Hip rehab

[Rikke Olsen]

Hi guys, I'll try to make it short.

In December 2011, I was at karate practice. In pairs, one would get into a wide horse stance/squat, thighs parallel to the floor, and the other should stand on the first person's legs. My partner was about 75kg, and with already sucking lower body strength, I couldn't hold him. My knees collapsed inwards, exactly as you're told to work against while being instructed in squats.

It was incredibly painful, and I had trouble walking afterwards. In fact, I had trouble walking for weeks.

Although it's gotten better, it's still not very good. I used to be pretty good with pistols, no issues whatsoever, but it now hurts so much in what I believe to be my psoas, that I can't. Getting out of the bottom position is quite painful.

My mobility is fine, and I can do regular squats which I think is a little strange. I'm thinking it may be the required active flexion of the psoas to keep my upper body vertical that makes it hurt?

I'm totally lay(wo)man when it comes to physiology, so this is as good as I can describe it. Of course, I'll answer questions to clarify things.

And yes, I have seen a doctor. She told me to do things as I felt capable of, and that if I want, I can get an appointment with an physio if I want, but I thought I'd ask here first.

What would you recommend that I do?

Thanks in advance

[Cole Dano]

I don't know enough about Karate to say if that is a standard exercise or not, but it certainly sounds unnecessarily risky. Plus the factor that you have no control over the weight of the person standing on you.

Do keep moving and without straining keep using all you ROM.

Of course, it's always better to see a real human, so if it's an option get to a physio.

I think some resistance band work could be helpful. I would start with eccentric movements.

For example, lay on you back with one end of the band attached to a fixed point, the other to the inside of your affected thigh. Use your Hold the thigh with an arm and roll a bit to the side to stretch the band, then slowly let you affected leg open against the resistance of the band. Roll back and repeat.

[Rikke Olsen]

Thanks Cole. I don't know if it's normal for karate either, but thinking back on it, it really is stupid.

I forgot to mention, that things like sidekicks have been totally out of the question as well. Lifting my leg sideways more than 45-ish degrees hurt badly in what I believe to be the Iliotibial band. That's probably what I've stretched badly. In fact, most kinds of flexion from my hip hurts

[Cole Dano]

And this all happened in December! That's quite a long time. I'd absolutely seek out some sort of physical or manual therapist. With situations like yours I've seen good results from Osteopaths as well and is my first choice when I seek treatment for these sorts of issues.

In general, I'd say to look for as many pain free ways to move as possible. For self therapy, like I said, I'm a fan of resistance bands, you can use them in the manner I mentioned above, and change the direction of resistance to any side of your leg.

You can also use them for assisted movement. For example if you lie on your back, loop the band around your foot and hold the other end, then circle your leg around letting the band act like a support.

The main thing in all of this is to feel what's happening, and see if you can find more pain free ROM as you focus intently on the movements. Looking for where the movement is free and where it is not.

[Blairbob]

I/we used to do the same/similar thing back in my days of Karate-do. Either horse stance with a partner on our thighs and backs or sumo squats.

Sounds like you just had too much weight on ya. As well, because the horse stance is a wide legged stance, I can see the legs buckling and going in.

[Nic Branson]

I hate that training drill, stupid with the risk involved. With pain this long you should get it checked out just to be thorough. You likely damaged several parts of your hip musculature and also will have triggered a heavy tension response by the body to prevent damage to that tissue.

Can you fire your glutes at all? If you were to do a shoulder bridge, carefully of course are they tight and do your hips extend?

Any lumps near the side of the knee? (Would be along the ITB)

Along with the stretching Cole has suggested I would do massage as you can as often as you can if there are sore spots.

After injuries of this nature you will have to re-learn some effective activation of the area without the related pain response. I'm really curious about the glutes firing though first before anything else. I'll add in more depending how that goes.

[Rikke Olsen]

Thanks again.

I usually focus on full ROM. I have pretty good mobility in my hips, can squat ATG no problems - and my A is literally just one or two inches from the ground. Standing up from there hurts a little when I squat weights, but not with just bodyweight. Pressing knees out = less pain.

Shoulder bridges are no problem, neither for glute activation. Stretching that way surprisingly does not hurt.

Also, as far as I can feel, no lumps. There's no pain from applied pressure either.

[Nic Branson]

Those are good signs, hips should be stable then.

One leg at a time make circles in front to the side and behind while standing. If you do 3 sets of whatever in theory the last set should be able to be raised higher then the first. Combine that with Cole's work. Slow ROM increases.

[Rikke Olsen]

Thanks a lot, all of you; I'll make an appointment with my doc to refer me to a physio.

Now, another question: Is it OK to do unloaded/things with no added resistance, although it causes pain, but shouldn't? For example, when I sit on the floor or on a chair and pull my leg (knee) up towards my chest, and that movement hurts, is it OK to do it?

[Cole Dano]

Again it's really going to be impossible to accurately answer that.

Being such an old injury, I'm going to say, yes but only as long as you are not afraid of the movement. I personally tend to doing painful movements as slowly as possible, looking for the onset of pain, and through repeated slow movements, trying to change it in any positive way. If that doesn't seem like it's going to happen, I call it a day.

[Rikke Olsen]

My thought as well. Doing them fast is very uncomfortable, so I naturally don't do that. But I figured it might be a good idea to work through that ROM to increase its strength, but I don't know. Will ask the physio about it!

[thenail01]

You would need a lot more questions and an exam... but with the mechanism of injury and chronicity (dating back over a year now) sounds like you have have ruptured (or at least partially ruptured) one of your quads. This might be 'fixed' by now, but with biomechanical changes from the initial injury you might have a resultant tendinopathy - or you may have never given adequate time to let the initial injury heal. You should see an actual sports med doc and probably get an MRI. Before you see PT, you should know what the real injury is to better guide therapy.