— Not actual patients

Exercises for Hip Pain

If you have arthritic hip pain and can’t have surgery due to a COVID delay or other factor, here are a few things you can do that may help ease your wait.

Staffing and inpatient variables have affected the ability of many hospital systems to hold elective surgeries over the last couple of years due to the COVID-19 pandemic. During the first part of the pandemic, safety restricted hospitalizations therefore limiting the amount of elective surgeries allowed. Then, scarce resources, not only staff but also inventory, started playing a factor in whether or not surgeries could be performed. 

Because hospitals and staff have been so overloaded, non-essential “elective” surgeries (which commonly include hip replacements) can get delayed. For many, this delay has led to the need for alternatives to surgery, in order to accommodate the impact of COVID-19 on the healthcare system.

During an unexpected delay, exercise and stretching may help bridge the gap. Hip specific exercises can help lessen the burden and limitations of hip arthritis while awaiting a joint replacement. An additional benefit, pre-operative rehabilitation “prehab” can help prepare your body for post-operative rehabilitation.

Ask your doctor before you try ANY of these exercises to see if they are right for you.  Over-activity or excessive loads may cause damage and some or all of these exercises may not be appropriate for your specific condition.  Zimmer Biomet does not practice medicine.  This information was prepared in conjunction with licensed healthcare professionals.

Water-based knee exercises

The buoyancy of water removes much of the load bearing across an arthritic joint. It also provides resistance for muscular strength and excellent heat transfer – helping reduce the discomfort from sweating. 

Using the water to walk for hip specific exercise is a good place to start. The endurance of the core, quadriceps, hip abduction muscles, and glutes are worked longer, more symmetrically, and typically with less injury than land-based walking.

The slower movement of the swinging leg helps to stretch the capsule of the hip. As the capsule has tightened over time with reduced activity, stretching it helps prepare for recovery. This type of tissue stretches more with slow movement and is less likely to tear. Think of it like Silly Putty. If you pull it too quickly, it can rip. Slower tension usually allows it to stretch more.

Land-based hip exercises

Building up the gluteus medius (abductors) and hip flexors and extensors (quads and hamstrings) are important. For the arthritic hip patient, isometric exercises are the first level to try. These do not involve joint movement… they involve tightening the muscles.

Here are a few examples of isometric hip exercises:

1)  Glute squeezes – This simply is tightening the buttock muscles while sitting, standing, or lying for 8-10 seconds. This exercise can be enhanced by bending the knees and placing the feet flat on the floor. Use the buttock tightening along with the abdominal core to elevate the hips off the ground lifting the pelvis. 

2)  Hamstring pulls – Sit on a couch or chair with a solid base, place the knee at 90 degrees and pull the calves against the base by tightening the hamstrings. Hold for 8-10 seconds.
3)  Abduction activation – Stand with the arthritic leg against a doorframe or side of a counter or cabinet. Actively try to press the entire side of the leg against the object by tightening the side muscles of the buttock and hip. Hold for 8-10 seconds.
4)  Quad sets – Place a small pillow or towel behind the knee while sitting or lying down with the leg extended. Tighten the quad to push the back of the knee against the object. Hold for 8 – 10 seconds.

The next level of exercise that can help are movement exercises without resistance. These are for both range of motion and endurance. They are a form of nonresistance isokinetic activity.

1)  Ankle pumps – Lie on the back and gently flex the foot up and down. Alternate feet, then try moving them together. This can help enhances blood flow and range of motion of the foot for post-operative function.

2)  Heel slides – Lie on your back in bed or on a mat. With legs straight. On the arthritic side, slide the heel up to bend the knee and hip. Repeat slowly. These are good for quad and hip flexion.

3)  Angel wings – Start in the same position as heel slides. Slide the leg out to the side with the knee straight. This can also be assisted with a belt on the foot to try and increase the lateral range of motion. 

The final level are isokinetic resistance exercises either using body weight (gravity) or light weights such as ankle weight or resistance bands.

1)  Short arc quads – Prop up the knee on the affected leg with a rolled-up towel or foam roll. Slowly straighten the surgical leg to full extension and squeeze and hold against gravity. Slowly lower the heel to the floor. This is similar to the previously mentioned “quad sets”, but here slight resistance, like light ankle weights, can be added.

2)  Standing hip abduction – Stand with your non-arthritic leg next to a chair or other object that can be gripped for balance. Actively lift the arthritic leg out to the side concentrating on squeezing the buttock muscles and holding the pelvis level. Try not to lean away from the leg to elevate it. Move slowly to increase the angle you spread the legs and then return it to the ground. Repeat 8-10 times.

3)  Long arc quads – Sit in a chair with an OPEN base. Extend the knee out fully straight squeezing the quad throughout. Lower the leg back to the ground (flex as far as you wish as well) then repeat. 

4)  Standing hip extension – Stand facing the back of a chair and hold the top for balance. Keeping the body upright, extend the arthritic leg backwards, lifting the foot off the ground. Return to the ground and repeat. 100 repetitions throughout the day.

2)  Single leg stance – Hold the back of a sturdy chair for balance. Lift the non-arthritic leg off the ground, standing only on the arthritic leg and maintain your balance. This can help improve balance and endurance.

Improving range of motion is also enhanced by exercise cycling. For the arthritic hip patient, upright exer-cycles are preferred. Try lowering the seat a bit after a week to increase the amount of knee and hip flexion. Use low resistance and employ the opposite, healthy leg to “drive” through the movement. This can help with flexibility after surgery.

General endorphin release, the body’s natural painkiller, is enhanced by strong muscle activity. Use upper body exercise with light weights as well to gain this release – it can work on the entire system.

One final caveat: exercise with arthritic joints can be painful. Remember, these areas have decreased cartilage, lower tolerance for stress, and are active sites of inflammation. If an exercise hurts, DO NOT PUSH THROUGH IT! Stop, stretch, and move on to something else. Always ask your doctor or healthcare professional for advice.  

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