LM: Lateral Hip/Thigh Pain with Prolonged Walking: Week 7 (8-11-17)

  • Week 7 important points
    • Getting all the pieces to work prior to doing alot of standing strengthening
    • We added activation of the inner thigh gradually working our way into a stretch
    • We discussed doing the non standing movements for the weekend and progressing back into standing movements next week everyother day, beginning with the squat, then the heelraise at the wall, then the pallof press listed in phase 3 below
    • We discussed a walking progression
      • Ideally you would work on the days that you are not doing all the strengthening every other day stuff
    • Everyday Movements
      • Abdominal Control With Hamstring Curl Phase 2 VIDEO
        • Just keep toes straight up towards the ceiling and feet apart
        • Begin by rolling ball into as deep of a knee band as comfortable and then all the way out straight letting heels raise off ball
        • If that feels fine, press into the heels as you move in and out of the knee band
        • 10x-15x
      • Bridge Band Around Knees Progression VIDEO
        • 10-20reps slow
        • Stop if you begin to feel knee discomfort
        • This felt better after doing the ball roll above
        • Make sure you keep outside of foot lined up with outside of heels
      • The above 2 exercises can be done multiple times a day
      • Hand Heel Rock Childs Pose to Plank or Up Dog VIDEO
        • In the video I rock further forwad then we discussed which is fne for you to do but the improtant part is rocking slowly back towards your heels
        • 5-10x
      • Myofascial Release
        • Focus on areas that are most sensitive
        • Self MFR Ball Glute/Piriformis VIDEO
        • 2-3 spots into the back of your hip each for 10-15 reps
        • Side Lying IT Band VIDEO 
          • I also discussed with you rolling on top of the tennis ball on your side to hit points along the lateral aspect of your thigh. Lay on each point for 30sec up to 1-2 min
        • Self MFR Hamstring VIDEO
          • lateral hamstring start by the hip and work towards the knee
          • 10-20reps multiple spots along hamstring
    • Every other day
      • Tall Kneel Lean Back VIDEO
        • This is the most challenging/threatening of the phase 2 positions
        • If you feel this in the knee, don’t do it that day
        • Goal is to feel tension in the quad
        • May be a good idea after this one to stand and walk or try to squat to make sure it does not increase pain in the knee
      • ONLY DO THIS MOVEMENT 1X/DAY, THE OTHER 3 ABOVE ARE FINE TO DO 2-3X/DAY AS NEEDED TO PROVIDE RELIEF
    • Phase 1: Additional Options
      • These movement are also likely fine to do everyday and are very low risk but I don’t beleive they are as improtant as the movements above in regards to decreasing your pain when your knee hurts
      • Beyond the tennis ball activities, you may want to add a new movement below each day to gradually add to your once a day list. This will help you to recognize if a particular movement is causing an issue
      • Supine Clamshell VIDEO
        • Progress to blue band if you are able
        • 30-90sec
      • Adductor Isometric Supine Video
        • Take straight leg out to side as far until you feel light stretch, back of just short of it
        • repeat 5 sec holds for 10-15 reps each side followed by gentle rocking of the foot
    • Phase 2
      • Quadruped with Physio Ball Hip Extension VIDEO 
        • This is to replace the over the bed position
        • Start by tensing your abdomen and straightening one knee
        • If that feels fine and you have no pain in the back, you can lift the straight knee off the ground
        • Get body further over the ball and you will be able to lift straight leg more
        • work up to 10-15 holding each 5 sec
    • Phase 3: These movements are in standing and involve an increase in load on the leg because you are standing
      • THESE MOVEMENTS SHOULD BE DONE EVERY OTHER DAY, ADDING ONE MOVEMENT TO THE ROUTINE EACH TIME
        • Organization should be
          • Day2-3 you do the four movements above that we found to reduce pain
          • Day 3, start to add a new phase 1 and 2 movement each day until you have all the phase 1 and 2 movements and you have no significant issues
          • Then start to add a new phase 3 movement everyother day
            • Standing movements are safer to add everyother day in the following order
        • Double Leg Heel Raise VIDEO
          • 5-20 reps
        • Standing Paloff Press in Lunge and Terminal Stance VIDEO
          • Start with feet side by side
          • If that feels fine, try a staggered stance, the more you step the back foot behind you, the more tension on your lower back
          • Only increase step length if you have no back pain
        • Upper Body Assisted Squat VIDEO
          • band around knees
          • weight on heels
          • feet pretty close (2-3 inches) from what you are holding onto
          • Just short of 90deg, Maybe even less knee bend if  there is any pain
          • 10-20reps