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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Archive for 'hip'

In the majority of patients I see with knee pain or knee dysfunction, I uncover gluteal weakness and poor proximal muscular stability. This can cascade into overpronation, vagus collapse, poor balance, and any number of kinetic chain issues. While this may  not be a big deal for sedentary individuals, it becomes a very big deal for athletes and those performing repetitive loading.

When searching for the best exercises to selectively strengthen the gluteal muscles, it is always wise to see what science has to say. More is not always better. I am all for efficiency and finding the most effective exercises in activating the glute over the tensor fascia lata (TFL). In this post, I am sharing a good exercise to do just that. Prior research has indicated that sidestepping and clamshells are very effective in doing just this. Click here to read a prior post on this.

The video below will walk you through his to do the running man exercise.

 

Click here to read my PFP column on this exercise.

Improving proximal hip stability and reducing frontal plane collapse is critical for protecting the knee. Poor frontal plane control often contributes to anterior knee pain, IT band syndrome, shin splints, plantar fasciitis and other injuries. This exercise is an advance progression of the standing pallof press, and it is very effective for enhancing single leg strength as well as hip/core stability.

Click here to read my full column on this exercise in PFP Magazine.

Femoroacetabular impingement (FAI) is now a common term in orthopedics. When I first started practicing physical therapy the term did not exist. As a matter of fact, I was told my hip had a bone spur in the early 2000’s, and I am sure it would now be classified as FAI. If you are unfamiliar with it, click here to read a prior post on the basics of it.

Today, as clinicians we face the tough task of helping patients overcome hip pain related to overuse injuries, acute strains, osteoarthritis, myofascial pain, etc. One of the biggest challenges is definitively identifying the etiology of hip pain. Hip pain can be extra-articular (outside the joint) or intra-articular in nature (in the joint). Consider this retrospective study published in AJSM in 2015 by Naal et al. on sonographic presence of groin hernias and adductor tendinopathy with FAI.

Differential diagnoses when ruling in/out FAI include:

  • Adductor (groin) strain
  • Rectus femoris strain or avulsion
  • Iliopsoas tendinitis
  • Athletic pubalgia
  • Trochanter pain/bursitis
  • Femoral neck stress fracture
  • Osteitis pubis
  • Cancer
  • Genitourinary issues
  • Low back pain

The list above is certainly not all inclusive. The key to obtaining a more accurate diagnosis involves taking a thorough history, performing a comprehensive exam, and getting appropriate imaging. Click here to learn about a paper on the diagnostic validity of tests to predict intra-articular hip pathology. Soft tissue pain related to muscle strains should improve with rest and treatment, whereas joint pain related to FAI is usually consistently painful or worse with increased repetitive activities such as running, dancing, twisting, jumping, cutting, etc.

Patients with FAI will often cup their hip and make what is referred to as the “C sign” when describing where they feel the pain.


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This exercise is intended for advanced users who want or need to increase shoulder, core and hip stability, while also seeking to improve hip disassociation. The core must function in an anti-extension and anti-rotation fashion throughout which is a safe and effective way to target those muscles while also providing a demanding strengthening exercise for the upper body and hips.

With that said, sufficient upper body strength is a must for this exercise.  Clients with wrist pain/weakness or elbow and shoulder pathology should only perform this exercise provided they have are symptom free and have moved through the following progressions. In many cases, it is best to start with tall planking and leg lift progressions on the floor before trying this exercise.

The video below will review the exercise in one of my latest columns for PFP Magazine.

Many athletes and clients I work with lack adequate pillar and shoulder stability. Whether this is related to acquired laxity, inherent instability or simply a lack of proper muscular control, I think it is important to assess baseline stability in anyone performing overhead lifts, ballistic upper body training and in overhead athletes.

In my clinic, I work with lots of baseball players, swimmers and volleyball players. Most females tend to struggle with hyper mobility (loose shoulder joints) whereas many of my males tend to have soft tissue tightness and in some cases limited internal rotation (GIRD). Both males and females tend to have a need to improve dynamic shoulder and pillar (core) stability to reduce injury risk and optimize mechanics.

The following exercise is one I use to both assess anti-rotational control/stability as well as train the body to resist torsional forces. In the video below, you can see how to assess your baseline strength and stability.

This exercise is very effective in working improving glenohumeral and scapular stability as well as enhancing shoulder, torso and hip stability. In my opinion, athletes with poor stability in this assessment should not perform unilateral Olympic lifting or ballistic overhead training as they may lack the necessary neuromuscular control to execute the proper movement pattern.