From prehab to rehab: the ‘hip’ new way patients are crushing their joint replacement surgeries

The hip is a large, complex, load-bearing joint responsible for connecting major structures in the body and translating force from one to the other effortlessly. Hip pain usually arrives insidiously, is difficult to treat and often ends in joint replacement surgery. But why? In this episode, we talk about treating hip pain before and after joint replacement and the importance of strengthening the supporting structures around it. If you or someone you know is struggling with chronic hip pain or facing joint replacement surgery, the next 30 minutes could change your recovery game forever.

Welcome to episode number 5 of the Unpain podcast.  Today, we are going to talk about the “transmission” of the kinetic body. Imagine this, if our core is the engine, if it powers everything in the human body, then what is the transmission of the body?  What transfers that force/power to your wheels, to your feet and legs?  That’s actually the hip joint. So the hip joint is an extremely important joint in the body. That’s where there is the interjunction between the upper and lower body. So you have two legs, attaching to your sacrum, creating that lumbosacral region, and then just right underneath that you have the hip joint, which is a very big joint and very powerful. So that’s why I call it the transmission of the kinetic body. Because whatever you produce with your core muscles, with your lat muscles, with your gluteus maximus muscle (the biggest muscle of your bum), that energy actually get transmitted to the hip joint, and then it goes to your knee, and then it goes to your ankle and foot and that’s how you walk.

It’s unbelievable how common dysfunction of the hip joints is nowadays. Mainly due to the fact that we spend so much time sitting.  Even if you don’t work in the office, driving to work: if you’re driving an hour one way to work and another hour coming back, it’s still considered sitting. And what happens is, when you start squeezing those glute muscles, because you’re sitting a lot, then the mechanism that moves the hip joint starts becoming dysfunctional and it starts putting more pressure on the on the on the hip joint. Therefore, you start having laborum problems, pain, and then, with time, probably with that compensation for a minimum of 10-20 years, you end up with arthritis or degeneration. And then most likely, hip joint replacement, which is, unfortunately, very, very, very common. And it is common, because even any compensation on the ankles, and knee, or even your shoulders can actually affect the hip joint. So, therefore, this joint has to deal with lot of compensatory movements and patterns.

But another thing that causes similar pain to the hip joint pain is a bursa on the side of the hip.  If you have had any hip joint pain in the past that came all of a sudden and very intense. Perhaps you could not sleep on that side or every time you were a passenger in the car or driving the car and you had a hard time getting out of the car because your hip was hurting. That’s most likely bursa pain. And people think right away that “Oh, that’s probably my my hip that is hurting.” Most of the time it’s not.  It’s a very superficial problem. It’s a very superficial dysfunction. But if it doesn’t get corrected, then it definitely is going to end up with problems in the hip joint.

So, now let’s say you’re in your like 40s or 50s and you’re experiencing what we call ‘greater trochanteric bursitis’ then that’s the first sign that you already have a dysfunctional muscle pattern.  Your pelvis, first of all, is usually not sitting properly. So then you have those muscles on the side called tensor fascia latae (TFL) muscles that control your IT band. And what they do is they start overworking, they get tighter and tighter and they start pulling the IT band.  Then just where the IT band actually crosses the hip joint, there is almost a soft tissue layer, like a sponge layer called the bursa, and we have bursas anywhere in the body, wherever the muscle passes bony prominences.

So prominences are like a bump on the bone where tendons attach. So wherever you have that you’re going to have bursas.  So if a muscle it’s putting more pressure, then it’s going to squeeze the bursa. If the bursa gets to the point that it cannot handle this much pressure, it will actually start getting inflamed. Once it gets inflamed, it fills with  lymph, it swells up and the pain becomes very intense. You cannot walk, you cannot lay on that side, it hurts anytime when you go from a sitting to standing position it will catch you. So this is the first sign that you’re going to end up with hip joint problems in the future. So you have to pay attention to this. We do shockwave therapy for this; shockwave therapy is amazing for greater trochanteric bursitis.

The next one that people commonly have is groin pain.  It’s actually caused mostly by a hip flexor muscle that runs pretty much from your lower back and it touches in front of your hip joint. That muscle usually gets super tight from sitting too much. So if you are, let’s say a truck driver or office worker, you’re spending a lot of time sitting, this muscle shortens up. And what happens is interesting. That’s just one side coming from the lower back down. And then the other aspect is from your thigh muscles up. So when you’re sitting, your thigh muscles (i.e. your quadriceps muscles) are stretched on the distal part, on the lower fibres, but then they actually shorten up on the proximal fibres, which is closer to the hip. So now when you go from sitting position to standing position, your quadriceps muscles on the lower part, which support your knee, they have been lengthened, we call it ‘inhibited’. So they get a little bit weaker. They’re not really supporting things properly, especially in that moment when you’re going from sitting to standing.  The hip flexor tightness with the quadriceps muscle, the upper fiber tightness/shortening. So that needs to lengthen when when we stand.

So these dysfunctional muscle patterns and changes in the muscle fibers, especially if you’re sitting for hours, the fascia gets congested.  So it’s not able to offer you proper stability to stabilize the joint. And that’s where you start pinching things deep inside like ligaments, tendons, joint capsule, etc.  Therefore it catches and it gives you that jarring groin pain, initially. So groin pain, it’s kind of the next or second level that your problem is very, very, very close to your hip joint.

Then the third one is the hip joint itself. So if you have have been functioning this way for pretty much all  or half of your life or for years, obviously, it’s going to wear out that joint. So now you’re going to get an X-ray or MRI and then they see changes in the in the hip joint.  So of course, they say ” oh, yeah, it’s the joint – it’s worn out. And let’s talk to an orthopedic surgeon, and you most likely need joint replacement. But before we do that, let’s try some cortisone shots because that could help to eleviate the pain. That’s the pattern that we typically see our clients go through.  So you treat the pain and, hopefully, the cortisone shot does the trick. That gives you temporary relief.

On the other side, the dysfunction hasn’t been corrected. And the time comes for hip joint replacement. So now, you have to remember that, if you have been following me with previous episodes, I mentioned in the past that as a humans, we only have two legs. So, if one is not working properly, the other one must take over and do the work. So if this hip, say the right hip, is worn out, now the left hip is compensating and a couple years later, you might end up in the in the same position facing another hip replacement, now on the other side. So, the first critical step before thinking about any surgeries, any joint replacement for the hip, you still have to think about the mechanism that moves that have that hip joint.  You have to consider that the mechanism is not going to change even though you change the joint. So, it’s extremely important to take care of that dysfunction first, before you go into surgery.

Because with any surgery in the body, especially with joint replacement surgeries, there is a saying, whatever you go in with, that’s what’s gonna be your starting point after the surgery. So let’s say if you have significant muscle atrophy, before the surgery when you come after surgery, that’s the starting point, or probably even worse. So, if you’re somebody that is looking to get a hip replacement surgery, then consider the option to still get care or continue with care. Shockwave would be, again, another great option wherever you are, to prepare to remove those scar tissues or those adhesions around the joint because then once they replace the hip joint, the mechanism, is at least working better, so then your recovery would be way, way better.

I want to share a couple of interesting stories that I’ve seen during my personal experience helping people using shockwave therapy. Let’s take an example of a human that hasn’t had any physical injury, had a pretty good life, normal activity, not too intense, never had a hip problem.  But when they were young, they had an appendectomy.

Surgeries anywhere in the body, anytime, whenever you had them, they still affect you, they still haunt you. So, that’s why I’m going to repeat the question that we ask every single client that walks into Unpain Clinic: “Have you ever had any surgery from the time you were born to today?” So in this case, for males typically appendectomies, same with females – it’s the same thing with C-sections too. But with appendectomies, what I’ve seen, they do affect the right hip.  First of all, when somebody has a surgery or a skin scar, your body your nervous system loses the ability to communicate but that site until the scar is healed.  But the scar doesn’t get nerve endings – they don’t heal overnight, so it’s gonna take a very long time for them to start working properly. So your nervous system is forced to find an alternative pathway and, in cases of an appendectomy, when the core becomes disabled, the next muscle that takes over is actually your hip flexors, specifically the iliopsoas muscles. So then this iliopsoas muscle group attaches just below your hip joint, and it starts pulling the hip, like the femur, more towards the hip joint so it causes more compression. And then you walk that way and you feel great. You’re doing running and walking and all those things. And then later in life, you start developing what I talked to you about previously where it starts with great trochanteric bursitis, and some groin pain and some other issues. And that’s how you end up with with hip problems.

So this is one way where we do see how the hip has been deteriorated as a joint, just due to the compensatory patterns. So even though you’re probably at this stage of getting a hip replacement, we would actually still go and treat that appendectomy scar, or that C section scar, so we can restore the core muscle function, release that fascia that is pulling, relax that muscle tension on the hip flexors and so on. So, it will stop pulling the femur towards the hip joint. So then when you replace the joint, the mechanism starts working properly. As a secondary positive, the other healthy side, the opposite hip, would work properly and not degrade. Because if one muscle group is compensating on one side, it’s going to initiate kinetic chain compensations on the other side, or in your upper body.

So, intertestingly, each each hip is connected to your opposite shoulder. So let’s say, you have a right hip problem, you most likely had, have, or will have problems in the left shoulder because they connect through a posterior oblique system. So your lat muscle, which is the biggest muscle of your back, connects with the opposite gluteus max muscle and the IT band. That’s how they kind of keep us stable and upright. These are the sort of things that we have to look at and not just “oh, you have hip pain, let’s try to actually stop pain by treating right here where it hurts.” Because at the end of the day, pain is just a signal that something is off in the system, but it doesn’t tell you exactly what is off.

If you live in an area where there’s no shockwave therapy available, I still want to help you in any way possible.  Muscle groups that you have to really look to strengthen when you have a hip problem: the most important ones are are the quadriceps muscles, the thigh muscles, and the glute muscles.  Typically those two muscle groups get weaker. And then the TFL that I mentioned in the beginning, the tensor fascia latae that controls the IT band, that gets super tight to bring stability to the hip area. And then your adductor muscle, the inner thigh, that gets super tight trying to support your hip and they don’t let go. And if you actually make a mistake, and you try to force them to let go without engaging the quadriceps and the glute max muscles specifically, then you’re pretty much eliminating the stability from the hip joint itself and things can get worse. Hamstrings pretty much take over. They get super tight. They’re constantly pulling because the opposite muscle (the quadriceps muscle), is not doing the work because it’s weaker. So there’s no antagonist muscle creating balance.  So it’s very important to stretch before you do any strengthening.   Just gentle stretching of hamstring muscles and try to slightly relax the TFL muscle you can use kind of a tennis ball or foam rolling; not on the IT Band though.  This is the difference. What you have to do is take your palm, like where your hands start, you place it on the hip, with your fingers down. So wherever your fingers end, from the base of your hand to the finger, that region is the area that I would highly recommend to loosen up because that controls the IT Band.   If you try to do anything to the IT band, forget it.  You can get temporary relief, but it doesn’t reall work. So, therefore, you do some loosening on the on the side there while still avoiding that bursa, (that sensitive spot by the bony prominence), so stay more on the soft tissue.  Then you do some abductor (outer/upper thigh) stretching, or just massage of the muscle, then you do the strengthening of the gluteus maximus muscle, specifically, and that the quads.  This is kind of a typical pattern for exercises to just help the hip joint. Just writing those names in Youtube nowadays, there are lots of exercises and you can look specifically for each of them. If you’re somebody that’s from Edmonton, Alberta, then we are here at the Unpain Clinic, we have two locations and we can actually help you directly. But anyone else around the world that is listening to this podcast, we’d still love to help you wherever you are. So we can probably guide you to the best clinic near you for shockwave therapy or other modalities that might help for the hip joint.

Another modality that we have a lot of clients get is stem cell therapy for degenerative hip joint or arthritis. And it’s interesting, it helps, but again, you’re not treating the dysfunction that caused the problem in the first place. So, we’re not against stem cells, we love them, because they are our master cells, and they do repair whatever has been physically injured. But before you go in regeneration, before you build a house, you need a plan. So that’s why you want to make sure that you’re not building your house on the river, you’re building on the land where it is actually solid. That’s why treating the dysfunction first is very important. If you’re lucky enough to get shockwave before the stem cells then we have seen, from our experience, they work amazing because first, the dysfunction is corrected, there’s scar tissues that will be removed in the area, then you add the stem cells or you can even do platelet-rich plasma injections (PRP) because stem cell injections are not available in Canada right now. So, even PRP would still help to get the biological stimulation going, then you add some light exercises just to re-engage those muscles.  Honestly, it could really help a lot.  To the point that we have had clients that we have saved from hip replacement surgeries because not everything that you see in the body that has degeneration requires a surgery. So, I’m not against surgeries, don’t get me wrong, but I’m against doing surgery without actually knowing the real cause of what the problem is. So we do have clients that still end up in surgery regardless, but when they see us before the surgery, the recovery has been significantly faster. So we are here to support you regardless of where you are in your life.

So yeah, I think I pretty much covered a lot about the pain; it’s honestly it’s just part of this compensation that I already explained. If you take and x-ray of the whole body and you see arthritis everywhere, that’s normal. That’s very normal because your body’s kind of degenerating equally so your biology it’s working properly. If you have arthritis more in one specific joint, it means that you overused that joint or you overloaded that joint and the patterns are the same. So at Unpain Clinic, we focus more on trying to understand the dysfunction rather than going after the name of the diagnosis. Although so many times, yes, the diagnosis is correct, but you have to understand the diagnosis for for human conditions are just like name tags. So practitioners have a communal language to help understand what what they’re dealing with. But it doesn’t mean anything when it comes to the function of the human body because inside our system, there are no names – the brain sees it as all one piece. So, just because we call it the hip joint, your nervous system does call it that.   It sees it more as a big joint to absorb and deliver more power.

Okay, so if you need any further help, we are always here.  We offer free telehealth sessions for all our listeners and clients.  They can connect with a therapist directly for a 15-minute session at no charge through our website at unpainclinic.com.  Get in touch. Let’s see if you qualify for our treatments. Let’s see wherever you are.

Yesterday because of the podcast, because of us putting the word out there, we had a client from the United States who was very interested to have this technology or approach available even in the United States.  Geography doesn’t matter, humans are humans and some humans need help.  They’re dealing with the same problems wherever they’re living. So yeah, it doesn’t matter where you are, get in touch. We truly want to help you. Thank you for your time and have a great time till the next episode. Thank you