Can You Fix Hip Impingement With Rehab Exercises?

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everybody, it's your co-host Sebastian with the Restoring Human Movement podcast. Thanks for joining the show today. Today we're covering hip impingement, and this is from a basic format that I will be putting together on a YouTube video for ours. It'll probably be just as long as this podcast will be today, about 10-15 minutes, and I'm going to show you what I'm talking about in regards to the exercises, but I think what I'm seeing through a lot of the people that I've encountered through our telehealth and a lot of our in-person sessions is they don't know exactly what exercises they should be doing for hip impingement, and they're kind of of this thought that hip impingement is like a bony change that will always forever be there, so why do any exercise or rehab to mitigate any problems?

And so to that note, I would venture to say that yes, impingement has physical signs, there's visual signs of the diagnosis being there, such as on x-rays, you see them on MRIs as well, you can do a physical assessment to see if there's, you can assess what we call and feel, but it doesn't really tell the whole story. There's actually a biomechanical aspect of hip impingement, which in my opinion, makes hip impingement symptomatic and asymptomatic, symptomatic, asymptomatic, meaning today you'll feel it, and then a few weeks from now, you're completely fine for like a month, and then you go back to activity like running, and then you feel it again, and then you take two months off, and you start to do things like yoga, and you feel okay, and then you go back to back squat, and then you feel it again.

Like this is a phenomenon which is really common, because again, the hip impingement will not go away, but what you can do is build a resiliency around it, and then change your biomechanics so that you don't have as much pinching and still can do all the things that you want to do. So I will cover some of the major talking points today about rehab exercise and the ones, the categories or the boxes you should be checking, in my opinion, but keep in mind that there are endless variations to this through a lot of our YouTube videos, the comments that I read. And again, if you want to find our YouTube videos, it's in the link description for the video, or you can search performance, play sports care, and hip impingement.

But what we find is that people are frustrated about the exercises that are shown in the video, and they say, well, I can't do that. It hurts too much to do that. Now what? I'm doomed, right? It's like doomsday about it. It's like that exercise was the only one that you can possibly suggest to someone to address hip impingement, and it's not the case. There's regressions, improgressions of everything. I would not tell my child to write a novel in cursive writing without teaching them, like they're stepping stone. There is to everything. And corrective exercises and stretches are, they have that as well.

There's standing versions, kneeling versions, on the ground versions. There's people who are stuck in their bed versions. There's so many different versions to do, and you can do it when you're in pain as well. And oftentimes, if you do it well, you don't actually feel any pain with it. But that is a topic we'll cover in a moment here. By the way, I apologize. I'm going to be raspy today because there is pollen around here, man. Pollen, I feel that you guys, the pollen crew, is like hunting humans. It is crazy. I've tried the honey thing. I thought that was very helpful. I don't take medications really at all.

I know you can take all the medications and it'll definitely knock it out. But, oh man, it really affects the ability to podcast sometimes. So I empathize with all the pollen allergy people out there. So the exercise categories that I think need to be addressed, and these aren't muscles only in particular, but they're categories, the gluteus maximus is one of them. It will encompass a lot of the glutes if you do it right. I don't think you need to do specific glute medius exercises or glute minimus and so on. Glute maximus usually takes care of a lot of them. The second one is the anterior core, anterior chain of the core.

The third one is lateral chain of the core and hip, and then the quad group. Now, these are, I'd put these in order of importance, at least an order of most commonly needed that I see, but everybody's a little bit different. And sometimes we start people just with a quad dominant approach, which I'll explain how we do that in a moment, but everybody's a little bit different. If you find the right recipe for things, people tend to get a lot better over the course of about two to three weeks, believe it or not. If you've been dealing with this for months, yes, I don't think you've missed the boat, but you've, I think, unnecessarily suffered for longer than you needed to.

So if you guys want suggestions on these, remember, we do have telehealth sessions and our contact for discovery sessions or consultations is in the description for this podcast player. Now, some basic tips, pro tips, as they call them. Rehab exercises should not be painful. And if they are, you need better cues, regressions, or pain management prior. Start with the hardest one that you could do well and look for burning of non-symptomatic tissue. For example, if you are doing a glute bridge for the glutes, you should not feel burning in other areas like the front of the hip or the groin or the hip flexor or so on.

You probably shouldn't really be feeling a ton of hamstring and low back either, but those would be signs of inadequate loading strategies, but we certainly shouldn't be feeling symptomatic tissue. Now, the ways that I would address the glute max, and yes, it gets all the glutes, is going to be, number one, I think if we're talking about our basic three-step regression, progression style, and by the way, there's endless versions of plugging in the middle of this. These aren't just like benchmarks of only you can do these three things, but these are really basic starting points. So regressions, the easiest, simplest, the ones that post-op people will do is clamshells.

Clamshells have been beaten up over the years. People say they hate them because they're not the right exercise for hip impingement. I would say they're just the simplest one. They're the easiest one. A lot of people underdose them. They don't do them hard enough. They don't feel a burn at all. Again, you need to see a burn in the tissues that are supposed to be challenged. And so starting with the glute medius or clamshells, a really easy starting point. Normally, we have people do this to what we call the perceived effort rating scale, which is going to be 10 out of 10 as you can't physically do it anymore.

Zero is like, I didn't do anything at all. Most people do three sets of 10, which ends up being like a rating scale of about three to four, which is not good enough for a long-term adaptation. Usually we shoot for about a seven or an eight. Like it's pretty hard to do. What's the sets? Usually about three. What's the break time between sets? Usually about 30 seconds. What is the reps? I have no idea. That comes down to how much you can tolerate and what burn you feel. Again, there's a different way of looking at rehab exercise. So I know that you'll walk away thinking, what's the reps and sets?

There is no reps. They don't matter. The reps literally do not matter. But when you get into weight training rehab protocols, yes, they do matter. The second exercise I like for the glute max is going to be a single leg bridge. There's endless references on YouTube that can work for this. The most common mistake I see is people put their foot in a poor position and they feel a lot more hamstring than they need. Just tinker around with the foot. Move it away from your hips or towards your hips and you'll feel like a sweet spot where it feels like you're getting a little bit more glute. And again, if you feel the groin with this, you may be challenging too much range and you just change that a little bit.

There's regressions. Again, you start with the hardest thing you can do well and look for a good burn. The third one is going to be the Y-Stance Core Drill. This has been referenced on our YouTube channel quite a bit with Mandy Riehl's plantar fasciitis videos. So if you search her name on our channel or search plantar fasciitis, you'll find Y-Stance. I think she shows it really well. She references it in regards to stability for plantar fasciitis, but it can be used for the entire chain, which is the entire leg. There's progressions to this too. There's glute max strength ones, which is probably going to be a deadlift or a hex bar deadlift or something like that, which we're not going to cover in this.

But I think three basic ones is a clamp shell, single leg bridge, and a Y-Stance Drill. Everybody should be doing at least one of those with some success. The next group is the anterior core. Again, this includes the abs and the hip flexors. It actually gets some of the quads too. I don't think we need to do isolated ab ones all the time. I think working on the core or the chain of the core is way better. We have books on this. If you guys are wondering why, it's on our website. So I think the easiest thing to do with this is first start with a posterior pelvic tilt drill supine. So this is where you're laying on your back.

It's going to look like a bridge position, but instead you flatten your back against the floor. This allows the person doing it to feel what a posterior pelvic tilt is because a lot of times moving forward into getting adequate anterior chain core function is going to be, you need to find a neutral or a posterior tilt. A lot of times people are stuck in an anterior tilt where that's your default, which really makes it hard to get activation of the anterior chain. So ideally find the position. Just find that you can actually post your tilt, your pelvis and say, Oh, that's what that feels like for this.

I, I don't really have like, you're not going to get to exhaustion. Like there's not going to be a seven or eight, like perceived effort rating scale. It's going to be, you know, 20, 30, 40 until you feel like you got it. We call this a reprogramming drill or rewiring drill. It helps you with just motor, motor programs or motor patterns. The next one is going to be something called a hard plank. A hard plank is like a plank, but from the elbows and from the knees. And then you pull the carpet together between your, your, your body. Again, we have references of all these exercises on our websites, but the hard plank is actually harder than a plank.

In my opinion, another great cue we use with it is looking through the tunnel between your legs to start to look through. If you have neck, a neck condition, this is probably not the best cue for you, but it usually gets a lot of ab work going on with this. And the next one is going to be from the hands, which is called a buttress plank. A buttress plank is the same thing from the knee, from the hand plank, but then deciding how hard you want to make it and what your tolerance is, you would move your hands further away from your shoulders. So that's stacked over your shoulders anymore as a plank would.

Now the question always comes up. So you think I should just do planks? No, I don't think you should do planks at all. I think you should do these or some versions of these. Most people that we start with our hip impingement rehab, we don't have them start with planks mainly because they've been doing planks for a long time and it's something familiar to them and they do it with a poor pattern. They do it with an anterior tilt, which mechanically, if you have an anterior tilt, it creates more impingement. So we need to break that pattern and using a regressed version of the exercise to be able to allow a neutral or posterior tilt helps a ton with that.

And also you can make those exercises equally hard, if not harder as well. The third group we have is the lateral chain of the core and hip. I say core and hip because you're going to get some glute or side of hip or thigh with this. Completely normal. First one's called a side bridge. Almost everybody can do a side bridge. It's going to be basically a side plank from your knees, but there's a hinging pattern with it. The reason they call it a side bridge is because it's a bridge on your side. It's like a hip bridge, but on your side. So there's a forward background movement with it. There's a little bit more glute activity with it because it's not as up and downy, frontal plany, if you will.

So this one is shown all over the internet as the McGill Big Three. There's a side bridge. Again, you can do it from the shoulders. You can do it from the elbows. You can do it from the hands. Most commonly, it's shown from the elbows. And again, this is a good example of how the exercise can be changed based upon your body's abilities. Like if you can't do it on the ground, we can do it on the wall too. But the most common version without making things too fancy is going to be on the floor. And this is going to be where gravity is your weight stack and you just go until the same rating scale of perceived effort.

The next progression is going to be a side plank. For this one, there tends to be a default to more shoulder problems with it. If you've had passengers, you have shoulder and neck issues, sometimes people complain about this with it. And so sometimes we can even jump past it and actually do something else. Which is going to be a suitcase carry. But for those of you who can use side planks, I like from the elbows, I usually put their feet against the wall so they can push or spread the floor, push yourself into the wall. And that gets a lot more side flank. It won't get as much glute or hip pelvis area as the side bridge, but that's okay.

Again, rating scale is what we use. The suitcase carry is kind of an enigma to some people. If I say, why would a carry, carrying a weight or a heavy object back and forth, why would that be part of this lateral chain? Why would it be like a side plank? Well, if you do it long enough, you'll feel other than your hand, you'll feel the side of your body start to tank. It's because your body has to stabilize against the weight. You're a moving plank now. That is the upper echelon of the side plank series, essentially. And this is a great example of how regressed exercise or what we call rehabilitation is actually strength training as well.

Like you can get to strength training and use that as part of your rehab. The last one is going to be the quad group. This one, if you go too deep, yes, if you go deep in the squat pattern, you will probably feel some of your impingement. But if you keep out of that range a little bit, allow the weight to go down, like we're doing isometrics instead of doing back squats and so on, a lot of times we can allow for a neutral or a posterior tilt, which again, may not be endorsed with high loads on your back doing a back squat. But when we don't have load on your back or on your spine, it's completely okay to do.

And we can use that as a means to try to get some of the pressure off of the impingement. So one exercise I really like is a low bear. A low bear, we can change where your hip position is really quickly. And it's an isometric. So we're just going to hold for quite a bit of time. Again, sets and sets, reps and the same thing as before. So what this looks like is a low bear is you are on kind of hands and knees, but you're going to go on your elbows instead of hands, like you're setting up for a bird dog exercise and you just bring your knees off the ground. It's almost like you're in a sideways squatting position.

And if you do it for long enough, your quads are going to burn. Now, the way we would not want this to go is for your groin to hurt. And so sometimes bringing your hips higher to the sky is a really easy way to get around this. Eventually, we end up doing this in a weight bearing position, which is wall sits. Great, great exercise to do. You have to change the torso position just a little bit because some people lean forward too much, which is more hip dominant. Again, we have hip exercises, so this isn't to substitute for that. But if you keep the torso pretty upright, then it's going to be really quaddy.

It's a very hard exercise to do. It's very classically used with physical therapy with various different conditions as well. And the last way we would progress this is, at least from the rehab scenario, it's going to be goblet squats. Goblet squats are, again, referenced throughout the internet. You take the weight, use a kettlebell, dumbbell's fine, put it up by your throat and just start squatting. Range of motion is going to be based upon your tolerances. And sometimes people actually squat to a box for this. The key with this is once you start putting load on your upper body, we need to make sure that you keep a neutral position in your pelvis.

And if you start to answer tilt, you may end up having some of the symptoms come back. So again, this is kind of that whole paradigm of when is it too soon to add weight? I think a lot of times on day one we can, as long as the person can walk. But are they able to do it at home successfully? That's kind of the problem. Under supervision or under coaching, when good coaches use cues as well, it helps to make the success go better. They're like a cheat code to doing it well. So there's nothing wrong with trying things at home, but there's kind of a problem with endorsing the movement strategy or the compensation, which has been creating the issue in the first place.

Again, if you have bony impingement and it's not really that bad and you're not a surgical case, then you don't have a labral issue. It's not like big amounts of arthritis, then you're a rehab case. But also your success is going to be dependent on how good your instructions are from your coach or your healthcare provider. And as well as can you do it successfully on your own for a long period of time. Now, we always say at Performance Place that our rehab exercises will be substituted by weight training exercises. They don't have to be super heavy, but they generally look like weight training exercises, resistance training, and so on.

But we're not going to make any change in a week. We're not going to make any real strength change in like two to three months even. What we need for you is to do this habit change and keep with some of the exercises and make your own changes for years. Literally years. Don't expect to get strong in a day, in a week, in a month, maybe a year. You get some neurological strength gain or probably in 12 weeks to get some neuro strength gain. But you're not going to see big size changes or big jumps of strength beyond beginner strength for probably years. And that's okay. Like the idea is to build a more resilient you.

And that takes time and habit changes and sticking to the plan. And this is where we get into trouble sometimes. We're just talking about hip impingement as like a pain management thing. Like, oh, you just don't do that. Or let's just do a surgery on it. Or let's just do medication. Or how about some tissue work? Like, all these things don't really help with stopping the adaptation from occurring, which some resources say that impingement turns to labrums, turns into arthritic change. And I hate to doomsday for people. But I think in reality, if you see some range of motion changes that are feeling kind of bony for someone in their 20s or 30s, like, yeah, I think we have a responsibility to tell them about what may end up happening over the course of time if they don't change their habits.

Like, there's a great training coach, Dan John, that says something of the source for for nutrition. He says, it's not what you're eating, it's what you ate. And the same thing goes with your non-traumatic conditions like this. It's not what you're doing right now, it's what you did. And so old habits die hard. And a lot of times people are not aware that habits and their past activities, that they may continue to do right now are things that are major contributing factors. So we need to help shape your life and shape some of your training. And that's what we're here for. So if you guys are looking for help for us, we are licensed in different states.

We have telehealth. We've managed a lot of people, thousands of people through telehealth for hip impingement and it's been very successful. So reach out to us. Our consultation is very affordable. We also have online programs on our website. I designed them myself. They're all videos that are not available on YouTube. We've heard a lot of structure about how to scale exercises like these. And they, as we always tell everybody in our programs, in our YouTube, we do not reserve or keep exercises hidden. So you guys can't see them. All the exercises, pretty much all the exercises we will use are on there.

But how do you use them? When do you use them? What is okay to have certain amounts of pain with? How long you should be using them? How to progress them? How to jump past certain ones so you don't have to do remedial ones all the time? That is where the magic happens. So there's an artistry with rehab. And I think people forget that. There's not just some magic exercises. It comes down to context all the time. So if you guys are looking for help, 714-502-4243 or email us, go to our website. All of our contact is below. Take care.