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 After C-section with Carmen Bott
• Cervical Neck Exercises with Josh Henkin

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Hip Flexor Injury Exercises with Dr Casey Kerringan [ 24:23 ] Play Now | Play in Popup | Download

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 »

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:

• What is New with Patellofemoral Pain Syndrome?
  

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

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

Hi,

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.

Sincerely,

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:

• Core Stability of the Hip
• Foam Rolling for the Piriformis
• Why the Psoas Isn’t the Devil

Read the rest of this entry »

I am so happy that I got a chance to sit down and look at what is new in the research world.

February was one of those months.  It was full of assessments and clients plus teaching of courses.

We will see how March goes.

Now lets get into the research.

You Squat Funny!

I am getting ready for two in-services over the next two weeks.  One is with a group of fitness professionals in a corporate fitness setting and the next is in a personal training studio.

What They Looked At:

Cool Stuff in the Paper:

What They Found:

So What?

If you try to replicate their findings, it makes sense.

Lets say you got into a single-leg squat and you try to decrease your knee flexion and increase your hip extension. You can feel your weight shift more over the middle of your foot and heel.  Plus you can feel the greater activation of gluteus maximus.

Just keep an eye out for this when you get your clients to single-leg squat, lunge and step-up-and-over.

Where to get more information: Dwyer MK, Boudreau SN, Mattacola CG, Uhl TL, Lattermann C. (2010). Comparison of lower extremity kinematics and hip muscle activation during rehabilitation tasks between sexes. J Athl Train. 2010 Mar-Apr;45(2):181-90.

While I was doing research for the above research paper, I came across this:

Fellin RE, Manal K, Davis IS. (2010). Comparison of lower extremity kinematic curves during overground and treadmill running. J Appl Biomech. 2010 Nov;26(4):407-14.

Is Treadmill Running the Same as Running on the Ground?

What they found was they were similar.

This did kind of surprise me.

They looked at things when it came to kinematics of the lower body.  They found that the differences were less then 1.5 degrees between the two except for rear foot dorsiflexion at footstrike on the treadmill which had a decrease of 4.5 degrees.

Interesting to note and something you can pass onto your client if they ask if there is a difference between running on a treadmill or on the ground.

That is it for now.

Still got some more journals to look at.

Take care.

Rick Kaselj, MS

Continuing on with the ice hockey theme.

I know this will help others in addition to ice hockey players.

It is an interview with Maria Mountain on hip pain and pinching in ice hockey goalies, but I feel it applies to all people with hip pain and pinching.

Have a look or listen.

What to Do About Hip Pain and Hip Pinching In Ice Hockey Goalies?

==>  Hip Pain and Pinching in Ice Hockey Goalies

Specifically, here is what Maria covers when it comes to Goalies with Hip Pain and Pinching:

• A screen to use to see if you need to get your hip(s) looked at
• Why hip pinching in the hip should not be ignored
• Two reasons why you may have hip pinching
• The person you should see if you have hip pinching
• If you are doing squats, what stance you need to take if you have hip pinching
• Pinching could be caused by your boney anatomy or tightness in the structures in your hip joint

Before I go – here is another quick interview that I did with Maria on a common hockey goalie training mistake a few months back.

Common Hockey Goalie Training Mistake

==>  Goalie Training Mistake

That’s it for today – I hope you enjoyed it.

Talk to you soon.

Rick Kaselj, MS

P.S. – If you want more hockey training and injury stuff.

Here are other blog posts on hockey and hockey injuries:

Hockey Training Blunders

Muscle Imbalances and Hockey Players

Hockey Training Mistakes

What to do about Hockey Groin Injuries?

P.P.S. – If you are a goalie and would like to check out Maria’s goalie training program, you can find it by CLICKING HERE:

I had a tough time getting started today.

It’s one of those days when I was not sure of what to write about.

But, I think I got it.

Here we go.

Private Knee Injury Course

I have been asked to do more private fitness education classes for fitness professionals in the Vancouver area.  Companies and fitness professionals have been asking me to come to their facility and teach a group of 5 or 10 people about an injury topic they are interested in.

It has been fun getting these personal requests and setting up private fitness education courses for them.

In March, I have another one for a group of fitness professionals who want me to talk about knee injuries and exercises.

They have some specific questions about what to do with collateral ligament and meniscus injuries.

I know what I would do, but I always like to head to the research to see what’s new.

I am reading this article right now:

Edson CJ. (2006). Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. 2006 Jun;14(2):105-10.

The article is okay -  there’s a strong focus on diagnosis and what to do right after the injury.

Not much about what you should do when it has been multiple months (or years) since your medial collateral ligament other than wear a brace.

I will have to keep searching.

The main thing that I do is look at the hip and the core stability of the hip.

When it comes to the medical and lateral collateral ligaments, they provide stability in the frontal plane (side to side) and so does the core stability of the hip.

When the core stability of the hip is poor, it puts greater stress on the collateral ligaments.

One thing I make sure to do is assess and look at the hip, to make sure it has good stability so that there is less stress put on the collateral ligaments.

Special Population Cheat Sheets

I have been looking at the last few Strength and Conditioning Journals.

In the last few issues, they have included a cheat sheet covering what to do for specific special populations when it comes to designing an exercise program.

The one I am reading now is multiple sclerosis.

I have been saving them on my computer and putting them into my “Special Populations” folder.

I am going to refer back to this one, and to others I find.

If you get the journal or have access to the journal, I would recommend doing the same.

A Few More Kind Words

“Plantar Fasciitis Exercise Solution is a very comprehensive program that not only describes the causes and consequences, but also tells you how to go about healing the problem and giving relief where possible.  Provides alternative ideas to suit all clients/patients.  The best thing of Plantar Fasciitis Exercise Solution was the whole thing really.  Specific advice for exercises and stretches, what to avoid and what to do.  Great!”

Joanne Butler

Bendigo, Australia

Fitness and Athletic Development Coach

Well that’s it, have a great day.

Rick Kaselj, MS

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How Can Hip Injuries Be the New Injury of Choice?

Hip Fractures are on the Rise

Hip Pain and the Lower Back

Read the rest of this entry »

It was some time ago when I heard a reference to: Rotator Cuff of the Hip.

I think it was way back in undergrad at Simon Fraser University.  I was reading an article on the topic and found it very interesting.

This past weekend, I was at a course and it was brought up again.

Mike Robertson talking about the Rotator Cuff of the Hip:

After hearing about it, it got me thinking.

I went looking for the old article but could not find it.

There was a lot of other information when it came to rotator cuff of the hip that has come out the last few years.

A lot of it had to deal with rheumatologists and orthopedic surgeons coming across a tear when doing a hip replacement.

What is the Rotator Cuff of the Hip?

The rotator cuff of the hip is the hip abductor tendon which is made up of gluteus medius and gluteus minimus.

Gluteus medius has the function of:

1. Abduction of the hip (femur) – anterior and posterior fibers.
2. Transverse abduction of the hip (hip flexion at 90 degrees and hip abduction) – anterior and posterior fibers.
3. Internal rotation – anterior fibers.
4. External rotation of the hip during hip abduction – posterior fibers.

Gluteus minimus has the function of:

1. Abduction of the hip (femur).
2. Transverse abduction of the hip.
3. External rotation of the hip during hip abduction.

Looking at the above function, you can see how they related, or can be compared to, the rotator cuff of the shoulder.

The muscle of the rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor) of the shoulder have a function of:

1. Shoulder abduction of the humerus – supraspinatus.
2. External rotation of the humerus – infraspinatus, teres minor.
3. Internal rotation of the humerus – subscapularis.

I know when I had done my masters’ degree in rotator cuff exercises, looking at the research there is all kinds of argument on how much each muscle is involved with each movement.  It looks like we see this when it comes to the rotator cuff of the hip.

Looking at Al-Hayani 2009 dissection of the rotator cuff of the hip, these are the functions he suggests:

1. Gluteus medisu had three distinct parts.
2. Gluteus minimus had two distinct parts.
3. All parts of the muscles had separate innervations from the superior gluteal nerve.
4. Anterior and middle parts of gluteus medius, and anterior part gluteus minimus, have a vertical pull and initiate abduction, which is then completed by tensor fasciae latae.
5. Posterior parts of gluteus medius and minimus stabilize the femoral head into the acetabulum during different stages of locomotion.

Then I look at course notes from Robertson 2010 and the functions are:

1. Gluteus medius anterior fibers – hip flexion, hip abduction and hip internal rotation.
2. Gluteus medius posterior fibers – hip extension, hip external rotation, hip abduction.

I think we can argue about the specific function of each muscle, but it is clear that the rotator cuff of the hip is made up of the tendon that makes up gluteus medius and minimus.

Read the rest of this entry »

Nine months of planning and preparation has arrived, and the Mike Robertson’s Bulletproofing Your Client’s Knees and Lower Back seminar is here.

It is so cool to be able to bring the best from around the world to the trainers, coaches, and therapists around Vancouver.

He had a great course planned with a big thick manual of what we were going to go through.

From the start of the course, he started delivering.

He started the day asking:

“What are the Top 10 Questions You Want Answered this Weekend?”

This is the list the group came up with:

• What to do about PFPS (Patella Femoral Pain Syndrome)?
• How to assess function movements?
• What to do about a posterior tilt?
• What are the best exercises for a disc herniation?
• How do you do core regressions?
• What can you do about SI (Sacroiliac) joint issues?
• When should you do rotation exercises?
• Keys to proper squatting.
• What are the key relationships between the knee and hip?
• How do you increase (gluteus maximus) function?

What trainer, coach, and therapist does not want to have one or more of these questions answered by one of the best?

So cool.

I am so excited for the weekend.

I am ready to learn and so is the small group of people, ranging from medical doctors to group fitness instructors, that have come from around the world to be here.

Having your questions answered from the best in the world in an intensive weekend seminar/course is so great.

I love bringing the best to Vancouver and can’t wait to bring more of them, like Justin Price.

I will have some more information on what I learned and some video clips from the course.

Here is a quick clip from today:

Rick Kaselj, MS

A few weeks back I did an interview with Maria Mountain.  She specializes in goalie training.

She wanted to get my thoughts on muscle imbalances and goalies.

Below I chat about:

- hip flexor and lower ab strains, are they different?
- what is important in preventing goalie injuries
- two things that increases a goalies risk of injury

Here is a clip from the interview.

Maria Mountain: Going back at least 10 years I had the opportunity to go see Shirley Sahrmann speak and attend one of her two or three day seminars. And 10 years later, I don’t remember all the minutia. She is so intelligent and it was great to hear her speak. But the one thing I do remember is, similar to what you’re saying, she said, “Look at what doesn’t look right, make it look right and then move on to the next thing that doesn’t look right.”

Symptoms of an Underactive Psoas

Dealing with an Underactive Psoas

I got  a guest post for you.

It is from Ben Greenfield.  I have been reading his stuff for some time and I asked him to send me a blog post.

I liked it and I know you will as well.  It talks about inflammation which is a huge issue in recovery from injuries, enjoy.

How To Recover Like Wolverine From X-Men

By Ben Greenfield, MS – Author of The Bulletproof Knee & Run With No Pain

Let’s make just one giant assumption and assume that you know all about Wolverine from X-Men.

You know he possesses animal-keen senses.

You know he competes like a super-human weapon.

You know he has retracting bone claws made from space-age metal.

And, perhaps, most importantly, you know he possesses a special healing factor that allows him to quickly recover from virtually any wound, disease or toxin.

Read the rest of this entry »

Few days ago I talked about John Izzo’s Lunge to Improved Performance DVD.

Today I wanted to share with you an exercise that I learned from watching the DVD.

Maybe today, I will take a break from the writing and let the video do the talking.

How to Do the Izzo Glute Exercise

==>  CLICK HERE to view a description of the Izzo Glute Exercise

Read the rest of this entry »