Hip impingement case study: two years of pain and how it improved

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 and I hope you've been liking the new format we've been having recently with quicker to the point and little chunks that you can bite off on your drive to work. Now, if you're an active individual and you've been having groin, lower back, hip, or even knee, foot pain, heel pain, this is a good show for you. We specialize in working with active individuals who are having lower extremity conditions and want to get back to their activity.

So I'm going to tell you about one today, which is a hip condition. This is a female. She's about 35 years old. She's been dealing with hip pain in the front of the crease of her hip for about, I'd say about two years now. It's been a bit of time. Actually, I think back, actually, she's had it for on and off when she was about 20-something. And so she was told she had a condition called hip impingement, which she said is going to get worse. And her doctor at the time predicted that she would need a hip replacement sometime in the future. If you've been listening to some of the other podcasts I put on, you realize that I hate when people try to definitively tell somebody what they're going to need in the future.

I think it's ridiculous. You can't predict anybody's future. A lot happened in that 10 years. Now, if you were going to have the current trajectory the person has in fast forward that you can make a more reasonable prediction. But if the person changes their habits, they do rehabilitation, if they change something about what they're doing, you cannot predict that in the future. Okay. But I do think reasonably telling somebody, look at the things that you're doing could end up landing you in this type of scenario. That's one thing. But this individual was told that they would end up needing some type of hip procedure, a labral surgery, and possibly hip replacement in the future.

And that really concerned her. And she was scared of using the hip for a very long time. For a job, she actually twists quite a bit. And so I saw her in the past for a similar type of scenario, and I got her back into some activity, and she was feeling mentally better about things. And I reached back out and asked her how she's doing. She's very nice. And so I wanted to see how she was doing. This was about three years removed from working with her. And it's funny. I've been actually talking to a lot of people I've worked with in the past and who has had treatment from other people in the past too.

And a lot of them do end up having some flare-ups over their years. And this is pretty expected. And so this person, I talked to her a little bit more about what's been going on. And she said, I'd still been having a lot of issues, and I'm not quite sure what to do about it. I've been scared of working out. Every time I work out, I actually usually feel worse. After I do a long day at work, I feel worse, and I'm not sure what to do about it. And so we had to discuss what the options were. Personally, I think that there is... I don't like to tell anyone that necessarily their job is the worst part.

But I know that when I've been doing something like hard labor for eight hours consistently, I can feel pretty bad too. And so it's a lot of work on the hips sometimes, a lot of twisting. People who stand a lot during the day sometimes, like their job, yeah, it's a factor associated to it. So more of just thinking of, is this the job that you want to keep forever if your body doesn't tolerate it? Or are you going to potentially look for something else? And so we talked a little bit about like future jobs and stuff like that. So lifestyle changes, like these are things that we needed to cover. But also too, we need to cover the standard things that we always talk about.

Every podcast that we do, we talk about first aids or things that help with pain management. We need to see if there's any corrective exercises or stretches the person needs to be doing. Like things that actually help them get out of pain, not just discuss like, hey, your life and your activity kind of sucks. So let's just blame that and just wait till it goes away because that's not correct either. But kind of chipping away at the equation from both sides of like limiting triggers, changing activities, but also giving them ways to build robustness and pain management strategies is really important.

And so we found some things that work for her. We found that stretching the hip capsule, like a standard hip flexor stretch, actually worked out pretty good. And this made her hip feel a lot less stiff. That actually stopped some of the lower back pain as well as she was experiencing. And to combine with that, actually, we're able to get some of a little bit more breaks associated to some of her workload. And so all that actually resulted in having a significant decrease in her symptoms in her groin and in the side of her hip over the course of just a week. Now, I've discussed this timeline with people quite a bit on the podcast as well as in person.

And I tell everyone reasonable expectations for their condition. It's reasonable to have flare ups. It's not reasonable to have pain ongoing for months and months and months and not be able to have any control over it. So as you can see, over the course of the week, she did feel better, not perfect, but she reported about 50% improvements with day to day life, like walking, just by doing some simple things. And this was actually all done via telehealth. And so if you don't know already, we offer telehealth services, which we can take through people through exercises and movements and a physical exam and let's do history and all these things help out to establish a diagnosis.

It helps out to establish a treatment plan and a home exercise program to make sure that they're doing all the right things. And so we have these and we offer our telehealth services. We have, we're licensed in different states and we actually have consultations are really very affordably priced too. So if you guys need help and you'll have help around you, reach out to us. Our contact is below. Now, this, the thing that I think was the most important variable in this case that I really wanted to share was not, not her pain, not, but I will bother her and stuff like that, but more about the mental aspect with it.

There's a lot of people who are very scared of using their body and rightfully so. One of the questionnaires that we have on our intake form is actually, if you're having pain, do you believe you should stop doing all activity? They say yes or no. And so some people say, yeah, if I'm having pain, I shouldn't do anything at all. I should just rest it. Other people say, you know what? I'm, I'm able to work through it. And this is a very big factor associated to what we call the biopsychosocial approach to managing pain. And so catastrophizing or fear avoidance is a really big factor, especially when people are having chronic pain.

So we can't really have them scared of doing anything, but also we have to give them context of, is it safe to do this thing? And the way we're going to figure out if it's safe or not is to do actually a physical exam and a movement assessment on them. And that's what I did. So we figured out that squatting generally didn't feel super good. Hip hinging wasn't, wasn't really bad, but it was a little bit iffy. We see that a single leg, I'm sorry, turning over one side, like looking over your shoulder, their shoulder actually made them move away from the side of complaint, which is actually common.

And if it hurt to do so, it makes sense. I asked, does it hurt? And she said, no. And I said, can you put more body weight on that side? Kind of like take your, your weight out of the other foot and then turn over your shoulder and look over your shoulder. And she said that actually that feels a lot better. I don't have the back stiffness, the hip doesn't hurt. And so it insinuated that actually improving the single leg patterning and building strength in that hip was actually appropriate at this time. Yeah. She can have hip impingement. That's totally common, but it doesn't mean if you have structural hip impingement, you should never challenge your hip ever again.

That's crazy. And so, but there is context, there is context of things that will generally bother more deep squatting with high load tends to, tends to bother people and stretching the hip across your body. So the approach we were going to take was to see if we can build an exercise program of safe things to do that doesn't make her feel worse after the fact. Because again, the thing that I noticed that was the most important variable that I want to share about her case today was not her pain, but it was more her mental, her mental attitude about it. And not that she had a bad attitude. I don't want to put that across as saying she was a bad, bad, she was very pleasant to work with, but it was more that she was mentally defeated, that she couldn't do any physical activity.

And she kind of gave off the impression that she didn't really have things to do that gave her purpose. Like she didn't really feel like exercise was fun anymore. She had been a college athlete in the past and she didn't like, she liked that, but she didn't really feel like she wanted to do it because it was just frustrating. And so that's not a good place to be in. And that changes my treatment approach a little bit from a pain management of doing simple things and to actually doing hard things. And what I would, what I call collecting wins. So the goal of the second day was actually to get her in the gym.

And I actually coach just through exercises that are not, I don't want to say not specific to her problem, but actually completely what we call green light. They don't hurt to do the targeting the appropriate tissues. For example, if you're doing squats, you should feel probably your quads. If you do it in high volume, if you're doing hip thrusters, you should feel your glutes or hamstrings, if you're doing deadlifting, you shouldn't feel your back. So we're looking for things that are completely green light. And then we collect them, collecting wins and exercises that are good choices. And so we found out that split squatting was completely green light.

We found out that deadlifting with a hex bar was actually green light. Deadlifting with a barbell was kind of iffy. It was kind of yellow. We actually did a single leg RDL, which was actually green light as well. If we elevated the weight, if on the floor, it didn't feel really good. And then I, luckily she had a sled in there. And so I can see it in the gym out of the corner of my eye and not all gyms have sleds. And so you can load up a sled that has, it has handles. A lot of times you can take them and put them on the other end. You wouldn't change directions. You don't have to fight with the sled.

And so I said, you know, throw a 45 on that thing. Let's just push the thing around a little bit. And she said, you sure that's safe? And I said, from what I see, I think it looks very promising. But you know what? Since it's okay to have a little bit of pain, as long as it doesn't increase with more steps and more reps and more sets and so on, then I would prefer that we actually explore it. Because remember, this person was afraid of doing things. So it's better to be a movement optimist in this case and say, you know what? That wouldn't, that wouldn't work out. Let's try something different versus like, you know what?

That may hurt. Don't do that. Because that's the worst thing I can do with this person is make them feel more defeated and give them very basic things to do, which are not physically challenging. Because a lot of people actually feel a lot better, believe it or not, when you challenge them physically, have them collect wins. And even things that are around the area, like if this was, if it's a hip impingement case, maybe we don't give a squat. Maybe we give a split squat. Maybe we give a deadlift. Maybe we just do a pushup. We do a pull up, give some dips, give them some core work and off the races.

Now, is this specific to the, to the hip impingement? It's working around it. It's, it's making it so the other body structures are going to be helping in the support system. But if I was really going to go after the hip impingement, I would just challenge that glute and I'd probably challenge the ab wall pretty good too. But that may take a little bit of time in the session to do. And if we're going to collect wins today, we'd, I'd rather not spend 30 minutes just tinkering around with these exercises that if we're all we know at the end, this hip is still so sensitive that it does not tolerate these.

And at the end, she left, she's going to leave feeling defeated, frustrated that I didn't really give her any exercises to do and everything that we did in there was just a lot of tinkering and pain. I'd rather not do that. So let's collect some wins. So we collected a lot of wins. And then a week later we talked, how did things go? She said, man, I feel so much mentally. I feel better from doing, being able to do gym work that actually didn't hurt because she was again, very afraid that actually doing exercise and activity would hurt for her. Now, so I give her some context too about like how to look at this.

We can play this from two sides. As I mentioned earlier, we can work with getting the right stretches and first aids and pain management and taking away the triggers. We can do all that stuff. But to the last time we worked, we actually worked on a better long-term strategy, which is improving habits, getting better hip strength and working on actually a strength protocol or entry point in the strength protocol. I didn't give her heavy, heavy weights. I just gave her weights that were manageable with the patterns that were an exercise that we're probably going to use as a strength training modality later.

And I gave her some basic programming suggestions. But then the next time we meet, we may have to work on work capacity. Maybe your cardiovascular fitness is really low. I don't really know that yet. Maybe she needs a little bit more pain management. Maybe the stuff that I gave her last time wasn't actually the best. I need to refine that a little bit. But I think this is a good way of looking at there's two ways to manage things. There's the long-term play, which is strength. But don't assume strength is going to help everybody with pain management. There's a time place to get pain management.

But as you can kind of see, it's all how you want to spend your time. And it's based upon what the person brings to the table. So if the person was already doing a lot of exercise, I would have just already done more pain management again today or corrective exercise. Things that would help them build robustness in the hip from a support system standpoint, not just from a strength one. So it's all about how you spend your time. Each time we met, it took over 45 minutes easily. And I had only planned 30. So for as much as I'd love to say that we can always get things done in 30 minutes, we can't.

It takes some time. It takes time to teach. It takes time to digest information. It takes time to coach it. It takes time to ask questions as I needed to. And it takes time for them to ask questions too. But the last thing we want to do is rush somebody through a program and say, look, that's all the time we have right now. So a sweet spot is typically about 45 minutes after the initial assessment. 45 minutes is more than enough to actually get a lot of great strength training in and even cover a little bit of pain management too. So if you guys are looking for help with something like this and you're not having success with where you're at, we'd love to help you.

We do have telehealth appointments that I mentioned. And we're located in Orange County, California. We're in Costa Mesa. It's a great place by the beach. So if you guys want to take a vacation and visit us, we do have people who visit us as well and see us on their trip and we can help them to find better ways to manage us faster. As I've had a lot of people ask me in the past, what makes you guys a bit different is that we get the job done faster and you get the results done faster. And I would estimate probably five times faster than a lot of places. So if you need that help, reach out to us, 714-502-4243.

I'll talk to you guys later. See you next time.