This week’s pose of the week is going to focus in on hip pain after surgery. You don’t have to have had hip arthroscopy to benefit from this post. But if you have, you may find it particularly helpful. As with all my posts, the Pose of the Week always focuses on join preservation, particularly for the hip, spine, and pelvis.
If you don’t have hip pain, but would like to avoid it, this post is also for you!
One of the biggest problems after hip arthroscopy is increasing (restoring your range of motion). I underwent a hip arthroscopy several years ago after 3 years of physical therapy and waiting for the right time to have surgery.
Let me say first, that as a patient and doctor of PT, I have zero regrets. The surgery was a success, but surgery itself isn’t the solution. That’s half the solution. The other half is getting good physical therapy so you CAN come back after surgery and do the things you want again. So you can get back to living.
Case in point on why increasing hip range of motion is critically important
The Half-Kneeling Trunk Twist is a great way to isolate hip extension and measure available trunk rotation. A lot of hip patients I see can have pain with attempted loaded hip extension (knee or foot to ground) and attempted loaded hip flexion (think child’s pose).
This pose is a prep to any lunge, squat, or kneeling pose, and can prepare a person for prayer twist.
This pose can reveal a lot of compensatory patterns, which you will see in the videos. Overusing the spinal paraspinals, quadratus lumborum, rectus abdominis, and hip flexors are pretty common, which lead to unsustainable movement patterns that can cause impairment and pain.
Watch these 2 videos:
The first is BEFORE hip joint mobilizations on my right hip at 3 months + 3 weeks post-op.
The second is AFTER hip joint mobilizations on the same hip.
What did you see?
Did you notice anything obvious about hip range of motion?
Probably not unless you have a trained eye for dissecting human movement. Or, unless you can get inside the joint and FEEL what was happening before.
What I can see in the “before” video is less stability (notice the front foot and knee wobble), less graceful, coordinated motion, and less integrated involvement from the trunk and core. I also have less range of motion available at the hip and torso.
In the “after” video, all of those variables are improved.
But, without a trained eye, it may be most important for you to know what to “feel” in your movement – so that you can seek out a PT for help when you know you are missing hip range of motion. Here’s a short list:
What you feel when you are missing hip range of motion
- Groin pain
- Pinching in the front of the hip joint
- Deep pain inside the hip joint
- Inability to step through during gait (push off the affected leg and have the hip extend behind you while you are walking)
- Pelvic floor pain – can be dull, achy, sharp, or dragging in the pelvic floor and inside the pelvis, lower abdomen
- Inability to bring the knee to the chest without pinching in the front of the hip
- Inability to bring the knee into the chest and toward the opposite shoulder without same pinching
- Inability to bound, jump, leap, skip, or do any higher level sport activities
- A feeling that you’ve retorn your hip labrum
- Night pain
- Inability to walk over uneven terrain, or even to do a simple yoga pose like Tree Pose, without pinching or mechanical-type hip symptoms.
The different types of hip range of motion
There are two different ways increasing your hip range of motion after hip arthroscopy will benefit you, and both are vital. One can’t exist without the other. See the figures below for an example.
- Osteokinematic range of motion is the movement OF the joint you can see, like hip flexion, extension, abduction, adduction, and internal and external rotation.
- Arthrokinematic range of motion is the movement IN the joint you cannot see, like rolling, spinning, and gliding.
What is the take-home message?
Joint range of motion at the hip requires MORE than just osteokinematic (seen) range of motion. It requires arthrokinematic motion too. A skilled manual or orthopedic physical therapist is trained to delivery graded joint mobilizations and/or manipulations to all the joints, including the spine, which can help restore pain-free motion.
But that is not all.
Full hip range of motion must also address the soft tissue, including the fascia, and the neurovascular structures. Treatment must also address biopsychosocial factors such as social determinants of health and pain science. Lack of joint range of motion doesn’t always have a a biomechanical cause – and even when it does, the biomechanical contribution is typically muli-factorial.
This means you can’t simply “stretch” joint pain away. You also just can’t use a singular treatment to increase (and restore) hip range of motion.
Some treatments I use to address stubborn loss of range of motion include:
- Myofascial release (quite often a first line of treatment)
- Soft tissue mobilization
- Joint mobilization in specific directions at specific amplitudes
- Joint mobilizations with movement
- Dry needling (can be very helpful and often a missing link to gain final range)
- Neuromuscular re-education
- Therapeutic exercise
- Gait training (learning how to walk and run properly)
- Lifestyle Medicine (i.e. nutrition, sleep, stress management, mindful movement, and environmental influences on hip health)
- Integrative Medicine, most often using Medical Therapeutic Yoga, for pain care
- Lumbopelvic real time ultrasound rehabilitation imaging
- Electrical stimulation (often used with dry needling)
- Pelvic floor PT
Before & After: Increasing Hip Range of Motion with Joint Mobilizations
In the two photos below, you will see a before and after screenshots.
The first is a picture of left trunk rotation in right half kneeling. The left picture is the before and the right picture is the after shot.
You may want to go back and watch the videos again once more. You’ll notice I point to the right sacroiliac joint – which was where I had pain with attempted trunk rotation and full hip extension.
The second photograph is a screen capture of repeating this same movement after performing hip joint mobilizations. The pain in my right sacroiliac joint is now gone. Movement is more fluid, and I have full pain-free hip range of motion and increased trunk rotation with less hip hike.
The takeaway message on increasing hip range of motion
- Remember that pain can have multiple inputs and causes. A good PT will root out all possible causes, which may have NOTHING to do with biomechanics at all.
- Don’t assume that a lack of hip range of motion means there is a mechanical issue. Sometimes other things are at play, like sleep, nutrition, and a biggie – stress management.
- Sometimes a loss of hip range of motion isn’t coming from the hip at all. It can come from other restricted tissue or joints if the problem is mechanical.
- See a hip specialist PT, and preferably one that also specializes in pelvic PT. You need both to get comprehensive treatment.
- Remember that hip movement and health doesn’t exist in isolation. You can appreciate just how much my trunk movement was limited too – just because of the hip.
- This means a good hip PT will look BEYOND the hip: She/he will check the low back, sacroiliac joint, spine, and pelvic floor. I also quite often see respiratory diaphragm and vocal diaphragm involvement as well as gut health contributors in hip pain.
- In addition a good PT will also look at lifestyle factors like I mentioned above. i.e. a food sensitivity could set you up for long-term low grade inflammation, which can cause pain; or a lack of sleep can increase pain or impair immune function, gut health, and healing, for example.
This is certainly not an exhaustive discussion on hip range of motion. And this post really focuses in on loss of hip range after hip arthroscopy. But, it also serves as a starting point to help you identify and begin to resolve tough to treat issues that surround hip labral tears and impingement. I hope this pose of the week will help you take a closer look at missing hip range of motion!
PS HERE ARE 3 MORE WAYS I CAN HELP YOU!
2. Take courses with me at Living Well Institute and Yoga U Online!
3. Take advantage of the Free Medical Therapeutic Yoga Basic Video Library.
DISCLAIMER: These movements are for protection and preservation, as well as maximizing, pelvic girdle function (hip, SIJ, low back, pelvic floor). This and any other videos I instruct do not constitute physical therapy or a patient-provider relationship. User assumes risk in performing this or any video. Finally, you need to get the approval of your healthcare provider before doing this or any instructional movement video. Assessment and evaluation of the hip & knee should only be done by a licensed healthcare provider.