Take Home Sports Medicine Hacks for Usual Pain Syndromes

While at the American College of Sports Medicine Summit for 2015, I had the pleasure of listening to Captain Steve Blivin, Orthopedic Doctor and Executive Officer at the Naval Health Clinic in Corpus Christi. He spoke about usual pain syndromes and shared his expertise on treating them with simple exercise programs. He estimates that greater than 80 % of all people get better with these recommendations. He is a big proponent for keeping exercise recommendations simple and easy. His catch phrase during the conference was a fun and smart recommendation for implementing exercise compliance. “The exercise that is best, is the one you will do.” Dr. Blivin chose these exercises to recommend because they do not require any equipment or money and they are easy to teach. They also have low risks of injury due to being completely self-regulated and static (meaning less movement involved). These self-regulated stretches and body weight exercises are suitable for a wide range of people with different training levels and exercise backgrounds. He talked about 5 different regional pain syndromes and their quick fixes. We will break this down into 5 different segments to cover each region. Check the blog for these other segments:

  • Segment 1 “Back” Pain (AKA SI Joint Pain)

  • Segment 2 Anterior Knee Pain

  • Segment 3 Anterior Hip Pain

  • Segment 4 Anterior Shoulder Pain

  • Segment 5 Plantar Fascia Pain

Before starting any exercise programming, it is very important to rule out any major or lift threatening issues. This is especially important with back pain and even more important to stress on a blog where I cannot see you. You are doing a self-assessment to see if exercise is suitable for you, I am trusting you to make a sound decision in your best interest. If you have any questions or concerns, contact a doctor. If not, use these red flags to help guide your decision to engage in exercise. American College of Sports Medicine defines a red flag as something that needs immediate attention from a doctor and should precede exercise programming. If you answer yes to any of the following questions, consult a doctor before starting an exercise program.

  1. Is your pain the result of an accident or major trauma?

  2. Have you had a persistent fever that won’t go away?

  3. Do you have a history of cancer that is not being controlled by a doctor?

  4. Do you have any metabolic disorders not being controlled by a doctor?

  5. Do you have any unusual muscle weakness?

  6. Do you have difficulty controlling your bladder or bowels?

  7. Do you have significant night pain?

If you answered no to ALL of the above questions, please feel free to continue to the next section.

What is Anterior Hip Pain?

The Anterior Hip is a group of muscles on the front of the hip that flexes your hip up. It is comprised of the iliacus and the psoas muscles. These muscles are called the hip flexors and they do two things. They flex the knee up to the belly or they pull the belly down to the knee. The above picture illustrates how the muscles run deep into the hip crease and attach to the front of the spine behind the abdominal contents.

Why do I have pain?

Pain results when an area is too weak and too tight to do the things that it is doing. This is a general term that includes all training levels and is specific to each person. Casual walkers and endurance runners can have the same symptoms and movement patterns, even if their exercise intensity is different. We are dressing the stability and function of the affected area relative to what specific activities each person does. If you are too weak and tight it will cause bone alignment and exercise form to suffer, which may cause rubbing and inflammation. In instances of anterior hip pain, this means that your lower-abdominal muscles and hamstrings are likely too weak, while your hip flexor is too tight. A high number of these instances are caused by too much sitting. In a seated position, the iliacus and psoas are at their shortest, especially if you slouch. Spending too much time in this position can cause chronic tightening and weakening of both muscles. To address this, we strengthen the weak things and stretch the tight things.

Anterior Hip Pain Exercise Protocol: 

Do the following exercises in 3 sets, 2-3 x a day for 6 weeks

  1. Lower Abdominal Strengthening: Bicycle kicks until you feel the burn in your abs, keeping your low back flat to the floor.

    • What if  my hip makes a loud clunk or pop sound? Popping and clunking for the most part is normal, if it doesn’t hurt, don’t worry about it. To get it to go away, try moving through the motion slowly and shortening your range of motion.

  2. Dynamic Hip Stabilization: Motorcycle kicks, stand on unaffected leg and kick affected leg swiftly in a downward motion like you are starting a motorcycle 15 times.

  3. Hip Flexor Stretching: Your favorite anterior hip stretch, hold 30-60 seconds. Try a deep lunge by stepping  your unaffected leg forward, foot onto a secure chair or step, and then shift your weight forward until you feel a stretch in the front of the back leg. (Don’t feel it? Bend your back leg a bit and sink down).

How long does it take for these exercises to work?

As with any exercise or healing process, the body takes about 6-8 weeks to change. At about 3-4 weeks you should feel better, allow 6-8 weeks to feel “fixed”.

What if I don’t feel better?

New studies are showing links between chronic pain syndromes and untreated depression. Between 30-80% of people who do not get better within 6 weeks using these simple yet effective exercise programs have depression as an underlying cause. Treating the depression with the injury has proven very effective for that population. There is more information on depression now than ever before. I suggest using the tool below to do a quick self assessment.

PHQ2 test

  1. How often in the last two weeks have you felt down, depressed or hopeless?

  2. How often in the last two weeks have you felt little interest or pleasure in doing things that you normally like to do?

If you answer more than 2 days for either of those questions, you might want to talk to your doctor about depression to get more information.

How do I prevent this from happening again?

  • Continue with cross-training exercises to promote body and muscle balance (wall sits, core strengthening, hip hikes, scapular retractions)

  • “Don’t over water” – don’t do too much too quickly to often. Only increase exercise by 10 % each week, any more and you will increase risk of injury

  • Warm up preexercise using foam rollers and joint motion, cool down post exercise using stretching and ice, read more about Foam Rolling on the blog under “Exercise Prescriptions” category

  • Ice after exercise to decrease inflammation; Icing protocol is 20 minutes on/2 hours off