Hip Strengthening

Your Hips: The ‘Core’ of the Problem?

I think most of us by now have heard about the importance of strengthening your ‘core’. But did you know that the most important part of your core for preventing hip, knee, and ankle injuries are your hip muscles? Your hip muscles or ‘glutes’ are the largest group of muscles in your lower body and are a part of your core that are often much weaker than they should be.

So what exactly are the hip muscles responsible for? Strong hip muscles keep your spine, pelvis, knees and ankles in alignment. If your glute muscles aren’t strong enough your hips rotate and drop, your knees move inward and your feet flatten (pronation). All of these motions create more strain on the joints, ligaments and tendons of your lower body. This excessive strain often leads to injury and persistent pain. Achilles tendinosis, patellofemoral knee pain, iliotibial band (ITB) syndrome, and piriformis syndrome are all common injuries linked to weak hip muscles. Research is also showing that hip weakness is a major risk factor for non-contact ACL (knee ligament) injuries.

So why do our hip muscles become weak in the first place and what can we do about it? The latest research done by Dr. Powers who is a physiotherapist in Los Angeles, shows that our brains have only a very small area dedicated to controlling the hip muscles. It is unclear why this is the case but it may explain why the majority of us don’t naturally use our hip muscles during activities such as: running, walking and hiking. The good news is that the same research shows that exercise can change the way our brains work.

In the study, patients that took part in specific hip strengthening exercises, actually showed changes in brain function. The areas on the brain controlling the hip muscles became larger after only a week of exercise! This is important because the larger the area of your brain dedicated to a certain muscle group is, the easier it is to ‘turn on’ and strengthen that muscle. Keep in mind though, these strengthening exercises need to be done for a minimum of 3 months in order to get significant strength improvements in the muscle.

So if you suffer from ongoing hip, knee or ankle pain, strengthening your hips may be the key to getting over your injury problems. Visit your local physiotherapist and ask for an assessment on your hip strength. If your muscles are weak your physiotherapist will give you the proper home strengthening exercises to address the weakness. Through these exercises you can change your brain to help change your pain.

Graham Gillies, M.Sc.PT, CAFCI, FCAMPT, MCISc(MT), CGIMS

Graham Gillies is a registered Physiotherapist at Sun City Physiotherapy Winfield and is a fellow of the Canadian Academy of Manipulative Therapy and a certified Gunn IMS and acupuncture practitioner.

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Knee Osteoarthritis

Foot and Ankle

Knee Osteoarthritis

You wake up, the sun is shining, you climb out of bed and realize that your knee feels stiff. Again. After about ten minutes the stiffness eases and you head out for your morning walk. You notice that you can’t walk as fast as you could a couple months ago, and you have started shortening your walking distance due to the pain in your knee. Over the last month you have also noticed weakness in the muscles around the knee, reduced balance and grinding in the knee joint with movement.

Does any of that sound familiar? If so, you may have knee osteoarthritis. Osteoarthritis is a common degenerative condition that often involves the spine, hip and knee joints. When the articular cartilage between two bones breaks down, the underlying bone becomes exposed, which can be painful. An x-ray of the knee can help confirm the diagnosis of osteoarthritis, although symptoms do not always correlate with the degree of degenerative change seen on x-ray.

While it is usually not possible to identify the exact cause of this condition, factors which increase the risk of osteoarthritis include increasing age, a family history of osteoarthritis, obesity, a previous injury that has caused trauma to the joint and a sport or occupation that has involved repetitive stress on the knee joint over an extended period of time.

There are a wide range of physiotherapy treatments that can be quite effective at alleviating pain, reducing stiffness and improving range of motion, flexibility, muscle strength, balance and overall function. These treatments may include education, manual therapy, exercise prescription, modalities and use of a gait aid, such as a cane.

Exercise can be quite beneficial to help reduce symptoms and improve function. Consider your physiotherapist your exercise expert who can put together a home exercise program for you which includes specific exercises for range of motion, stretching, strengthening, aerobic exercise and balance training. As well, swimming and/or cycling are often well tolerated and help improve aerobic conditioning, joint lubrication and can help with weight management.

Manual therapy involves different hands on techniques performed by your physiotherapist which can help reduce stiffness and improve range of motion. We will often measure knee range of motion before and after treatment and between physiotherapy visits to determine how effective the treatment is for you. Modalities, which include heat, cold, electrical stimulation, ultrasound and acupuncture may also help to reduce symptoms. Ultimately, our goal is to reduce pain and improve function and the treatment you choose will depend on your goals, the severity of your symptoms and your current level of function.

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Iliotibial Band Syndrome and Running

Sports

Running is a popular activity that can help maintain or improve your cardiovascular fitness and in some cases help you lose weight. There are many different reasons to run but often there is a goal set that may include 5Km, 10Km, half marathon, or full marathon.
When training for longer runs including 10km, half and full marathons it is important to remember that the training schedule should take place over long periods of time to allow your muscles and joints to accommodate for the increased strain that will be placed on them during the long run. As a physiotherapist, I treat many runners with all sorts of injuries. Some of the most common injuries include plantar fasciitis, achilles tendonitis, muscle strains, and Iliotibial band friction syndrome (IT band syndrome).
IT band syndrome is a repetitive stress injury that occurs when the iliotibial band glides over the lateral femoral condyle on the outside part of the knee. The iliotibial band is the thick band that runs from the outside of the hip down to the outside of the knee. It is a common injury for long distance runners (20-40 miles/week) but is not limited to only long distance runners. Running on various terrains can increase the risk of developing this condition. Up and down hills, graded slopes, and cambered roads have all been shown to increase the risk. This syndrome may also be found in other athletes or weekend warriors such as cyclists, weight lifters, and participants in jumping sports.
With IT band syndrome there is rarely a history of trauma. Patients will often complain of knee pain that may be difficult to localize and usually increases with repetitive motions like running. The symptoms usually get worse with changes in training surfaces, increasing mileage, or training on crowned roads.
Studies have found that long distance runners with IT band syndrome have weaker hip abductor and glut muscles on the involved leg compared to the uninvolved leg. The hip abductor muscles are located on the outside part of the hip and help prevent the leg from moving towards the centre of the body. It is also noted that fatigued runners are more prone to having their hip adduct (move towards the centre) and internally rotate (leg turns inwards) which causes more friction on the iliotibial band and therefore the symptoms get worse.
The management of IT band syndrome usually includes: 1) activity modification (usually decreasing mileage). 2) New running shoes. Shoes should be replaced about every 500km. 3) Heat or ice. 4) Stretching the IT band. 5) Strengthening the hip abductors and glut muscles.
If you are interested in pursuing long distance running you should: 1) follow a certified training schedule. 2) Make sure the shoes you are wearing are the right shoes for you. 3) Increase your mileage slowly to allow your body to accommodate for the increased strain. 4) Hit the gym – muscle weakness can cause problems down the road. 5) Go in for an assessment with a health care professional if you start to experience aches and pains that aren’t going away.

Jumper’s Knee

Foot and Ankle

Jumper’s Knee

Patellar tendonitis, commonly referred to as ‘Jumper’s Knee’, is a breakdown of the soft-tissue structure connecting the knee cap (patella) to the shin bone. We see this condition quite frequently in the clinic, and it tends to affect people participating in any activity involving repetitive squatting movements, or repeated jumping. This would include volleyball and basketball players, gardeners, and runners just to name a few.

Excessive physical stress can cause micro-tears in the fibers comprising a tendon. The body recognizes this and sends inflammation to the tendon to start the healing process. Special cells start to lay down new tissue (a form of scar tissue) and clean up damaged tissue. Pain, swelling, redness, heat, and loss of function are common signs associated with this inflammatory process. When inflammation occurs in the tendon connecting the knee cap to the shin bone, we call it patellar tendonitis. Your physiotherapist can help you rehabilitate from this injury in many ways.

In the early phases (acute phase) of injury the inflammation in the tendon needs to be resolved. Icing the injured tendon for 10 minutes at a time several times a day will help this process in the first few days of aggravation. The proper use of a patellar strap can also help in decreasing the inflammation. A patellar strap is a piece of neoprene or tubing that is attached just below the knee cap directly on the patellar tendon. It helps to decrease or redirect the forces traveling through the tendon, therefore limiting the amount of inflammation created during the day. Also, your physiotherapist may use modalities in the clinic such as ultrasound, cold laser, and interferential current that may help to speed up removal of the inflammation.

After about 5-7 days, the tissue enters a new phase of healing called the sub-acute phase. New tissue starts getting laid down. This new tissue your body has put down on the injured tendon needs to be re-modeled so it is aligned along the lines of stress and has appropriate length. This can be accomplished with a physiotherapy technique called deep transverse friction massage along with appropriate stretching exercises for the quadriceps muscle group in the front of your thigh.

Along side tissue remodeling and stretching, the new tissue also needs to be strengthened in a controlled environment. Drop squats are exercise of choice for these types of tendonitis. This involves a progressive squatting program of speed and load. Parameters provided by your physiotherapist are vital for success.

Other strategies your physiotherapist may employ include analyzing the alignment of your whole lower extremity, and screening the biomechanics of surrounding joints (hip and ankle), muscles and ligaments. There are often secondary instigators of patellar tendonitis such as excessively tight quadriceps muscles that increase the potential for the patellar tendon to break down, or poor arch control in the foot that can increase the angle of force through the knee and respective patellar tendon. Your physiotherapist may also revise factors such as your training progression, or modify the way you perform certain activities such as squatting in the garden.

Depending on the severity of the patellar tendonitis, in about 4-6 weeks you’ll be jumping for joy and back doing the activities you love once again.

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Sun City Physiotherapy Locations

Kevin Bos, B.Sc.PT, FCAMPT, Dip Manips, Sports Cert, CGIMS

Kevin Bos is a co-owner of Sun City Physiotherapy and has been working as a physiotherapist for over 17 yrs. He graduated from the University of British Columbia in 1996 with a Bachelors of Science in Physical Therapy and worked for several years in the Fraser Valley before moving to the Okanagan.

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