This is part II of a three-part series. If you haven’t read part I yet, check it out as I explain my two biggest reasons for not getting surgery after being diagnosed with Femoroacetabular Impingement.
In this article, I’ll dive into the main strategies I utilized that helped me get out of hip pain. The strategies below are not specific exercises but more general principles that led to important breakthroughs during my training.
When I first began troubleshooting my FAI diagnosis and hip pain, I kept trying to find that one exercise that “fixed” everything. That one movement pattern I can optimize that held me back from a healthy hip. A perfect sequence of exercises that made me feel better…..
Do you see where this is going? Many people come from a history of seeing many professionals that make these types of promises: the orthopedist that “fixes” your FAI through surgery, the chiropractor that adjusts your spine, or the acupuncturist that puts needles in your body to heal your physical and emotional suffering.
One magic thing. One magic pill.
So when I realized that corrective exercise could help me with FAI symptoms, I came in with this attitude. I was looking for the magic pill in the form of exercise. After a couple weeks, it was another exercise. Then another. Then another sequence. But the pain kept coming back. And so the cycle continued.
It wasn’t until I began looking “beyond” the hip pain when I started to finally make more permanent progress.
I had to ask bigger questions. How did my hip actually move? How did the rest of my joints move?
What was going on with my hip flexion, hip abduction, hip external rotation, etc.? What was going with my feet, my ankles, my knees, my spine, etc.?
The body works as a unit and the hip pain was a culmination of everything happening up and downstream in my body.
There is no perfect sequence or ONE perfect exercise. And by looking for that one perfect exercise, I set myself up for failure every time I trained.
Instead, I urge you to objectively identify your movement deficiencies and improve them. That’s it. It’s not about one quick fix.
It’s not about just your hip flexors. It’s not about just your TFL. It’s not about just your hamstrings. It’s about your whole body.
“I just spent 90 minutes training and my hip still hurts! Maybe I need to do that stretch one more time. Maybe I shouldn’t be sitting down right now. This hip pain is never going away!”
Every time I had pain, this is the type of self-talk I responded with. It took me years to fully appreciate the value of my emotional and mental response to pain.
We need to understand how vital our emotional response to pain is. Pain and suffering is no less human than eating. We all experience it. But how we respond to it can be the difference between debilitating hip pain or mild discomfort.
Instead of responding like I did in the example above, I began inviting the hip pain into my awareness without judgment or taking any action in response to it.
For example, if the hip pain entered my awareness while cooking, I’d respond with something like “Oh, hello pain. Welcome back dear friend. I’m going to keep cooking while you’re there. Feel free to stay here with me if you’d like.”
This took a lot of the stress out of the pain. And that in and of itself reduced the intensity of the pain.
I take movement breaks but not IN RESPONSE to the pain but rather to get the body moving. I realize that being sedentary for long periods isn’t what the body is meant for. It’s meant to move.
I also stopped responding to the hip pain with worry or fear. Fear and worry sends a message to the brain that we cannot tolerate this pain and want it to vanish immediately. That thinking gets the body to tighten up. It reinforces a feedback loop of pain and fear and constantly trying to escape.
For years, what was my main goal in my movement training?
Like most of you, it was to get out of hip pain and do all the stuff I wanted to do. Well what did I want to do?
I never really thought about this. I just wanted to get out of hip pain.
I never truly reflected on what this journey toward pain-free movement was all about.
When I ask clients about their goals, they always answer the same way - "cure my FAI" or “get out of hip pain Maks, duh!”
BUT what do you want to do without hip pain?
Some clients will say something like, “I want to do the Ironman again without pain.”
Ok, that’s getting a little better but what types of movements are involved in the Ironman. Ironman is a triathlon that involves biking, running and swimming.
Let’s just take biking for now. What type of hip movement is involved in biking? Biking requires deep hip flexion.
What else requires deep hip flexion? A squat. Can this client squat with moderate function? Not even close. They also can’t lift their left knee without pinching sensations. Can they sit without slouching? Nope.
So let’s see if we can realign this client’s goals a little bit.
Instead of getting out of pain...what if a long-term goal would be to hang out in a deep squat for 1 minute. This might take a few years but it’s a good long-term goal to have.
A more short term goal could be to perform each exercise in our beginner hip flexor sequence.
Then we continue to progress up until we have adequate hip flexion competency to squat. During all this training, his hip flexion will get better. Which means biking will become more comfortable and participating in the Ironman is much more likely.
This is how I structure my goals and my training.
What movement goal am I trying to reach - ass to grass squat? Handstand? Pull-Up?
What is preventing me from getting there? Usually, these limitations are the same things causing us pain and discomfort in daily movement.
For me, this reorganization of my movement journey has been a game-changer.
I don’t focus on “out of pain.” I focus on a big end goal that I really want.
When I first drafted this article back in 2018, the three strategies I provided were specific exercises.
After working with many more clients, I now understand how unhelpful that advice was. It also showed me how much my understanding of the body and movement changed and continues to evolve.
Sure, there are certain exercises that will most likely help most people with sedentary lifestyles, and I could’ve written an article on that...
But what I’ve discovered however is that an exercise is useless if done with the wrong intention and with the wrong attitude.
I can see myself a few years ago reading this article and saying to myself, “OK enough with this voodoo zen crap, give me a routine to get out of hip pain.”
I would like to go back in time and smack myself in the back of the head!
If you’ve read this article, I implore you to reflect on your hip pain, your body and your movement goals.
Do you slow down during your training and really pay attention to how your body is responding to exercise or stretching? Or do you fly through your training just to “get it done” and desperately hope that your hip pain will go away after?
In my humble opinion, answering these questions is more important than any exercise or stretch you add to your routine.
It’s more important than any of your MRI’s or X Rays. And, crucially, it’s more important than your FAI diagnosis.