Hip & Pelvis Pain

 

Total Hip Replacement (Posterior Approach) Recovery Exercises

For a total hip replacement, it’s very important to know, and abide by, your precautions after surgery. Listen to your surgeon and physical therapist and do what they tell you to do because they are the most familiar with your particular situation and know the things you should do to recover as quickly as possible. Always check with them first before doing any rehab or recovery exercises.

There are three big precautions for a total hip replacement with a posterior approach. These three precautions are don’t bend past 90 degrees of hip flexion. So that means no bending down to tie your shoes or pulling your knee up towards your chest to put on socks. The next one is no hip adduction. This is crossing your leg across your body, like crossing your leg over your knee. The last one is no hip internal rotation, which is turning your foot inward. All of these put a lot of pressure on where the surgery site is and where the muscles are very weak, so they are important to follow.

Now I will show you some isometric exercises you can do very soon after your surgery. The first exercises are quad sets. Sit in long sitting with your legs straight out in front of you. If you want, put a rolled towel underneath your knee to give yourself a target. Then squeeze your knee down into the roll towards the ground. Hold it for 3 seconds, and do ten of them. 

Now is a hamstring set. Bend up your knees in a hooklying position. Push your heel down into the ground and hold it for 3 seconds, do this 10 times.

Then you will do glut or butt squeezes. You are basically trying to tighten your buttocks muscles, almost like if you have to go to the bathroom, and you are trying to hold it. Start off with 10 of these with a 2-3 second hold.

The next two are hip adductor and abductor isometric exercises. First take a ball or pillow folded in half, and put it between your knees. Squeeze into the ball and hold for 3 seconds, repeat 10 times. Then take a belt and wrap it around your thighs just above your knees. Push outwards toward the belt like your legs are opening up like a clamshell. Hold for 3 seconds, and repeat 10 times. 

Then you will do an ankle pump. You can prop your ankle up on something if you want, but keep your heel free to move around. I am using a roll, but you can just hang your foot off of the bed or stool. You are going to pull your toes up at your ankle, and then push down like you are pushing on a pedal. This is dorsiflexion and plantarflexion. It works as a natural pump to get the fluid and inflammation out of the leg, so you can do this several times a day. It can also help prevent DVTs, so this is very important.

Finally, you want to focus on the way you walk. Getting back to a normal gait pattern is very important. When we walk normally, our heel hits first, we roll through our foot, and then we push off with our toes. If we don’t get the heel strike in the beginning of the step, we tend to limp. If you are still limping, then you still need an assistive device like a walker or cane. If you walk with a limp, then your muscles will get in the habit of doing it, even when your muscles are strong again.

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SI Joint Dysfunction Exercises & Stretches

SI Joint Dysfunction pain (or sacroiliac joint pain) is often felt in the low back, and it's on one side or the other. Sometimes it’s called a pelvic rotation.

SI Joint Dysfunction is often caused by a trauma. It can also be caused by tight hamstrings or hip flexors, and/or weak hamstrings or hip flexors. These stretches and exercises should help.

The first stretch is a hamstring stretch. You can stretch the hamstring many different ways, and you can check them out in my hamstring stretching video. Today I will show you the stretch with a strap or belt. Put a loop around your foot, and use the strap to bring your leg straight up into a stretch. Try to keep your knee straight, and don’t let it bend. You should feel the stretch in the back of your leg. Hold the stretch for 30 seconds, and do it three times on each side.

The next stretch will be on your stomach, or in prone. This will stretch your quadriceps muscle. Take a belt or dog leash and wrap around your foot/ankle. Take the strap and gently pull your foot towards your buttocks until you feel a stretch. Hold for 30 seconds and do it 3 times.

Now you will do a simple butterfly stretch. Sit on the ground, and put your feet together pulling them towards your body. If you need more of a stretch, you can place your elbows on your inner thighs, and apply gentle pressure downwards. Hold the stretches for 30 seconds, doing 3 of each set.

Then try some gentle trunk rotation stretches on your back with your knees bent in hooklying. Gently rotate your bent legs from side to side. You can hold them on each side for 3-5 seconds or you can continuously rotate them back and forth. Again, try to keep your lower back on the ground. You can start off with 10 and work your way up to 20-25.

Next, you will do some isometric exercises to help get the joint back in place. With isometric exercises and all exercises, make sure you are not holding your breath. If you cannot talk while you are performing exercises, then most likely you are holding your breath.

First take a belt and wrap it around your thighs just above your knees. Push outwards toward the belt like your legs are opening up like a clamshell. Hold for 3 seconds, and repeat 10 times. Then take a ball or pillow folded in half, and put it between your knees. Squeeze into the ball and hold for 3 seconds, repeat 10 times.

Finally, you will do a hip flexor stretch. Start in a kneeling position. Place the knee of the hip flexor you want to stretch on the ground, and take the opposite leg and bend it in front of you at a ninety-degree angle. You might want to place a pillow under your knee to protect it. You will be in a lunge position with the knee of your injured side on the ground. Now drive the knee forward away from your body. Hold for 30 seconds, and do this 3 times.

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Hip Arthritis Stretches & Exercises

Hip arthritis can cause pain all around the hip and in the groin area. It can also be painful when you walk. These hip arthritis stretches and exercises should help make the hip area stronger to relieve the pain.

The first stretch is called the pelvic tilt. You will roll back onto your back with your knees bent. You want to imagine pushing your belly button into the ground, or push your back flat onto the ground like you are squishing something. You can put your hand under the curve of your back, and try to push your back into your hand. Make sure you are breathing and not holding your breath while doing these exercises.

Next you will do a bridge. Push your bottom up off the ground, but try to do this slowly, and do one segment of your back at a time curling upward. Then slowly go down the same way, one segment at a time.

Now you will do a four way hip lying down. Start off lying on your back. For all of these you want to try to keep your leg straight by locking out your knee, and pull your toes towards your nose to activate the muscles in your leg. Slowly raise your leg to about the other side where the knee is bent, and then slowly come back down. Then roll onto your side with the leg you want to work on the bottom for hip adduction. You can place your bent knee on top in front of or behind the leg on the ground, which ever is more comfortable. You won’t be able to lift your leg high without rolling your hips. Then you will roll to the other side for hip abduction. Keep your leg straight, and try to lead with your heel and take your leg slightly behind you to engage the glut muscles. Then you will roll over onto your stomach for hip extension. You won’t be able to lift your leg very high with this one either. Do all of these ten times, and work your way up to 20-25.

The next exercise will be a plank on your elbows. You can do this modified with your knees bent and on the ground, or you can get into a full plank position. Make sure your elbow lines up with your shoulder, and that your body is in a straight line. Hold this for about 20-30 seconds, and work your way up to a minute.

Now you are going to get onto all fours or in the quadruped position. Try to keep your hands directly underneath your shoulders, and try to keep your back in a straight line, no arching up or down. Kick one leg straight out behind you, and raise the opposite arm at the same time. Some people call this the bird dog. Do ten on each side.

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Iliopsoas Tendonitis (Snapping Hip Syndrome) Stretches & Exercises

Iliopsoas tendonitis, which is also known as snapping hip syndrome or dancer’s hip, is when you feel a snapping sensation when you flex and extend your hip. These stretches and exercises should help.

Iliopsoas tendonitis can cause pain and be very annoying.

The first stretch will be a quad stretch. Get into a lunge position. Place the knee of the quad you want to stretch on the ground, and take the opposite leg and bend it in front of you at a ninety-degree angle. You might want to place a pillow under your knee to protect it. Then grab the ankle of the side you want to stretch and pull it up towards your buttocks. Hold for 30 seconds, and do it 3 times.

Next, you can stay on your knees, and put the leg you want to stretch out in front of you for a hamstring stretch. Try to keep your knee straight and your hips forward. With your back straight, bend forward at your hips. Hold the stretch for 30 seconds and do it three times.

Now you will sit on the ground with your knees propped up out in front of you. Take the leg of the side you want to stretch, and cross it over the other leg just above the knee. This will look like a figure 4 if you are looking down at your legs. You might feel the stretch already, but if you don’t, keeping your back straight, bend forward at your hips. Hold this stretch for 30 seconds, and repeat 3 times.

This stretch is a very intense stretch and will hurt for some people. For the IT band stretch, if you have a noodle or foam roll, lie on your side with the injured side down on the roll. Gently roll/pull your leg up and down from the hip to just past the knee. Start off with 30 seconds and work your way up to a minute.

Now you are going to get onto all fours or in the quadruped position. Try to keep your hands directly underneath your shoulders, and try to keep your back in a straight line, no arching up or down. You can do the exercises two different ways. First you can put your leg straight out behind you, and lift it up and down. You can also bend your knee with your foot facing the ceiling, and push your foot upwards.

Finally, roll over onto your side with the side you want to work on top. The top leg is going to stay straight and pull your toes up towards you. Keep your body in a straight line as well. Try not to let your leg come forward. Also, keep your hips up towards the ceiling, perpendicular to the ground. This is going to work your hip abductor muscles. Start off with 10 of these and work your way up to 20-25.

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Hip Labral Tear Stretches & Exercises

The labrum of the hip works almost like a suction cup to keep the joint stable. With a hip labral tear, the hip becomes unstable, and sometimes you feel a popping/clicking with movement as well as pain. These stretches and exercises should help relieve the pain.

The first set of exercises will be a four way hip with a resistive band while standing. Make sure you hold onto something sturdy for balance. Anchor the band onto something sturdy, and make the movements in the opposite direction of the band. Start off with hip adduction. Keeping your foot and knee straight for all the movements, pull your leg across your body slowly, and control it coming back. After doing these, you will turn facing the chair or countertop. Now kick forward for hip flexion. Turn again, and now kick out to the side for hip abduction. Finally, turn one more time, and kick behind you for hip extension. Try to keep your body upright for all of these. Start off with 10, and work your way up to 20-25. If those become easy, you can go to a heavier resistance band.

The next exercise will be a balance series. Stand on one foot, but hold onto something sturdy. Try to balance for 30 seconds to a minute. When that becomes easy, just use one finger one each side. Then just one finger for balance, and finally try balancing without holding on at all.

Now you are going to do squats. The best way to do a squat is to give yourself a target like a chair or couch. Spread your feet about shoulder width apart, and make sure your knee does not go in front of your toes.

Then you will do a lunge. You can use a block or a pillow for a target now. Put one foot back into a lunge position keeping your toes straight. Try to keep your upper body upright. You can bend your back knee down to hit the target, and slowly come back up. Start with 10 of these and work your way up to 20-25.

The last exercise will be a sideways squat using a resistive band around your thighs or ankles. Use the same techniques for a regular squat, and wrap the band around your thighs to start. As you step out, squat down. You can take several steps in one direction, and then step back without turning around

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