Stiff Hips: Mobility, Hip Impingement and Exercises That Help

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. And now, your host, Dr. Sebastian Gonzales. Hey everyone, it's your host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time to show welcome, where we are into around 300 episodes and going strong with some really nice topics on the hip, groin, sports hernias, low back, and so on. We've had some guest hosts recently, such as Dawne Costantino, DC. Is that you?

That's me. Okay. I realized I got to mention that we're chiropractors on here too, but we specialize in rehabilitation and sports medicine. So we are going to cover the stiff hip today, as well as some mobility hacks and exercises we can do to help people move better, feel better for various different diagnoses. Dawne Costantino, do you have, what type of experience do you have working with people with stiffness of their hips? What kind of experience? I'd say a lot of experience. That's like a daily thing, for sure. What we see in the office is stiff hips. A lot of different reasons and causes for it, but that's obviously what we're going to get into.

Yeah. So I think the thing that I notice a lot of times is that like we see people with these problems like low back or stenosis or discogenic pain or hip pain, but a lot of times they don't actually present for care anywhere unless they're dealing with this problem. So it, the stiffness of the hip sometimes is just a random incidental finding when you're examining somebody's low back or their hip, you find it, but it doesn't always hurt. Yeah, absolutely. I noticed it. I mean, just kind of bringing that up. The stiff hip, a lot of times people won't come in until it's stopping them from doing something that they love.

Right? Like I have a stiff hip this morning, but it kind of goes away the more I walk. So when it plays a role in your ability to get better or do something that you love is when they're going to present to the office and ask for some help. Yeah. What type of things do you see people normally not being able to do as a driving factor for them to improve this? I feel like with a stiff hip, especially with what we see, it has a lot to do with, I'm going to say squatting as like a general term because squatting is used throughout the day a lot. It's not just a barbell on your back and sitting to the floor.

It's, you know, driving, it's getting out of a car, it's getting up and off the toilet, it's rolling out of bed and standing up. It's a movement that's utilized a lot. So anything that kind of brings the knee close to the chest, that happens a lot throughout the day. So that's, that's what I see people kind of present with. Yeah. I, I'm reminiscing about a YouTube video that we did a long time ago. We were, we were back and forth in the things that people typically have with, with knee problems. And you mentioned a few of them already and the getting out of a car is a common one, walking upstairs, crossing their legs, putting on shoes and especially athletic activities, not just weight room stuff, but like sprinting, running, changing direction.

These are things that people typically have issues with. And I think if they're astute to it, they'll, they'll think maybe my hip, it just has a problem versus I'm too old for this activity. Yeah. I mean, the age things brought up a lot. A lot of times they'll just say, well, I'm getting old. So that's just my new normal. Yeah. There's, there's a few guys that I, I still play recreational baseball with that they're, they're in their sixties and seventies and some of them don't move super well, but man, they're out there all the time. They're having a great time, but also like, it's a good, they have realistic expectations for their body's ability.

You know, they're not trying to be 20, but also that their social circle is still there. They still have a lot of friends in the sport. And so they really, I think that really helps them out mentally too, with the aging process, as they say. What's that age range you were just saying? They, oh, like they're like 60. Well, I said, I play with people all the way from like twenties to seventies. So I have a lot of like 30 year olds who will be like, oh, I'm just in my thirties now. And my, you know, my hips are just stiff. So that I guess that's my new normal. Like you mind if I change your perspective on that?

I know. It's, it's so, it's so frustrating. I say like some of the people that I, that I end up seeing, again, these aren't, these aren't patients. They're just like people I talk to, you know, on the, at the field. And like, I'm just getting too old for this. How old are you? 25. What are you talking about? I've just been using my, using my body so much. It just, come on, come on. Like there, there's more to it than just age. Cause you'll probably feel better at the age of 40 than you do at 25 right now. So. Yeah, absolutely. It's not age. It's not getting older. It's what you do and don't do with your body as you get older.

That's playing a role. It's more about the habits and the day-to-day routine. Right? Yeah. So let me just put a checklist down here of things that we're going to cover today. I should have done a little earlier, but we're covering, you know, why you should care about hip mobility as well as how it affects your performance. Some diagnosis it can be, how it feels. We already covered mechanics, potentially of how the diagnosis may occur and what an exam may look like. How do you identify, like if you have a stiff hip or like the other variables with it, difference between sensitivity and damage, how getting better may look and how to do it, as well as some exercises and stretches that we typically like here at Performance Place.

Does that sound pretty fair, Dawne Costantino? I like that. Okay. We're going to try to cover this in like under 30 minutes, so we may have to just be brief on some of them. Cool. Okay. So in your experience, talking to people about why the hip is important to their overall, let's just say with squatting, we don't even go performance yet, just getting up and down. How is that important? Why is the hip important? I think the hip is important in movements like that, like just daily function movements, mobility-wise and ability to access that mobility. A lot of illities there. But I think it's important because where you move from plays a role in pain, discomfort function throughout the day.

So a lot of times what I see is, let's say people's just ability to access their hips, ability to move better through the hips a lot of times is lacking. But if you have some true mobility deficits, like maybe there's a reason why your hip's not moving into, you know, knee towards your chest, hip flexion, your body's still going to find a way to accomplish that movement. And usually they're going to, it's going to compensate somewhere else. So what I'm trying to say is, is if you can't access the hip, usually you're going to move from somewhere else, which is going to be the lumbar spine. And then that's typically when you start to see pain set in.

Yeah. There's a lot of knee correlation to hip stiffness as well, or hip, I don't even want to say to stiffness, but lack of function or strength. But you're right. The body will find a way just like Jurassic Park dinosaurs did. It will find a way. You got that reference? I feel like we haven't done this in so long. I forget about your references. Yeah. You're still good at that. Life finds a way. Okay. So now that we know that there's some importance to it, at least for low back and knee health, but to say, what are diagnosis that you see are, that are commonly associated to stiffness of the hip?

Like which ones do you see stiffness of the hip findings in that exam? God, I really want to define like the difference between feeling of stiffness and like true stiffness. We can cover that first if you want. I mean, just really quickly, like the easiest way to kind of recognize stiffness, just the feeling of stiffness is like, if you go to touch your toes, you can put your hands flat on the floor. Like people will say their hamstrings are stiff, right? And they go to touch the floor and their hands or palms are completely flat. It's like, well, you don't have short hamstrings. You don't have like true stiffness in that tissue.

It's just a feeling of stiffness. And that can happen at the hip flexors, the groin kind of around the back of the hip as well. Sometimes it just feels sore, feels stiff, feels like you can't access ranges. But then when we go and test it, they have full range of motion in that area. As compared to when you test the mobility of that joint, you actually see some differences from side to side. You would expect to see more range of motion in the hip itself. So sometimes people come in just feeling stiff, but they have great mobility. Yeah, there's a big difference. I know that a lot of times I talk to people about it.

I draw their attention to the stiffness or change of range on one side versus another. I used to tell them that the side that moves more is probably their anatomical, quote unquote, normal. And it'd be reasonable to think that if there wasn't some type of bony obstruction or like big defect, then we can get back to that. And they're like, sometimes that stiff hip doesn't always hurt. And they say, well, it doesn't hurt. The other hip hurts. Yeah, there's a difference. There's a difference between stiffness and pain. Stiffness doesn't always equal pain. Absolutely. So going back to diagnosis, like what could cause maybe feelings of stiffness in that area?

A lot of times the lumbar spine, I'll bring that up first because we see that a lot. Lumbar spine, meaning nerves that come out of there that supply the joint and the muscles of the hip, if those nerves just aren't functioning properly, then you can feel stiffness in the hip itself. But then true stiffness, true mobility deficits, things like hip impingement, we can see a lot in our office too. Yeah. By the way, I think your video looks pretty good from here, Dawne Costantino. So why don't we use some of these clips for some social media too? Does that sound good? Okay, I'm just staring off at the end of it.

No, that's what I was... Not that I know you're recording that part. Well, you're meandering, but I can tell you're really thinking about the response. Yeah. I mean, it's probably more engaging than me just like, I'm just like a talking head right here. At least you're sporting your Nike. Yeah. So low back condition. So that would be discogenic pain or disc herniations is the most common probably. That would be even older people with stiffness of the hip takes more load in their spine that creates more scenarios of arthritis in the spine and even lumbar stenosis or even chronic old knee issues.

I see it a lot with knee issues like patellofemoral pain, your runner's knee, your meniscal injuries, non-traumatic, very commonly found in those as well. Hey everyone, it's Sebastian. I'm going to hijack the show just for a second here to tell you about an opportunity that we have called the Discovery Session. A lot of people over the years have reached out to us from our YouTube channel because we have 150,000 YouTube subscribers at this point in time, probably more by the time you're listening to this. And we have a lot of people listen to this show and read our articles online. They're frustrated.

People are frustrated about not being able to get back to full activity. They're frustrated. They can't really trust their body. They're frustrated that they have not found any long-term answers or things to make them happy. And so we're here to help. We may not be the ones to actually help you and we're okay with that, but we're hoping that if you are able to speak with us, that we can maybe give you some insight of things that you potentially haven't tried yet. And if we know people, we'll suggest those people too. So if you want to take advantage of the Discovery Session, all you need to do is go to p2sportscare.com and find the Book Now button.

It's all in there. We have virtual or in-person options. You can go to the show notes for this show and find a link that'll directly connect you to us, or you can call us, 714-502-4243. We'd love to help you the best that we can, and we're always here to serve. Now, back to the show. Now, I'm just going to take the elephant in the room here. So that pain in the front of the hip that everybody has, so is it my hip flexor? Likely not, no. So how do you know in a test that it's not the hip flexor? Well, what are we, I mean, the thing is, is like most of the time, what are people thinking is wrong with their hip flexor?

Like it's torn or it's strained, right? Just because of the feeling of it. So a lot of times- But it's overused. It's overused. I'm sitting there too long. Yeah, like overused stuff, a lot of times it's going to be some sort of strain of the muscle, right? And when you have a true strain of a muscle, a lot of times you're going to feel weakness with it too, not just pain. So when you test the ability for the muscle to withstand some resistance, for example, laying on your back, knee and hip are up at 90 degrees. We say, meet my resistance with my hands. If they can fight back pretty strong, there's probably nothing going on with that hip flexor itself.

It's not strained. There's no tear. If there is some weakness there, then we might be thinking that's, you know, truly a tissue that's involved. But most of the time, there's no weakness involved. Yeah, I would agree. Now I'll play devil's advocate. What if it's a micro tear? Like when I think of micro tears, I think like we just got done exercising at the gym. Okay, so like it would go away type of thing. What do you mean by that? Define micro tear. Yeah, I know. Well, I'm just going off of what I hear a bunch of. It's like, because it's like, it's like there's a big disbelief that like, well, I feel the pain there.

I see that there's a muscle there or a tendon and it's probably the iliopsoas. I know you tested it and it feels strong and it's not painful to test, but I feel the pain there. So it's probably it. So the what I sometimes hear people say is, well, maybe it's overused. Maybe it has micro tears, which you can't see. Maybe that's why you're not feeling it with resistance. Maybe it comes over time or it's overused, which is, well, we can't really duplicate it in here because we haven't used it enough. I mean, possibly all of that is very, very possible and still could be true. But sometimes it's even if that is all true, let's say the hip flexor has micro tears being overused.

The solution then to it is how do we get that area to then stop being used so much, right? And a lot of times we're going to be looking at other areas of the body that aren't working so well. So I don't know if I'm taking you a different path that you want to go. No, I'm just I'm just spitballing here and which brings us into mechanics. OK, so like like how do these symptoms actually start? Because I would agree with you. I know I'm playing devil's advocate with it. Just make sure no one's on the other side is listening to. Well, they're only talking about this. I'm not talking about really what I think it is.

But yeah, those like the hip flexor can have overuse and create pain in the front. Maybe create stiffness of the hip, maybe not. But why is it working so hard? You know, like so some of the mechanics that sometimes we see and I and I think that some of the if there's some physical therapists or other movement professionals listening to this, there's there's I'm sure that everybody's suggested a glute exercise at some point, like whether we're debating whether it's to glute meat or glute max or glute men or, you know, gluteus aurelius. It's a Roman joke. I like everyone to guess glute exercises like this can't be like a coincidence.

So everybody's probably been taught that in school. There's probably some research that says the glutes are important and the glutes are the antagonist to the hip flexors. So they're the muscles that do the opposite. So there's plenty of techniques out there that will try to facilitate the glute to get the hip flexor to stop helping so much because it is very helpful, which I personally think comes down to first with core stabilization to help the glute come back online or encourage it, which will decrease activity of the hip flexor. And then all that pelvic tilt and all that comes into it, too.

Like it's all one one big thing. What do you think? Yeah, absolutely. I was thinking in the beginning when you said mechanics, I went to the core as well because I think the glutes are talked about a lot and I think that they need to be utilized. And it's usually an argument about the way that we're describing why we're choosing the glute exercise. But most of the time, it's just we've got to get the freaking glutes to function properly. So glutes are involved. Glutes tie into the function of the core. A lot of times our attention with, let's say, just groin and hip issues is of the core itself.

It's the position of the pelvis. It's the way that you can breathe into it. It's the way that you can stabilize that area best. Pelvic floor plays a massive role in that as well. And then can you take that function off the floor and put it through just normal daily movement, right? We've got to progress you away from things that you're just like on the floor doing booty band stuff all the time or just belly breathing all the time. You have to get that skill into other exercises moving forward to see actual true progress. Yeah, and I think that like what you had mentioned that there's all these, like whatever means to get the glute seems like that's always a common factor or the core as well.

Like if we were to take like some, like everyone has different logic with like maybe why they're using like the methodology that they're using. Like if you say that your hip flexor is tight because you're sitting too much, yeah, well then sit less, walk more. You walk more, it'll get the glute active, right? Some people say, well, if you sit too long, it makes your glute inactive or dormant or amnesia. In that case, work the glute, walk more, stop sitting so much. It also like, like there's plenty of conditions like hip impingement. There is a glute max relationship with low back pain. There's a glute max relationship.

And so if you're finding that you're doing glute booty band exercises and it's really hard to feel your glutes, that's probably a good takeaway. And then if you're doing low back, sorry, if you're doing hip exercises or hip dominant ones, like single leg hinging or deadlifting and you feel your back or your quads, it's kind of like, well, your glutes are still not willing. Like it's a lot of easy signs to follow, whether you want to get into intricacies of the mechanics or the diagnosis, or you just want to follow the easy signs. Yeah, absolutely. I mean, coming back to like the, like, let's say it's a hip flexor issue.

We can stretch it out. We can do minimal things to make it feel better. But the stuff that we're mentioning right now is ultimately, so call it a hip flexor, call it hip impingement, call it what you want. Ultimately, we got to look at the function of this person and start to get them to just function and move better and educate them a bit. Know how things should feel, know how things should look. That's where that long-term benefit comes from. So this brings us now to sensitivity versus damage, because you said it's kind of like, well, whatever it is, it doesn't really matter. I mean, it does matter, but it doesn't, sometimes it doesn't matter, right?

So, but there's plenty of things that you don't see on an image that still could be symptom generators. So there's like sensitivity, like you don't really see a sunburn on an image of any type, but it still hurts like heck, right? And so there's like the strain category, the overuse category you don't see on an image. But if you had damage, you would see that on an image because images are very good. So, but if you don't see an image that verifies that you have a certain condition and it appears there's nothing wrong with you, maybe you have a sensitivity and you still have a lot of opportunity to reverse engineer that before any damage actually does occur.

Yeah, I think what you're talking about there too, I see that a lot with just like hip impingement signs, right? Because true hip impingement would be, there would be some bony deformities that you see on imaging right away. But sometimes you see early signs of that. So when you bring the knee towards the chest, when you bring the, when you approximate the joint, you create some stress in that area. It can still be positive. It'll create your pain that you're dealing with. You're just not at the point yet where long-term it's adapted by growing more bone in that area. So we don't have true hip impingement, cam impingement just yet.

We're catching it in a place where it's just sensitive, like what you're talking about. Yeah. I think if you, like if someone does a good exam on you, like it won't take you more than 10 minutes, at least to go through the testing, ask the right questions and figure out like, are you at risk, you know? And an exam of the hip, like say you didn't even do low back or any other stuff that's usually involved with it, watching movement screens, like you can usually see, like with just watch person squatting, you'll see possible signs of it. You can do fadiers, fabears, scours, circumduction, like there's plenty of like orthopedic tests you can do where you don't need the image to find stuff like that.

But also the history taking process is super important. That's why your practitioners should spend a little bit of time with you first as well. Yeah, absolutely. Adding, going back to just really quickly saying it doesn't really matter what it is, excluding all like red flag stuff, of course. Right. Correct. Yeah, it's so I like to say that it's, it matters what it is, but also we have to figure out what bucket to put it in. If it's an infection, yeah, it's a totally different treatment plan. But if it's just, if it's simple impingement, hip flexor, getting too tight, like these are all rehab cases for the most part and they could be easily managed with conservative care super early.

Now, Dawne Costantino, let's get into, I think we have about maybe under 10 minutes left on this recording and we, I want to cover just some easy tips that people can walk away with and maybe some timelines of what we may want to see with resolution with immediate symptoms and then maybe sporting ones. What do you think? As far as resolution, I mean, I tell people, you'll know fairly quickly if you're on the right path. I conservatively say four to six weeks. A lot of times it's quicker, but four to six weeks kind of helps me not shoot myself in the foot. If I say you're going to feel better really, really quickly and then they don't.

So usually within a month, you should see some pretty significant changes in pain if you're on the right path. What about you? Yeah, I would agree. I probably take a shorter timeline, but I, I agree with what you said. I don't want to shoot myself in the foot either. I've seen plenty of people who have felt better in like about 10 days. Fair. But three weeks is pretty fair. Four to six is probably more along the person's like rational timeline. Because sometimes you tell them three weeks, they're like, no, I've had this for like two years. This isn't going to go away in three weeks. Okay. Give me, give me four to six.

We make it in three or one. But I'd say it's going to be like nominal things first. Like you're waking up and your hip isn't stiff. You can lift your leg. You can get out of the car. You can squat down to the toilet, but maybe squatting to a lower depth is not going to be doable yet. So I think we just have to take an audit of things that are more reasonable. I wouldn't expect you to be sprinting on week three. Yeah, I'd say mostly what you would see is because when we treat people in the office, there's a difference between subjective audit. So like how you're feeling, how you're describing to us, what you're noticing, what you're seeing improvements and no improvements in.

And then what we can test, hip range of motion, ability to squat and the way that it looks symmetrical from side to side, things of that sort. So most of the time, what changes quicker, most of the time, is people's subjective pain audits. They'll come in and tell you, hey, I'm feeling so much better. I can get up and off the toilet. My morning time pain is better. But then the things that take a little bit longer are those, you know, when we want to see change in hip mobility, when we want to see your function improve in certain exercises, that stuff just takes a little longer, takes a little bit more time and consistency from the patient.

But those are the things where usually your, you know, trial of care, your program, we want it to be a four to six month window because it's easy to change pain, but to keep it from coming back over and over and over again, that function needs to change as well. Yeah. Like I've, I've even met people where we make a change in range of motion on day one, whether it be with tissue work or an exercise or a stretch, but pretty consistently that does return back to its old status within about a week's period of time. So I'm not saying hands-on treatments need it all the time, but it's, it's more unrealistic to think that that change will stay gone or sorry, stay around and the range of motion will stay.

If you do nothing else for it, pain though, can reduce very quickly. Like you said, it's super easy. A lot of this stuff is like really comparable to just diet and wanting to lose weight, right? Like just to get some people to understand it better, you know, you can change your habits and you can do these changes and you'll, you might feel better really quickly. And you might see some pounds, you know, come off the scale really, really quickly. But if you go back to your old habits, if you stop doing these changes, you're going to go back to where you were. So a lot of this is very similar to that when it comes to pain and function and, you know, hip impingement, hip flexor, whatever we're talking about.

Okay. So let's do a quick fire around then. So if you had to pick one stretch to help out people with hip pain in the front, what would you pick? Stretch? I mean, God, I love so many. I want to not go to the, just the simple hip flexor, but I want to go to the hip flexor, like just get you to just extend the hip a little bit better. So a simple like half kneeling hip flexor stretch is a great one. Sure. Yeah. I would agree with that. I think most people don't do it enough. If it is accurate to do, they do it like 10 times. They're like, well, I think it's better. And they walk away, maybe do a little bit more.

It's actually, it's actually just, if you compare it to like sit less, it's actually just the opposite hip position. So you could hike too. That would also suffice for the hip brain, but I think it's an easier way just to plug in range of motion, whether it's hip flexor stretch or not. That's a really good point. It's like, you could do it once a day and that'd be different for you, but then you, the rest of the day, you're still sitting, you're still in hip flexion. You're just overriding what that stretch did for you. So it is about how much you do it in the beginning sometimes. Do you want me to give you a quick fire now again, or you want to give me one?

We got to, we got to cover about two, three topics in this quick fire before you finish. Okay. Well, cause I know you love strength training and putting weight in people's hands. So if you had somebody comes to the door with hip flexor and you want to put weight in their hands right away, what exercise are you doing? So if we're talking actual hip flexor, then I would probably deep squat them. Okay. Now, if it was hip impingement, I wouldn't do that because it is slightly different. This is how like things tangent a little bit. But so if it was actually a hip flexor, I would probably just put a nominal weight in their hands.

So most people like, so we do a goblet squat, possibly let's just say like 15 pounds, something that's not really too heavy to really traumatize the spine in case they do have some spinal sensitivity, but I'd probably just get them down to a really low squat. The weight is a counterbalance, get them butt all the way to the floor, keep the heels and toes on the floor and just get them to be down there for like 30 seconds and then up and down and so on. At that point, I wouldn't really care about how long, how many reps because it would be an initial exposure to it. So I wouldn't even call it strength training per se, but later on, we'd probably explore a little bit deeper hip range of motion because it eccentrically loads the glute max.

So it's a progression on some of the corrective exercises. Just kind of playing like what listeners might be thinking. If I'm sitting all day long in hip flexion, why would you want to put me in more hip flexion? Yeah. So that's because this one allows a little bit more. Well, you want the easier or hard answer? Whatever, whatever. Man, this is okay. So I'll do the complicated one here. Okay. So the hip overall like needs support, right? Being able to go to a deeper position in a squat isn't always helpful. Again, based upon the diagnosis, if it's hip impingement, then maybe not. But ideally, if we want to stimulate the glute max, we want to do it in a way that is acceptable to the person.

Now, some people only feel their groin pain or hip pain come on with prolonged sitting. So the initial move in a sitting doesn't actually bother them. It's actually more of the passive structures that they're putting, either the passive structures they're putting load into on the sitting, or it's the overactivity of the hip flexor, being in position too long, creating, trying to be in better posture. So being in better posture is more of a anterior tilt, lumbar extension, anterior tilt, classically, you know, sit up straight. So it's exhausting. I remember I went through, I was on a car ride and my back hurt and so it hurt the slouch.

So I was trying to not be in bad posture that entire five hour car ride and my hip flexors were just on fire. And, and finally, when I stopped doing that, it went away, but also I could deep squat. It felt fine on my hip flexors. It felt terrible on my back. So if you're not dealing with back pain, we can deep squat you. It's not high load that we're using. Now, if we're going to use high load with it, I don't think I'd squat you that deep. I think I'd change the range a little bit or change the exercise. I don't know if that clarifies or not. Cause that's a little bit, it's going to be a little bit more of a convoluted answer.

It's case specific. It does. I think it's really like you're going from passive thing of sitting to now doing a more active version of it. You're taking the tissue through its full range in that exercise you're talking about. It will change your pelvic position. And you are clarifying that if it's a hip flexor, it's probably safe to do that as compared to a different diagnosis, like hip impingement. Yeah. The, um, the, the people who tend to not do as, uh, sorry, the positions that you can be in for a long time without moving from are the ones that are a little bit more, more risky or like troublesome for people.

Like if you can sit, like you can sit for hours and hours, hours, there's no active component to it. Like I could go into a deep squat position with the counterbalance, like a goblet squat. I could be there for a bit, but like, I'm, I'm not spending five minutes in that position. So there's activity involved. And so I believe if you've, anyone's spent more time doing weight, weight training or personal training, there's something called metabolic equivalence. So metabolic equivalence is basically how much effort it takes to do a certain thing. Sprinting is high metabolic equivalence. Sitting is less.

You know, if you take sitting on a BOSU ball, it's higher metabolic equivalence or more effort to be on the ball than it is passively. So if you find a position that requires more metabolic equivalence, then you'll actually fare better than being passive. Makes sense. Sit crisscross applesauce on the floor. That's been your favorite these days. That's how I'm doing it right now, actually. Nice. So, oh man, you got a hard one there. I wasn't expecting that. I thought we were going to easy stuff, Dawne Costantino. Sorry. I feel like you do that to me sometimes. I had to do it to you. Oh, you just wait till the next one then.

Okay. So now that we covered the best stretch, if we had to put a gun to your head and we covered the best exercise with all things considered, how about the best cardiovascular activity? Best cardiovascular. I mean, I'm just going to choose my favorite. It's going to be hiking. Best cardiovascular exercise for it. I mean, really, it could be any of them. Anything that gets your heart rate up is going to help with any inflammatory stuff that's going on in that area. It could help be analgesic. Not for everyone. You got to find your threshold for it. But for me, I look outside because I think walking around my neighborhood is like hiking.

Change in direction changes the way that you'll stabilize in different spots around the hip. I'd choose hiking. Okay. So now I get to make this question harder for you then. Okay. So if it hurts to bring my hip up towards my chest and I'm stepping up something higher, like a rock or a boulder in front of me, how is that going to be helpful for my hip? Because it hurts to do so. That's a really good question. You might need to regress it a little bit. And we got to add a stretch and a warm up in before we go do that stuff. No, I really, with that, a lot of times it's different for everybody. Sometimes the more and more you do it, the better it'll get.

The more you do it, the worse it's getting. So you're probably pushing your threshold a little bit too much. Are we properly warming up before we go and do it? It might make you feel better. That's a good question. You got me on that one. But it's just so patient dependent to answer that. Yeah, so let me, because it all is going to come down to context too. Like, so we could also like, I remember I had someone recently that they wanted to go hiking and they had groin pain. They had been told by another provider that they should stop doing all that. And they did not like that, you know, just because like they said for the most part, it didn't really hurt to hike.

It just hurts sometimes, you know, and hiking really didn't make it too much worse. So I said, go, you should start hiking. And so she started hiking and she started to feel mentally better, but also physically she felt fine until she got to a big log. And then the log was like, she's like, well, I don't know what to do. Should I not hike anymore? It's like, no, maybe can you find another way around the log for now? Part of her rehab at that point was doing box step downs. So it's going to be building the tissue capacity of the hip and leg to be able to overcome that obstacle when she wasn't prepared to do so prior.

So, but everything else, like 95% of what she did that day was perfectly fine. And it's going to be helpful for her condition, but that one, yeah, that's maybe a little bit too much. So why don't we build that with some rehab exercises? There you go. Little regression and then you'll be good. What would you choose? Sprinting? Not yet. No, I wouldn't, but no, I would, I'd probably choose hiking too. Like I do think sprinting is going to be helpful, but like at least for cardio, it's hard to say like with, I mean, my heart rate gets up. So I'm going to count anything with heart rate elevated as cardio, by the way, for the listeners, I would push a sled.

Simple silence there. You got, that makes total sense though. I, I, that's a good choice. Not everybody has access to that. Or you remember during COVID time, you go out and push your car. Put it in neutral and go push it. So the, so the reason behind the sled pushes is because there's still a lot of leg drive component, which a lot of times we do need to improve firing to the muscles of the leg. Let's just include all of them at this point. Cause you get calf, quad, everything like that to make sure that everything stays online while you're rehabbing the area that's, that's painful. Also a lot of people with hip flexor or hip impingement do better with core activation.

And so by having your hands on something and leaning in, that's usually some form of default core activation. So they can get away with a lot more with it and then they can just start walking. And by the way, if you push hard enough, you will actually get hip extension too. So you get all these components at the same time, plus some fun. I like that. That's a good one. Okay. How do you want to wrap this up, Dawne Costantino? We got just a couple minutes. How would you summarize things to people if they were maybe lost about what to do with their hip stiffness? What are some starting points they could do? I think very simply, a lot of times the body will tell you what you want.

People will come in telling you what's going to work for them. So most of the time they'll say, you know, I've done this stretch and it gives me temporary relief. So the big takeaway with that a lot of times is you're just not doing enough volume of it in the beginning to see some changes in discomfort and pain. So whatever exercise or stretch that you're doing right now that feels good for the area, do it a little bit more. Pay attention to what you're doing in the hip. Are you extending it backwards and you're liking that stretch? Then maybe we just pay attention to how much we're doing the opposite of that, like knee towards the chest throughout the day.

Just modify your activity a little bit, a little less sitting, a little bit more walking, a little bit more stretching. And you'll start to see some changes in pain and discomfort. And another thing too is just kind of opening up the mind a little more to like where your pain is, is not always the problem. The tissue might be aggravated, but what's contributing to that tissue being painful or irritated or stiff or sore is usually there's not a better team player doing its job somewhere around the chain. So like the core, the glutes, a low back, the knee, like we mentioned today, a lot of that stuff needs more attention than the painful spot.

So when you go see somebody, be open-minded about, you know, their attention going to other areas that are a little more dysfunctional than the true painful spot. Yeah, I think it's a good cap. We also do have a free webinar too that me and Dawne Costantino did do about three different types of hip pain diagnoses and how to unravel the mystery of some of the hip conditions. If you jump into there, we do show some really fun exercises and stretches to do, which we use a lot at our facility performance place. If you guys need any help as well, just call us 714-502-4243 and we can see you virtual or in person.

Stay tuned for more of the podcast, subscribe to the show, and please give us some likes if you liked what you heard today. Say bye, Dawne Costantino. Bye-bye.