Hip stability. The holy grail of post-op hip arthroscopy, total hip, and pretty much all hip rehab.
It has been a little over 6 years now since my own hip arthroscopy. Achieving good hip scope outcomes is often easier said than done. It requires staying up on all the research and surgical techniques, and putting them into practice. I also teach continuing education on hip rehab and safer yoga practices for the hip to healthcare pros and yoga teachers. As you might guess, my patient case load is full of hip and pelvic pain patients. But it’s important to note that hip pain can show up as other things too.
Here’s some of the ailments patients have had that turned out to be part of a bigger hip problem:
- Low back pain
- Sacroiliac joint pain
- Pelvic pain
- Pelvic floor dysfunction
- Pain with intercourse
- Pain with attempted intercourse
- Knee pain
- Digestive issues
- Diaphragm dysfunction
- Voice issues (yes, true)
- Same sided shoulder issues (yep, that one too)
So if you are suffering from any of these issues, it’s a good idea to have your hip thoroughly evaluated by a hip specialist PT.
Not sure who to go to first, the PT or orthopedic surgeon? Let me clear up confusion:
- A hip surgeon is highly trained to do hip arthroscopy (they specialize).
- A hip physical therapist (PT) is a trained to evaluate and treat hip musculoskeletal and neuromuscular issues (also a subspecialty of physical therapy).
Every good surgeon and PT will tell you diagnostic tests can never take the place of a well done, thorough physical exam and subjective interview. Diagnostic tests for the hip are plagued with both false positive (says you do have a tear but you don’t) and false negatives.
So when the rubber hits the road – you want someone to be able to physically examine your hip thoroughly AND give you the exercises to get better. That depends highly on if the healthcare provider listens carefully to you.
I don’t recommend heading to a surgeon for every little joint ache and pain. It’s expensive for you and the system; and it clogs up surgeon’s offices with loads of people who would actually be seen much sooner, and get better quicker, if they saw a PT first. If you want orthopedic surgery and are sure you need it, go see a surgeon first. Otherwise, see your PT first.
A side note: If you do need surgery, a good hip PT can handily refer you to the best hip folks in your area. Make sure you find a hip and pelvic PT specialist, not a general PT.
One final key point: A KEY take home point is that a general orthopedist or a hip replacement surgeon is NOT a hip arthroscopy surgeon. You only want a hip scope surgeon to do this surgery.
Now let’s talk about the foundation of a good hip scope outcome: hip stability
Today’s pose of the week is a moving yoga pose I call “Swing Through.” Typically people think of yoga as being postures that you hold, like tree or triangle or mountain. But in integrative physical therapy, I often teaching moving yoga poses. One of those poses is called the “Swing Through.” And to do it, you have to “Lock and Load.”
A Lock and Load is essentially another way of describing a Hip Lock.
The Hip Lock is kind of like a “screw home” mechanism where you create stability of the hip joint by centering the femoral head (ball of the hip joint) in the acetabulum (hip socket). When patients successfully learn this maneuver a lot of their pain typically subsides.
Now, that isn’t ALL you have to do to rehab a hip, but it’s a foundational part of recovery.
In the video below, I demonstrate one of the MANY, MANY exercises I did to restore my hip. And by the way, the odds were stacked AGAINST me when I had this surgery.
- I was OVER 40.
- I had crappy hip structure (hello hip dysplasia). That is what fueled me to create Medical Therapeutic Yoga, which combines yoga with rehab and sports medicine science (chiefly used by PT, OT, and Athletic Trainers) to make yoga breath and postures safer and more effective.
- I was postpartum for the THIRD time (aka completely out of shape and in dealing with ALL the postpartum rehab needs too).
- All these things combined was a recipe for disaster. My long-term surgical prognosis was poor (statistically speaking).
- Basically, I fell under the “don’t expect your fixed hip to stay fixed” category.
But, I was and still am undeterred. Today I’m nearly 50 and my hip is doing fantastic. You can do well too!
Key take-home points about the “Swing Through” exercise:
It’s all in the (Neuromuscular & Musculoskeletal) details
- TATD Breath – I am practicing TATD breath in order to create enough core stability to do this exercise. But notice how on the right side, I just don’t have enough of it. But that’s not all that made it hard.
- Knee Alignment – Also notice the knee alignment when I stand on my left leg – it tends to turn in and make the knee want to collapse toward the other knee. No good. That’s part of the structural issue I have – which is called excessive femoral anteversion. It means I can “W sit” really easy – and probably did it a LOT as a child, but shouldn’t have. It means I can also abuse the movement to the detriment of my hip and knee joints (I’m speaking to all the yoga teachers out there. It’s critical you screen for this in your classes because it changes how you teach.) It also means I tend toward instability at the knee and hip joint, and can sublux (partially dislocate) my joints too easily. So what do I do? I work VERY hard at doing something I call “LOCK AND LOAD.”
Lock and Load for Hip Stability
- The Lock and Load –
The “Lock” part involves firing the deep gluteal sling BEFORE I move. Now, you won’t always have to “Lock” before “Load.” But during rehab, you do. You have to consciously teach and work on a movement before it becomes second nature (kind of like learning a foreign language). The hip lock part can be easily learned practicing a Warrior I in the MTY Method. Now the deep gluteal sling (aka hip rotator cuff) does not just externally rotate the hip. It stabilizes it during activities like this one, and also stair climbing or while doing squats. So for this exercise, I do a “Hip Lock” before I move.
Next, comes the “Load.” The “Load” means I have my “hip lock” on, and now I can practice the Swing Through.
- The “Feel” of Lock and Load – It feels like more than just your gluteus maximus firing – it feels like something I call “plugging in.” I borrowed the “plug in” term from equestrian PT – when a rider plugs into the saddle when horseback riding English style.
- The “Plug In” – Next, you need to “plug in” your hip lock to the pose or movement. To do this, sit on your hands – put your hands underneath your sitting bones and sit on them, palms up. Make the muscles under your sit bones “plug” into your hands.
- The Advanced Plug In – Next, relax. Whew. This isn’t easy. It’s nuanced. But that’s what good hip physical therapy is. Now Plug In again, and this time, don’t let your hip flexors contract. Oooh, that’s really hard. That’s where I spend a LOT of time in physical therapy with people – teaching them how to fire muscles in the right order at the right time. That’s why it’s hard to just follow a protocol or some exercise sheet you found online. Hip rehab isn’t that easy.
- The Load – Once you have mastered the “Lock” via “Plugging In,” now you are ready to “Load.” Watch the video again to see how I successfully “Load” the both hips, BUT I am able to do FAR less on the right side. Notice how I have to look at the ground to even sustain the movement. I am working HARD and thinking HARD to stabilize my lower body.
Getting Hip Stability on the Surgical Side
- Notice what happens when I shift to my right leg. I just can’t fully do the Swing Through. Yet. And this is AFTER FINISHING THREE MONTHS of the SURGICAL PROTOCOL for rehab.
- This means the surgeon’s protocol is really a vague safety blueprint. It keeps you safe by allowing healing to happen via metering a gradual roll out of exercises and movement. A surgical protocol isn’t a recipe for physical therapy. There’s a LOT more to hip scope rehab that the protocol. And, if you are like I was – a postpartum mom who waited 3 years to have surgery, then you can expect your rehab to take FAR longer. Mine took 18 months start to finish, and I was a PT and athletic trainer with 20 years of experience in orthopedics.
- I am moving MUCH slower and with far less range of motion on the right (leg leg swinging through) because it takes a lot of effort to stability and balance the right hip. I don’t have the strength, endurance, or coordination to do what the left leg was doing.
- There are many ways to improve hip stability. Some of them are:
- Work MORE on TATD breath and in more varied postures and movements.
- Work on scar tissue. I spent a great deal of time dry needling and doing scar mobilization.
- Master all the MTY Locks.
- Use the Hip Lock in all your standing postures if you need hip stability.
- Use TATD breath as well.
- Balance pelvic floor and abdominal strength.
- Balance left to right side transversus abdominis strength.
- Don’t overuse the external obliques and hip flexors. It’s way to easy to compensate and use those while not training the deeper muscles.
My physical therapy would continue for another 15 months. I considered myself finally done with physical therapy when I was in Costa Rica and I was able to surf for the first time.
I was there teaching a Medical Therapeutic Yoga alumni retreat, so all my medical pro buddies saw it and cheered me on. That was a real victory moment for me. And whatever your goals are, you can reach them too.
Here are a few helpful videos to get you started:
Yogic Locks (Medical Therapeutic Yoga Method)
Warrior I (Medical Therapeutic Yoga Method)
Join my Facebook Community
If you DO have hip or pelvic pain, you may want to join my community Facebook Group, Hip Labral Physical Therapy Network.
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.