The EXACT Approach that Reduced Anne's Hip Pain

            Meet Anne. Anne is one of our personal training clients, who heard me give a presentation at the Can-Fit-Pro conference. What was she doing there? She’s both a fitness instructor, and a yoga instructor.

            So a few months later, she contacts me, wanting to start personal training. Why? Both hips were sore.

            Not just a little bit, but badly, so much that it was really impairing her quality of life. As mentioned earlier, she’s a fitness and yoga instructor, so the hips were affecting her ability to teach her classes effectively. In addition to that, the hips hurt so badly that:

• The pain would wake her up throughout the night, every 1-2 hours, every night.
• If she was driving for longer than 15-20 minutes, it started to hurt
• She had difficulty doing squats and lunges without pain

And all this has been going on for 8-9 months at the point when she started working with us. Plus, her joint and movement function had been declining for about 2-3 years. This was something she was just attributing to getting older, and figured it was just a normal part of aging.

Nowadays, the pain is almost completely gone, and function is almost fully back to normal.

In this article, I’ll outline the exact approach we used to be able to help her regain function, and enhance her quality of life.

But first, click here to hear Anne herself explain her situation, and tell her story.

 What She’s Tried Before

            Prior to working with us, she tried the most obvious things to help her heal her injury:

• Chiropractors
• Massage therapists
• Her GP

…and it didn’t work.

Most of them provided very temporary, symptomatic relief, but they weren’t addressing the root cause of the problem: movement.

            If you move improperly, it doesn’t matter how many spinal adjustments, and massages you get. It doesn’t change the fact that you’re moving improperly. That’s the root cause. That’s not to say that spinal adjustments and massages aren’t beneficial. They’re just not addressing the base.

The Assessment

            After meeting with Anne for the first time, I connected her with one of my trainers, Brian. So everything after the initial meeting was how Brian helped her, except for two Bowen sessions that I did on her, which I’ll talk about later in this article.

            His first step was a postural assessment. This isn’t your run-of-the-mill postural assessment, where you just look at a person for 2 seconds, and say “you have bad posture.” This goes a lot deeper than that.

            Here is what Brian found during her postural assessment:

• Anterior pelvic tilt, which is an exaggerated lower back curve. This caused her glutes (butt muscles) and transversus abdominis (the deep abdominal muscles, not the 6-pack muscle) to not “fire” properly when she walked and did general strength training exercises.
• Shortened quadriceps (thigh muscles) and hip flexors, which caused a domino effect, that prevented her upper back from working properly.
• Internally rotated shoulders. This also showed that she was having poor recruitment of the muscles in her upper back, and rotator cuff.

The static postural assessment was part 1. Part 2 was a movement assessment. It’s one thing to see what the body looks like statically, but it’s another thing to see what the body looks like when it’s moving.

            So in addition to the static postural assessment, Brian also did a dynamic assessment. He looked at Anne’s mechanics during different movements.

            The movement that stood out the most to him was the hip extensions on the stability ball. When you do that exercise, you should feel your butt muscles working. Anne instead felt it in her thigh muscles.

            This indicated to him that the glutes weren’t working, and the quads and hip flexors were dominating. In other words, his observations from the static postural assessment were confirmed in movement tests.

            There were other movements that were used as tests, but the results there were unremarkable.

All this caused the stabilizer muscles to not fire (contract) at the right time, which created inflammation and pain within her joints.

What are “stabilizer” muscles? These are muscles whose function is not to cause motion, but rather, to stabilize joints. In the case of the hip, it’s to pull the “ball” (the end of the thigh bone) into the “socket” (the cavity inside the pelvis where, the end of the thigh bone fits in). Here is a picture of what the architecture of the hip joint looks like. After all, during walking, or doing anything that involves the hip, the thigh bone position constantly changes, relative to the hip/pelvis. So what prevents the thigh bone from dislocating? The stabilizer muscles. And in Anne’s case, they weren’t working too well.

I want to point something out here: Brian assessed Anne. He didn’t just implement a one-size-fits-all exercise program for her hip pain. The reason is that 10 people can have hip pain, but it could be caused by 10 different reasons. If you give a generic program, you may see progress, but you may actually do more damage as well. So Brian had to figure out the exact reason for Anne’s hip pain.

If you want to have your joints assessed, you can apply to get that done by filling out this form.

What Exercises Were Used

            In Anne’s program, exercises were divided up into 2 categories:

• Corrective/mobility exercises
• Strength exercises

Corrective/Mobility Exercises

Some of the corrective/mobility exercises used were:

• Stiff legged deadlifts with no weight. The idea here was to stretch the hamstrings, but also learn how to hip hinge properly. It’s important to be able to differentiate motion at the hip, from motion at the lower back.
• Hip extensions off the floor. Remember how in Anne’s assessment, Brian found that her glutes (butt muscles) weren’t working properly? This exercise taught her how to indeed get them working properly. Notice that by “not working properly”, I didn’t say that they were weak. Strength was not the issue here. Timing of contraction was. They simply didn’t contract when they should have been contracting. This re-taught Anne when and how to contract the glutes. Had we gone for strengthening the glutes, it wouldn’t have had the same effect.
• Deep core activation exercises. These exercises worked Anne’s transversus abdominis (TVA). Just as with the glutes, Anne’s TVA didn’t need strengthening. It needed activating. “Waking up.”
• Static stretches for the muscles around the hips, to decrease the tight muscles around there.

In addition to these corrective exercises, there were certain tools used to release tight muscles.

The tools were a combination of lacrosse balls, foam rollers, and theracanes.

These tools help decrease the tone of muscles that are too tight (in technical terms, “hypertonic”). I wrote more about this in my article on foam rolling.

Strength Exercises

            It’s great to do exercises to correct muscular imbalances, but you can’t avoid strength exercises, either. Although Anne is a fitness instructor, her level of strength was not where we wanted it to be.

            Once we got the right muscles firing at the right times, it was time to strengthen them. This brings up a key point: why didn’t we start strengthening right from the beginning? Because as mentioned earlier, strength wasn’t the issue at first. Timing of contraction was the issue. If we had strengthened first, without correcting timing, it wouldn’t have changed when the muscles were contracting. If Brian had done strengthening exercises first, the muscles would have contracted harder… but still at the wrong time. And if a weak mis-timed contraction hurts, a strong, mis-timed contraction hurts even more. That’s why the order was important.

            So once it was time for strengthening, what was the progression Brian had used?

In the first month, he used exercises like bodyweight lunges, hip extensions on the stability ball, seated rows, and others.

In the second month, he progressed her to weighted lunges, weighted hip extensions, assisted chin-ups, and others.

Outside the Gym

            It’s great to exercise in the gym, but even if you do 3 times per week, that’s still 165 hours per week that you spend outside the gym. And just because something looks good under careful supervision in the gym, doesn’t mean that it will look good outside the gym.

            So Brian used certain specific strategies to help Anne when she wasn’t under his watchful eye.

            Ideally, posture and movement is something you don’t have to think about. It’s something you “do” naturally, and correctly. However, what if your posture and movement mechanics are improper to begin with? Then, you have to make the unconscious conscious. You have to “shine a big light” on improper movements and posture. So Brian identified which movements Anne was using most frequently in her daily life, and corrected those.

            He had established the importance of extreme vigilance of proper movement mechanics and posture.

            This way, even when Anne wasn’t in the gym, she wasn’t doing damage. She wasn’t “undoing” the good work that she did at the gym.

            The goal was to make her aware of movements that are supposed to be unconscious. Eventually, after a few months of awareness and implementation of good mechanics and posture, eventually, they become unconscious, and replace the bad unconscious mechanics.

            In addition to that, one factor in rapid recovery is frequency. It’s not enough to just work out 1 hour 3 times per week. You also have to do several, quick, 30-120 second exercises multiple times per day, for a short period of time (a few weeks, to a couple of months), until whatever imbalances you’re working on are corrected.

            So Brian gave Anne some exercises specific to her imbalances to do several times throughout the day.

Bowen Technique

            One other very helpful tool that I used was Bowen technique, which is a hands-on technique that helps realign the body, and improve communication between the nervous system and muscular system. It’s hard to explain what it is, but you can read more about it here.

            After the first Bowen session, Anne wrote to me in an email:

I've had a huge improvement!!! Both in terms of increased ROM in my hip, and pain reduction. I'm still having some difficulty doing lunges, and working on one leg, as the muscles around the hip fatigue easily, and then start to cramp and spasm. But at least I can get through a set of 8 reps before that happens.

            This was within 5 days of the first Bowen session. The improvement was significant enough, that it made sense to do a second Bowen session, and the range of motion improved even more.

The Results

            As Anne says in her video, nowadays, she:

• Pain is almost completely gone
• Can sleep just fine at night
• Range of motion has completely returned to the hip.
• Can now drive long distances without pain whatsoever
• Can now do lunges, with good technique, and no pain whatsoever

Oh, and as a “side effect”, she’s also noticing that she:

• Lost a few inches
• Has more energy
• Is less tired after teaching her classes
• Is able to get into yoga poses that she hasn’t been able to do in 2 years

As mentioned earlier, even before the pain started, going back 2-3 years, Anne had reductions in function, and range of motion. She took that as just a regular part of aging, but once she started working with us, every couple of weeks, she had regained something she had lost years earlier. In some cases, it’s a bit more movement, in some cases more strength, and in some cases, better control of movement during yoga and Pilates. Pretty cool, considering it’s basically turning back the clock to things she could do decades earlier.

If Anne’s story resonates with you, and you’ve been uncomfortable with your body for too long, and other approaches haven’t worked, do what Anne did: work with a movement professional to help you address any issues caused by faulty movements. You can see if you qualify to work with us by filling out this questionnaire.