Low-impact exercises help with hip pain

Previously, I’ve written about the primary medical exercise conditions of the shoulders, knees and back. This week, I’d like to focus on the hips. The hips are especially susceptible to arthritic changes due to their role as a “weight bearing” joint. When arthritis starts, the hips become painful, fragile and unstable and contribute to a greater risk of falling.

As with the other primary medical exercise conditions, when a client reports they have hip pain, we screen for red flags that might indicate more serious medical conditions. These include joint deformity, inability to move the leg or hip, inability to bear weight on the affected side, intense pain, swelling or any signs of infection like fever, chills and redness. The presence of any of these red flags requires a medical referral and disqualifies the client from participating in an exercise program.

When a client is cleared to exercise, I do a fitness assessment to determine muscle strength and endurance, paying special attention to the thighs, buttocks and the core. This helps when choosing exercises for strengthening specific muscles. Flexibility and range of motion assessments are also performed focusing on the hamstrings, hip flexors and the hips.

For a client who has mild or occasional hip pain and has been cleared for exercise, the most conservative fitness solution for them is to follow the protocols established for someone with early stages of osteoarthritis. As with all arthritis, exercise and movement is very important to maintain strength and optimal levels of functional ability. On the other hand, choosing the right kind of exercise is even more important.

For someone with an arthritic hip, it is essential to perform low-impact exercises. Jumping, bouncing and/or running and walking on hard surfaces should be minimized, as should extreme ranges of motion and fast, uncontrolled movements. For these reasons, aquatic exercise is a great option. The water eliminates gravity, and moving quickly increases intensity and resistance while keeping moving limbs secure.

I feel there is tremendous value in this type of exercise, but I tend to think of it as a “bridge” to more traditional land-based training. Since we live our lives on land, it’s vital to have a land-based exercise program for someone who is trying to get better at managing their daily activities with as little pain and as much confidence as possible.

My favourite protocol for achieving this is to use a 12-week progression made up of three to four “phases” that last between two and four weeks each and are comprised of three to six exercises that can be performed as a standalone routine or can be integrated into an overall fitness plan. The first three weeks focus on increasing endurance for long duration — sustained activities like walking and standing and require little to no equipment. Gradually, strength exercises become more important, and resistance bands and stability balls can be integrated into the training to increase challenge and intensity.

Here are the “Big 3” from Week 1 for getting started.

1- Body weight squats within pain free range of motion. Perform for 30 seconds.

2- Standing side leg lifts to 45 degrees. Complete 30 seconds of repetitions with each leg.

3- Hip bridges. Lying on your back with knees bent and feet flat on the floor, contract the muscles of your hamstrings and buttocks, while pushing your hips upward within a pain free range for 30 seconds of repetitions.

Repeat the circuit above for three to five rounds with 60 to 90 seconds’ rest between rounds, four times per week for two weeks. Monitor for signs of increasing pain around your hip, down your leg or into your back. Seek medical attention if your pain increases or level of function decreases.