Why Corrective Exercises Help Hip Impingement Without Changing Bone

Hey, everyone. It's your co-host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Got caught up there in my tongue a little bit. Now, we've done some recent podcasts on sports hernias and postpartum return to running. We've done hips and sciaticas and low back. This time, I'm going to do one a little bit more directed towards theory because I do have some people who come in or do our telehealth session asking us why we're suggesting what we're suggesting and why certain exercises may be helpful and also the ever-important question of, so why would this exercise fix my hip?

So, let's just say we're talking about somebody with hip impingement. I think a common question that I get about hip impingement is something revolving around, well, if it's a bony abnormality, why would an exercise change that bony abnormality? I thought it was I need to get the bone shaved off. You're correct. The exercise will not change the bony abnormality. And in fact, any corrective exercise or physiotherapy exercise, any band, any ball, any weight that you use will not actually change that bony abnormality. So, corrective exercises, we don't really say, I don't know who named them corrective exercises, but they don't actually correct anything.

They don't fix anything. And when I've told people that in the past, they say, well, they're kind of baffled by the whole concept of why, why are we doing this then? Why not? Is the answer to surgery to change the bony abnormality? No. With something like hip impingement, it's actually a biomechanical problem with many people. Yes, they have a lot of times a bony abnormality, which has been around since they were teenagers. Usually athletic teenagers do develop it when they're actually still developing skeletally. But they've been okay with that bony abnormality for a very long time. What's happened, though, oftentimes, is something's changed.

Their activities have changed. Usually you're evolving around more load or a spike of activity. I had someone recently that I had spoke with that they had actually started a New Year's program where they started to add barbell back squats in. They have not done barbell back squats in about 10 years. And they just started to go full bore with lighter weight, but do a lot of reps. And they actually did 100 reps every single time that they went to the gym. Now, I'm not here to debate what good exercise programming is, but let's just think of this from more a theoretical perspective here about what they knew they'd been doing versus what they haven't been.

Well, they started adding squats in higher volume. I mean, he's been doing this for, like, months now. 100 reps, three days a week, every time he goes to the gym. So, 300 squats a week times the amount of months that he's spent. And now we have a new habit change, which his body didn't have the affordances to do. And I'll explain affordances here in a moment and how corrective exercises and strength training helps out with affordances. So, but I think the first takeaway here is that no corrective exercise, no strength training, any of that stuff will physically change the bony change. What it does is it gives your body new movement options.

It gives options to move around one movement pattern, which is, at this point, the one he is defaulting towards, and he's developing pain with it because it's not adequate in order to, or it's not sustainable for the activity that he's doing. Now, if we zoom in too far into the hip here and take a microscopic view of the hip, we'll actually lose the whole concept of this. But if we zoom out a little bit and we take a look at the pelvis, the core, even down into the foot, the whole limb, we'll actually get a better idea of how this can actually work. Now, what we want to do is we need to give the body new movement options for that one task.

Let's just say they're doing their squats, their knee likes to dive in, and their body's default pattern is to use a knee valgus or knee collapse type of movement pattern for that squat. Maybe it's because the glute max is weak, maybe the glute med, maybe poor core strength, maybe they have excessive knee valgus because of cue angle or something like that. Who knows what it is, but the body's defaulting that pattern, but it obviously has other ones because if we watch that person and coach them out of that position, hey, knees out, knees out, knees out, all of a sudden they feel a little better.

Now, the answer is not necessarily knees out, knees out, knees out forever, but we need to make this more of an automatic default change of movement pattern for the person when they're going through the volume that they want to do. I'm not saying that 100 reps a day is a good thing to do, but if that's what the person wants to do, and that's the volume and intensity they want to do it at, our job is to make that possible. So, what we need to do is build a better default movement strategy or a few different movement options with that lower load movement, the squatting. This is where the corrective exercise and strength training comes into play.

I will give you an analogy of a movie theater here to give you a better idea of what affordances do for our movement strategies. So, imagine you're in a movie theater here, and you're sitting at the front row, and a fire breaks loose up on stage. Now, everybody sees this at the same time, and you're the one that's deepest in the movie theater, and you've got to find the exit. But, we can see that if there was a central aisle and an aisle down the side, many of the people will probably move into the central aisle first. So, when you turn around, you see the central aisle is actually the most clogged up of all of them.

So, if the task to get out of the movie theater, a.k.a. the task of squatting 100 reps, is not doable with that pattern, we need to find a different way out of the movie theater or a different movement strategy. So, the movie theater one, now we have an option of speed, let's just say. There's a different aisle to your right. It's about double the distance long. So, obviously, everyone took the one that's the shortest route, but you can't take that anymore because you're the last one in line. But, the fire is growing, so you've got to get out. So, if you have enough speed, you can get around the clogged up aisle into the aisle that's double the distance long, but still get out of the movie theater in time.

That is how speed could help you in this scenario. Now, let's just say you also had issues with mobility. Like, your hips were stiff and you were sitting in the front aisle, and now the other aisle is also clogged up, too. So, both aisles are clogged up. There's only one way out, and it's through the seats. You could actually hop over the seats if you had hip mobility. In this case, speed doesn't matter quite so much. Mobility is more important. So, your body gets a different movement option, a different way out of the theater, a different task if it has different attributes, in this case, hip mobility.

Now, let's just say the hip mobility is not an option because these seats are now, like, five times the height. They're massive, tall, they're giant seats, but they're fairly light. Now, the option is to push the seats over. They're not bolted to the floor anymore. You can push them over if you want to. Now, someone who's really weak and fragile, they can't do this. They don't have the affordance to do it. They don't have the opportunity to, but someone who's stronger can. They don't need to be fast. They don't need to be mobile, but they can move their way out of the theater because they're just physically moving the seats.

So, there's four ways out of this theater. Over the seats, through the seats, around the aisle that's longer, or through the first aisle, which is no longer an opportunity for you because that one is clogged up, a.k.a. knee valgus squatting movement pattern. So, what we could do with our corrective exercises or our programming is we would program to build the other attributes, and we coach and tell the person exactly how we want them to do this. And then, that attribute will carry over to the exercise without it being coached. I'm going to say that again. You don't need to think about moving your knee outward in the exercise if you already have the attributes that will allow it to get there without you thinking about it.

So, one way we may do this is we would do a glute max strengthening program on the side of involvement, let's just say. And we can strengthen that thing to holy hell, and it would take about a couple months to do so. And then, what we find is the person has less knee pain with squatting, but actually, they still kind of show a little bit of knee cave. Not perfect, but it actually doesn't hurt to do it anymore. This is a new movement option because the strength gives them that new attribute. I know I sound like a broken record, but this is a very complicated topic for a lot of people. I want to make sure to hit it a few different ways.

Okay? Now, let's just say core support was a problem. Like, you had poor core support, poor core stability, which ended up in a default anterior pelvic tilt, which oftentimes couples with knee valgus and so on. And it also can create less room in the front of the hip with hip impingement cases, with the bony abnormality or the cam deformity. Now, one thing we can do is think about posterior tilting in the squat, which you don't want to do. Again, you shouldn't have to think about that kind of stuff. But what you could do instead is you can do an exercise or rehab program that would build a better ability to get away from an anterior tilt as a default movement strategy.

So, we would reverse it a little bit or give you a little bit of the opposite as not to say you can't have an anterior tilt, but you would give a core support type of rehab program to double down on the idea that maybe the anterior tilt is part of the problem. Now, if you build that up enough and you build enough robustness and enough endurance in that pattern, then it will also carry over to your squatting pattern. But it's important to note that you will not change your bony abnormality. And this is where, again, rehab, sometimes the purpose of it gets lost because we think we're supposed to be fixing something.

And when you look at your image again after you feel better, and I would suggest someone with a little bit of extra money, if they want to spend time doing an MRI, do an MRI before you feel any better. Do some rehabilitation. And if you feel better for a couple months, do another image. Burn some money. Spend another grand. And then look at your image. I bet it will probably say the same thing. You'll still have the bony abnormality. You'll still have all of the same stuff that you did. You may have a little less irritation in the area because a lot of times pain in the location will insinuate an inflammatory component.

So that may dissipate a little bit. But the overall structure and architecture of your actual, like, hip will not be any different. But who actually images themselves when they feel good? Nobody. Now, I have a personal experience with this that I'm glad my mother's very organized and kept my MRI from when I was 15 years old. I have an MRI and a bone scan that shows all the things that happened with my first low back injury. Because remember, this happens with all different types of injuries, not just hips. But I was 15 or so. And then at 35, I also had another back injury. And I got an image done again.

It was the exact same image. The exact same image finding. Three millimeter disc protrusion, centrally located L5S1. Same exact thing. So same level. Same severity. But what happened? Did it push itself back out again? Was it there for the last 20 years? I'd venture to say it was there for the last 20 years. I haven't imaged myself again because I don't want to lay in a little tube. I don't really like it. But I bet if that was a thing you like to do and you image yourself all throughout time, you will find the exact same thing over and over and over again. And with all your different aches and pains, your meniscal tears, your patellar tendinopathies.

I remember this one girl that I had worked with that she had, I was looking for bone marrow edema in her foot, in one of the small bones of her foot because I was concerned she had a stress fracture. And then we saw a ton of tendinopathies in her foot with different tendons of various sorts. And I asked her, I said, did you have any pain in those tendons, the locations? I pushed on them and stuff. And she says, no, at all. She had pain in another location. That's why I was seeing her and that's why I did the image. But she was, I mean, there was nothing wrong with the area. So I don't know if this makes it more clear to you guys or not.

But I want you to think outside the box with some of your understanding of what you're supposed to be doing with your exercises and really what good rehabilitation and good recovery really means. Because if you're hell-bent on changing your image finding, you will be severely disappointed because the only way you'll do that is surgery. And you may not feel any better at all, which is really common with a lot of people. But plenty of people feel better if they just rest a little bit, change activities a little bit, stop doing 100 squats every day, or do structured rehabilitation, build their attributes, and actually go back to the 100 squats a day.

So I see this continually with a lot of guys I play baseball with. They can't throw. Their shoulder hurts. But everything else throughout the day is okay. Like throwing the baseball is a very specific skill set. It takes a lot of shoulder mobility. It takes a lot of support. And you can't just jump into it again all the time. So rehabilitation in that case, again, building affordances, strength of the shoulder blade, making sure that the T-spine has or the mid-back has a lot of rotation extension potential, making sure the legs are part of the equation because we know that I think it's 80% of throwing velocity comes from belly button and below.

So there's other attributes that need to be built. So if you guys are looking for help, virtual or in person, we do have telehealth services, and we are licensed in different states. And we also have really good online programs that we put together to build these different attributes that you may have not considered already. So take advantage of those. All the links will be in the description for the video or for the podcast, and I'll see you next time.