You May Be Doing Hip Physiotherapy Exercises Wrong
If you're doing hip pain physiotherapy exercises, there's a very good chance that you're making one of the mistakes that I'm going to cover in post.
Watch the video to learn the most common mistakes that people make when doing hip pain physiotherapy exercises, and how to fix them. Plus, learn the 3 most common reasons that people with hip pain fail to improve with with physical therapy exercises.
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In this post, you'll learn:
- 3 Common Mistakes with Hip Pain Exercises Laying Down
- 2 Common Mistakes with Standing Hip Strengthening Exercises
- The Most Common Hip Stretching Mistake
- Why People Don't Get Better From Doing Hip Pain Physiotherapy Exercises
- Get Expert Physical Therapy For Hip Pain
3 Common Mistakes With Hip Pain Exercises Lying Down
Clamshell Exercise
One of the most common hip exercises that people do in physical therapy is an exercise known as the clamshell.
The purpose of it is to strengthen the hip adductor muscles and external rotator muscles: you gluteus medius, gluteus minimus, as well as your 6 deep hip rotator muscles.
To do the exercise, you slightly separate your knees, and you should feel it in your buttocks muscles.
This might be the most common hip pain physiotherapy exercise. If it's not, it certainly ranks high up there.
It's a good exercise.
It's not a super hard exercise though.
The reason?
Because you're lying down.
Doing exercises lying down is nowhere near the demands that you put on your leg when you're standing and putting your entire body weight on it.
But if your hips are really weak or you're just starting out, or if you've got a whole lot of pain and you just can't bear weight on it, they're a starting place.
But there are some really common mistakes that people make when doing that clamshell exercise.
The most common mistake that I see is improper stabilization of the lower back.
By rolling backwards, people end up using their lower back muscles instead of the hip muscles that they're actually trying to get stronger.
Often, people do that exercise for back pain as well.
If you're moving at your back instead of at your hip, you're just potentially making the back problem worse as well.
The other problem with rolling back when you're doing the clamshell is that the gluteus medius and particularly the back part of the posterior fibers of the gluteus medius, their hip external rotators. But when you start rolling back like this, you actually start incorporating a muscle called your tensor fasciae latae, which also abducts the leg or raises the leg up.
However, it's an internal rotator of the hip.
The tensor fasciae lata attaches to the IT band and can cause IT band hip pain or outer hip pain or pain on the outside of the knee as well.
So you DON'T want to get this tensor fasciae lata into the exercise.
How To Fix The Clamshell Exercise
To stop that, you actually want to roll forwards a little bit.
Roll forwards a little bit more than you think you might have to.
If you're worried that you might not be far enough, just roll a little bit farther. You almost can't go too far forward with this.
Then use your hands to kind of make sure you're not rolling back.
Use your fingers on your hip to make sure you can feel your gluteal muscles contract.
It doesn't have to be a large lift. In fact, it's usually a pretty small lift.
Rather than doing a lot of fast repetitions, hold each repetition for five to ten seconds.
The goal isn't so much about just doing a lot of reps, it's more about getting the right muscles to work.
Learn more about the clamshell exercise here.
I mentioned that the is a hip abduction exercise, which means moving your leg out to the side.
That brings me into the next hip pain physiotherapy exercise which is the side-lying hip abduction (a.k.a side-lying leg raise).
Side-Lying Hip Abduction Exercise
This is a harder version of the clamshell because instead of having to lift part of the weight of your leg, you now have to lift the entire weight of your leg.
So it requires approximately twice as much force.
When doing the hip abduction exercise, you want to raise your leg using ONLY your gluteal muscles. Make sure you don't roll backward or allow your pelvis to hike up.
Doing so will allow you to recruit other muscles groups instead of isolating the glutes.
That means you don't need to raise your leg very high. In fact, less is more.
To make sure you have good stabilization, keep yourself slightly rolled forward, and then just lift your leg slightly.
Hold five or ten seconds in the top position, and make sure you're feeling it in your gluteal muscles
Usually it's the back fibers, or the posterior fibers, of the gluteus medius that get weak.
Gottschalk F, Kourosh S, Leveau B. J Anat. 1989 Oct;166: p182.
To further isolate the posterior fibers of the gluteus medius, roll forward even a little bit more and try to turn your toes up toward the ceiling. This causes external rotation of the hip.
Bridge Exercise
The next laying down exercise is laying on your back doing a bridge.
The goal of this exercise is to strengthen your butt muscles or your gluteus maximus.
When you do a bridge, the goal is to get hip extension. Because you have your knees bent, you're not using your hamstrings as much.
Therefore, this is a good way to isolate the gluteus maximus.
The way that most people do the bridge exercise is just lifting their bottom up in the air.
However that causes your lower back to arch. This mistake allows you to substitute back extension for hip extension.
Additionally since many people do this exercise for lower back pain as well, doing it incorrectly can actually make their back pain worse.
To do this exercise correctly, you want to do a pelvic tilt like that and just flatten your lower back out on the bed or the floor.
Get your lower back nice and flat and almost tilt it more than you think you might have to, really flatten that lower back out.
Then hold the tilt as you go to lift.
Don't allow your lower back to arch.
That may mean that you can't lift very high.
Again... less is more.
You should really feel your glutes working or your butt muscles working. If you don't feel that, you're probably losing the pelvis tilt.
You may also feel a stretch in your quadriceps, the muscles in the front of your thigh.
Hold for five or ten seconds at the top of the movement, and then come back down.
So those are the three laying down hip pain exercises.
Again, those are really common physiotherapy exercises that people do for hip pain.
And usually, those are pretty decent exercises if you do them correctly.
But the problem with them is that they're all laying down.
Largely people have hip pain when they're standing, walking, going up and down stairs, squatting, doing things in weight-bearing.
And so laying down exercises don't functionally mimic the way that we actually use our hips in everyday life.
And so the more functional exercises to do are hip exercises where you're standing up.
2 Common Mistakes With Standing Hip Strengthening Exercises
Some really common hip exercises when you're standing up are the hip abduction exercise and the hip extension exercise.
Standing Hip Abduction Exercise
This is basically the standing version of the sideline leg raise.
Much like the sidelying version, a common mistake that people will make with this exercise is that they either allow their pelvis to hike up as they're raising their leg.
So they get too much trunk muscle activation and they're not isolating their hip abductor muscles.
The other mistake is leaning your trunk toward the leg you're standing on.
This allows you to use the weight of your trunk to counterbalance the leg raising out to the side.
Truthfully though, balance is the biggest part of this exercise.
It's not that hard to lift the weight of your leg out to the side.
What's actually much harder is to hold your bodyweight balanced on one leg while you're kicking out to the side with the other leg.
So usually the first thing that I tell people is to get really comfortable standing on one leg.
If you can't even stand on one leg, then you probably really have no business kicking out to the side.
It's the stance leg that's getting most of the exercise.
So get really good at standing and balancing on one leg and then practice kicking out to the side.
Standing Hip Extension Exercise
In the standing hip extension exercise, you stand on one leg and kick backward with the other leg.
Much like the bridge exercise, you don't want to allow too much back arch, which is the common flaw.
People tend to go too far into hip extension and end up getting back extension instead of hip extension.
Instead, you want to isolate movement to the hip joint.
You may not be able to kick your leg back very far if you do this correctly.
And that's OK.
Just do a slight backward kick, really thinking about squeezing your gluteus maximus, or your but muscle.
Just like the standing hip abduction exercise, a lot of the effort of this exercise is really just maintaining the balance on your stance leg and doing the stabilization with your trunk.
You use the gluteal muscles of your stance leg along with your abdominals to stabilize your trunk and pelvis while you kick with the opposite leg.
That makes it a really good functional exercise to help you be able to push off when you're walking.
So that's the standing hip extension exercise.
The Most Common Hip Stretching Mistake
So far, I've gone through five common mistakes with hip strengthening exercises, but what about stretches?
Largely, most people do stretches for hip pain fairly correctly, but there's one really common one that people mess up on pretty often.
And that's possibly one of the most important stretches:
The Hip Flexor Stretch
The hip flexors attach to your lower back as well as to the inner rim of your pelvis, and one of your quadriceps, your rectus femoris, is also a hip flexor.
One good way to do a hip flexor stretch is to kneel in a half-lunge position.
Then push your pelvis forward, so you feel a stretch in the front of your hip.
If you go too far with this, then you're going to end up arching your back, and you're not really going to stretch your hip flexors.
Instead, you want to think about doing that pelvic tilt, kind of like when you start the bridge, and then just push your hips forward a little bit.
There are many different ways to do hip flexor stretches. This is just one option.
Learn 4 Hip Flexor Stretches here.
Why People Don't Get Better From Doing Hip Pain Physiotherapy Exercises
Those were six common mistakes that people do when doing physiotherapy exercises for hip pain.
Now I mentioned at the beginning that I'd share three problems that are even bigger and that keep people from getting their hip pain better with exercises.
1. Improper Exercise Dosing
If you're not doing the exercises frequently enough or often enough, you're not going to see improvement.
Physical therapy exercises aren't physically that hard.
They're more brain retraining or neurological retraining. That means you need to do them often to form new movement habits.
If you're not doing them regularly, they're probably not going to be effective.
Additional dosing problems:
- Not doing enough repetitions
- Not enough weight
- Too much weight
Those can all decrease the effectiveness of the exercise as well.
But largely, it's frequency.
The more often you do them, the better your brain gets the new movement patterns ingrained.
2. Treating All Types Of Hip Pain The Same
The second problem is that people treat hip pain exercises like they're one thing.
But there are different exercises that are good for say, groin pain or pain in the front of your hip, for example, from a labral tear or from hip arthritis.
Additionally, different exercises may be needed for pain on the outside of the hip, say from IT band syndrome or from hip bursitis.
And different exercises yet may be needed for pain in the back of the hip which often is referred from L5-S1 in your lower back. However pain in the back of the hip can also come from an SI joint dysfunction.
All of those different types of hip pain are going to have different exercises that are good for.
Therefore, you need a specific program that's going to help your specific problem.
3. Assuming Physiotherapy Exercises Will Fix Hip Pain
The third problem is just assuming that doing exercises is going to carry over into your everyday function.
Again, largely physiotherapy exercises aren't necessarily to strengthen your muscles as much as they are to retrain better movement habits so that you move better in your everyday life.
As we often tell our patients here at More 4 Life, it's not what you do the one hour per day or less when you're exercising, but it's what you do the other 23 hours when you're not exercising that makes the biggest difference.
If you don't carry the exercises over into your daily function, even if you do your exercises every day with perfect technique, you're probably not going to get better because those other 23 hours outweigh the exercises that you're doing.
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