What’s Wrong with My Hip?

Your hip hurts, and you don’t know what to do about it.

We’re here to help: an orthopedic surgeon who tries to keep his patients out of the operating room and a water rehab specialist whose pool program is followed worldwide. Together we help guide our patients to their own solutions by educating them. Since you have found our website, you’re ready to get started.

Once you start to feel pain or limited movement in your hip, a downward spiral begins. If you’ve been aware of your pain for a while but have taken no measures to combat your hip condition, you may have already entered this downward spiral. First you feel pain or limitation of movement, so you move your hip less often. You stop running, bicycling, and working out in the gym.

You begin driving your car to places you used to walk to. Because you are moving your hip joint less, it isn’t receiving the fluids and nourishment it requires, and it becomes further constricted and inflamed. The muscles begin shrinking, a process called atrophy. Once these muscles start feeling weak, you use them even less, and they atrophy even more.

It’s time to learn more about what is going wrong with your hip.

The Main Causes of Hip Problems

• Osteoarthritis (OA) — The most common cause of hip problems known as the “wear-and-tear” form of arthritis usually strikes the weight-bearing joints after the age of forty-five. Obesity and family history are known to be risk factors. As we age, OA can dry out our crucial cartilage, deteriorating this protective cushion between the bones. As the disease progresses, the cartilage begins to grow brittle and to crack.

• Labral tears — The labrum is a ring of rubbery fibrocartilage that attaches to the rim of your hip socket. It acts like a seal or gasket to hold the lubricating joint fluid inside the hip and stabilizes the joint. Most labral tears come from impingement of the bone against the labrum, but they can also occur from the trauma of a car accident or high-impact sports.

• Hip dysplasia — Hip dysplasia is a congenital condition in which the hip socket develops abnormally over an entire lifetime. The deformity usually means a smaller, shallower socket than normal.

• Femoroacetabular impingement (FAI) — Femoro refers to your femur or thigh bone; acetabular refers to your hip socket, the acetabulum. Impingement means to have an effect upon or to strike, especially with a sharp collision. Thus you can imagine why you have hip pain if this is your diagnosis. Your femur and your acetabulum are banging into each other, and your labrum is probably being damaged between them with every blow.

• Posttraumatic osteoarthritis — Posttraumatic osteoarthritis is virtually the same thing as osteoarthritis except that it is caused by previous structural damage. That damage doesn’t have to be of the hip to now cause OA of the hip.

• Avascular necrosis (AVN)– Death to the bone because of an absent blood supply. There is only one major blood vessel into the hip joint. If that vessel is damaged in any way, your hip will lose its source of nourishment to the bone, and it will die. The head of the femur collapses and there is usually an abrupt onset of sharp pain.

• Soft-tissue injuries — these consist of tendinitis, muscle strains,
Bursitis, capsulitis, ligament strains, and muscle and capsule contractures

• Rheumatoid arthritis — Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system attacks its own tissues. It is passed on genetically. The immune system falsely identifies its own tissues as foreign substances and begins to attack them as if they were an invader to be eliminated.

How Can I Relieve This Pain?

Whether your hip pain started abruptly or has been an ongoing problem, you want relief. Here are some things you can do today to help the pain subside.

• Reduce High-Impact Activities — Reduce the duration of your everyday high-impact activities by climbing fewer stairs, carrying fewer heavy packages, or walking shorter distances. In addition, modify your sports life: Replace high-impact activities with (in this order) water workouts, bicycling, and elliptical training.

• Wear Impact-Absorbing Shoes — The harder your shoes, the more impact you are transmitting to all your weight-bearing joints, including your hip. Wear the highly cushioned athletic shoes made for runners. That may not be realistic all the time given the demands and dress codes of your workplace, but wear them whenever you can.

• Contrast Ice and Heat — Use ice as the only treatment for the first forty-eight hours if you have a sudden or acute injury to the hip. If the hip problem is considered chronic, both ice and heat can be used. Apply heat. Follow it immediately with ice. Go back and forth several times: heat, ice, heat, ice—this alternation is called contrast ice and heat. Heat causes vasodilation, an increase of blood supply to the area, then ice brings about vasoconstriction, a decrease in the blood supply. These contrast treatments confuse the body by bombarding it with stimulants that are opposites. The confusion brings about a tremendous amount of circulation and healing to the area.

• Pool Exercise — Starting to move in water can be the best possible thing you can do for immediate pain reduction. It naturally increases circulation, releases endorphins (the body’s painkillers), and stimulates the body’s healing mechanisms. Best of all, you can gain all of these benefits without putting any weight on your hip. Exercising in water is the gentlest, safest way to increase flexibility, increase strength, and gain endurance. That means you can regain movement, mobility, and function.

If you live in the Los Angeles area, come to one of 18 Waterpower Workout classes offered each week where expert instructors will keep you safe as you exercise.

• Land Exercise – Once people have felt how painless it is to exercise in water, they often question why they would want to do a land program at all. Your main reason for exercising on land is that your activities of daily living take place there, not in buoyancy, but in gravity. When you can perform your ADLs with decreased pain and greater ease of movement, you improve the quality of your daily life. Plus, exercising on land loads weight onto your bones, which provides stimulus to develop healthy bone density and prevent osteoporosis.

Chapter 1 of Heal Your Hips Second Edition offers an introductory 15-minute program of pool exercises followed by a 15-minute program of land exercises. Photos and text make the exercises easy-to-follow.

• Pilates — The popularity of Pilates is increasing worldwide both in fitness and rehabilitation programs. A decade ago it was practiced by five thousand people; today that number has grown to over five million in the United States alone. Avoid the machines and stick with mat Pilates as you work with an instructor who understands hip problems.

• Yoga – If you have limited range of motion in your hip but your X-rays show no mechanical reason for the lack of movement, yoga can be an effective method for relieving your pain and gaining strength and flexibility. As you relax deeply into each sustained stretch, you may discover that the tightness around your hip gradually releases and gives you more movement. Avoid full forward bends and seek out an instructor who understands hip problems.

• Acupuncture — Acupuncturists insert thin needles through the skin at specific points on the body to relieve pain and stimulate the body’s natural healing systems. It has been in use in Western society with success for decades.

• Lose Weight – This can be the hardest thing of all to do. Keep in mind that with every step three times your body weight goes onto your sore hip. If you lost ten pounds, there were be thirty fewer pounds pushing down through your hip every time you take a step. Find a system or app that works for you. Your hip is telling you it’s time to do it now.

Can I Prevent Hip Surgery?

Here’s what Dr. Klapper says in the Preface to Heal Your Hips 2nd Edition:

“It was always interesting to me to hear things like this from my patients: ‘I’m a skeptical person and I didn’t believe how miraculous the water exercises could be in truly changing my life.’ The patients either prevented surgery with the pool program, or, if it turned out they had to have surgery, they had regained muscle strength and joint flexibility so that the surgery was much easier to go through.”

So, yes, you can prevent hip surgery, but you won’t know if you can until you give it an honest try of at least two to three months. Start our short pool and land programs in Chapter 1 until you make them part of your life. Then increase your time in the pool or doing the land program in our book by moving to the full programs in Chapter 9 and 12. Be dedicated and consistent every day, and don’t even think of giving up until at least four weeks have gone by. That’s how long it may take to get the rusty wheel turning smoothly again. At that point, you’ll be fully motivated to increase both your pool and land sessions, because now your pain will be greatly reduced and it will be fun to exercise. If you can identify that you’re getting better each month, you’re headed in the right direction. Keep going and you’ll find yourself becoming more and more capable and enjoying the running and jumping exercises in chest-deep water. Those Impact Exercises make you feel like a kid again, playing in the water and smiling from ear to ear.

But it doesn’t happen without guidance. You’ll want to know what your specific diagnosis is. You’ll want to know which exercises are good for you to do and which ones you should avoid. For instance, if you are diagnosed with osteoarthritis (OA), you’ll want to know if it is Stage 2, 3, or 4. With Stage 2 and 3, you can likely prevent or postpone surgery for many years. If you have femoroacetabular impingement (FAI), you want to make sure you don’t do any deep squats, deep lunges, or extreme range of motion with your hip. You, too, can work to prevent hip surgery by learning more about the condition and following our precise pool and land protocol. You’ll want to do the Snibbe Stretch several times every day, working your way up to being able to hold it for five minutes each time.

Snibbe Stretch, Exercise 5 in Chapter 12, page 214.

Just as in the world of business, we like to talk about a win-win situation. Working to prevent hip surgery can create several wins for you. The ultimate win, of course, is that you follow the programs in this book, relieve your hip pain and dysfunction, and never need hip surgery of any kind. But there are several other possible wins. After several months of doing our pool program, you are likely to realize you’re in great shape, so you keep the water at the center of your lifelong fitness plan. It may turn out that you’ve postponed the need for hip surgery by five or ten years. That’s significant because technology keeps improving, and the surgery of the future will no doubt be superior and easier. But the other win is that even if you find yourself eventually scheduling a surgery, you will have become much stronger and able to bounce back more quickly.

Pool Program for Hip Patients

The pool program we provide in Chapter 9 of Heal Your Hips Second Edition offers forty exercises accompanied by lovely photos posed by fitness model and author LaReine Chabut. The program is divided into the following categories:

• Gait Training
• Deep-Water Intervals
• Stretching
• Deep-Water Exercises
• Kicking Series – Speed Kicks and Power Kicks
• Impact Exercises and Shallow-Water Running
• Lower Body Exercises

Here we will give you a peak at one of the exercises in each category.

Gait Training

You may have damaged your hip in a sudden injury, or it may have taken months or years for your hip condition to develop. Either way, you have probably found that your normal walking pattern has become irregular due to pain or limitation of the hip’s movement. If walking on land causes you hip pain or discomfort, you’ll find it a welcome relief to have most of your weight lifted off your hip joint while you walk in the water. In chest-deep water, you can walk relatively pain-free and at the same time relearn or refine the correct biomechanics of walking.

Exercise 2. Marching.

You don’t need to lift your knee as high as the photo. This is a goal to strive for, but it may not be where you begin. Begin marching by lifting one of your knees as high as you can without hip discomfort or pain.  Lean forward and take a step, then lift the other knee to a similar position. If you feel pain in the affected hip and you’ve tried the basic modifications in the box on page 189, don’t lift your knee so high. Pay attention to the direction your knees are pointing while you march. Perhaps your right knee is pointing straight forward while your left knee points slightly to the left side or across the midline of your body. Try to correct the movement so that both knees point straight forward. If the full correction causes increased hip pain, adjust the correction back to the point of no pain, thus returning to a position that is comfortable. You can aim toward better alignment again next time. Use bent arms in opposition to the bent knees. Your right arm should move in time with your left knee, and your left arm should move with your right knee.

Deep-Water Intervals

Most people will need a few sessions to learn the balance and rhythm of each of these exercises since they are unfamiliar movements. If you’re a non-swimmer, you can hold on to the side of the pool.

Exercise 5. Deep-Water Walk.

Start in an upright position with no forward or backward lean. Hold your right arm and your left leg forward at the same time to establish your “opposition” position as in the photo. Then begin an exaggerated walking motion, one in which the knees never bend. Swing your arms and legs forward and backward—right arm with left leg and left arm with right leg—in a smooth, flowing motion.

Stretching

Stretching reduces muscle tension and makes your body feel more relaxed. It increases the range of motion of your hip joint while it helps you get to know your own body better: As you stretch, you receive messages from your body. Listen to these messages carefully.

Exercise 12. Quad Stretch

Hold the side of the pool for balance with your right hand. Grasp your left ankle with your left hand and slowly pull the left heel toward the buttocks as shown in the photo. Keep the knees close together, and make sure you haven’t gone into a sway-back position. Breathe deeply five times as you feel the muscles relax and lengthen. Switch sides. Hold on to the side of the pool with your left hand and repeat with the right leg.

Deep-Water Exercises

If you’re a non-swimmer, you can hold on to the side of the pool. Start all exercises slowly. Then, if you feel no hip pain, gradually increase your effort level.

Exercise 16. V-Kicks.

This exercise can be tricky to learn, so here’s the easiest progression. Start by doing a Basic Walk as in Exercise 5. Next, lean back slightly and lift your legs halfway to the surface as you keep walking. Then open your legs slightly apart to create the V as you swing both arms toward the leg that lifts as in the photo. Keep both legs straight throughout the entire exercise.

Kicking Series (Speed Kicks, Power Kicks)

The Speed Kicks are just what they sound like—you do them fast. Or at least you work your way up to top speed over weeks and months. The Power Kicks are larger, more forceful movements, so you can add resistance pieces to your ankles while doing them, which forces the muscles to work harder.

Exercise 19. Deep Back Kicks, Power Kick.

Brace yourself at the side of the pool as shown in the photo. Lean forward and look down at the water. Let your hips float near the surface of the water, and let your right leg dangle below you as shown. Push your left leg straight back, but not so high as to arch your back. Now switch leg positions and keep reswitching  smoothly, taking care to hold your hips steady. Don’t let them roll from side to side. Focus on keeping your legs straight and contracting your gluteal muscles to enhance the backward push.

Impact Exercises

You can start doing jumping and running exercises in the water long before you can think of doing such movements on land. Usually, jumping up doesn’t hurt; it’s the landing that causes pain. When you wear a belt, you jump up painlessly; then when you land, the water catches the belt and the belt catches your body, eliminating most of the impact upon landing. Still, we like to start slowly.

Exercise 25. Power Frog Jumps

Bounce gently with your feet together and your arms out to your sides at chest level. Jump off both feet, and lift both knees toward your chest as you sweep both arms forward to meet in front of you as in the photo. Push the arms back to their starting position as your feet return to the pool bottom. As you begin, you can sit low in the water. As you get stronger, jump higher and pull your hands powerfully to the front.

Lower Body Exercises

If you feel any pain during these exercises, slow down or narrow the range of motion. You’ll start your program using only the water’s resistance against your legs. As your strength improves, you can add any of the resistance pieces shown and described in Heal Your Hips Second Edition, Chapter 9.

Exercise 40. 2-Way Hip

You can start holding onto the side of the pool for balance, then move away to stand on the pool bottom. When you have mastered the exercise, you can add resistance pieces. When you want to make the exercise harder, use a step as shown. Keep your eyes on a focal point straight in front of you to help you maintain good balance. Balancing and stabilizing is as important a part of this exercise as is the movement aspect. Engage your core muscles and the muscles in your feet and toes to grasp onto the step or pool bottom. Stand on your stronger leg while you move your affected leg.

Robert C. Klapper, M.D., likes to tell his patients: “My father was a carpenter and my mother was a nurse, so I was destined to become an orthopedic surgeon. The most important thing my father taught me was ‘Measure twice, cut once.’ It comes in handy every day I’m in the operating room.”

This fits comfortably with Dr. Klapper’s education and medical training (an art history degree from Columbia College, a medical degree from Columbia University’s College of Physicians and Surgeons, an internship at Cedars-Sinai Medical Center, and a residency at the Hospital for Special Surgery in New York, followed by a fellowship in arthritis and implant surgery at the Kerlan-Jobe Clinic in Los Angeles) and with his bold, visionary research that has led to patents on instruments used to do complicated hip surgery. He is currently Co-Director of the Joint Replacement Institute at Cedars-Sinai Medical Center in Los Angeles. He has written articles for Clinical Orthopedics and Related Research, the American Journal of Sports Medicine, and other publications.  He wrote Chapter 10 of the book Operative Hip Arthroscopy titled “Hip Arthroscopy without Traction.”  He is the host of ESPN radio’s “Weekend Warrior” and the sports medicine expert on Fox Sport 1 TV.  He can be found on Twitter @DrRobertKlapper.

Besides medicine, Dr. Klapper lists surfing and sculpting among his passions.  He does both regularly, the sculpting in Manhattan Beach and Italy, and the surfing in Ventura and Hawaii.

Lynda Huey, M.S., starred as a sprinter at San Jose State University, earned both a bachelor’s and a master’s degree, coached track and field and volleyball at several universities, and wrote her autobiography, A Running Start: An Athlete, A Woman, before she was thirty. Her second book, The Waterpower Workout, resulted from her pioneering work in developing water exercises for fitness and rehabilitation of athletic injuries; and her third book, The Complete Waterpower Workout Book has been the best-selling book in its field for over twenty years. She writes a self-help blog at CompletePT.com/blog. She can be found on Twitter @LyndaHuey.

Through her fitness business, she sees many of the Hollywood elite in their home pools and through her physical therapy business, she and her staff of physical therapists treat over 400 patients each week. She designs therapy pools and aquatic therapy protocols for major hospitals and health care providers. She has written six books on water exercise and rehab, which are considered to be the foundation of aquatic therapy world-wide. She is a renowned international lecturer and has developed an online training seminar to share her advanced techniques that have been well proven by many of the world’s best athletes.

Lynda shares the waves with Dr. Klapper as they write books. She body boards as he surfs. They have also written Heal Your Knees: How to Prevent Knee Surgery & What to Do If You Need It.