of course, Bob.
- Today we're going to show you
how to self-treat pain on the side of your hip.
Now this could be if you're diagnosed
with trochanteric bursitis or gluteal tendinopathy.
We just did a video on this, trying to help diagnose it.
The problem is they both present the same way.
Luckily they're also treated the same way
and that's what we're gonna show you today.
- Right.
- So we got some treatment suggestions first
and then we're going to do some treatment exercises.
- Sure.
- So suggestion, number one,
you wanna avoid repetitive stress.
So like if you're maybe biking or
what would be also be repetitive?
- Walking. - Probably just running and...
Yeah, yeah.
- I mean, you'll know because as you do it,
it hurts while you're doing it or after you get done
it's like it flares it up. - Yeah it flares up
- And you wonder why?
And then, "well what was I just doing before that?"
Maybe you walked a half a mile,
or you went up and down a lot of stairs.
- And in that case maybe you're gonna need to use a cane.
- Yeah.
- And take some stress off the hip for awhile.
- Right.
And I know all of you out there
I know I can hear them saying already,
a lot of them don't want to use a cane or a walker.
- Not going there.
- But you know, you only use it for a while
until it calms down.
- Mm-Hmm.
- So listen to us.
(chuckles)
Number two, if you actually have one leg
longer than the other, and some of you know this already.
- True.
- You may have been told, you want to correct that
because when you have a shorter leg...
I don't know it's in... Brad and I ever talking about this.
It could be a longer leg or a shorter leg
but that where you have... but usually
the more stress is on the shorter leg.
- Yeah.
I think even, well with walking, like you said
it could be on the longer one.
- This one is one of those things
that's hard to do as a layperson.
It's not easy to do as a therapist or a doctor too.
How do you address it?
Is it a posture thing?
Is it in the pelvis?
- Right is it a real thing. - So...
- Cause sometimes certain health care providers
I know will have you lay down lie down,
- Yes - Flat on your back.
- And they'll... if you have your hip shifted
it looks like one leg is longer than the other, so.
- I've had people that were diagnosed
with leg length difference and I thought it was
give them a insert in one shoe
and it wouldn't make a difference.
I mean, sometimes it would, sometimes it wouldn't.
It's not as clear cut as it seems that it should be.
- Yeah, it is the easy correction though.
So on the short side, you could just take
a piece of carpet and cut out the shape of a heel and...
- Go to your carpet and... (muffled laugh)
- Well, you know, if you have some laying around.
- Right yeah.
I've used the rubber pads, I've put cardboard and
put her up on top. - Oh yeah, cardboard,
There you go.
- You cut it out to put in there.
But carpet's good though Bob.
- No, I like cardboard because you can do layers then.
- Right.
- And you can keep layering it up until...
and then try it, if it feels better,
it works, great, if not, forget it.
- Just take it out, yep.
- The other thing is you wanna make sure
you're standing correctly, especially
if you stand a lot like on a job or whatever.
You don't wanna be leaning on one side the whole time.
And a lot of people do that.
- And they don't even... they're not even aware of it.
- They're not even aware of it.
It's a habit.
- Right. And you know, there is a way you can actually,
when you lean on one side what you're doing
is you're straightening that knee.
You're actually hyper extended sometimes.
You can actually take tape and tape...
Put a piece of tape, run it from the back of your thigh
down to your calf and tape it when your knee is bent.
And then when you stand and try to straighten it,
it'll pull, so remind you that, "No, don't do that."
And if you have trouble breaking a habit,
you could try that.
You also wanna sit correctly and I'm guilty of this one.
I don't know why, but when I eat at my kitchen counter,
I have a stool and for some reason,
it's just more comfortable for me to be on one side.
- Sure.
- And it's not a good thing if you're having
either one of these problems to be doing.
It's just... yeah.
- This is a really bad habit.
It's hard on the knees, it's hard on the...
tilts your hip, it puts stress on your back.
And some people have been doing it for years.
And I think as you get older, that could catch up with you.
- That all catches up to you.
Muscles shorten that shouldn't be,
muscles lengthen that shouldn't be,
and they start causing pain.
All right, you wanna sleep correctly.
You really wanna avoid sleeping on the painful side.
- Right.
- But if you're not sleeping on the painful side,
let's say you're sleeping on the non-painful side.
You still gotta make a correction here,
because if you lie down on...
And your painful hip is right here.
- Yep.
- And you do something like this, or even like this.
There's stress on it.
- Right?
- So you wanna get a pillow in between the knees
and that levels it out and take stress off the hip
all night long.
And most people, you put that pillow on and say,
"Oh yeah, that does feel better."
- Yeah right.
- But then you don't have a pillow for your head.
- Well, you gotta have another pillow.
- Get another pillow, take it from your wife, whoever.
- Yeah, you'll find out.
I actually use a kind of a different pillow
because it gets warm. - Is it one made for that?
- Yeah, it's kinda made for it.
Yeah.
All right.
Next one, u.se a cane in the opposite hand,
which we kind of alluded to
when we talked about with walking.
- So here's my painful hip.
I'm gonna use it in my left hand.
And that'll take... there's that show that Dr. Shore,
where he's got a painful right leg.
- The doctor.
- And he's a doctor and he doesn't know how to use his cane.
- House, Dr. House.
- Dr. House, that poor guy.
- Yeah.
But so you want to use an opposite side
bio-mechanically, physics wise, it works better.
It takes more stress off off the hip.
- No doubt about it.
- And you'll walk with less of a limp.
- Yep.
- And again, we emphasize again if you need it, use it.
All right.
Now, we're gonna go to some of the treatment exercises.
This is a progression.
We're gonna start with just strengthening
without movement, which is isometric strength.
- Right?
- So we are gonna need a belt.
You have the bell Brad.
Oh yeah.
We've got one right here, Bob.
- So, Brad's going to put a belt on, around his thighs
and he's gonna start in bed.
He's actually gonna lay down flat on his back
and he's gonna work on spreading his legs out
but the belt will stop him from doing so.
- So you put that belt through this.
- And that strengthens...
- Above the knees would probably be
the best location for this belt.
- Yeah.
And you can do it with your legs bent
or you can do it with your legs straight.
How much of a warm set?
- So I'm pushing out the belt, simply just locks
your knees in so you get that isometric strengthening
on your hips. - There you go Brad.
- Oh, thank you.
You know, we could start here.
It's gonna work a little different fibers of the hip.
- That's exactly, it will.
You're gonna get both fibers if you
do it with bent and straight.
- I usually do my isometrics about six, five, six seconds.
Count in my head, 1001... - And I do 10 reps.
- Yep. - Yep.
- So if this hurts down here, but it feels good here,
I would go up to here and do it here.
You know, when you're standing, your hips are straight.
So this would probably be a little more functional.
- Yeah you don't wanna flare up the hip.
But you know, you can control with how much stress
you put on it and put on how much it can tolerate.
If it can tolerate a full pull, go ahead
and you let her rip.
- Yeah.
Push it hard as you can.
If you put your fingers right here above your hip
you'll feel those muscles kick in, very clearly
and that gives you some good feedback.
- It gives you some motivation.
Brad, you can stand up and actually the next one
is you're actually gonna do that standing.
Now you'll probably need to hang on to something.
- Yeah.
Now this was going to fall down,
so just, you know, don't use the belt.
I'm gonna hold onto this for balance.
I gotta work my left leg.
- It's supposed to be isometric.
Oh, you're gonna push against something.
- Yeah. - Oh!
- I'm gonna push against a sturdy table leg or...
- Leave it to Brad, right away he's gonna
come up with an improvement.
- Good part.
Well, that was kinda hard to hold.
- Yeah, I understand that.
- I'm gonna push and relax.
You know, you can have a chair over here.
You may... if your balance is good.
Yeah, you could go up against the wall
and push against it that way.
- Sure, right here.
- Yup.
- If you push through the wall,
you know you're really strong.
- All right.
The next one is called the reverse clam shell.
Now some of you may have heard of the clam shell.
Which is actually you look like a clam,
you know, you're move the leg...
But now these two muscles, two that are involved
and the bursa too, it really doesn't affect the bursa.
But it's gluteal tendinopathy?
There's the gluteus medius, gluteus minimus.
And they are internal rotators.
One of them does both, but it turned the hip in like this.
- Yep.
So the femur goes this way, so watch his foot goes up.
The knees staying together.
- Yep.
- And now the clam shell does just the opposite
where the feet stay together but they're both working for...
It's a nice exercise cause they compliment each other
the clamshell and the reverse.
- Yeah, this actually gets to the glute back better.
Cause that's an external rotator.
So you're going to start off with putting your knees
together and lifting up your heels on just one side.
And that's how you're going to progress this.
You're gonna start off with that.
- Yeah.
How high you can lift your foot
is gonna vary from person to person.
Some of you might not how much motion there.
- Right.
- And some of you may have a lot.
So we're gonna have you do that 10 times.
It's funny Brad, you know,
- You feel that don't ya?
- It seems like nothing, but you start to feel
that burn when you get up to that 10.
All right.
The advance for there is these muscles also abduct the hip.
They bring the hip up like that.
- Right.
- So now you're gonna do both.
You're gonna do hip abduction
and you're gonna do internal rotation.
- So he's got this gap in here, which is working a muscle.
I've never done these before, so I had to,
- This is a coordination.
- It is a little coordination.
- If you have problems doing it, you're not feeling right.
- And believe me, you feel that one faster.
- Sure.
- And then it gets some different fibers.
You're actually gonna do it in extension.
Am I out of the way?
- Yep. Don't worry I'm just gonna...
- So you're gonna bring the hip back
and then you're gonna flip the...
Turn it inside or turn it internal rotation.
- So the knee goes this way.
- Yeah. I'd go back further.
- If you're not doing this or if you're elderly
or you haven't done a lot of exercise, you know
those are gonna be a little challenging,
- Here's the advanced one then Brad,
the final one that you'll work up to is
you actually, you're going to do a plank, a sideline plank
and you can start on your knees.
And then you're gonna try to do hip abduction
while you're doing it.
- Here Bob, can you do that without your hand there
so people can see.
Yeah, so this is gap here.
He's got this hip up.
So he's working both hip and glutes.
- This one below is really working hard right now.
And then if you get real advanced,
I'm gonna go off the mat here.
(chuckles) - Get rid of shallow Bob.
- Oh geez.
- You know, if you're at this level,
you're probably a younger person.
- You're probably... - Or a very fit senior.
- Yup. There you go.
So there you go.
10 times on each one of those.
You can do them, probably I'd say every other day.
I wouldn't do them every day.
Yeah until you to get stronger,
you gotta listen to your body.
If you're sore, you know, you just did them the first time,
you're sore the next day take that day off.
Wait for the next day, for sure.
- Cause you're trying to build up muscle not make it worse.
- Right, you don't wanna get things flared up.
Bob are we gonna mention this PDF.
- Yeah, this video by the way is
part of a series of videos on hip pain.
So if you're interested in seeing those, this free series,
go to bobandbrad.com, go to the program section
and look for hip pain and under hip pain,
you're gonna find a whole bunch of videos.
All about the hip, go to the title that fits your need.
Pick the title that you want to watch.
You don't have to watch every one.
And then with each video, we also have
- A printout which is a review of the whole video,
with the exercises and whatnot.
So you can take that and use it for a review
later on with the video off, it's all free.
You don't need your email.
It's just a heck of a deal.
- We're giving people.
So, all right. - Yeah. it really is.
All right, thanks for watching.
(feel good music)