 Welcome back to Movement Matters. I'm your host, Christine Lenders, physical therapist, and board certified orthopedic clinical specialist. Today, we're doing part two of my Unbreak Your Body series where you will learn all the best stretches and exercises to improve comfort, flexibility, and strength in your hips. You will also learn how performing these simple exercises will help improve your balance, sports performance, and even decrease pain in your knee and your back. Let me welcome my guest, Joan Lenders, to think tech-high, Movement Matters. Welcome, Joan. Oh, thank you, Chris, glad to be here. So this is great. I'm so grateful to have you on the show today because I flew out to see you in Connecticut from Hawaii last December about 10 months ago because you were saying that you were concerned you were having so much hip pain and you live in a, I guess, a three-story place so to go upstairs or to go downstairs, you weren't able to bear weight on your leg and you were worried that you had a fracture due to your age. So do you remember about that? Can you tell us about that? Your symptoms? Yes. I have to two-step it down, lead with the left and then bring the right down. So I wasn't sure what was going on. I was going to get an x-ray and then you showed me exercises, so I've been doing the exercises and I feel that it's improving, so I'm not concerned about getting an x-ray anymore. So I've done a lot of what you told me to do and using the band above my ankles and the slides, I do my exercises on the bed rather than on the floor, it's much easier at that, you know, on that surface, let's say. Yes, and I know that nobody knows your age, so I won't tell them. But I know that in your age range, one of the concerns is a fracture from osteoporosis and I know your mom had that happen. She was just standing and felt like someone kicked her, but her bone broke and then she fell and I know that her bone-sensitive tests were negative even though after it broke, they saw that the bone was so brittle and that could happen sometimes. So that was my concern, I feel about last December and I remember you had so much trouble bearing weight to step on it or to get up off the sofa and I massaged out that IT band on the side and then we did those exercises. Right, well I know that was kind of painful, how'd that feel? Painful, but it loosened it up. How'd it feel? My yelling. Well wait, tell everybody how it felt after I was done. Oh, after, yes, it felt like it was eased up. The muscle was so tight apparently and I didn't realize that, but you told me that I could also massage that area and dig deep myself also. It's not as effective as you do it, but still it's the thing I can do. That's great and that's one of the things I like to tell people because when patients come in the clinic often I tell them, hey, did you massage it? Did you ice it? What did you do? And they're like, no, can I? I'm so used to massaging myself because I've been injured at such a young age and I'm a physical therapist that I want to teach you all my patients, family, friends, et cetera, what to do at home and then I kind of make you an honorary physical therapist. So, hey, it's OK to massage this muscle. Why that muscle got tight is you had some abnormal movement, which we'll see in a few minutes that was making that muscle tight and creating a huge amount of strain on your hip, not the hip's fault, but the biomechanics that were altered that gave you that problem. And so a lot of times I tell people when I'm massaging, I'm like, that hurts, that hurts. I didn't do that to you. I'm trying to undo it for you. Like your mechanics, muscle to be painful. You didn't even know that muscle was painful because the muscle wasn't where your pain was when you were moving. Yeah, yeah, exactly. Yeah, you know, I've been doing the bridges and and I could feel that the muscle is being worked when I do the bridges. I could feel the the tightness and also you have me using ankle weights and I really feel that the softness of the muscle is getting firmer. And that's the way to put it. That's great. Yeah, that's great. So yeah, let's I know everybody watching wants to know what your leg look like. Let's go to video number two, which is a clip from our prior show on how to solve knee pain to learn a little bit more. So let's look at image number six, which is an image of my mom, who I always joke with her about her crooked knee. But what happened with her knee? She did injure her knee when she was young. She fell on, I think, some glass or a pile of rocks. But also the thing that I've been harping on her for 15 years, probably, is that she walks with her right foot turned out. Always. I take videos of her every time I see her. Turn your foot straight, mom. Turn your foot straight, mom. Turn your foot straight when you go up and down the stairs. And she mentions that every time she does turn her foot straight, her knee doesn't hurt when she goes up and down the stairs. And why that happens is like I explained before, if your foot is out, it takes your tibia and puts it in a different position and it twists at your knee because you're going forward. It's a complicated biomechanics. But the important thing to take home is you could even see her foot turned out just ever so slightly. But look at that bending in her knee. That's that sideways angle I was telling you about the crooked knee. And she has terrible knee arthritis and knee pain. And of course, she does because she's been having abnormal wear and tear. That rotational twisting every every step she takes as she goes forward about her day, as she does her gardening, as she walks around an uneven yard. And now let me point out the pelvis. If you can see up at her pelvis, she's got that wrinkle in her shoulders or completely angled down to the leg that she's not standing on. And that is because her gluteus medius on that right side is not stabilizing her pelvis. So not only is her foot out, but her hip is dropping, causing her femur to rotate inward. So her knee is literally getting twisted every step that she takes over and over and over again, leading to that collapse at her knee. The gluteus medius is one of my favorite muscles to strengthen. And the reason why is because during function, it moves your leg mostly what sorry, not during function during action. If you were just going to say gluteus medius fire, it would move your leg mostly just to the side. It also moves it backwards and a little bit rotation to the side as well. Those are its secondary and its third actions. But during function when you are walking, that gluteus medius stabilizes your pelvis and your spine on your leg. So here's your leg. Here's your pelvis. You can kind of see it behind me. There's your pelvis. There's where your legs come down. Your gluteus medius, when you stand on one leg, stabilizes the pelvis like this. And you can see in Joan's photo that her pelvis was dropped. And that is because her gluteus medius wasn't functioning. Now, I've done many shows on these alignment issues and the foot out and the knee in and all that. And so Joan's situation is a little more complicated because when the foot is turned out, it doesn't set off what we therapists call a chain reaction that would allow the lower leg bones to move and trigger the brain to fire the gluteus medius to stabilize the pelvis and your low back on top of the femur, your thigh bone, because the leg is already collapsed. When your foot is straight and it pronates, it sets off that chain reaction and a message gets sent to your gluteus medius and it fires and it stabilizes your pelvis on your leg. And so that was what Joan was saying, a band around her ankle's exercise, which you'll learn in a little bit to help stabilize. So, Mom, when you look at that photo, what are you thinking? Because that was last December when I came out to see you and your knee hurts. I'm not even talking about your knee right now, but your knee pain is a huge problem. We're talking about hip today, but when you see that photo, what do you think? I can't believe the angle that it's at. You know, you can't see yourself, but when you see a picture like that, need some improvement. Yeah, that's great. So a lot of people need flexibility in the hips, people that have osteoarthritis or maybe they've had a laboral tear and an injury and then the muscles in the area tend to get tight. So while someone's in my first session, I go through flexibility, strengthening and homework. I want to share with the audience today. One of the first steps is in video number three, let's look at some flexibility. These are great ways to gain some flexibility in your hips. So you can lay on your back to do most of them and you are gonna grab one knee, clasp your hands behind to start getting some hamstring flexibility and try to kick your leg straight. I usually do it 10 times each side. Don't be alarmed if it only goes as far, but you need adequate length in your hamstrings to have healthy hips, 10 times each leg. Another one is the knee to opposite chest strap. So you grab one knee and you line it up with your opposite shoulder. So you kind of have this number four position. You put one hand here, one hand here and you hug it gently up and breathe. There should be no pinching in your hip. If there is, you just stay loose and just gently oscillate that on one leg. Then you can line your knee up with your opposite shoulder so the foot falls just outside of that thigh. Hug your knee up to your opposite shoulder. That stretches out all those glute muscles that could be tight, creating more pressure on the front of your hip joint. The next one, you're gonna put your feet very wide and your knees close up to your hips and then you're gonna let your knees drop off to one side. You'll probably feel a nice stretch in here. There should be pain, just some tightness. And then you're gonna go to the other side. You can breathe and stretch. If you have pain, you can kind of do what you see me doing with my hands. Help your legs over to support them and stretch. Let that stretch out. Help to support. Let those deep hip rotators get stretched out so you can get some mobility in your hips. Now, another common muscle that gets tight is the front of your hips so you can scoot your bum over to the edge of the bed. Hug one knee to your chest first to protect your back and then drop the other leg off the edge to feel a nice, deep hip flexor stretch. If you've been stooped over or you've caught yourself slouching for 20 years over your desk or you drive a lot, these muscles can get tight. But you can also do it in standing. So if you just put your foot up on a surface, you can lunge forward, suck your stomach in to protect your back, tuck your butt under and you can get a nice hip flexor stretch here. You can hold onto a surface, reach your hand up and allow those hip muscles to stretch. Enjoy. So Joan, are any of those stretches familiar? Yes, especially in the very beginning. And as I wake up, before I get out of bed to do the stretch, I put my hand behind my knee so that I'm not pulling on my knee in particular because, you know, and then the leg up to the sky, up to the ceiling and do my ankle twist. But that seems to stretch out my back which gets tight overnight. So I like that a lot. I'm glad you mentioned your back because in my show description, I talk about how strengthening your hip and improving flexibility in your hip can really help decrease low back pain and even knee pain. And that is something that in your picture that everybody looked at in the beginning, you could see that drop. And what happens when here's your leg, here's your pelvis, you get that drop as you get a bending of the spine. It's almost like visible on this skeleton right here. You can see this pelvis is higher than there and there's that bending. That's very similar. Now this is the gluteus medius that's the weak side right over here. And when the pelvis drops like that, the spine bends and all these muscles here get short and tight and all these muscles get strained. But worse on this side is a space around the nerves. The canals gets more narrow when your spine is bending to that side and it leaves you open to get nerve pain or compression down your leg. And when I was just visiting you, Joan, in last week I was there, it was great. I remember we were sitting on the sofa and I was trying to shove a pillow under your butt and you were saying, oh yeah, my thigh is hurting and the hip area. And that's just part of the problem with this bending here. Yes, yes, you put it under one side. So I was more straight rather than having that curve. Yeah, and that's just like some strategies you can do. My mom and I have scoliosis. So this is a contributor to having the sitting problem and getting more compression, but the same thing holds true in someone that has the normal straight spine. And this hip is weak, so every step you take, let's say you're doing 10,000 steps a day, walking up and down stairs, every step you take, your pelvis is dropping, dropping, dropping because the gluteus medius is not stabilizing you there and you're not only at risk for a crooked knee or knee pain or osteoarthritis, but getting spinal compression and back pain or tightness like you were saying in your bag. Yeah, yeah. Now let's say you have hip arthritis, but you don't really have a stiff hip per se. Let's go to video number four where we look at one of my favorite exercises do if someone has a very stiff arthritic hip and they have trouble getting in and out of the car, bending enough to sit on the toilet seat. Let's check out video four. You have hip arthritis or an immobile hip or you just are having trouble bending it to get in and out of the car or it's painful sitting in a chair. Do this exercise. This exercise is great for recreating the position of your femoral head in the pelvis which is where your hip sits in the socket. So you're gonna get on your hands and knees, you can be on the bed, on the floor, hands and knees, like this. The important thing is that you don't round your back because that's keeping the femoral head forward in the hip socket and it's pinching on the tissues which is giving you hip pain. It's putting the ball on the socket in the wrong spot and creating more wear and more pain. You wanna drop your, sway your back like a horse. Suck your stomach in to protect your spine and move your butt backward. It's okay if it's an inch, that's fine. What you were doing, are you stretching out the posterior hip structures to allow that ball to sit back in the socket or belongs instead of forward on a different spot that's causing more degeneration to the joint and more pinching on these structures giving you pain. It's okay if you can go back far. That's great, but not far enough so your background. Only tailbone to the sky, sit back. I usually do 20 times just to help stretch that. Most of the time it feels like you're doing nothing except for when you get to a point you might be like, oh, there's a pinch, that's okay. Go to the pinch once and then come back and then you stay above the pinch and you help restore the joint mechanics of your hip. Enjoy that one. What do you think of that one, Joan? I'd like to try that. Is it okay if I try it on the bed though? Yeah, it is, it is. I worry about that one because of your knee but definitely go on the bed so you're on a soft surface and especially you with the back pain and having a scoliosis curve. That exercise, the way I perform it, I've kind of tweaked it when I learned it from someone in the past for alignment. I feel like what happens, like I explained in the videos, is it stretches out those posterior hip structures so that head of the femur of your thighbone can sit back in the pelvis where it needs to be instead of pushing more forward for people that have that anterior hip pain or that hinge or a very stiff arthritic hip. So I'd love for you to try that but what you might need to do is when you're on your hands and knees you might need to look down through your legs to make sure that your feet are here because you might find with the knee you might find that your leg is like out like that and you might need to just adjust it so you don't like twitch your knee as you sit back. Okay. But don't forget to suck your stomach in too when you do it. Absolutely, suck it in. Suck it in, stabilize your spine. I think I gave dad that one in the past for his spine just to help align it and I've given it to so many younger and older hip arthritis people. And when I say younger, I mean people in their late 40s, sometimes people have hip injury or something happens when they're younger that they get that degeneration or the positioning is poor in the socket and they get early arthritis. That one works great to get people to function and do what they wanna do without having that painful hip pinch that makes you wanna live. Yeah. Yes, I'm gonna try it. Okay, great. I can't wait to hear how you do. So the next video is something that I go through and I think everyone should really pay attention to and it's when I look at someone and how they stand and how they squat similar to that picture that I showed of you in the beginning Joan, I look at the alignment of the pelvis, the alignment of the thigh, the knee, the lower leg and it's really important to understand the alignment if you have hip pain, knee pain, back pain and you wanna learn how to correct it. I'm correcting it right now when someone who's in her 70s, she's an active triathlete, she's playing pickleball, she injured her hip and we have been looking in the mirror trying to teach her brain that this limping is not right and the way to move properly. So let's go to video number one to learn about alignment. To have a healthy hip or get rid of your hip pain, you have to learn about proper alignment. So one of the biggest things I see when someone comes into the clinic is they're walking when they stand and their hip is dropping like this or they're walking and they walk over the hip like this over the painful leg. Why that's bad is when you move that way there's a very vital hip muscle, your gluteus medius that will not fire because your brain doesn't get the message when you shift your weight onto it and that's one critical muscle to help stabilize your hip joint. So what you wanna do if you're at home and you can look in the mirror is you wanna look in the mirror here and pick up one leg and see what happens. It's okay to hold onto a surface if you don't have balance but you see what happens. You use a line like maybe your shirt line here to see if when you stand you're here to see if that happens or to see if that happens on your hip. So that's one critical thing that you need to look at and how you fix it is actually pretty simple once you can learn it. So if you have the hip drop you can lift the other leg up like this like you're trying to hike the opposite hip up. If you do about 20 of those you're gonna feel it burning in that standing legs hip. That's a great way. If you're leaning over this way when you pick up your leg you practice shifting your weight over to that hip and then lifting the other leg and you look at your trunk to make sure you're not leaning over this way. Load that hip muscle give the brain the message to fire gluteus medius then pick up the other leg. Again, I don't care if you use a finger to hold on it's all about balance but to get rid of your hip pain you need to help restore your alignment. Enjoy. Now mom, have I gone through that with you? I know I was just home last week and we didn't do that but does that look familiar? Yes, but not that particular exercise but when I go for a walk you told me to, even if I put my hands on my hips to make sure I feel the rocking not just on one side because I used to not pay attention but I do pay attention now. Make sure I got that like a little wiggle going on and if I, just to test it I'll put my hands on my hips to make sure I'm doing it correctly and that helps. That's a good, I like the word choice that you're using is the pay attention. I think that's one of the biggest things that I'm so proud of you and all of my patients for learning is the paying attention to your body and that's why I go through all these fine details in all my videos and instructions with my patients is I've been told over the last 15 years I'm an expert at picking out the little finest detail the nitpicky thing but often the nitpicky thing is the thing that's leading to your pain not the glaring huge problem that you just see on the surface and so you paying attention to how you move movement matters, that's the name of the show is enabling you to shift your weight like you said the wiggle to shift your hips, your pelvis side to side to give your brain the message to fire that gluteus medius especially on the leg that dives in to stabilize your pelvis so you don't hurt your back so that's great I need to do my show I need to say life is better when you pay attention to your physical therapist instead of listening to your physical therapist but that's not what that person said they said listen I think, right? Yes, yeah so when I go for the walk I'm checking my right foot that is not winging out and paying attention to what the hips are doing. Excellent, excellent so I love it and now let's go to what everyone wants to know right now is how do you perform these strengthening exercises I am gonna give you the best, the simplest right now in video number six. This exercise is fantastic for getting at these tiny little deep hip rotators so if you have a labral tear or if you have just deep, deep, deep hip pain that you can't find a way to get to or if you're working with a physical therapist or massage therapist they can't get to it this exercise is fantastic so I have a very particular way I designed doing it when I had injured my hip a long time ago so you're gonna lay on your side if you're at home you wanna get so that your legs are about eight inches your thigh off the bed and then you're gonna line your two knees up as if someone drove a spike right between the central axis of your knees. The bottom leg you're gonna bend it out of the way and the top leg you're gonna be bending it 90 degrees at your knee and you're gonna go from horizontal or parallel to the floor and you're gonna drop that leg slowly down and back up, drop that leg slowly down and back up you don't wanna straighten your knee you wanna keep it 90 degrees, drop it slowly down and you also don't wanna lift it very high because if you have hip arthritis this motion can be painful so you can go maybe a little bit above the parallel but you're gonna do that 20 or 30 reps you don't need a weight, you don't need a band just do enough until you can feel it deep in your hip now if you wanna work the other direction or the other hip you bend the top leg back drop the bottom leg off again, 90 degrees not out here, right at the L shape and you drop that one down and up towards the ceiling down and up towards the ceiling and if you wanna do the other side you just lay on your other side on the bed and that is great to help work those deep hip rotators that I call the hip rotator cuff. We only have a few minutes left so I'm gonna go straight to video number five to show more strengthening. These exercises are the best to begin strengthening the important muscles that stabilize your hip and control the position of your leg while you're walking so you'll need an exercise band you can get them anywhere on Amazon you can get them online get them from physical therapy clinic you're gonna put the band around your ankles and you're gonna begin to isolate the gluteus medius muscle that is the most important muscle to stabilize your hip in the pelvis while you're on your legs standing or walking. So you are gonna lay on the surface you're gonna pull your toes up you're gonna squeeze your buns tight you're gonna push your legs down into the surface and slide them apart. The reason why I say press down is because if you lift you work this tiny muscle up here you don't want that that's not gonna help your hip you're gonna squeeze your buns, push your calves down, slide your legs apart you're gonna do 10 times. That keeps your pelvis stable it's great for people with low back pain hip pain, knee pain, you name it. Then you're gonna start isolating one leg you're gonna pull your toes up squeeze your buns tight, press your right leg down your left leg down, slide your right leg apart do not lift it, push down and slide you're gonna do 10 on the right when you're done with 10 on the right you're gonna push down with both legs slide your left, isolate those muscles. Now you're gonna start working your hip rotators your gluteus maximus and your deep hip rotators we're gonna combine them with this exercise band above your knees you're gonna suck your stomach in to protect your back lift your buns up in the air all as one unit and you're gonna open your knees 10 times to work those rotators and then come down suck your stomach in, lift, open sometimes I'll go 10 times here, come down other times I'll go up, out, in, down up, out, in, down and you will get a great glute burn to your largest hip muscle as well as your tiny rotators and your deep core. Now we're gonna start working what I call and probably many others the hip rotator cups you're gonna land your side with the band above your knees and there's four different ways so here the hips and the knees are bent your feet are together, you're gonna lift up you're not gonna rotate your whole body back you're only gonna lift your knee up so your body stays the same, you're gonna do 10 after 10 you're gonna keep your knees apart you're gonna tap your foot from parallel to the foot parallel to the foot for 10 times now to get the other side of the deep rotators you're gonna make yourself in a straight line with your knees bent and you're gonna open your knees again 10 times after 10 you're gonna keep your knees apart lift your foot 10 times very important to get all the hip rotators you could also do if you're advanced sideline but do not go forward enough you need to go back and up to get your gluteus medius and you gotta be careful that you don't use your waist muscles you wanna keep your legs long and reaching out and then lift up it's not very far to exercise that muscle another one of my favorites that helped me with my hip people that have labral tears or osteoarthritis of the hip is if you get on the side of your bed or a table and you get your knees off about six inches and you don't need the band I'm just gonna leave it there you put your knees together like a spike was drilled between the two 90 degrees at your hip 90 degrees at your knee and you're gonna drop that top leg down and back up to horizontal that is a fantastic exercise to work the deep hip rotators there shouldn't be pain but you'll feel it somewhere in there it is great now to switch you're gonna take the top leg and put it back and bring the bottom leg forward and now you're gonna move it a little bit down but again, you don't wanna drop this foot all the way down cause it could pinch in your hip so you're just gonna move an inch down then you're gonna move it up inch down, move it up inch down, move it up to get all the way down inch down, move it up to get all those really tiny hip rotator muscles so that you can rescue your hip and enjoy your life Joan, we are out of time I expect that you'll be performing some of those exercises but I know that that one on your back with the band around your ankles is the one that you did Yes, and I'll do some more of those working the band up a little higher around, you know, and then the knees moving the knees so I'm gonna try it Excellent, I love it Thank you so much for coming on you've been a joy and thank you everyone for joining us Life is Better when you listen to your physical therapist Aloha everyone