I have hip pain – What is the best activity for hip pain or is rest best?
Best activity for hip pain
Over the last few weeks we have looked at what pain actually is, and examined the hip joint, its anatomy and what can go wrong with it.
When looking at what is the best activity for your hip often just altering what you already do can be very effective. We have looked at some simple ways you can change how you do things (such as walking and running) to reduce your hip pain. In this blog we will discuss how much you are doing of something and is that too much or too little!
What can I do for my hip pain? Is rest best?
Two common responses to musculoskeletal pain or injury are to either stop doing everything in fear of further injury, or to ignore the pain until it completely stops you in your tracks.
Sometimes a short period of rest is required, but the ‘use it or lose it’ phenomenon is unavoidable. Rest for too long and you will quickly start to lose fitness, strength and capacity to do your normal activities. At the other extreme, completely ignoring your body’s warning signs may lead to a worsening of the situation.
Most of the time, the answer is somewhere in-between, not stopping but listening and modifying activity levels.
1. Think of all the physical activities you do in your daily life:
- at work,
- in the home,
- in the garden,
- in the gym or
- in your sport or recreation
2. Is your hip or pelvic pain worse with activity either :
- during or
- after any of these activities?
Be aware, “after” may well be later in the day or even the next day, not necessarily immediately after.
3. The Traffic Light Approach: A Hip Pain Guide to How Much Activity is Okay for your Hip Pain
The aim is to continue to exercise but without aggravating your symptoms too much. Rate your pain during or after an activity on a scale from 0 – 10, where zero means that you did not have any pain and ten means that you had the worst pain imaginable. A traffic light approach can provide a simple, general guide for managing activity-related hip and pelvic pain.
- GREEN LIGHT= GO If your pain is low, in the 0-2 zone, you are good to go and can continue with your normal activities.
- YELLOW LIGHT = WARNINGIf your pain is in the 3-5 zone, this is a warning that you need to modify your activities to allow your pain to settle back down into the green zone.
- RED LIGHT = STOPIf your pain is in the 6-10 zone, it is usually advisable to stop the provocative activities until your pain settles back down to the yellow zone. You may be then able to modify the activity to continue in some form without aggravating your pain.
How to Use the Traffic Light Approach
This traffic light approach has been used successfully with athletes with groin pain¹, but it is also a useful tool for anyone experiencing hip, groin or pelvic pain related to activity.
As with real traffic lights, the easiest 2 things are to STOP and GO and the meaning is clear, which is probably why most people resort to either end of the scale for managing their pain.
Now that yellow traffic light, let’s face it, sometimes it can be tricky to know whether you should stop or go. So, let’s talk a little more about modifying your activities. Health professionals refer to this as “load management” – managing the amount of load you place on your body, and therefore the potential for overload and pain.
In the previous blog, we discussed some key strategies for modifying your walking or running to avoid overload around the hips and pelvis. As part of a load management strategy, your Hip Pain Professional may give you tips on “how to perform an activity”, as well as strategies that are targeted at modifying how much or how often you perform an activity.
“Load Management” – Managing How Much Activity you do for Your Hip Pain
How frequently you perform high-load tasks and how much you perform in one session, can have a big impact on your body’s ability to recover and adapt to the loads you are placing on your muscles, tendons and bones. These structures take 24-48 hours to recover from a heavy dose of exercise. Applying high load to your musculoskeletal tissues on back-to-back days can increase risk of injury.²
Common examples of load managing activity for your hip pain include:
Load Management in the Gym
This is why regular gym-goers will usually know not to do heavy sessions on the same body part/muscles, 2 days in a row. Allow your body a day’s break between hard work-outs on the same muscle groups.
Load Management in Walking & Running
You don’t have to do the same route every day or in the same amount of time. If you’ve done a long or fast run one day, you might not go as far or fast the next day. Hill running or walking is also usually best separated by a day, particularly if the hills are long and/or steep.
Load Management in the Home or Garden
Spending hours standing bent over weeding, digging in hard ground or shovelling soil or mulch for the garden may be aggravating for your hip or pelvic pain. You may benefit from getting assistance with harder tasks and/or taking on these tasks in bite-sized pieces that your body may better tolerate. This strategy is often called ‘pacing’. Limit your harder gardening tasks for example to 30 minutes, then do some more another day. The limit will be different for everyone, so it’s a matter of testing your limit. However, it’s advisable to first start with less than you think your body can manage and then build up slowly from there. In the home, you may apply these pacing principles to the vacuuming, the spring-cleaning and standing in the kitchen cooking. Take regular breaks and/or spread these tasks over several days.
Load Management at Work
If your job involves some heavy physical tasks, are there alternatives or pacing strategies you can introduce? For example, you may be able to use a trolley instead of carrying tools or equipment. Schedule jobs so that if you have a task requiring heavier physical effort, you try to alternate with an easier task. Sustained positions such as prolonged sitting and standing also result in cumulative loads which may be aggravating for some conditions. Changing your position and moving regularly can be very helpful and you may need to request a workplace assessment. Something like a sit-stand workstation may work for you.
Learning to be your own best ‘load-manager’ will help you become your own best pain-manager. Some individualised advice from a Hip Pain Professional can help get you on the right track quickly.
Your Hip Pain Professional Can:
Hip Pain Professionals:
- Use the information you provide on what you do, how much you do and how often you do it, to develop an individualised load profile. By also considering your pain response to an activity, they will structure a program that is best suited for you.
- Educate you on what changes are necessary and why, so that you can understand how changing your approach can best benefit your hip.
- Teach you some specific pacing techniques and how to vary your loads to have heavier and lighter days.
- Reassess you at suitable intervals to change or progress your program. They will be your load-management coach, ensuring you not only settle your hip and pelvic pain but gradually become more tolerant of higher-load activities so that you can get the most out of your body and your life.
- Support you if you have flare ups along the way and help educate you on how to change your load during a flare-up, so that you can settle your pain and return to activity as quickly as possible.
- Wörner, T., Thorborg, K. and Eek, F. (2019). Five-Second Squeeze Testing in 333 Professional and Semiprofessional Male Ice Hockey Players: How Are Hip and Groin Symptoms, Strength, and Sporting Function Related? Orthopaedic Journal of Sports Medicine, 7(2), p.232596711982585.
- Magnusson, S., Langberg, H. and Kjaer, M. (2010). The pathogenesis of tendinopathy: balancing the response to loading. Nature Reviews Rheumatology, 6(5), pp.262-268.
Don’t miss our next blog……
From these last couple of blogs, we have started to look at changing things you do, how you do them, how much you do of them and so on. But what about the role of you body shape? Your posture? How does this affect your pain and what can you do about it
In our next few blogs we will look at some of the common posture types we all fall into, what this means and when, and when it might not, be relevant to your pain – Check out next week to find out more!
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This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.
Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.
Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.