Your guide to reducing hip pain, improving hip mobility, and preventing falls.

Bold Statement #1: If you have hip pain then you probably sit to much. Although ‘taking it easy’ may seem like the best (and easiest) thing to do, this is usually counter productive and making your joint pain worse.

Bold Statement #2: Even if you have hip pain then your hip joint may not actually be the problem. Your hips, although not indestructible, are actually designed to withstand a great deal of wear and tear. It is at least as likely that the source of your pain is your low back, even if you do not feel any pain in your back.

Table of Contents
Statistics
Causes of Lower Back Pain
Current Treatment Options
The 6 Acupressure Points for Lower Back Pain Relief
Additional Acupressure Tips
Summary
References

The first important thing is to understand the nature of your pain so you can make an educated effort towards fixing it. Some questions to ask yourself are:

• Are your hips just tight? If so, then simply increasing your activity and applying some light stretching and hip mobility may improve your range of motion.
• Does one of them grind when you step on it? Oftentimes grinding is a structural malady. You should think arthritis or possibly a damaged labrum.
• Does your hip pop when you walk/ stand up/ turn around? There is likely some instability or a compromised labrum. Some strength training to particular muscle groups are a good idea.
• Does it only hurt when you step on that leg? This tells us that compression of the joint is irritating something. It could be as simple as arthritis pain, or it could be something more complicated.
• Does it hurt when you are lifting the leg off of the ground to move it? Lifting the leg activates a combination of muscles that creates joint compression for the sake of stability. That compressive force could be irritating arthritis, straining a muscle, or flaring up a stress fracture.
• What word would I use to describe the pain? Sharp? Achy? Dull? Throbbing? Sharp and sever pain is generally a sign that you should see a doctor and/or get an x-ray.
• What can I do to relieve the pain? (Rest, Anti-Inflammatory Meds, Heat, Ice) How the pain responds tells you a lot about its nature. If anti-inflammatory meds work, then something is causing irritation. If they do not help but Tylenol does, you know that the pain is manageable but not necessarily due to inflammation. Heat generally helps strained muscles and decreased blood flow issues.
  • Note: These issues are not comprehensive but I aim to convince you that your success in pain relief depends on you being able to differentiate symptoms.

The Hip Joint:

Anatomy:

Insight:

You probably should not blindly stretch your hip when you have hip pain. Hip hypermobility (loose hips) are just as common as tight hips. If you stretch the wrong target muscles then you may be doing more harm than good.

The Lower Back And Lumbar Spine:

Anatomy:

There are 33 spinal bones called vertebrae that are divided into 5 regions. The lower back region is called the lumbar region. These lumbar vertebrae are the largest and specialize in supporting the weight of the upper body.

Insight:

Nerves are responsible for all sensation and for controlling the firing of all muscles. Even if you have a single point of localized pain directly in the hip and no other symptoms, it is still very possible that the cause of the issue is your lumbar spine.

Look At This Like A Physical Therapist Would:

The hip is a very complicated joint with multiple degrees of freedom and multiple structures that contribute to its mobility and stability. Additionally it is a passthrough for the major nerves that govern the lower legs.

A good physical therapist will realize that your hip pain is not to be viewed in isolation but considered along with the integrity of your lower back, abdominal muscles, spinal curvature, upper leg and lower leg orientation, knee and ankle mechanics. You are a complete person and not just a painful hip to be exercised.

This is how you should view your hip injuries so that you can perform the right corrective actions.

Oftentimes it is much more important to enhance your functional mobility than it is your flexibility. There is a subtle difference. Physical therapy exercises can help to achieve this in young athletes and older adults with the right strategy. This is why a physical therapy consult can be invaluable when dealing with arthritic hip pain, chronic hip pain, hip replacement surgery, or plain old sore hips.

How To Tell If Your Hip Pain Is True Hip Pain:

Location	Symptoms	Timing
True hip pathology is usually found at the side or front of your thigh and hip.	Pain during movement or weight bearing. Stiffness. Tenderness to touch.	During or after movement.
Oftentimes in the inner thigh and anterior crease at the top of your leg.	Reduced flexibility. Possible swelling. Possible grinding or grating with movement.	Stiffness is usually greatest after periods of inactivity or when waking up.

How To Tell If Your Hip Pain Is Actually A Back Issue:

Location	Symptoms	Timing
Posterior aspect of your hip and in your butt muscle. It may feel like it is directly in your ‘hip bone.’	Sciatic Nerve Pain that starts in your lower back and travels down your right and/or left leg. Possible numbness or weakness in the hip and leg muscles.	Back issues typically are worst with prolonged postures (either sitting or standing) and while laying down.
It is exceedingly rare that pain in the back of your hip originates from the hip.	Potential bladder control issues and incontinence. Potentially reduced anal tone leading to more flatulence and bowel issues.	Laying flat on your back is a big problem due to the compression this position places on the spine.

The following exercises will provide are great examples of exercises that will address common issues at that cause hip pain. Remember that consulting with a physical therapist is a great way to jump start your recovery and skip some of the guess work.

Note: If any of these move increases or causes severe pain, you should consult your physician or physical therapist. It could be as simple as improper performance of the exercise or it could be a sign that you need medical management.

5 Daily Hip Exercises: (Perform 2-4 repetitions of each stretch and 10-20 repetitions of each exercise)

1. Kneeling Hip Flexor Stretch:

Hip Flexors are notoriously tight due to the excessive sitting that we all do.

1. Starting position: Kneel on the ground with your right hip and right knee bent and your right foot flat on the ground. Your left knee should be directly under your left hip and your left foot behind you.
   • You may already feel a stretch in the tight muscles on the front of your left thigh.
2. If tolerable, engage your core, tuck your pelvis, and press your left hip forward while keeping your torso upright.
   • Aim for a significant BUT NOT PAINFUL stretch.
   • Your goal is to hold the gentle stretch for 15-30 seconds.
     • Research suggests this is the greatest change occurs at 15-30 seconds.^1,2
     • No further benefit is had after 2-4 repetitions.³
3. Repeat on your right leg.

Modification: If you can not knee without sore hip, knees, or back, you can perform this stretch in the modified Thomas Position pictured below:

2. Piriformis and Abductor Stretch:

The piriformis was found to be excessively tight in almost 80% of the population.⁴

1. Sit on the floor and extend your left leg directly in front of you, then cross your right foot over your left thigh, placing your right foot flat on the floor to the left of your left thigh.
2. Rotate your torso to the right.
3. Next, reach back place your right hand on the floor behind your right hip and reach your left elbow to press on the outside of your right thigh, increasing the stretch to the outside of your right hip.
   • Take deep breaths while you count up to 15-30 seconds.
   • After you have had a good stretch, switch legs.

Modification: If you have trouble getting onto the floor or if twisting causes too much pain, then you can perform the Seated Piriformis stretch pictured below:

3. Donkey Kick into Fire Hydrant:

Most people have strength and mobility deficits in all directions except straight ahead. This move will remedy that problem.

1. Start on your hands and knees
   • Your left and right wrist directly under your left and right shoulders, respectively. Your bent knees should be directly under your hips.
   • Engage your core by imagining squeezing your belly button down to into your pelvis.
2. Use your gluteal muscles to slowly kick back and extend your leg in a straight line with your body.
3. Return to starting position and immediately lift your bent knee to the side, mimicking a dog peeing on a fire hydrant.
   • Again return to starting position and repeat with opposite leg.

4. Squat: The King of All Exercises (maybe)

When done correctly this simple exercise works your gluteus muscles ( gluteus medius and maximus), the quadriceps muscles on front of your thigh, the hamstrings on back of your thigh, and everything else down to the soles of your feet.

1. In the standing position, start with your feet shoulder width apart.
2. Bend knees and hips to move as if you were beginning to sit back into a chair.
   • Maintain good form by keeping your knees above your feet and not letting them drift forward past your toes.
   • Lower to your tolerance, with the goal being a 90-degree angle.
3. From this semi sitting position, use your legs to push back into stance and squeeze your glutes together at the very top.

Modification: If you have difficulty balancing while keeping this alignment, perform in front of the kitchen sink with hands holding onto the counter and a chair placed behind you for guidance.

5. Side Lunge:

This is one of the best exercises to stretch your hips, train your balance, and build strength from the standing position.

1. Stand with your feet wide apart, approximately twice the width of your shoulders.
2. Begin the movement like a squat but keep your left leg straight as you allow your right to bend and accept your weight.
   • Allow your upper body to drift over to align above your bent right knee.
   • If you have knee pain, simply do not lower down as far.
3. Use the strength in your right leg to push back up to the starting position.

5 Daily Back Exercises: (Perform 10-20 repetitions of each exercise)

The key to low back health is appropriate mobility at the spine combined with synchronistic activation of the core. This includes pelvic floor activation, appropriate length of hip flexors and consistent gluteal tone to maintain pelvic alignment, optimal performance of the transverse abdominus and the multifidus to support the spine and allow force production, and full functional range of motion at the diaphragm.

The good part is that you do not have to understand all of that to achieve the desired affect, simply follow these strength exercises:

1. Bridge Exercise:

The first exercise is the basic back bridge from the supine position.

1. Lay on your back with your knees bent and feet flat on the floor.
2. Push down through your heels and lift your hips into the air.
3. Hold for 2+ seconds, lower to the starting position, and then repeat.

2. Pelvic Tilt

A great way to optimize pelvic and low back mobility.

1. Lay on back with knees bent and feet flat on floor, place your hands on the bony front of your hips to guide movement.
2. Rock your pelvis forward and backward through full range of motion.
   • Flattening and hollowing your low back.
3. Perform10-20 and move to the next motion.
   • Side-to-side, circles, riding a bike motion.

3. Abdominal Hollowing / Vacuum Pose

The most direct way to work your transverse abdominus, aka your ‘inner girdle’.

1. Lay on your back with knees bent and feet flat on the floor.
2. Suck your belly button in and down towards your spine as if trying to make your waist as small as possible.
3. Hold for 5+ seconds, relax, repeat.
   • You can make this exercise more challenging by performing in different positions:
     • Sitting
     • Laying face down
     • Standing
     • While performing other activities and/or exercises.

4. Multifidus Walk Out:

You will need a resistance band for this one, but it is well worth the small investment.

1. Attach one end of the resistance band to a solid and immovable object such as a door. Grasp the other end with both hands and hold at arms length directly in front of you.
2. Side step away from the anchor point without letting the resistance rotate your body.
3. Return to starting position without letting resistance pull you off balance or move you too quickly.
   • Repeat.

5. Kegel Squeeze:

This is a strength exercise that is

a.] simple,

b.] overlooked,

c.] critical for spinal stability and urinary health

1. Squeeze your pubococcygeal muscles in the exact same way as if trying to stop the flow of urine.
   • Variations:
     • Hold for different lengths of time.
     • Gain control by varying the strength of your contractions (25% power, 50%, 75%, 100%)
     • Perform in different positions.
     • Perform throughout the day while doing your daily activities.

BONUS: Diaphragm Breathing

The above exercises address all of the critical components of your core except for the diaphragm.

The Diaphragm is the cone-shaped muscle directly beneath your lungs that flattens out when it contracts and is directly responsible for you taking a breath.

A healthy diaphragm muscle is the last piece of the puzzle that is your healthy core and spine support.

• Tissue Box Breathing:
  1. Lay on your back with a box of tissues (or other light object) on your belly.
  2. Breath in deeply while allowing your belly to rise and lift the tissue box as high as you can.
     • Perform these breaths for 30-60 seconds in a natural rhythm.
• Tissue Breathing
  1. Hold a Tissue 3-4 inches from your face.
  2. Take a deep breath in through your nose (while allowing your belly to push out as above).
  3. Blow out through pursed lips causing the tissue to flutter (but hold onto it). Try to keep the tissue ‘in the wind’ for as long as you can, completely emptying your lungs.
     • Perform 5-10 breaths like this.

A Personal Word from Dan / Lead Therapist and Owner at Rehab Revolution:

I have been doing this for well over a decade and I know that almost everyone can help themselves with just a modicum of effort. Whether that is performing low-impact cardio, identifying bad habits, or simply not settling for ‘the way it is.”

While the above exercises and stretches are not comprehensive and there is no one-size-fits-all program, they do offer a fantastic and easily accessible starting point. If you have any questions or need some insight, please reach out to me.

References:

1. McHugh MPMagnusson SPGleim GWNicholas JA. Viscoelastic stress relaxation in human skeletal muscle. Med Sci Sports Exerc. Dec 1992;24(12):1375–1382
2. Bandy WDIrion JM. The effect of time on static stretch on the flexibility of the hamstring muscles. Phys Ther. Sep 1994;74(9):845–850; discussion 850–842
3. Taylor DCDalton JD, Jr.Seaber AVGarrett WE., Jr. Viscoelastic properties of muscle-tendon units. The biomechanical effects of stretching. Am J Sports Med. May-Jun 1990;18(3):300–309
4. Mondal M, Sarkar B, Alam S et al. Prevalence of piriformis tightness in healthy sedentary individuals: a cross-sectional study. Int J Health Sci Res. 2017; 7(7):134-142.