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Excellent Foam Roller Exercise to Stretch Out Your Hip Flexors


Filed Under (Corrective Exercise, Fitness, Foam Rolling, Hip Injury) by Rick Kaselj on 25-01-2014

I like using the foam roller with my clients.

I even did a 2-hour presentation on it called Your Foam Roller Exercise Guide:


Okay, back to what I was going to talk about.

I think the foam roller is the most neglected piece of equipment in most gyms.

One of my favourite stretches with the foam roller is the 90-90 stretch.

I have talked about the 90-90 stretch before.  It is a great exercise to target the hip flexors, specifically rectus femoris.

You can do this stretch without the foam roller, but using the foam roller makes it easier for you and your client to do the exercise, especially in a fitness centre which has very uncomfortable floors to kneel on.

Excellent Foam Roller Exercise to Stretch Out Your Hip Flexors

CLICK HERE to watch the video on YouTube

Let me explain the exercise in a little more detail.

Place the flat side of the foam roller on the ground.  Have your client kneel on the foam roller with a focus on having their ankle in maximum plantar flexion.  Do not let your client have their foot off the edge of the foam roller, make sure it is on the foam roller.

Kneeling on a Foam Roller

The kneeling knee starts off at 90 degrees of flexion, but you make sure it is in line with the hip of the same side.

The opposite leg is at greater than 90 degrees of flexion with the foot on the ground.  The foot is inline with that side hip.  (This is very important!)

Now you contract your abdominals in order to prevent any lumbar extension, which is a compensation strategy and takes away from the stretch.

Then you move the hips forward, bringing the kneeling leg into hip extension and the front leg into 90 degrees of knee flexion.

Your client is looking for a light stretch in rectus femoris of the kneeling leg.

They hold this position for 30 seconds and perform the stretch twice on each side.

Try the exercise out with your next client that has tight hip flexors.

Now before I go.  The negative part about using the half foam roller for this stretch is it is difficult to fully flatten (plantar flexion) the foot.  Some people will be too tall and their foot will hang off the foam roller.  Plus if your client is wearing shoes, this limits plantar flexion even more.  Just keep that in mind.

This is a great stretch, give it a go.

Rick Kaselj, MS

P.S. – If you are looking for a program to help you loosen up your hip flexors, make sure to check out Fixing Tight Hip Flexors:

fixing tight hip flexors

 Rick Kaselj, MS


Groin Strain Exercises


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 20-07-2012

It is Friday, so let’s do the QnA thing.  Today let’s focus on a question that I received on groin strain exercises.

This is the email that I got from a friend:

Anyways, wanted your professional opinion about an injury actually.

Any advice on how to best quickly heal a groin injury?

I hurt mine doing (of all things) bodyweight squats with a little too wide a stance on vacation (just doing hundreds of reps of bw squats a week to try to make up for lack of access to weights) …

So I stopped squatting about a month ago, and only deadlifted about twice in that time to about 80% if that (groin started acting up) … trying to get it to heal.

I’m pretty good on nutrition and supplementing with Vit C, MSM, Wobenzym, Glucosamine, and of course fish oil …

Layed off the squats and just focusing on bench/press stuff (along with some power cleans).

Anyways, any idea of exercises to help this thing heal? I’ve never done the good girl/bad girl machine or anything — would that help you think?

I’ve been focusing on walking more than usual and dragging the (light) sled, etc — just trying to keep blood pumping in the area without overworking the groin too much.

Much appreciation for any ideas bro! Been dealing with this for over two months and just now got on some ibuprofen cause the chiro is telling me it’s mainly inflammation at this point 🙁


Wow, I have never heard the Hip Adductor/Abductor machine called the good girl/bad girl machine.  That is funny, it put me on the floor.

This is what I would do it if it was me.

Some of the things that you will need to work on are:

  1. tissue recovery to relax and lengthen the muscle
  2. core stability in multiple planes of movement
  3. core stability of the hip in multiple planes of movement
  4. strengthening the hip in multiple planes of movement
  5. work on bilateral and unilateral stability
  6. working on that groin dynamically in multiple planes of movement

I know, it sounds like a lot, but it is easy to integrate into your workout based on the appropriate exercise selection or progression.

Let’s get started.

Let’s start with the rapid fire answers:

  • Yes, you can do the the good girl/bad girl machine. This will help work on point #4 from above but also you need to work on the other planes of movement in the hip.
  • Sled dragging is great. Start working on dragging the sled in different ways – sideways and backwards.  Start progressing your speed based, on symptoms and feel.

Let me go through a few other things that you can do.

Here is an exercise to work on point #1 from above.

Foam Rolling for a Groin Strain

CLICK HERE to go directly to the video above.

About Foam Rolling for a Groin Strain

In the above video, what I go through is an adductor foam rolling exercise. This would be appropriate and important for someone that ends up having a groin strain. This exercise is great when it comes to helping with the adductors, helping relax the adductors, and helping  the adductors recover from an injury.

But it’s not going to be the only thing that you do to recover from a groin strain. Remember, you will need to integrate or isolate the five components that I talked about at the top of this article.

How to do Foam Rolling for a Groin Strain

You lie down on the foam roller. You can use a 3-foot foam roller which I have in the video or a 1-foot foam roller. With the 3 foot, you end up having the foam roller on the lower part of your leg from below the ankle, up the shin and with the top of the foam roller in the inside part of your knee.

You have the rest of your body in a plank position and roll all the way up the inside part of your thigh, right up to the private parts. Then you move all the way back to the start. You move in a nice slow, controlled manner, really working on the adductor muscles.

You can add a little bit of internal rotation (rotating your thigh inwards). Start with your shin on the foam roller and then begin to lift your ankle and shin off the foam roller to move into more internal rotation to hit the adductor more.

There you go – so those are the foam rolling exercise for the adductors.

Now let’s move onto a strengthening exercise (#4 from above).

Excellent Groin Strain Exercise

To go straight to the video, CLICK HERE.

Foot Position and the Groin

Let’s go through a strengthening exercise for the groin. When I am performing leg exercises, I can change up my foot position . A lot of times the foot position is about a hip width apart, but as I go with a wider foot position, it targets the adductors even more.

How to do the Bodyweight Hip Thrust

One example of an exercise that you can do is a bodyweight hip thrust.

Here I get into position with my shoulders on the bench. If you have a shoulder injury, you may have to modify the height of the bench. You have your feet about a hip width apart and then you work them out to about a shoulder width apart. You bring your seat down towards the ground, so it’s close to the floor. This is the starting position.

Then what you do is drive your hips up so your knees, hips and shoulders are in good alignment. You are really working on gluteus maximus. With a wider foot position you are working the adductors a lot more when it comes stability of the hip and dynamically lengthening.

It Targets Hip Movement

I also like this exercise as it works on hip movement. I like to move down to where my seat touches the ground and come back up. Then I can work into hip flexion back to neutral.

Injury Tips

A few things to remember if you have certain injuries:

  • Vertical Shin – If you have patellofemoral pain syndrome, ACL injury or a meniscus tear, work on keeping the shin in a vertical position or a negative slope.
  • No Stress on the SI Joint – If you have SI Joint injury, watch the end position of the thrust. You should not feel stress in your SI joint, but if you do, decrease how high you thrust.
  • Shoulder Pain – If you have shoulder impingement, decrease the height of the bench or the depth that you drop your hips.
  • Knee Pain – One thing to remember about the wider foot position is it puts more strain on the medial part of the knee. If you end up having a meniscus injury or medial osteoarthritis, it puts a little bit more strain on that area. You need to be cautious of the excess strain.
Well CO, I hope that helps you out.
Just wrapping up with a few kind words:

Helped My Rotator Cuff Clients

Effective Rotator Cuff Exercises has helped me provide exercise programs for my clients who have rotator cuff injuries and feel confident that not only will the program be effective but also that the exercise program will not cause further harm to the client’s shoulder.  The exercises included are easy to teach and most are simple enough that clients can feel confident doing them on their own without worrying about whether or not their technique is correct once they have been shown how to do the exercise.

Jeff Peterson
Personal Trainer
Racine, WI, USA

Here are a few more kind words about Muscle Imbalances Revealed:

Okay, have a great weekend and we will talk to you soon.

Rick Kaselj, MS

P.S. – Here are a few other exercises that will help you out with your groin:

Single Leg Squat with Foam Roller

Foam Roller Hamstring Exercise




Hip Bursitis, Textbooks to Get and Other Stuff


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 13-07-2012

Thanks for all the Facebook messages and emails.

Here are some replies from my messages that may interest you

What to do About Hip Flexor Spasm?

I’m getting over hip bursitis brought on by a major hip flexor spasm. I’m on oxaprozin to help inflammation. Are there some stretches I can do once the pain is gone?

Jim Harbourne

Before stretching, I would look at what is causing the hip flexor spasm.

Things that it could be:

  1. The position that your hip is in at your desk
  2. The position your hip is when you drive
  3. Do you drive a vehicle that is automatic or standard?
  4. Do you have an anterior tilted pelvis?
  5. Do you have good hydration or electrolyte balance?
  6. Is your technique correct when performing planks, curl up or crunches?
  7. etc

Try to find out what is causing and target things that address it.

Now getting to the stretching.

I would suggest performing a prolonged hip flexor stretch. I don’t have a video or photo of it but you are in a supine position (on your back) on a bench.  Move the leg that you want to stretch off of the bench and move the leg into hip extension (leg behind you) to a point where you feel a light stretch. Hold this position for 2 minutes.

I hope this helps, Jim.

Best Textbook for Injuries and Exercise

Hey Rick,

Quick question, mate. What would be the best textbooks you’d recommend for a basic-intermediate level when it comes to injuries, rehab, prehab, therapy, etc? I’m not necessarily talking PhD standard but just for someone who is looking at incorporating injury and physical therapy into personal training and sports performance. Are there any certs/courses you’d recommend also?

Thanks in advance!

Marc Stokes

 Thanks for the question, Marc.

To be honest, I spend less and less time referring to textbooks when it comes to injury and exercise information.  I find the information in them is outdated, too general or outside the scope of what a trainer or coach can do.

I spend most of my time referring to journal articles for new information.  At times it can be a challenge and I might have to patch together 3 or 4 articles to cover all the information, but I find the information in journal articles are the things that are up to date the most.

For example, for this month’s Injury of the Month: meniscus injuries, this has been a great article for the anatomy and injury mechanism (I was looking for something newer but after looking at 27 articles, this was the best one that I could find.):

McCarty EC, Marx RG, Wickiewicz TL. (2000). Meniscal tears in the athlete. Operative and nonoperative management. Phys Med Rehabil Clin N Am. 2000 Nov;11(4):867-80.

It goes into a lot more detail than any of the textbooks that I have on my shelf.

 If there is one textbook that I like and that I refer to often, it is this:

Kinesiology of the Musculoskeletal System by Donald A. Neumann

When I had done some consulting for the BC College of Massage Therapy on the kinesiology and injury component to their curriculum, this was a textbook that I recommend that they include.

I would not call it easy reading but it does focus on the muscles and joint movement stuff at a higher level.

I hope this helps, Marc.

Here are a few other kind words that I got this week:

Your Program Helped Me Revise My Training Program

“First of all let me compliment you on your job with Scapular Stabilization Exercises. I have appreciated it very much. Even though I am not from an English speaking country, I found it very clear and straightforward.

I purchased your webinar on scapula for personal purpose. I am not a P.t. or Fisiatric. Since I started suffering from pain in my shoulder a year ago, I have been interested in the topic. X Ray and Resonance were negative and I was told it probably depended on posture. I realized that my fitness training program was not going to work without serious work on posture too.

Very few professionals focus on Scapula. After reading your webinar I had the key to totally revise my way of training my upper body.

The exercises you propose are relatively simple and effective.

Anyway, I think it could be a great work for fitness folk too, not only for preventing injuries but also for building a harmonious body. Now I pay attention during my exercises on my scapula position and I can feel the difference. And I can tell that a lot of people around me would need help to recognize their scapula deficiencies.”

Best regards,
Filippo Chini
Florence, Italy

Effective Rotator Cuff Exercise Program is a Steal of a Deal

“The Effective Rotator Cuff Program is not only effective it is an amazing value (a bargain really).

To be able to have such a comprehensive program in an understandable format is terrific.

To get .6 ceu’s from it at that price is amazing!

It has helped me personally and the handouts and exercise descriptions are phenomenal for clients.

I’ve become a huge fan of Rick’s!”

Scott Levine
Personal Trainer
Astoria, NY, USA

Exactly What I Hoped It Would Be

“I recently purchased the MIR series and have only had an opportunity to view one of the webinars and one of the bonus materials, but both were exactly what I hoped they would be. I viewed them yesterday and have already referred to them twice in conversations earlier today. I know I will be referring to what I’ve seen again and I can’t wait to see the other material. I will be updating/implementing some of this material to future workout programs for my clients.”

Coach Johnson

Feedback on the Fitness Education Gifts


“Rick, thank you for the Exercise Education Gift. As a trainer, I’m always looking for ways to expand my knowledge to help my clients. I found each gift to be useful in its own way. Thanks again.”


Chris Murphy
Personal Trainer and Strength Coach
St. John’s,NL, Canada

“Thank you for all the education gifts!

You have a great sense of how to convey information in a no-nonsense sort of way, and yet with great intellect and insight.

At present, my life has become overwhelmingly busy with family matters, but I will be working through my Scoliosis workbook and tuning in to your current emails/website as often as possible. My
primary goal is the self-assimilation and implementation of the knowledge conveyed through your courses, but I also look forward to sharing what I’ve learned with family and friends at work.”

Many thanks!

Collette Hansen

This is the email that I got back from her after I thanked her for her email:

“You are so welcome. Am sorry I could not say more! Have had 3 family members in hospital with 1.5 weeks’ time! Ridiculous. Two out of 2 are ok… but my other brother has a brain virus. He looks like he is going to be okay, and your email and gift could not come at a better time. Your carefully-researched teachings and enthusiasm are the perfect tonic for recreating balance when I have been feeling so unsteady, not only spirit-wise, but also physically.

Making and taking time for self care and exercise helps me able to care for others, and this is such a gift. Plus, it rounds out my life and gives me the feeling of true accomplishment. Caring for others has been my life’s project up until now, and now you’re helping me (and countless others) do the same for myself in a way that I can manage at home. It’s awesome.

One of my coworkers is a personal trainer, two have scoliosis and they are now sitting on the ball and a ball chair at work, and all are very interested in your training tips and website. I am bringing some copies of exercises to share, and will naturally forward them to your website.

I would love the Core Stability of the Hip product. Thank you so much!

Have a great week’s end and weekend!”

Collette Hansen

That is all.

Rick Kaselj, MS



Which Side-Lying Exercise Targets Gluteus Medius the Best


Filed Under (Fitness, General, Gluteus Medius Exercises, Hip Injury, Hip Pain, Run Injuries) by Rick Kaselj on 04-05-2012

This weekend, I am teaching Exercise Rehabilitation of the Lower Body courses.  This is where I talk about exercises for knee, hip, ankle and foot injuries.

Before heading to teach, I thought it would be a good idea to see what is new in the research when it relates to the lower body.

Here is a paper that stood out on injuries and exercises:

Hip Muscle Activation in 3 Hip Exercises in Runners


What The Researchers Looked At

It is thought that PFPS and ITBS is caused by weak proximal muscles leading to dynamic valgus of the knee.

Dynamic Valgus is defined as:

“..a malalignment characterized by pelvic drop, which is inferior movement of the contralateral side of the pelvis during single-legged stance; femoral adduction and internal rotation; genu valgum; tibial internal rotation; and hyperpronation, and it occurs when the hip muscles cannot overcome the external torque caused by gravity acting on the body’s center of mass.”

Very cool stuff – try repeating that five times.

The research they did was straight forward.  They used 20 distance runners from a local running club.  They looked at the EMG (electromyography – electrical recording of muscle activity) of gluteus maximus (GMax), gluteus medius (GMed), tensor fascia late (TFL) and anterior hip flexors (AHF) during these three exercises:

  1. side-lying hip abduction
  2. side-lying clam exercises – it is thought that it focuses on strengthening the abductors and external rotators of the hip
  3. side-lying hip abduction with the leg externally rotated – it is thought this exercise targets GMax better than other exercises

Cool Stuff in the Introduction

As I have said before, I love reading the introduction to papers.  There are always great stats and nuggets of information in there.

  • 19% to 79% of runners will sustain a lower extremity injury
  • The knee, lower leg and foot are the most common running injury areas
  • The most frequent injuries in runners is patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS), injuries to the gluteus medius muscle (GMed), and greater trochanteric bursitis.
  • TFL and GMed contribute to hip abduction but TFL also helps with hip flexion.
  • VERY IMPORTANT ==> “authors of cadaver-based anatomical studies have demonstrated that beyond 40 degrees of hip flexion, the GMed no longer functions as a primary hip abductor.  In more than 40 degrees of hip flexion, the GMEd functions as an internal rotator, and hip abduction is performed by the deep external rotators.”
  • VERY IMPORTANT ==> 40% of maximal voluntary isometric contraction (MVIC) is needed in order to obtain strength gains.

Exercise Set Up

Here are some exercise set up points that stood out:

  • Tempo – 60 beats per minute with a metronome with 1 beat concentric, 1 beat eccentric and 4 beats rest.
  • Hip Abduction – They limited people to 35 degrees of hip abduction.
  • Pelvis Neutral – They prevented any pelvis movement by using a blood pressure device in the lower back area.
  • Resistance – 5% of body weight.
  • Clam Exercises – It was done with 45 degrees of hip flexion and 90 degrees of knee flexion.  The top leg was lifted to a point of 25 degrees to the horizontal.

The Results from the Research

  1. Side-lying Hip Abduction – GMed (79.1% MVIC) was more active than TFL (54% MVIC), AHF, and GMax
  2. Side-lying Clam Exercises – AHF (54.2% MVIC) was more active than GMed (32.6% MVIC), TFL, and GMax.
  3. Side-lying Hip Abduction with the Leg Externally Rotated – TFL (70.9% MVIC) was more active than  GMax (31.7% MVIC), GMed, and AHF.

Rick’s Comment on Things

Very interesting stuff.  It highlights how side-lying hip abduction should be the focus when targeting GMed but ensure that hip abduction does not pass 35 degrees and lower back does not flatten.

Also remember that there is a difference between body weight and resistance exercises.  This research showed that with resisted side-lying hip abduction, GMed had a 79.1% MVIC while other research showed when it was just body weight it had 46.06% MVIC.

The point about 40% MVIC in order to see strength gains is a key thing to remember as side-lying clam exercises and side-lying hip abduction with the leg external rotate did not meet these requirements when targeting GMed or Max.

Where to get more information: McBeth JM, Earl-Boehm JE, Cobb SC, Huddleston WE. (2012). Hip muscle activity during 3 side-lying hip-strengthening exercises in distance runners. J Athl Train. 2012;47(1):15-23.

Where Should You Put the Tubing Around Your Knees in Order to Target Gluteus Medius the Best?

What The Researchers Looked At

The researchers wanted to look at designing a progressive rehabilitation program based on muscle activation.

They looked at the “Monster Walks” and “Sumo Walk”.  Within each exercise they looked at tubing placement at the feet, ankles and knees.

They looked at 9 healthy male subjects and their muscle activation in the hip and torso.

The Results from the Research

  • Tensor fascia latae (TFL) – demonstrated an increase in activation when you moved the band from the knees to the feet but there was no difference between the ankle and the foot.
  • Gluteus medius – demonstrated an increase in activation as you move from the knees to the toes.
  • Gluteus maximus – was only active when the tubing was wrapped around the feet.
  • External Rotation of the Hip – when the tubing was wrapped around the ankles or feet, this lead to greater external rotation of the hip which lead to greater gluteus medius and maximus activation.

Rick’s Comment on Things

I was talking about this last weekend during the Exercise Rehabilitation of the Lower Body courses.  I am glad I dug this up and finally read this.

I think this info will help bootcamp instructors, personal trainers, senior fitness leaders and rehabilitation professionals.

Darn, I love research.

Where to get more information – Cambridge ED, Sidorkewicz N, Ikeda DM, McGill SM. (2012). Progressive hip rehabilitation: The effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech (Bristol, Avon). 2012 Mar 29. [Epub ahead of print]

Here is a resource for gluteus medius exercises. It is the video presentation that I did on Gluteus Medius Exercises:


That is it, have a great day.

Rick Kaselj, MS

If you enjoyed the above article, here are some of my other research reviews:


Hip Flexor Injury Exercise Considerations with Dr. Casey Kerrigan


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 11-08-2011

These interview things are so much fun.

I am so excited to have another one for you.

I know, not many people get excited about injuries, but I do. Sorry.

About the interview, it is with Dr. Casey Kerrigan.

You might remember Dr. Kerrigan from the High Heel Pain post.

Dr. Kerrigan contacted me after she stumbled on my post and asked if we could do an interview.

She said she had a lot to share which was not seen in the research.

How cool is that?

We go through it all in the audio interview:

Click Here to Listen to the Hip Flexor Injury Exercises with Dr Casey Kerrigan

You must listen to this if:

  • You work with older adults
  • If you work with anyone with hip extension issues
  • You have questions about spinal stenosis
  • You think you should rest with an injury
  • You want to know the most important yoga pose

CLICK HERE to listen to the interview or head down to the bottom of this article and click the play button.

What we go through in the interview is:

  • Her breakthrough research
  • Her research in walking
  • The one parameter that was different from the older adult and young population
  • Can a hip stretch improve gait in older adults?
  • What happens to your body when you do not have hip extension
  • What they saw in low back pain
  • Very interesting research on spinal stenosis
  • Importance of walking, no matter what your condition
  • Why yoga works
  • Importance of stretching when warm

If you would like to get more information on Dr. Casey Kerrigan, you should see what she is doing now when it comes to shoes. She has started a shoe company based on her research to help minimize stress and pain in people. Very cool. You can see what she is doing at OESH Shoes.

Before I go, I need your help. If you have a story or know of anyone with a story where they used exercise to overcome their injury, I want to hear about it.

You can email me at support(at)ExercisesForInjuries.com and let me know.

Thanks a lot.

Please do take the time to leave a comment or FB “like” this article.

Rick Kaselj, MS

P.S. – If you like this interview, I have done a bunch more that may interest you:




Exercises for the Elderly


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 14-06-2011

Today I have a great exercise for the elderly.

Once again it is researched back.

Lets go through it.

How Important is if for the Elderly to Stretch their Hip Flexors?

What They Looked At

In a 10 week supervised hip flexor stretching program in the frail elderly, they looked to see if the stretching program would improve:

  • hip extension
  • stride length
  • gait speed
  • reduced anterior pelvic tilt during comfortable and fast-paced walking

They had 74 frail elderly (65 and over) individuals in the study with 41 in the control group and 33 in the stretching group.

What They Did

They had the stretching group perform a hip flexor stretching program twice a day and twice a week the program was supervised by a rehabilitation clinician.

What Kind of Hip Flexor Stretch Did they Do

They did a kneeling hip flexor stretch.

Highlights of the Study

The stretching group showed increases in:

  • walking speed
  • stride length
  • passive hip extension range of motion

After the stretching program there were no significant changes in peak hip extension or anterior pelvic tilt during comfortable and fast-paced walking.

Last Word from Rick Kaselj <==  THE PART TO READ

This is important information if you work with an order adult and you need to improve gait function (walking).

This research shows that a kneeling hip flexor stretch can help do that.

Where to Get More Information

Watt JR, Jackson K, Franz JR, Dicharry J, Evans J, Kerrigan DC. (2011). Effect of a supervised hip flexor stretching program on gait in frail elderly patients. PM R. 2011 Apr;3(4):330-5.

As I was researching the Watt 2011 study, I cam across some other studies that build on hip flexor stretching in the elderly.

Christiansen CL. (2008). The effects of hip and ankle stretching on gait function of older people. Arch Phys Med Rehabil. 2008 Aug;89(8):1421-8.

Participants participated in a 8 week stretching program and had improvements in joint motion in the hip and the ankle.

Kerrigan DC, Xenopoulos-Oddsson A, Sullivan MJ, Lelas JJ, Riley PO. (2003). Effect of a hip flexor-stretching program on gait in the elderly. Arch Phys Med Rehabil. 2003 Jan;84(1):1-6.

Unfortunately I was not able to get the Watt, 2011 full text journal but I was able to get the Kerrigan 2003 full text journal which is very similar to the Watt study.

In this study they got one group to do a hip flexor stretch and a second group to do to an arm cross shoulder stretch.

Each group did the stretch 4 times on each side, alternating and holding for 30 seconds for a total of 8 stretches.  They did this twice a day for 10 weeks.

In the journal they had a photo of the Kneeling Hip Flexor stretch they got the participants to do:

Read the rest of this entry »

Best Gluteus Medius Exercises for a Hip Replacement


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 10-06-2011

I am so excited about this.

I have not done this in a few weeks.

It is “dig into the research and see what is new when it comes to exercises and injuries”.

I know, it is a little strange but we all have our passions or weaknesses.

Let’s get to it. I found some great stuff for you.

Best Gluteus Medius Exercises for a Hip Replacement

What They Looked At

It is common for those with hip arthroscopy (hip replacements) to have a weak gluteus medius muscle which often leads to iliopsoas tendinitis.

In the study they looked at exercises that focused on gluteus medius but minimized hip flexor activation (iliopsoas muscle).  Finding exercises that had less ilipsoas activation would decrease the risk of iliopsoas tendinitis.

They looked at the EMG (electormyography) of gluteus medius and iliopsoas during 13 hip rehabilitation exercises in 10 healthy subjects.

From the study they were hoping to create a three phase continuum that people with hip replacements could do for improving gluteus medius strength.

Gluteus Medius Exercises They Tested

These are the gluteus medius exercises they tested in the study:

  1. Resisted hip extension
  2. Side-lying hip abduction with wall-sliding
  3. Hip clam exercises with neutral hips
  4. Prone heel squeezes
  5. Resisted terminal knee extension
  6. Hip extension
  7. Double-leg bridges
  8. Side-lying hip abduction with internal hip rotation
  9. Stool hip rotations
  10. Single-leg bridges
  11. Resisted knee flexion

This is a great list of exercises and a few of them are new to me.  I will work on getting some videos up for you.

Highlights of the Study

The big highlight was the continuum they recommended based on their research.  It is great.  Here it is:

Phase I – Initial 4 or 8 weeks

  • Resisted terminal knee extension
  • Resisted knee flexion
  • Double-leg bridges

Phase II – subequent 4 weeks

  • Resisted hip extension
  • Stool hip rotations
  • Side-lying hip abduction with wall-sliding

Phase II – final 4 weeks

  • Prone heel squeezes
  • Side-lying hip abduction with internal hip rotation
  • Single-leg bridges

Key Exercise Rehabilitation Program Design Notes

  • Exercises involving hip rotation were avoided in phase I.
  • Hip clam exercises with neutral hips is an exercise that people with hip flexor tendinitis should be cautious of.

Last Word from Rick Kaselj <==  THE PART TO READ

Not much to say, the program above is a keeper.

Here is one more exercise that I like for gluteus medius:

Where to Get More Information

Philippon MJ, Decker MJ, Giphart JE, Torry MR, Wahoff MS, Laprade RF. (2011). Rehabilitation Exercise Progression for the Gluteus Medius Muscle With Consideration for Iliopsoas Tendinitis: An In Vivo Electromyography Study. Am J Sports Med. 2011 May 12. [Epub ahead of print]

Can Hip Weakness Lead to Patellofemoral Syndrome?


What They Looked At

The study looked to see if hip muscle weakness was a factor that lead to patellofemoral syndrome.

Prior to a 10-week “start to run” program they tested the isometric strength of the hip of the hip abduction, flexors, extensors, internal rotators, adductors and external rotators in 77 healthy female novice runners.

They had an orthopedic surgeon assess and diagnose the runners.

Highlights of the Study

They did not find any significant difference in isometric hip strength in the runners who ended up having patellofemoral syndrome and those that did not.

Take Home Message

Isometric strength may not be the best indicator of potential risk of getting patellofemoral syndrome in novice female runners.

Last Word from Rick Kaselj <==  THE PART TO READ

I agree that isometric strength is not the best tester because I find fatigue to be a big factor.

Where to Get More Information

Thijs Y, Pattyn E, Van Tiggelen D, Rombaut L, Witvrouw E. (2011). Is Hip Muscle Weakness a Predisposing Factor for Patellofemoral Pain in Female Novice Runners? A Prospective Study. Am J Sports Med. 2011 Jun 1. [Epub ahead of print]

Rick Kaselj, MS

If you would are looking for some exercises for gluteus medius exercises or gluteus maximis, this will help:

If you would like some more articles on gluteus medius exercises and patellofemoral pain syndrome, check these out:

If you would like more information on gluteus medius exercises and patellofemoral pain syndrome, these videos may interest you:

Importance of Gluteus Medius Exercises

Muscle Imbalances and Gluteus Maximus


Treatment of Piriformis Syndrome


Filed Under (Fitness, Hip Injury, Hip Pain) by Rick Kaselj on 05-05-2011

I got an email from a reader about the treatment of piriformis syndrome.


I saw you on the FB post, I think it was; and just have a question about Piriformis syndrome…

I injured myself somehow working out at the gym; and the orthopedic diagnosed it as piriformis syndrome.

It’s been almost a year now; he prescribed anti-inflammatory and physical therapy which did help. After PT they released me and told me it was ok to go back to working out; running etc. even though I told them I still had pain.

When I tried to start running, it flared up again. I ended up doing more PT and they recommended Pilates which I am still doing. I want to stay as fit as possible even if I have this injury; and I am just asking a lot of advice on what I can do.

The dr told me a couple of wks ago that he can do injections; but I am a little leery. I am still considering it but I guess I want to see if there’s any thing else I can do first.

I have tried massage and acupuncture which have helped, and of course do stretching every day. I have done some light training at the gym and I seem to be fine as long as I don’t over do it. I was just wondering if you have any ideas about this injury and what I can do to stay fit. Thank you for any ideas you might have.


Teresa S.


I really appreciate all the email questions.  I do read them all.  I do my best to reply back but to be honest, it is tough to reply to everyone.

Now back to the question.

I have a soft spot for piriformis syndrome as I suffered with it for 6 months in 2005 when I was training for a 1/2 marathon.  It was very frustrating.  I had also gone to physical therapy which helped but most of the recovery was up to me and the exercises that I did on my own at home.

I go through what I would suggest to Teresa in this video:

==> Treatment of Piriformis Syndrome

I am sorry about the poor sound on the video.  I thought it would be nice to go outside but I forgot to put on the wind setting.

Rick Kaselj, MS

P.S. – Here are some other posts and videos that may be helpful:

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