As we start to structure a strengthening program, we will continue to challenge different areas of your hip. I want you to continue with the tennis ball daily. When we look at the anatomy of your leg, out major muscle groups include: 1) Quad, 2) Glue 3) Hamstring 4) Hip flexor 5) Adductor. Initial goal is to be able to isometrically activate each without pain prior to loading them in a more functional and weight bearing pattern
The bridge progression below is hamstring
Another option for the hamstring is the treadmill or
You choose between the bridge progression ball, treadmill, and the new one above which produces muscle activation with the least amount of pain and stick with that
Quad progression
Isometric activation gradually toward more of a stretch
Try loading the hamstring and the quad every other day continuing with the tennis ball
3-12
Let’s alter the position from last week to progress to more of a feet elevated position. I want you to try the tennis ball before and after. The progression below is more hamstring then glute but puts your lower back in a more neutral position. You may want to alter one set of the movement below with 2-3 minutes of tennis ball on the hamstrings. Same instructions as below. Do this sequence instead of the sequence below it. If you feel the sequence below is going alright, the next thing I would do would be to try to load the front of you in a similar mid range position.
If this doesn’t feel comfortable try the elevated plank with small leg lift, doesnt have to be knee to chest and kick back like the video below, just start with small lift of foot off ground
Building on the tennis ball mobilization, I would focus on a hip ext based progression. see how you do with the bridge progression below. You should be able to find a range that does not cause pain
Bridge Progression Floor 5 to 20 reps, once you achieve 20 rpes progress to the next movement down. try one set everyday
Goals: Identify mobility deficits that are severely restricted, different on the painful side, movements that reduce your symptoms
Activate muscle groups that have been not been engaging properly: Can you feel the the muscles engage in the same way that they do on the non-painful side? How does it feel different on the involved side?
Become aware of maintaining spnal stability and not compensating in the back as you attempt to isolate glute activation and hip mobility
Daily Movements: Meant to begin with proper abdominal stabilization and lightly move into restricted directions without increase in symptoms. This initial phase is more of an assessment to find your specific limitations as well as how you respond to certain positions. You need to be able to delineate between what is good and not good for you. As you are doing any of these movements keep the following in mind
It is good to feel tension or pulling as long as it feels the same or easier to do as you do it and you do not have any increase in symptoms afterwards
The first time through any movement do it very lightly, we are going to be stressing some sensitive areas and you will be surprised how this controlled movements can increase pain if done too aggressively, you can always push it a little harder the next time.
If you have soreness try to assess which movement is producing it. Do each very slow and controlled instead of pushing for 20 reps right away
Complete each 5-20x 1 set 1-2x/day as a sequence. You can do many of these lightly throughout the day which is a good idea to keep your hip from tightening up
If 0 is no improvement and 10 is back to doing everything you want, where are you at right now?
1 on 0-10 scale
In regards to the movements I have given you so far, which one feels like it is most helpful in either reducing pain or engaging your body in a way that you feel is helping your current situation
Movement: Probably the movement laying on my back, flexing glutes and pushing belly button towards ceiling is the most beneficial.
Most Difficult is where I am sitting in a chair and using the cane following my hands with my head.
What continues to be most difficult for you in regards to a functional activity that you have trouble doing and which movement that I have given you is most challenging or painful?
A couple of things: In the mornings I seem to be feeling better when I get out of bed and the pain stays away from my groin until later in the day. I can flex my glutes much better after one week. The burning pain around my leg above my knee has maybe subsided some. I think the outside of my leg near the IT Band and glute is somewhat sore. I have had the leg pain since 2009 so I don’t feel this will be the fastest recovery but I am hopeful. The positive is when I can keep the pain away from the adductor tendon. Currently the adductor tendon acting up a bit but it is late in the day and it seems when the rest of the leg fatigues the adductor tendon starts to take back over. I do think my leg is slightly stronger after the week of exercising. Most of the exercises I do 12 to 13 times at this point. When I started I was 5 to 6 reps. I can do the stomach flex laying on my back 15 or so. One other thing. The tendon that is just on the back side of the adductor tendon seems to be some of the issue as well.
Phase 2 (10-31 through November 7)
Goals:
Progress the endurance of the phase 1 movements
Progress into increased range of hip extension to increase the stretch on the front of the hip while working on engaging your glute deeper into hip extension
Assess your tolerance for hip flexion based movement
If you feel a pinch or pressure on the front of the hip with any of these movements stop short of that sensation or hold off on that movement and contact me.
Continue to do the phase 1 movements everyday
The movement in the chair that you told me is difficult
The goal with that movement is to progress into mid back or thoracic ext
Try the following options as a substitute for that one if needed. You pick the one that feels like it accomplishes the most with the least amount of pain
Do these as a circuit with each working towards 5-20 reps
As before, do them very lightly the first time through and if any do not feel right email me right away and I will you another option
This is alot of new stuff and the one thing that I can’t do as well online as I can in person is assess your level of irritability. Normally each movement I give to a patient i start to recognize how they tolerate that movement which guides my thinking. Some people are ready to do the following list all together. Others need to work on a couple movements at a time.
Your week should look like the following
Monday Phase 1 and phase 2 the first 2-3 movements, ice after to reduce risk of subsequent soreness 10-15min
Tuesday Phase 1 only
Wednesday Phase 1 and Phase 2 bottom 3 movements, ice as needed
Thursday Phase 1 only
Friday Phase 1 and a phase 2 whole group only if you were able to do the other phase 2 days without any major issues
If you had any problems, try to pick the phase 2 movements that were least likely source of any increase in pain
Saturday phase 1
Sunday rest or light phase 1 with 1/2 the reps you typically do
This version can be done from higher surfaces throughout the day
Strength Circuit:
Goal: Be able to get 5-20 reps. Once you get to 20 reps and do not feel a significant challenge you may progress to the next movement in the progression. The goal remains, the first time through each do it lightly and we will discuss any road blocks that you face. Complete the sequence below every other day
This update will attempt to reflect on the response to current movements to guide the future of this program. It seems your hip does not currently tolerate hip flexion or bringing your knee toward you very well. We will focus on hip extension with a gradual progression into hip flexion as tolerable
It is difficult when you have significant pain for a long period to recognize good vs bad pain
With each exercise that you attempt you have to assess if that exercise feels like it is accomplishing something good or if it is acting as more of a negative. Initially we focus on hip ext because that is typically the preferred direction for the hip to move into with less pain and then gradually it is important to progress into hip flexion as able. Do the daily mobility stuff above each day
Every other day do one of the strength progressions above
For the plank at the counter avoid lifting the non-weight bearing leg into too much hip flexion
I want to know what you notice as far as pain the following day to assess which progression seems the most helpful versus harmful.
Your reps are a little on the lower end with alot of these progressions so I really don;t want to give you anything more challenging at this point. Work on increasing the reps as long it does not come with the cost of increase in pain
11-22 Update
It sounds like there has been a rough stretch lately. Lets focus on the routine below this week.
Do this only everyday 10-20 reps of each. It will focus on hip ext while maintaining abdominal control
These movements, as we discussed via email, should provide a challenge without provoking significant symptoms. Based on your feed back we will make some adjustments
try to hold each 5 sec gradually progressing distance between front heel and back knee as able
try alternating the MFR with the isometric in a stretch position
1-28 Update
You asked about self MFR for the ITBand. The movements below involving MFR for the glute and the TFL which are the origin of the band
I am going to give you one other stretch option to open up the anterior aspect of the hip and low back. It is a little more aggressive stretch so if it is too much hold off.
