Steps To Avoid Long Term Hip Pain
The hip is the epicentre of human power and performance, the strongest joint in the body. Many activities hinge on the hip (pun intended) and therefore it is all the more frustrating and debilitating when the hips are not in good order.
Often hip dysfunction is not even felt in the hip, instead, it can be experienced as lower back pain and/or knee pain because these joints are immediately above and below the hip and are most affected.
As a strength and conditioning coach, in my 14 years of experience, in 99.99% of the cases (exception is genetic disease and accidents), hip pain is caused by either a habitually sedentary lifestyle, habitual lack of simple daily mobilizing, or habitual poor movement technique.
When all three causes are present, it creates the ‘perfect storm’ for increasing hip discomfort and eventually pathology. Did you notice that habit plays a central role here?
That is because most hip pain is, in fact, the compound effect of less than healthful habits accumulated over a long period of time.
If untreated, this mild form of hip pain degenerates into arthritis, cartilage degeneration and other conditions that require surgery and medication. If the pain is fresh, it can be easily remedied with adjusting your activity, movement and mobility habits.
Next I will give you a little bit of anatomy, for the geeks among us. I notice that many clients find it easier to understand the cause of the problem and implement the solution if they know what is happening.
Then there are clients who just want to be told what to do. If you are the former, this section will help you understand why we do what we do. If you are the latter, feel free to skip straight to the exercise section.
A Little Bit of Hip Joint Anatomy
First, your hip is a ball-and-socket joint. A joint is a bone covered in cartilage. Cartilage, as you might have seen it when eating chicken or lamb, is the white smooth tissue covering the bone in areas where it would otherwise have to rub against other bone.
The cartilage covers both bone surfaces in the region of contact in order to create smooth movement. Cartilage also gets lubricated, like the engine of your car, except instead of oil your body uses a liquid called the synovial fluid.
So, the hip is a joint upholstered in cartilage and lubricated by synovial fluid for smooth friction-free action.
What moves your hip joints is skeletal muscle. The simple picture is this: there is deep skeletal muscle, responsible for posture and ‘stability’ of the hip (sort of like shock absorbers in your car) and then there is superficial muscle, which is responsible for actual movement.
Normally when you need to perform a physical movement, the muscles of your hip joint would ‘lead’ the head of your femur (leg bone) precisely in a correct path within the joint.
The thing is, your body operates on the principle of ‘use it or lose it’, and when you don’t move much during the day, the muscles supporting your hip joint disengage and begin to weaken.
In addition, if you move incorrectly, the muscles become imbalanced (some get weak, some get tight).
When the muscles are disengaged or imbalanced, atrophied or too tight from disuse and sitting, they will allow the head of the femur to grind and bump uncontrollably against the socket. This grinding damages the cartilage causes inflammation and hip pain.
If left unattended over time, the cartilage of the hip socket and the tip of the femur are ground away, leaving bone to rub against bone. This causes severe pain, further inflammation, degradation of the bone and total loss of hip function.
This is when your only choice is a hip replacement.
What lubricates your hip joint isn’t just ANY movement, but movement through a full range of motion (ROM), or in modern terms ‘mobility training’. When any joint in your body moves through its healthy range of motion, the body is triggered to release the synovial fluid to lubricate that joint.
Think about bushmen and aborigines in the jungle – in the course of the day they would walk, run, climb, squat (to eat, to rest and to defecate), using the hips at many angles and through full range of motion.
Hip pain and dysfunction are unheard of in those populations, even in the oldest (80+ years old) members of the tribe.
Our hips are naturally designed to move frequently and through a full range of motion, and they do not like being static.
If the hips do not move, and, in particular, if they do not move through a wide range of motion on a daily basis, the synovial fluid is not released and the hip literally ‘dries up’ and starts to crumble.
The good news is all of this is both preventable and treatable.
Here are a few simple habits and exercises that have helped my clients eliminate hip pain when they adopted them into their daily routine.
- Frequent movement.
This is essential if you want to reduce hip pain and prevent hip degeneration. Yes, even if they ache and feel stiff when you first start moving, they will benefit from movement more than from sitting on your tush.
You will simply need to find a form of movement that doesn’t hurt and do it daily.
Since walking and squatting hurts most people with hip pain, swimming, cycling, stretching and the below range of exercises will be a better start.
Eventually, once you are pain-free, you will reduce the below exercises and replace them with more advanced movements (hiking, climbing, squatting, dancing, yoga, weight lifting, sports, running etc).
If you have a sedentary job, you will keep the below exercises as a supplement to your daily exercise routine, completing them for 5 minutes before you begin your regular exercises.
Please remember, frequent, habitual and wide range movement is the ONLY way you can keep your hips healthy for life.
ACTION: move every day for accumulating 30 minutes total per day. It doesn’t have to be a formal workout. Set a timer on your computer (there is a great timer my clients like to use called Tomato Timer) to beep every 1-2 hours.
When you hear the beep, get up and go for a 10-minute stroll or perform some of the exercises/stretches below
- Mobilize and strengthen – the exercises and stretches.
In order to ensure that when you do move, you move well, you need to both stretch the tight muscles and strengthen the weak muscles supportingthe hip joint.
This will also help you take the hips through larger ranges of motion, thereby lubricating the joint as well. Healthy hips are BOTH flexible and strong.
The execises below
- select ONE flexibility exercise and ONE strength exercise per day
- complete 2-3 sets of each, alternating between them with minimal rest. This will take you 5-10 minutes max.
- rotate through them during the week
- if you are a habitual exerciser, add this to the beginning or end of your training routine, if you are not, do this 2-3 times throughout your day.
- Focus on technique, do not just go through the motions in a half-hearted manner.
The duration of each stretch depends on your age. The older you are, the longer it takes for your muscles to relax and lengthen, so the longer each stretch would be.
20-30 years old: hold each position for 30 seconds, 1 set
30-40 years old: hold each position for 40 seconds, 1-2 sets
40-50 years old: hold each position for 50 seconds, 1-3 sets
50+ years old: hold each position for 60-90 seconds, 2-4 sets
Hip Flexor and Quad Stretch (beginner version of couch stretch)
- Kneel down in a lunge position with one knee resting on the floor (use a towel or mat under that knee if it causes discomfort)
- Place both hands on the ground (or an object like a yoga block or a kettlebell if you can’t reach). Tuck your pelvis under until it’s neutral and drop your hips down while keeping your chest high. Do not let your pelvis tilt forward and your lower back to arch, this will make the exercise pointless.
- Hold the position for the required time, breathing steadily. (see guide above)
- Now, raise up until your torso is vertical (you can hold onto an object for support, but eventually you’ll develop the balance needed to hold without support). Keep your pelvis tucked under and push your hips slightly forward until you feel the stretch in the top of your kneeling leg’s hip, as well as the front of the thigh.
- Do not allow your lower back to arch or your pelvis to untuck.
- Hold for the required time, breathing steadily.
- Change legs and repeat as necessary.
Couch Stretch (advanced version of Hip Flexor Stretch)
- Get down into a lunge position from above, except your lower leg on the kneeling side will be resting against a couch or wall. The less flexible you are, the farther your knee will be from the wall/couch.
- Place your hands on the ground (or a raised object such as yoga block) and tuck your pelvis under, pushing is down towards the floor. You will feel this stretch in the top of your kneeling leg’s hip.
- Hold that position for the required time, breathing steadily.
- Now, raise your torso until it’s vertical, keeping your pelvis tucked under. You can hold on to an object for stability (my beginner clients use a Kettlebell for that) but eventually, you will develop enough stability and will not be wobbling around. You will feel an intense stretch in the front of your leg and your hip.
- Hold for the required time and change legs.
Reclining Spinal Twist Stretch
Quadruped Hip Circles
Single leg Drops
Single leg glute bridge
Single Leg Romanian Deadlift
Standing High Knees / Toy Soldier
Workout A: Pain-Free and Buns of Steel
Repeat 2-3 sets
- Hip flexor and Quad Stretch x 30-90 seconds each side
- Single Leg Glute Bridge x 10-20 reps each side
Workout B: The Butterfly effect
- Butterfly Stretch x 30-90 seconds
- Single Leg Romanian Deadlift x 10-20 reps each side
Workout C: The Bedtime Activator (performed lying down)
- Lying Hamstring Stretch x 30-90 seconds each side
- Single Leg Drops x 10-20 reps each side
Workout D: The Karate Kid
- Glute Stretch x 30-90 seconds each side
- Standing High Knees / Toy Soldier x 10-20 reps each side
Workout E: The Abdominator
- Reclining Spinal Twist Stretch x 30-90 seconds each side
- Side plank x 30 seconds each side
Remember, your body operates on ‘use it or lose it’ principle. If you do these exercises but are not moving frequently, you will not see much effect.
Your body does not like keeping muscle that is not being used, so it will atrophy and disengage it.
Therefore I cannot say it enough, to save your hips, you MUST use them frequently.
(notice, I didn’t say ‘with high intensity’, frequency is more important).
Find movement that you enjoy doing, be it walking, weight training, hiking, team sports, Zumba, Dancing, Yoga etc.
This will be an essential element in your recovery and the above exercises and stretches are but supplements to optimize your frequent movement.