Why overthinking your exercises slows hip injury recovery

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Now, the reason I wanted to go over this topic about quality rehabilitation today is because we as an office, we see a bunch of people who have not had success doing rehabilitation or treatment before.

And I'm sure there's many offices out there like this. And so when we end up getting people like this, they actually have a lot of things that they're thinking about when they're doing their exercises. And a lot of times the exercises can help them. Rehabilitation or corrective exercise can help them. But the way they're doing it is actually subpar. And when we correct those things, a lot of times they do get better. So the typical history that people end up having is they've been through a lot of healthcare providers and they start programming their own exercises or they start thinking too much about where their body position is in the exercise.

For example, if you were suggested to do a plank for your hip pain and you start thinking about, well, I should have my pelvis tucked and then I have my shoulders down. And then next, I need to make sure that my toes are in the floor and I need to suck my belly button to my spine and so on. Like these are, this is too much. It's too many cues. And it is basically corrupting the quality of movement in the exercise. So ideally, we want to focus on one cue or one focal point. Ideally, it's an external focus point. And in case you guys want to do more detailed reading on this, there's a great book by Nick Winkleman, which goes into the weeds about it, but also there's very simple suggestions.

You'll see halfway through the book, it'll tell you exactly the cues that work well for him. And they're simple. When you're going to jump, reach for the ceiling, grab the net, push away from the earth. It's not like bend your knees and tuck your hips and look down and look up. It's not all that stuff. But in the beginning part of the book, it does get very convoluted and the research of why coaching in simple terms works better. So I'll cover a few exercises today that are common ones that people use for hip conditions and also low back ones. And I'll tell you the cues that I like more commonly.

And again, the exercise themselves are not magic. It's how they're being coached in the unique cues that you need to actually get the job done and get the appropriate target tissue or the response from the exercise. Ideally, what we're looking for in, say, something like a plank is you want to feel your belly working. Not a strip of your belly, not just the center, but you kind of want to feel all of it start to slowly fail. You shouldn't feel your back. You shouldn't feel your hip flexors. You shouldn't feel your toes. You shouldn't feel your shoulders. If you're feeling these, there may be a need to take a precursor step, which we call a first aid, which is a movement medication.

Do it again. Or it just needs to have a better focus. So usually with a plank, what we'll tell people to do is we'll first start them on their knees. A knee plank is easier to coach than a foot plank. And the leverage on a foot plank is actually quite a bit higher on people's midsection or their pelvis. So a lot of times when they are weak, they dump automatically. And it's not because they're trying to do it poorly. It's just that they're not strong enough to do it well. So I would do it from the knees first. And I usually tell them to slowly look through their thighs so they can see daylight between your legs.

And naturally, this will bring the head down and look through and you'll see between your thighs and the knees are still on the floor. And everything will start to slowly come up. It's almost like you're starting to turn into a little roly-poly. And now, for a lot of people, you might say, well, this is a terrible plank. Yes, it's a starting point. It's cue number one that I would use as I'm teaching the plank to simply get them into a part of it. Now, from here, I would let them do five, six reps or so just to feel it out. I hate to give people a suggestion early on after one rep and say, you know what?

That's good. Let's do something different now. Like, I want them to feel it out. Like, I know that if I was hitting baseballs, I kind of want a chance to warm up to the speed of the pitcher. Like, don't give me excessive suggestions just yet. Like, let me work things out a little bit and then give me a different suggestion, which is called set two. Set two, I would have them then look at their hands because they'll either be in their hands or their elbows. And I said, can you look a hole between your thumbnails and push away from your thumbnails? Like, create a lot of distance between your thumbnails and your face.

And so that'll usually create the same phenomenon. Now, if you're wondering, like, should we be coaching or thinking about looking through the tunnel still? Probably not if the person got the general gist of the exercise. And we call this cue stickiness. The cue should be sticky and you should be able to layer and go to the next one, which is going to be a better fit for the overall experience of the exercise. It's kind of like if you were going to, again, have me hit some baseballs, you kind of have to get me familiar first with how to grip a bat and then let me get used to it. And then they give me use to the pitcher.

And then you can give me more specific cues like hands up or backhand the ball, etc. So there's different cues you'll use for different skill levels. And for the beginner people, sometimes you need to start with something that's very beginner. Give them a chance to do five, six reps or so. Set two, you layer the cue and you go on to something different. So those are the ones I like for planks. And if that works, then you put them up to their feet and see if they can hold it. And then something like a bridge is another great one. I actually like two-legged bridges more than one for various reasons, but one, this will work as well.

Now for a quick pause before we keep going. Hey, everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working. And we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity. The link's in the description.

It only takes a few minutes to fill out the form. Okay, back to the show. And so I usually show them how to do it. I say, this is a bridge. I want you to copy what I'm doing. And so I'll demonstrate the bridge to the best of my ability. Note to any healthcare providers or coaches out there, if you demonstrate the bridge poorly and they do it exactly like you, don't blame the client because they're copying you. So you need to be able to do it with some competency as well. So they'll copy you first and you kind of get a gist of it. Or if the person already knows, if you didn't know how to do a bridge, then you say, look, can you do a bridge?

And then they do a bridge and say, great, that's a good starting point. Do five, six reps. Cool. All right. Here's what I want you to do on the next set. I want you to act like there's, you have a belt buckle on. Can you push your belt buckle forcefully through the ceiling above you? And that'll put more hip drive into it versus low back extension. And so that would have people do that a little bit. And that's a really great cue to use. Or you put a kettlebell in their belly and use the kettlebell as a reference point. Can you push the kettlebell through the ceiling? And this makes all those fun things happen, like hip extension and bracing and all that type of stuff too.

Now, there is a phenomenon where people don't really respond super well with the hip drive type of cue. And that's if they have the rib flare pop up with it. They almost look like a little slippery snake when they're doing it. They have like a really flexible spine. For some of these people, these are usually the ones that have like more hip impingement. The ones that have groin pain. The ones that have a grumpy low back. It's been ongoing for years or decades. For these people, we have to control that part a little bit more. And so I tell them to tuck their ribs into their front pockets. Keep that.

We're going to slap a piece of duct tape metaphorically onto the front of their rib cage or belly area. Now, if they arch their back or they pop their ribs up, they're going to stretch the duct tape off their body. So I want you to imagine that duct tape has wrinkles in it. Can you preserve the wrinkles and do this exercise? Again, the focus is on the duct tape, not on the body, not on a body part. But they will do the best of their ability if they really respect that cue to keep the torso with without extending. They'll keep the torso in the position started and they'll drive more of hip drive.

And then you can go back to the kettlebell cue and say, can you push the kettlebell to the ceiling? So those are two easy ones. Now, for something like a deadlift, I would use, number one, I would use blocks for most people, especially people over six feet tall. You're going, and they can't touch your toes. Like you're going to probably not be deadlifting from the floor for a very long time. And it's not that you can't ever do it, but it's just you don't have the range of motion to really do it super well. And so all the coaching in the world cannot make me touch my toes because I can't really do it.

So don't assume it's the coaching. It's actually just the person or the individual's internal constraints. Like they don't have the range of motion to do it. So we can take that out of the picture and then put them up on blocks and you can use a kettlebell or you can use a barbell, a hex bar, etc. Use all your favorite things. And then so usually with a deadlift, the first thing we have to do, especially with runners, and unfortunately a lot of runners do this, is they like to round their low back a ton with it. I don't know what it is, but I'd say easily like 75% of the distance runners that we see, they just round their low back while they're doing it.

And so, and eventually they'll feel it in their hamstring probably or their back. And so we coach them first to logo up. If you have a logo on your shirt, show me the logo. I'd be standing in front of them. Can you show me the logo of your shirt the entire time you're doing this lift? I keep the weight really low because at this point I'm coaching movement. The weight doesn't matter. The person doesn't know how to do the lift in the first place. And so we teach them doing one cue for five to ten reps or so. Great. Those look good. How does that feel? It feels really good. Perfect. Now, say they're squatting their weight, which a lot of runners do as well.

They're squatting their hinge to their hip hinge. So instead of, I said, you see how like it kind of feels like you're sitting on a toilet? Yeah. Can you imagine you're shutting a car door shut with your butt and your hands are full? And so they kind of push their hips back, which gets them into a hip dominant position. Can you initiate the lift doing that? And so they do it. And if it looks better, again, five to ten reps or so. And this makes the exercise hip dominant, not quad dominant like the squat would, not low back dominant like a low back rounding version would. And we can use a deadlift in this scenario if it works out well to rehab a hip, believe it or not.

You can use it to rehab a hamstring strain. You can use it to rehab a low back disorder like a disc one or a sciatica. But it has to be hip dominant. Now, you don't have to lift like this all the time. Like, you don't have to lift a golf ball off the ground like this. Certainly, around your back. Like, bend your knees. That's all okay. But if you're doing it with some weights, like, you have to push it to the hip. Now, these are examples. I hope you guys get an idea of, like, how the coaching is actually important. And also understanding that, remember earlier I said that, like, we're not thinking about body parts as much.

So, logo of shirt, pockets back, shutting a car door shut with your butt, hip, sorry, kettlebell to the ceiling, look through the tunnel. Like, these are all task cues or they use other objects other than your body, especially your muscles, like deep body parts. Like, no one, I didn't tell anyone to think about contracting their glute. Like, if it's coached well, it'll get all of the muscles that do hip extension with a bridge or with a deadlift and not just a momentary glute pump. So, the exercises, again, are important, but they're not everything. How you do them is important. And actually, what you think about when you do them is important.

And this is the value of a good coach. Good clinicians can do this. Good rehab people can do this. But it depends if there's skill sets there or not. Like, we have a performance place. We're in Costa Mesa. California. And we have a local chiropractic school, which actually refers their interns over here, which, quite honestly, usually in the beginning, most of them are terrible at rehabilitation. And it's because that's not really taught too much at their school. Like, they're actually taught to itemize, like, contract your hip, hips up, et cetera. And I don't hide this from them. I tell them.

I think it's too messy. Like, it makes it way complicated for the person. And then, at some point, if the exercise doesn't work or the rehab doesn't work, we're making people who are thinking too much about this. Like, we're contributing to the problem. So, ideally, you find someone who's good at skill sets with it. Usually, a good strength and conditioning coach can do that with you. If you guys are looking for help as well, we do have telehealth sessions. And so, we coach people virtually in all this stuff. And you can see verbally, you can actually do it. Administrating-wise, you can do it through a video.

And tactile is the last one. You can put your hands on somebody and just show them what you want or put them in a position or, like, you resist them. If anything in today's episode resonated with you, visit the link in your podcast player. There, you'll find any free resource that we mentioned in the show, any guest links, and a link for a free discovery call with us. We're licensed to work with our outdoor active people via telehealth across many states in the U.S. at this point. In fact, we cover almost half of the population in the U.S., and we add more states every year. Thanks for listening.

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