Speaker 1: Welcome to Moving Conversations, a podcast for movement professionals, by
Speaker 1: movement professionals. If you coach, train, or teach movement, pilates
Speaker 1: or fitness, then this podcast is for you. With more
Speaker 1: than sixty years of experience and fitness and pilates, your
Speaker 1: host Brian Richie and North Saint John explored to science
Speaker 1: of human movement, diving deep into the backs, myths, and
Speaker 1: common misconceptions, hoping to spark thought and conversation about how
Speaker 1: we view fitness and movement. Now let's jump into Moving
Speaker 1: Conversations and welcome back to Moving Conversations. I'm Brian Richie
Speaker 1: joining me as always, there's Norris John. Morning, Nora. How
Speaker 1: you doing.
Speaker 2: I'm very well, Brian.
Speaker 3: How are you understand you're under a heat dome?
Speaker 1: Because oh my gosh, I just took a small little
Speaker 1: walk and from the time I left to the time
Speaker 1: I got back it was weltering. It must have went
Speaker 1: up five degrees. And we're supposed to get without heat
Speaker 1: index over one hundred to like one hundred and three.
Speaker 1: With heat index, they're expecting to be well over one
Speaker 1: hundred and ten, maybe hotter than that one fifteen. So
Speaker 1: we'll see things change here and there. But that's what
Speaker 1: they said yesterday's news, and I went, yeah, I'm not
Speaker 1: leaving the house. I'm gonna stay home. I'm gonna stay
Speaker 1: with the air conditioning on. I pray it doesn't break.
Speaker 3: You know.
Speaker 1: It's one of those things. It's just like, Okay, let's
Speaker 1: hope here. You know.
Speaker 3: I grew up in La right, So I always think
Speaker 3: that La greg Banilla was kind of funny because the
Speaker 3: summers could be pretty miserable, and when I was growing up,
Speaker 3: was also really smoggy, so I actually spent more time
Speaker 3: inside in the summer, like, rather than in the winter.
Speaker 3: So the whole thing about hibernating is like, oh no, no,
Speaker 3: I'm outside all winter and all fall and some of
Speaker 3: the spring, and then summer was like and you know,
Speaker 3: you go out, you do your thing, you come back
Speaker 3: in and you hang out until the heat wave goes away,
Speaker 3: which is just a backwards way of thinking about things.
Speaker 1: I've always wondered why my parents decided to move from Colorado,
Speaker 1: which was already warm in the summer, to Phoenix.
Speaker 2: Oh yes, and they must like heat, and no.
Speaker 1: The opposite, they really don't. It was just one of
Speaker 1: those weird things that air quality and all of that,
Speaker 1: it made sense to move there. Okay, I said, wait
Speaker 1: a minute, it's going to be one twenty one hundred
Speaker 1: and twenty degrees and maybe that's done a good day.
Speaker 1: I mean, people usually just go out first thing in
Speaker 1: the morning and then wait until the sun goes down.
Speaker 1: So I said, are you sure, Oh, we'll just stay
Speaker 1: inside those days. I'm thinking that's most of the year,
Speaker 1: isn't it.
Speaker 3: I was going to say, that's pretty much May two October.
Speaker 2: If I remember Phoenix.
Speaker 1: Yeah, exactly, exactly. I remember we were there for an
Speaker 1: event in beginning of April, and one day was beautiful.
Speaker 1: It had a little light overcast, it was gorgeous. The
Speaker 1: next day was already ninety degrees and I thought, oh
Speaker 1: my gosh, and it's April. I'm about to go back
Speaker 1: to the west or to the east coast, where it's
Speaker 1: going to be in the forties. How do you dan
Speaker 1: all that heat? And yeah, and we have the humidity
Speaker 1: here as well. So we're supposed to go to a
Speaker 1: baseball game Friday night, and I just said, you know what, No,
Speaker 1: I don't think so. My family doesn't do well with
Speaker 1: with you know, warm temperatures. I don't mind them nearly
Speaker 1: as much. I'm not comfortable, but I don't mind them.
Speaker 1: Rest of them are like, no, no, thank you, it's
Speaker 1: your wind blood exactly exactly. So I just said, it's
Speaker 1: it's not worth being miserable sitting there sweating, and just
Speaker 1: uh so it's like, nope, we'll stay inside, we'll rent
Speaker 1: a movie, we'll watch something. You know, well, we'll chill
Speaker 1: out because well, because there's nothing going on that we
Speaker 1: talked about that thinking, oh, what are we going to
Speaker 1: do this weekend? As little as possible. That's what we're
Speaker 1: going to do. The office work. I have a feeling, yeah,
Speaker 1: it's going.
Speaker 2: To be inside.
Speaker 1: Yeah.
Speaker 2: I have a little bit of an announcement.
Speaker 3: I actually have a website now nor a Saint John
Speaker 3: so and it includes everywhere I'm presenting and everything I'm doing.
Speaker 2: It also includes links to.
Speaker 3: Our show and all of our show, our past episode,
Speaker 3: a little a little document that.
Speaker 2: Has a lot of that in it.
Speaker 3: So if you're interested in that, feel free to come
Speaker 3: up or sign up for the being on my contact
Speaker 3: list or any of that kind of thing.
Speaker 1: Fantastic, fantastic, and do us a favor, hit the like
Speaker 1: and subscribe button. We really appreciate it. It helps the algorithm,
Speaker 1: whatever the heck that means, but what it basically does
Speaker 1: is help us to spread the word a little bit more,
Speaker 1: gets us out there to more people. It's always interesting.
Speaker 1: I get to see the analytics and some shows hit
Speaker 1: very well, others have a miss. So the more you
Speaker 1: can comment, the more you can like subscribe to all
Speaker 1: of those things. We really appreciate it because it does
Speaker 1: help us out a lot. Check out the YouTube page
Speaker 1: under my name Brian Ritchie and also check us out
Speaker 1: on Instagram at Moving Combos or you can email us
Speaker 1: at movingcompos at gmail dot com. So last couple of weeks,
Speaker 1: we've been talking about hip replacements primarily YEP, and the
Speaker 1: topic start came up a couple times. Yeah, yeah, no,
Speaker 1: was not just the rehabilitation aspect, but also the prehab
Speaker 1: of it. We spoke with like you said, Beth a
Speaker 1: couple of weeks ago and the topic came up about prehab,
Speaker 1: and it did last week, and I thought, why don't
Speaker 1: we sort of continue on with practical application of rehabilitating
Speaker 1: hips hip replacements, but also focus on the prehab because
Speaker 1: that's something that is really being shown to be more
Speaker 1: and more useful and more and more effective with our clients.
Speaker 2: And there's two key things I wanted to bring up
Speaker 2: about that.
Speaker 3: One is that oftentimes, and you know I both had that,
Speaker 3: I've both had that experience. Clients come in with hip
Speaker 3: problems and they're saying they are preparing for or considering
Speaker 3: a hip replacement, and then you work with them for
Speaker 3: a while and it turns out that really they were
Speaker 3: just deconditioned and that that essentially just exercise and movement
Speaker 3: were enough to move them out of enough pain to
Speaker 3: basically put off that hip replacement indefinitely or certainly for.
Speaker 2: A longer period of time.
Speaker 3: And as you know, you and I've both talked about,
Speaker 3: and it's certainly side of the show, the longer you
Speaker 3: put off those replacements to a certain extent, the better,
Speaker 3: because they don't last forever. If you've got somebody in
Speaker 3: their fifties or sixties who's thinking about a hip replacement,
Speaker 3: you know, you kind of do want to put that
Speaker 3: off if you can. Seventies and eighties in a little
Speaker 3: different but certainly fifties and sixties, you want to really
Speaker 3: give them the opportunity to make the changes and manage
Speaker 3: that pain a little bit differently through movement and strength,
Speaker 3: so they didn't have to have the HP replacement, or
Speaker 3: don't have.
Speaker 1: To have it so soon, and something to think about.
Speaker 1: I had a client come to me five six years ago,
Speaker 1: I think it was right around at the beginning of COVID,
Speaker 1: maybe middle of something like that, and came to me
Speaker 1: and said, I need a hip replacement. He's younger than
Speaker 1: I am, He's in his early forties. And I said, okay,
Speaker 1: and I'm trying to get out of him. Why could
Speaker 1: it be a structural issue. I've had a couple of
Speaker 1: people who need it because of structure. Sure, Okay, that's
Speaker 1: the only thing that's going to get them out of pain. Sure,
Speaker 1: I've had other I've had many dancers. I've had people
Speaker 1: who have had you know, large bouts of pread in
Speaker 1: his own there are reasons to have it. Sure, But
Speaker 1: I was trying to get that out of him, and
Speaker 1: finally he said, well, I was doing yoga and I
Speaker 1: was doing a real wide split sort of thing and
Speaker 1: leaning over trying to increase my range of motion because
Speaker 1: he had some back problems and was trying to do
Speaker 1: yoga to you know, supplement that and he said, in
Speaker 1: my hip began bothering me, and began bothering me, began
Speaker 1: bothering me, and he got worse and worse and worse,
Speaker 1: and he's he's a little bit of a hypochondriac, just
Speaker 1: a little bit, okay. He he tends to focus on
Speaker 1: these things. So he went to see a doctor. And
Speaker 1: the first thing the doctor said, oh, yep, it looks
Speaker 1: like you might have a label tear. I think we
Speaker 1: need to do a hip replacement. WHOA, that's that's a
Speaker 1: big jump.
Speaker 2: That's a big jump.
Speaker 1: That's that's a big Yeah, that's a big leap. And
Speaker 1: with the doctor in that way, yeah, he looked at
Speaker 1: the MRI and said, well, it's too big of a gap.
Speaker 1: It would it would basically they'd have to go in
Speaker 1: and just separate it and all of this. And I said,
Speaker 1: when is it scheduled? And we had I think three
Speaker 1: or four months, I believe, so. I think it was
Speaker 1: at August, and I think it was gonna be late
Speaker 1: December or something. I said, fine, give me three months.
Speaker 1: I said, you can cancel it at any time. You
Speaker 1: can always cancel that, but I got to make you
Speaker 1: as strong as possible. But let's see how close we
Speaker 1: can get you to pain free before that. And if
Speaker 1: we can, and you maybe can put it off until
Speaker 1: it starts bothering you again, maybe that'll give you an
Speaker 1: extra five years, ten years, whatever. And within a month
Speaker 1: his pain went from being in his mind a seven
Speaker 1: six seven to being a one. He barely noticed it,
Speaker 1: and then after a while he just said, yeah, I
Speaker 1: don't even think about it anymore. Should I still have
Speaker 1: the surgery? He asked me this, and I looked at
Speaker 1: him and I said, so, what are you trying to call?
Speaker 1: When he said, yeah, that's kind of what I'm thinking,
Speaker 1: I said, you can always call the doctor back. I said,
Speaker 1: trust me, he will book you. That's he felt bad. Oh,
Speaker 1: I made the appointment a long time ago. I said,
Speaker 1: trust me, he'll book it. I said, these touches a waiting.
Speaker 3: List, especially he was booking that far ahead exactly. He's not,
Speaker 3: it's not a problem. He can fill somebody in that
Speaker 3: spot and no problem.
Speaker 1: It'll heartbeat exactly. And so he put it off. And
Speaker 1: that was, like I say, years ago, five years ago,
Speaker 1: and he now, I mean, he graduated from me to
Speaker 1: just working out on his own. He checks in from
Speaker 1: time to time. But he's basically doing whatever he wants
Speaker 1: and doing fantastic and has no issues. Got to play,
Speaker 1: got back to playing softball and baseball again, sliding all
Speaker 1: sorts of things, and has no issues. So it can
Speaker 1: be done. And oftentimes it's just doing the right things
Speaker 1: and strengthening the right way to really see if we
Speaker 1: can get that the mechanics right and take pressure off
Speaker 1: of the area that may causing the issue, so it
Speaker 1: can be done.
Speaker 3: Yeah, I had a client who was a she was
Speaker 3: a hiker, like a professional guide for hiking up in
Speaker 3: the Sierras. And if you ever, any of you ever
Speaker 3: a hiking this airas a lot of times you're literally
Speaker 3: walking on granite. It's a pretty unforgiving surface. And then
Speaker 3: you've got, you know, a backpack on a twenty to
Speaker 3: forty pound to probably even higher because she's a guide,
Speaker 3: you know, fifty pounds backpack on, so it's a it's
Speaker 3: a lot of force. And her hips were killing her,
Speaker 3: both hips. Actually was kind of a lateral in her case.
Speaker 3: And then and she'd gone to a doctor. She's probably
Speaker 3: in her late forties, early fifties. She was not that
Speaker 3: old either, and they said, well, you know, we're thinking
Speaker 3: about a hip replacement.
Speaker 2: So it was interesting. In her case, it didn't take
Speaker 2: very long, Like like she came in.
Speaker 3: We just did footwork, feed in straps, a little bit
Speaker 3: of abduction adduction work, like nothing fancy at all. But
Speaker 3: she came in I think three times a week for
Speaker 3: about a month, and even after that month, like her
Speaker 3: pain was gone on. Then we kept working and I
Speaker 3: think this was in the winter, so she wasn't in
Speaker 3: her hiking season because she was afraid too that she'd
Speaker 3: have to like change her job. She couldn't do her
Speaker 3: job anymore, like it was a big, big, major life thing.
Speaker 3: So we had about three more months of just working,
Speaker 3: just getting her stronger, getting crew more resilient. Then when
Speaker 3: the next season came along, she was right back out there,
Speaker 3: able to hike, you know, fifteen twenty miles a day
Speaker 3: with a backpack on. And she put that off as
Speaker 3: far as I know, for years after that. So again
Speaker 3: these are two very positive experiences.
Speaker 2: You may not have the same thing out.
Speaker 3: There if you're teaching or if you have a hip issues,
Speaker 3: but it's something to know, especially if somebody hasn't done
Speaker 3: a lot of very specific hip stabilization and hip mobility
Speaker 3: training to kind of get things balanced.
Speaker 1: And I'm going to preface it by saying this, I
Speaker 1: had that client, but I also had sort of the
Speaker 1: opposite person. He was in his early fifties. He went
Speaker 1: in to get it for a hip replacement or to
Speaker 1: talk to a hip doctor because he was having anterior
Speaker 1: hip pain. And the doctor said, you need a hip replacement,
Speaker 1: and he said, I'm too young. No I no way,
Speaker 1: no way, no way. And I even looked at the
Speaker 1: X ray. He had a misshapen head of his femur.
Speaker 1: It was like an eight, and he had ground the
Speaker 1: center of the acid tabulum so that it was bone
Speaker 1: on bone. I mean, I looked at it and saw this,
Speaker 1: and I said, I'm sure that's what the doctor saw.
Speaker 1: Because I'm not a physician, so I'm thinking, I know
Speaker 1: that's what the doctor's looking at here. And I said,
Speaker 1: have you did he mention anything about a misshapen for
Speaker 1: more ahead. Again, I'm not going to give him any advice,
Speaker 1: but I saw it, and he said he said something
Speaker 1: about that, but no, I think there's something else. So
Speaker 1: he went to another physician who said, oh no, no, no, no,
Speaker 1: your hip pain is caused by your low back. You
Speaker 1: need to have a spinal fusion. Oh god, he chose
Speaker 1: to have a spinal fusion and he didn't need one. Yeah,
Speaker 1: I mean, and that was the whole thing is Was
Speaker 1: he having some nerve pain, yes, he and I said,
Speaker 1: please get a second or third opinion. But he so
Speaker 1: badly wanted to put off the hip issue that he
Speaker 1: immediately jumped to the spine.
Speaker 3: Yeah, of a final fusion and a hip replacement.
Speaker 2: Okay, that's and just not knowing what.
Speaker 3: The differences are.
Speaker 1: Yeah, And I mentioned that. I said, look, this is
Speaker 1: not something to just jump into lightly. And he he
Speaker 1: did it. I saw him afterwards, and it took a
Speaker 1: while to get him back into decent shape. But the
Speaker 1: hip pain never went away, and he went to doctor
Speaker 1: after doctor after doctor, ended up at Johns Hopkins. Maybe
Speaker 1: he ended up at male clinic. That's where he ended up,
Speaker 1: MAO clinic. The first thing they did was take a
Speaker 1: look and say, oh, you got an egg shaped femoral head.
Speaker 1: You just have worn down the cartilage. You need a
Speaker 1: hip replacement. I mean, it was that apparent. He he
Speaker 1: called me and said did you see that? And I said,
Speaker 1: so did your doctor? I said, I asked about that.
Speaker 1: He said, Oh, yeah, I guess so. I mean he
Speaker 1: really wanted to avoid that. And I don't know if
Speaker 1: it was just because of the fear of a hip replacement.
Speaker 1: Maybe he had a relative. I never drove that diet
Speaker 1: went that deep into the reason why. I'm sure there
Speaker 1: was a reason, but for him, that's what he needed,
Speaker 1: and had he had that done first, he probably could
Speaker 1: have put any spinal issue off for a long time
Speaker 1: because his core was very strong. He wasn't having issues
Speaker 1: with that. So there are some times in some cases,
Speaker 1: I've had a number of people who either threw like
Speaker 1: I say, drug interaction that their bones have just worn
Speaker 1: down severe osteoporosis. I've had a couple people who were
Speaker 1: severe bulimic and anarexik who became who basically wore down
Speaker 1: their bones to the point that they had very little
Speaker 1: in way of bone support and fractured their hip and
Speaker 1: needed to have the replacement. So I've seen a bunch
Speaker 1: of people who are younger who have needed it. Yeah,
Speaker 1: but my thought is, let's try the exercise first, because
Speaker 1: because some people have just never exercised property before, right, right, And.
Speaker 3: I think of one other clim I had who had
Speaker 3: rather see your hip dyspleasia, where you're just meaning that
Speaker 3: the femur and the acetabulum don't fit very well, or
Speaker 3: the acetabulum is very shallow, so it's just super unstable hips.
Speaker 3: And she had an april placement pretty early on, like
Speaker 3: I think in her late thirties, but she needed it,
Speaker 3: like there.
Speaker 2: Was nothing was free hips for not holding together without it.
Speaker 3: But that all being said, even with that, even when
Speaker 3: they need to do have surgery and that's the right
Speaker 3: thing and that's a good choice for them, then it's like, okay,
Speaker 3: so let's prepare them for that. And it's it's in
Speaker 3: some ways it's pretty basic. You want to get three
Speaker 3: dimensional strength around the hip, you want to get three
Speaker 3: dimension strength around the knee. You may want to work
Speaker 3: on gate, You certainly want to work on their core
Speaker 3: in order to just get them as strong and capable
Speaker 3: as possible.
Speaker 1: Yeah, I find that you said earlier with the word mechanics.
Speaker 1: There are some people by the way they stand their
Speaker 1: hips jut out and the femur heads are riding forward
Speaker 1: in the sockets slightly. And when we say forward, we're
Speaker 1: talking about millimeters. We're not talking about you know, a
Speaker 1: huge amount of slack we're talking about. It's just pushing forward,
Speaker 1: so maybe their hip isn't sitting as well as it should,
Speaker 1: and just getting them into proper positioning, getting them proper exercise.
Speaker 1: Something simple. I mean the exercise I started with that
Speaker 1: one gentleman, literally hands and knees. Let's just have him
Speaker 1: do hip circles on hands and knees, just tracing like
Speaker 1: a silver dollar and just let that leg hang for
Speaker 1: a moment, and then let's just start doing some simple circles,
Speaker 1: something simple. And again, what that was teaching was that
Speaker 1: the joint was going to have a little bit the
Speaker 1: weight was going to pull it slightly out, just slightly,
Speaker 1: so that he had greater range of motion, greater freedom,
Speaker 1: so we wouldn't be, you know, if there's any grinding,
Speaker 1: and just retraining how to do those movements. And he
Speaker 1: said that was one of the things that made such
Speaker 1: a huge difference, and it was something so simple and
Speaker 1: didn't really require money.
Speaker 3: Yeah, and for and for all my clients it's feet
Speaker 3: and straps, which is the same kind of deal. Feet
Speaker 3: and straps, Yeah, either on the reformer or on the
Speaker 3: trap table. And the one girl who was really prehabbing. Specifically,
Speaker 3: she was actually a forest ranger, so she was used
Speaker 3: to hiking a lot. So again, hiking seems to be
Speaker 3: a theme today. And for her, it was like, we
Speaker 3: would just go onto the trap table and do leg
Speaker 3: slides and I would have, you know, first we just
Speaker 3: do leg slides, and then I'd add a strap around
Speaker 3: her knee, uh, you know, going.
Speaker 2: Behind her so you had a little bit of resistance.
Speaker 3: Into her hand strings. And we do some leg slides,
Speaker 3: a little bit of resistance, we do some adduction, some abduction,
Speaker 3: and basically.
Speaker 2: We started with that and it ranged.
Speaker 3: It didn't hurt, and didn't didn't increase your symptoms anyway,
Speaker 3: not that didn't hurt, but didn't increase your symptoms. And
Speaker 3: that was you know, that's where we started. And then
Speaker 3: slowly built up to footwork and then slowly built up
Speaker 3: to feed and straps, you know, with more weight on
Speaker 3: the on the to the lever basically, and again she
Speaker 3: had much much, much improved response, and she didn't put
Speaker 3: off her hip replacement. But she had a much quicker
Speaker 3: recovery than I think she would have before.
Speaker 2: Yeah.
Speaker 1: Yeah, the thing I noticed that one of the rules
Speaker 1: I follow, especially when it comes to someone who's pre
Speaker 1: hip replacement or even pre knee replacement, when we're doing
Speaker 1: pre hab work or trying to see if they really
Speaker 1: need it or if they just need to exercise it properly.
Speaker 1: Is trying to deweaight the joint as much as I can. Okay,
Speaker 1: because standing often bothers them if they have a labor issue,
Speaker 1: it can be that it's pinching into the laborum, whatever
Speaker 1: it is, if they are bone on bone or whatever.
Speaker 1: Sometimes just getting the pressure off of it can really
Speaker 1: alleviate a lot of the discomfort. So trying to stay
Speaker 1: within that pain free range of motion, especially at the beginning,
Speaker 1: gives them, first of all, a lot of confidence that
Speaker 1: we're what we're doing is not going to hurt them
Speaker 1: because they've been in paint for a while. So just
Speaker 1: showing them, hey, this isn't going to bother too much.
Speaker 1: And if we find a range of motion that does,
Speaker 1: let's change the angle, because even something like clamshells forty
Speaker 1: five degrees from the hips may bother it, but ninety
Speaker 1: may not, or thirty may not. Sixty n find what
Speaker 1: doesn't hurt and train the heck out of that angle,
Speaker 1: and you can still gain strength, and again hands and knees,
Speaker 1: feet and straps, all of these sorts of things. Sometimes
Speaker 1: I would just have them stand on one block on
Speaker 1: a step or stare that I teach them to do
Speaker 1: at home, and much like doing a pendulum for the shoulder,
Speaker 1: where we.
Speaker 2: Just have the yeah, you know, just let the legs
Speaker 2: swing right.
Speaker 1: Yeah, And I'll say, first of all, just use your
Speaker 1: other leg to sort of let it swing. Don't kick
Speaker 1: your leg back and forth, just use the other leg
Speaker 1: to just sort of let it dangle, just dangle. And
Speaker 1: they say, oh, man, that feels pretty good. Great, Now,
Speaker 1: maybe let's draw an alphabet with that leg small, make
Speaker 1: it very very small. Now, maybe circles, infinity sign, whatever
Speaker 1: you want, whatever you I mean, it really doesn't matter.
Speaker 2: Yeah.
Speaker 1: But eventually, now you're asking the muscle to work, but
Speaker 1: it's moving in small ranges of motion, it's not compressing
Speaker 1: the joint, and it's able to get a little bit
Speaker 1: of that stability. And again, working with them in a
Speaker 1: way that doesn't cause them more discomfort or pain lets
Speaker 1: them trust that they can work out without pain, but
Speaker 1: also lets them trust in me and in us that
Speaker 1: we're not going to make the situation worse and hurt
Speaker 1: them so that they feel okay and they're willing to
Speaker 1: try a little bit more rather than closing off. And
Speaker 1: I can't do anything.
Speaker 3: Right absolutely, And one of the things I always think
Speaker 3: about with that, and I'll say this to them when
Speaker 3: they say, well, this doesn't feel like much, right because
Speaker 3: oftentimes I'm doing pretty light work with them. But again
Speaker 3: light work somewhat unweighted or at least so those that
Speaker 3: joint isn't jammed up against itself. Is I say, Look,
Speaker 3: muscles are designed to actually hold the joints slightly apart,
Speaker 3: right Like. That's what the nemas do, That's what the
Speaker 3: hip muscles do, that's what the spinal muscles do. If
Speaker 3: they're working appropriately, they allow you to just just very
Speaker 3: slightly decompress the knee joint or the hip joint so
Speaker 3: that it can move smoothly and freely in that socket
Speaker 3: without bumping up against itself. There's a million studies that
Speaker 3: talk about people who have arthritis, even kind of bone
Speaker 3: on bone arthritis and the hip or the knee, and
Speaker 3: how many of them are actually pain how many of
Speaker 3: them are not right, same situation, same pathology, same wear,
Speaker 3: and tear on the joints. But one group is able
Speaker 3: to manage that and even be comfortable with it, and
Speaker 3: one is not. And a lot of times it is
Speaker 3: that strength, three dimensional balance, strength around the joint. So
Speaker 3: sometimes to your point, I liked what you said earlier
Speaker 3: about that that what I think it was a posterior
Speaker 3: tilt shoving those femurs forward.
Speaker 2: M h right, that's kind of a very typical, I find,
Speaker 2: very typical.
Speaker 3: Issue that can lead to hip pain over time because again,
Speaker 3: those femurs just going to push slightly forward, push us
Speaker 3: into the lake room, pushes into the tendons that run
Speaker 3: along in front of that hip joint, pushing the joint capsule.
Speaker 3: And more than once, just changing that posture, stick your
Speaker 3: tailbone out, shift your weight slightly to the front of
Speaker 3: your feet, and practice that makes all the difference. So again, posture, balance,
Speaker 3: not causing more pains are all really key pieces.
Speaker 1: Yeah, that really trying to establish that pain free range
Speaker 1: of motion is a great place to start. And then
Speaker 1: trying when you said working three dimensionally, we've been talking
Speaker 1: about that, you know, you and I for how many
Speaker 1: years have I known you? We've been talking about doing
Speaker 1: that because it really does train in all planes of motion,
Speaker 1: including rotation and really getting the body to move properly.
Speaker 1: I had a gentleman who, when I say, needed a
Speaker 1: hip replacement. By the time he got his the X ray,
Speaker 1: he had a severe, severe cavitation on his greater tro canter.
Speaker 1: He was missing two thirds of it. It was almost gone.
Speaker 1: The ball itself had deteriorated so much. But he had
Speaker 1: almost no pain for the longest time because he had
Speaker 1: developed enough strength and it really didn't bother him, to
Speaker 1: the point that when I saw the x ray, my
Speaker 1: first question was, how are you walking? It just and
Speaker 1: even the doctor said, I don't know why you weren't
Speaker 1: in here five or seven, ten years ago. Yeah, because
Speaker 1: there's it's unbelievable. I'd seen him for fifteen years by
Speaker 1: that point. But it was a lot of just keeping
Speaker 1: him strong, working range of motion in ways to keep
Speaker 1: him three dimensionally strong. And he was in his seventies
Speaker 1: early seventies at the time. He did great and eventually
Speaker 1: was sort of like, oh, okay, this is what I need,
Speaker 1: and when we saw the x ray was sort of, yeah,
Speaker 1: there's no choice. It really was that clear cut. It's
Speaker 1: sort of okay, you've put it off for as long
Speaker 1: as you can.
Speaker 2: Now, let's replace your party. Man, your part is done.
Speaker 2: It needs to be replaced.
Speaker 1: Yeah, exactly exactly. But again, you what it shows on
Speaker 1: an X ray. You and I have seen this many times.
Speaker 1: When you look at an X ray, we can usually
Speaker 1: see when something's bone on bone because that nice black
Speaker 1: area that shows the separation of the two bones is
Speaker 1: no longer there, and it kind of looks like it's
Speaker 1: fused together one solid piece of white. But we've also
Speaker 1: known people who have had that in their knees or
Speaker 1: hips where they don't really have any pain. They've gotten
Speaker 1: an X ray for something else, like a tendonitis tendinosis,
Speaker 1: and that's just the first step of the process, and
Speaker 1: you look at it and think, how are you walking
Speaker 1: on this? But they don't have any pain. All it
Speaker 1: takes sometimes is the thinnest microscopic layer of cartilage that
Speaker 1: can't be seen on an X ray to still give
Speaker 1: you protection and you don't have that bone on bone
Speaker 1: pain exactly exactly.
Speaker 3: One other thing, which I'm sure you've had clients like this,
Speaker 3: and I think about one particular person whenever I think
Speaker 3: about this. One of the issues that I've seen a lot,
Speaker 3: and this is where I work on. This is what
Speaker 3: I work on with prehab and post post surgical as well,
Speaker 3: is the compensations that people get into from pain. Because
Speaker 3: again I've had a lot of clients and I'm going
Speaker 3: to think of this one instructor particularly who really put
Speaker 3: off a hip replacement way longer than they probably should have.
Speaker 3: So by the by the last really three or four years,
Speaker 3: I would see them, they were literally not flexing that
Speaker 3: painful hip much at all. So they would walk by
Speaker 3: taking one step and then lifting that whole hip up,
Speaker 3: shortening that ql on that right side, and then putting
Speaker 3: that foot down and then basically that was their gait.
Speaker 3: Very little hip flexion was happening, because I'm assuming that
Speaker 3: was what was causing pain. And that was the other
Speaker 3: thing that I like to work on or notice with
Speaker 3: somebody who was coming in for prehab or also ideally
Speaker 3: prehab through surgical after is what are the compensations that
Speaker 3: are happening that I may need to work on, Because
Speaker 3: that was interesting in her case, is after the surgery
Speaker 3: saw her and she was still having the same compensation. Yeah,
Speaker 3: like her gate was a little better, but it really
Speaker 3: wasn't as much better as it should have been given
Speaker 3: her situation and what she knew about the body and
Speaker 3: all that. So it's like, huh, those compensations can get
Speaker 3: really wired in because again it's just the body reacts
Speaker 3: to what it reacts to.
Speaker 2: So the other thing, too, is looking at what's happening
Speaker 2: with the core.
Speaker 3: Look at what's happening with the quadrat of some borum,
Speaker 3: with the hips, with the puriformis, with the hip flexers,
Speaker 3: with the hamstrings, like who's trying to do the job,
Speaker 3: Because a lot of times as you go through that,
Speaker 3: you'll just see, oh, they're trying to do all of
Speaker 3: this with their in this case her QL right lifting
Speaker 3: that hip hop's.
Speaker 2: You know, or it's or they're not doing any flexions,
Speaker 2: so it's all happening.
Speaker 3: Kind of from the knee right. The knee is doing
Speaker 3: all the work, so it's or they're walking there up
Speaker 3: on their toes or something. There's all kinds of funny
Speaker 3: compensations you'll see, and a lot of times for me,
Speaker 3: I also look at and just try to see what
Speaker 3: that is. What are they doing that's possibly taking them
Speaker 3: out of pain but causing other trouble in the process.
Speaker 1: And that's the issue you said to yourself, getting them
Speaker 1: out of pain. Pain doesn't always happen overnight. Sometimes, yes,
Speaker 1: you have a trauma. And sometimes I tell people it's
Speaker 1: the straw that broke the camel's back. You've had this
Speaker 1: issue for so many years and finally the last little straw,
Speaker 1: and they have pain, but a lot of times they've
Speaker 1: been avoiding pain. I can tell you right now, my
Speaker 1: knee's bothering me because I went on a long walk
Speaker 1: when we were in Chicago. My arthritic big toast started
Speaker 1: bothering me and I started circumducting my leg in a
Speaker 1: funny way. I caught myself. But guess what, how I
Speaker 1: can't tell you if I did it for five minutes,
Speaker 1: thirty minutes, three miles. I couldn't tell you how long
Speaker 1: I did it for when I caught it. And again,
Speaker 1: I'm a movement professional, so for me to catch it,
Speaker 1: I thought, wow, Okay, what about our clients who don't
Speaker 1: know what's going on in their body? Thousands upon thousands,
Speaker 1: millions upon millions of repetitions are being done the incorrect way,
Speaker 1: the wrong way, over stimulating a muscle, over strengthening. Like
Speaker 1: you said, a QL especially. We see that a lot
Speaker 1: with hip hiking, that QL becomes so tight and so
Speaker 1: overly strong that even when they do have the hip
Speaker 1: replacement or knee replacement or whatever they need, you're still
Speaker 1: going to have to deal with that that's going to
Speaker 1: become an issue. So if you spot it before the surgery,
Speaker 1: I highly recommend start working on that immediately, because it's
Speaker 1: something that's going to be addressed eventually. You may as
Speaker 1: well start.
Speaker 3: Now right bouncing out the core so for me, a
Speaker 3: lot of loater reflection, a lot of rotation in the torso,
Speaker 3: a lot of just basic core work, a lot of
Speaker 3: back extension work, a lot of abduction for sure, because
Speaker 3: that's oftentimes where for many people that's your hip stability
Speaker 3: is the weakest, is a deduction, and I've had with
Speaker 3: a lot of my hip replacement clients, I've had to
Speaker 3: start really really small, like tiny isommetrics with let's say,
Speaker 3: you know, the ring around the thighs or a band
Speaker 3: around the thighs and just gently pressing out and holding
Speaker 3: it in kind of a basic seated position, and then
Speaker 3: we slowly build that up because sometimes even that just
Speaker 3: that slight pressure out will cause pain or discomfort, so
Speaker 3: just finding again finding what they need to work on
Speaker 3: in terms of getting those areas loosened up and stronger abduction.
Speaker 1: We've talked about this in plates. It's underutilized in plates,
Speaker 1: and I think it's underutilized a lot in fitness in general.
Speaker 1: Although I will say this, in the last probably five
Speaker 1: years or so, I'm seeing more people doing things in
Speaker 1: gym environments. I travel all over, I see a lot
Speaker 1: of different gyms, and I see people doing much more
Speaker 1: lateral work, and I'm thrilled. I have to say, I'm
Speaker 1: thrilled to see that because it's so important and it
Speaker 1: was what was missing for are so long. We're so
Speaker 1: sagital in everything we did that we really didn't worry
Speaker 1: or work on our lateral plane nearly as much. And
Speaker 1: rotational forget about it. Hardly anybody did any of that
Speaker 1: unless you were into sport specific things. But to work
Speaker 1: the abducture abductors is so important that glut meed is
Speaker 1: so critical for walking, it is so critical for balance,
Speaker 1: and it is still I think underutilized a lot in
Speaker 1: our older clients because they go with what feels comfortable,
Speaker 1: they go with what they've done for so many years,
Speaker 1: and we really need to introduce those to them and
Speaker 1: make sure that they're doing those motions and getting them strong.
Speaker 1: And like you said, start easy, start very basic. Don't
Speaker 1: overload or else they're not going to be able to
Speaker 1: walk and sometimes you'll cause other issues.
Speaker 3: Right, So starting with just like isometrics as we often do,
Speaker 3: for a beginning stage as measures in various different angles,
Speaker 3: and then solely working into sidestepping with nerve resistance, and
Speaker 3: then with bands or then the reformer standing or standing
Speaker 3: worth what you guys do, I know with cables and
Speaker 3: things like that, So playing with that is for sure.
Speaker 3: The other thing too that I've played with, and this
Speaker 3: is what I really love about feed and straps is
Speaker 3: working the hip in different angles. So we often think
Speaker 3: about inflection and extension, right.
Speaker 2: That's what walking is. That's what most of us spend
Speaker 2: most of our.
Speaker 3: Time with our hips doing seated standing, seated standing. But
Speaker 3: what we miss is we miss adduction abduction, and we
Speaker 3: also miss rotation, both medial and latter rotation.
Speaker 1: In the hips.
Speaker 3: And one of the things that they say about arthritis
Speaker 3: is arthritis can be both an overuse and an underuse situation,
Speaker 3: meaning if we never stimulate the joint in certain areas,
Speaker 3: it can also become arthritic. I mean we often talk
Speaker 3: about wear and tear, which it certainly can be. But
Speaker 3: if people never mediately rotate or never like cross the
Speaker 3: midline in terms of their adduction, then they're not stimulating
Speaker 3: a certain part of the acidtabuline and sometimes that can
Speaker 3: also lead to a bit of arthritis. So again, whenever
Speaker 3: I'm working with them, I play with let's play parallel.
Speaker 3: They a little turned out, they a little turned in,
Speaker 3: and then things like feet and straps, Like if I'm
Speaker 3: doing circles, and this is I have to credit Valentine,
Speaker 3: my good teacher friend Valentine for this. She'll basically have
Speaker 3: people draw different things with their legs with feet and straps.
Speaker 3: So she'll do like snowmen, right, so you're going to
Speaker 3: kind of like three little circles one on top of
Speaker 3: the other. Or I do have to call spirograph where
Speaker 3: they take little circles and they start with the legs together,
Speaker 3: draw little circles out and then little circles back in.
Speaker 3: Because one of the things I've found is to get
Speaker 3: hip stability, you want to challenge it in a whole
Speaker 3: bunch of different somewhat unexpected angles. Yes, right, not just
Speaker 3: straight side forward back, even just extra inter rotation, But
Speaker 3: how do you find all those little in between spots
Speaker 3: which is often what's missing, And that's a lot of
Speaker 3: times why there is hip pain. It's because they're missing
Speaker 3: some critical piece of the support system in there.
Speaker 1: Yeah, something that I've worked on with people. First of all,
Speaker 1: I love that the idea of drawing different figures and
Speaker 1: all of that works so well. The spirograph really works well.
Speaker 1: It really shows our generation in our age though, because
Speaker 1: I don't know how many younger people have.
Speaker 3: To my hands, my hands make little circles out, a
Speaker 3: little circles back in because they're like, what are you
Speaker 3: talking about?
Speaker 1: But but it's true, that really does get it. I'm
Speaker 1: going to throw something out here that I do with
Speaker 1: a lot of people, and I haven't seen a lot
Speaker 1: of people do this, but I think it's important. Is
Speaker 1: if you're having them do something like standing up and
Speaker 1: sitting down, if you're having them do something like squats,
Speaker 1: even footwork on the jump board or you know a
Speaker 1: leg press that you're doing more like a squat, very
Speaker 1: the foot position a lot, but make it a Cemricle
Speaker 1: m hm.
Speaker 3: Yeah.
Speaker 1: A lot of people will always want to make it
Speaker 1: exactly symmetrical. So you may say, take your feet out
Speaker 1: a little wider and then they're perfectly balanced. Take out
Speaker 1: a little wider and they're perfectly balanced between the two.
Speaker 1: I'll have someone start marching and I'll say stop, okay,
Speaker 1: now squat, and you can see that their brain wants
Speaker 1: them to change their foot position. I say no, right,
Speaker 1: like how it is just like this? Oh nice? How
Speaker 1: many times have you gotten up off a chair, off
Speaker 1: the toilet something one leg slightly turned out, one leg
Speaker 1: slightly turned in, one foot slightly forward, one slightly back,
Speaker 1: whatever it is. Rarely are perfectly symmetrical. Yeah, And it's
Speaker 1: the same thing with pushups, the same thing with anything
Speaker 1: that we need to when we're I'm in contact with
Speaker 1: the ground or a wall or whatever, change the foot
Speaker 1: position and make it variable because that's real life and
Speaker 1: those changes are going to change how the joint mechanics work.
Speaker 1: And again, it's just making it more real life. It's
Speaker 1: taking that from the fitness environment, the gym environment, the
Speaker 1: plates studio environment and putting it into real life and
Speaker 1: giving them something that they can do that doesn't have
Speaker 1: to be perfectly symmetrical, perfectly balanced left to right, because
Speaker 1: rarely are we.
Speaker 2: I love that. I love that.
Speaker 3: One of the things that I learned, possibly the hard way,
Speaker 3: because I tend to learn things this way, was I
Speaker 3: was teaching a short box abdominals. Okay, so reformer, you're
Speaker 3: sitting in the reformer's sitting in a box, a feud,
Speaker 3: are under something, and you're basically rotating, and this is
Speaker 3: the rotation work. And what I found there that was
Speaker 3: interesting to me was that I had a reformer class Monday,
Speaker 3: Wednesday Friday at eight o'clock for years and so that
Speaker 3: this was my guinea pig group. And they would basically
Speaker 3: do let's say, roll back into a small, small curl
Speaker 3: basically and then rotate side to side, just straight rotation.
Speaker 2: With some flection. And they would do that.
Speaker 3: Let's do that for two or three weeks, just that
Speaker 3: version of oblique work.
Speaker 2: Then let's say say, oh, let's change this up, so
Speaker 2: then we would do something.
Speaker 3: More like around the world where you start you know,
Speaker 3: you start side and then you kind of rotate up
Speaker 3: all the way around the other side and then back,
Speaker 3: so you're getting different angles of all those A those
Speaker 3: oblique abdominals essentially and how those are working. And what
Speaker 3: I found was whatever we had done, like let's say
Speaker 3: we did just a straight rotation for three weeks. If
Speaker 3: I went and then did around the.
Speaker 2: World, it was as if they hadn't done it before. Yes,
Speaker 2: and they had, because like, we've done this a million times.
Speaker 3: So it really really drove home to me how we
Speaker 3: get good at exactly what we do. Yes, like yeah,
Speaker 3: and and and that's that's kind of what we're doing
Speaker 3: with the hip work, is if we can play with
Speaker 3: let's not just do it one way, because we don't
Speaker 3: live one way, right, How do you just like change
Speaker 3: at angle, change an angle, or change an angle with
Speaker 3: the feet and straps, or change the hand position.
Speaker 2: And I love that.
Speaker 3: Because that's really where our body learns to stabilize in
Speaker 3: unexpected ways.
Speaker 1: Yes, correct, That's so important in everything that we do.
Speaker 1: We want to make it unexpected. We don't want it
Speaker 1: predictable because life is not predictable.
Speaker 3: Right.
Speaker 1: I'm going to throw something out there that I I
Speaker 1: know you do, but there's I think a lot of
Speaker 1: people don't realize this. I think we have biases when
Speaker 1: it comes to the human body and we get something
Speaker 1: stuck in our brain. Especially you know, my specialty has
Speaker 1: been especially post rehabilitation, but low back. I spent lot, many, many,
Speaker 1: many many years studying it well. Tight end flexers are
Speaker 1: always part of it. Tight in flexure, tight it flexers.
Speaker 1: But if all you do is stretch them and you
Speaker 1: never strengthen them, you're creating an imbalance. If all you
Speaker 1: do is strengthen the glutes, strengthen your glute, meed glup men,
Speaker 1: but don't ever address the hip flexer, you're creating a
Speaker 1: huge muscular imbalance. So I find that there's a lot
Speaker 1: of people who sort of get these thought processes in
Speaker 1: their brain of oh, tight FLEs, Oh that's bad. Hip
Speaker 1: flexus are bad. We want to avoid working those. No, no, no, no, no,
Speaker 1: you actually want to strengthen them. We need to strengthen
Speaker 1: every muscle because a weak muscle is often going to
Speaker 1: be a muscle that's tight. Not always a muscle that's
Speaker 1: overly shortened or overly tight is super strong. A lot
Speaker 1: of times it's the exact opposite.
Speaker 3: And going into the so as with the hip specifically, right,
Speaker 3: if you think of the ilioso as tendon, it literally
Speaker 3: runs over the ball of the femur and.
Speaker 2: Connects into the lestratkanter on the on the femur.
Speaker 3: And one of the things that you know, I certainly
Speaker 3: have seen and have experienced is if you're doing something
Speaker 3: like leg circles, which is a plot is exercise where
Speaker 3: one legs up in the air and you're making circles
Speaker 3: their legs, and there's a clunk, clunk, klonk at a
Speaker 3: certain point in that circle. Oftentimes it's one sided, not both,
Speaker 3: and oftentimes that is that ilioso as tendon popping over
Speaker 3: the front of the femur. So when I look at
Speaker 3: that and when I hear that, it's one of the
Speaker 3: few clunks that I'm concerned about because I'm thinking that
Speaker 3: that iliosis tendon is potentially rubbing over that joint capsule
Speaker 3: and that labrum every time they do that, and that
Speaker 3: same thing happens to some extent when they shove their
Speaker 3: femurs forward, that they're also putting pressure in their whole
Speaker 3: anterior joint capsule and the labrim of the hip. So
Speaker 3: one of the things that I think about, and this
Speaker 3: is just getting to your point with the so as,
Speaker 3: is I want to strengthen the hip flexors. Yes, but
Speaker 3: I specifically want to try to create balance in the
Speaker 3: so as both mobility and strength, and almost every client
Speaker 3: I know with hip issues has incredible imbalances in their
Speaker 3: so as strength. And this is again I know muscle
Speaker 3: testing is like whatever, slightly controversial thing, but if I
Speaker 3: just have somebody sit with their feet on the floor,
Speaker 3: they're a roughly ninety degree angle, lift one leg up
Speaker 3: and then try to push it down themselves, and they
Speaker 3: can do that on one side. They try the other side,
Speaker 3: usually the injured side, and it's like they have no
Speaker 3: resistance there. That's a kind of a very simple, basic
Speaker 3: kind of muscle test for the so as, and a
Speaker 3: lot of times that shows me that that injured hip
Speaker 3: so as is super super weak. It may also be tight,
Speaker 3: but it's super super weak. And you know, I want
Speaker 3: to balance the forces on the spine. I want to
Speaker 3: balance the force on the hips. I got to balance
Speaker 3: some of that strength out.
Speaker 1: And the position you were just just explaining where that's
Speaker 1: that tendon and muscle is riding right over that joint capsule.
Speaker 1: If we go into a traditional hip flexor stretch where
Speaker 1: we're just basically doing a lunge forward, what's happening. We're
Speaker 1: literally just stretching out that portion and it's pushing right
Speaker 1: on that joint capsule the whole time. Unless you put
Speaker 1: yourself into a posterior tilt or you can sort of
Speaker 1: rock back and get to lengthen more length that excuse me,
Speaker 1: through the lumbar spine to really get more of the
Speaker 1: so as involved and get that lengthened as well. You're
Speaker 1: basically not getting a lot of stretch involvement, which is
Speaker 1: why so many people go into that lunge all the
Speaker 1: way down and they say, oh, I don't feel very much.
Speaker 1: But if you put them in the right position, they say,
Speaker 1: oh my gosh, do I feel this? Yes, So I
Speaker 1: don't have to go into a deep, deep lunging stretch
Speaker 1: in order to do that. But I agree one hundred percent.
Speaker 1: Even if you just have a client sit at ninety
Speaker 1: degrees and have them just march, yeah, exactly ten minutes,
Speaker 1: they're dying, yep. And if they're injured on one side,
Speaker 1: oh my gosh, you'd be lucky to get that foot
Speaker 1: off the ground for more than a couple of inches.
Speaker 1: And what I do is I start lowering their seat.
Speaker 1: I love putting them in office chairs, because I can
Speaker 1: start them up high and then they can lift their
Speaker 1: leg and they're often lifting just to ninety they're not
Speaker 1: lifting beyond that, and they think, oh, this is easy.
Speaker 1: Let's lower you an inch, let's lower you another inch,
Speaker 1: let's lower you another And once we get to a
Speaker 1: certain point where they have to go above that ninety degrees,
Speaker 1: for every repetition, you see how quickly they fatigue, and
Speaker 1: you can see just how weak they're so as is
Speaker 1: their reliaca says that hip flex or as a unit
Speaker 1: is so weak. But in their mind, oh, I just
Speaker 1: need to stretch it. I don't need to stretch, I
Speaker 1: just need to stretch my mindset.
Speaker 2: It's definitely stuck.
Speaker 3: And one other regression there that I've taken a few
Speaker 3: times with clients with this is I actually have them
Speaker 3: soupine with their feet on the wall at ninety degrees,
Speaker 3: so there's still there's still lifting above ninety, but they've
Speaker 3: got gravity assisting like in kind of a major way.
Speaker 3: And oftentimes for this so as, I have to start
Speaker 3: that far back, yes, to get to get it comfortable
Speaker 3: and to get them started to strength, and then I'll
Speaker 3: slowly move them a little bit away so they're starting
Speaker 3: below ninety through ninety and up above ninety and then
Speaker 3: we slowly work up to seed it, et cetera.
Speaker 2: But I've had to go a few times.
Speaker 3: I've had to go that far down the chain in
Speaker 3: terms of a regression to really get that hip flexis
Speaker 3: to work on, especially on the injured side.
Speaker 2: It's just so common there.
Speaker 1: But I have sometimes done for an assessment if someone
Speaker 1: is arguing with me, because there are some people who
Speaker 1: do get it stuck in their head that no I
Speaker 1: don't I don't want to work my hip flexor I
Speaker 1: don't I need to stretch it. I'll say, okay, let's
Speaker 1: just do a simple assessment. Okay, I'll take it. I'll
Speaker 1: take a step, put it at twelve inches and they
Speaker 1: look at it and tall. That looks really high. So
Speaker 1: we're not stepping up on it. Just take your foot
Speaker 1: and tap the top and then tap the top, tap
Speaker 1: the top.
Speaker 2: Yeah yeah, yeah, nice.
Speaker 1: And they easy easy. About the third or fourth one,
Speaker 1: they kick this, kick the step and I go ooh okay,
Speaker 1: and I put it back. I say, keep going, and
Speaker 1: eventually they're having a hard time getting it up and
Speaker 1: over that they're kicking the step I'll do this with
Speaker 1: a ball as well. I can put a soccer ball
Speaker 1: and say just tap the top lightly yep. And after
Speaker 1: the first third or fourth repetition, they kicked the ball,
Speaker 1: and I say, well, you better go get it, and
Speaker 1: then they go get in. And then they try it
Speaker 1: again and they kicked the ball. I say, oh wow,
Speaker 1: say see said it may be tight, yes, but there
Speaker 1: also seems to be a lack of strength. And I
Speaker 1: think we can increase your flexibility and mobility by increasing
Speaker 1: the strength of that muscle as well. When you explain
Speaker 1: it to them, Oh, you sometimes have to show them
Speaker 1: and demonstrate that. Yeah, yeah, in a way that they
Speaker 1: can see it.
Speaker 3: Yep.
Speaker 2: Yeah, that whole idea.
Speaker 3: That's something because PILATEUS two has some of that bias
Speaker 3: of don't use your hip flexes, don't use hip flex
Speaker 3: do hip flexers, And sometimes I would I would describe
Speaker 3: that as you want to think about the hip flexers
Speaker 3: in a more complex way, ideally for all of you
Speaker 3: out there, So not just like as one giant group,
Speaker 3: which you can think of them as, but I have
Speaker 3: to think of them individually. So we've talked about the
Speaker 3: ilios as the thing I think about is the rectus femeris,
Speaker 3: which is our major quadricep hip flexer, are sartorious, which
Speaker 3: is will also do external rotation and abduction. And then
Speaker 3: are semi our tensor fascial law to and our glutas minimus,
Speaker 3: which you do an intern rotation and an abduction or
Speaker 3: a flex.
Speaker 2: And then even are.
Speaker 3: Some of our deeper aductors. So what I often find
Speaker 3: is those are also imbalanced. We've talked a little about
Speaker 3: the AliOS as and and one thing that is kind
Speaker 3: of a well, I'm not sure it's an easy easy
Speaker 3: assessment or not, but if you watch somebody walk towards you,
Speaker 3: you can often see especially if they're running, but walking
Speaker 3: can sometimes see it too. Does that leg tracks straight ahead,
Speaker 3: that knee and that femur track straight ahead when they walk,
Speaker 3: does its track in later rotation or does it track
Speaker 3: in medial rotation? And again you can't always see that
Speaker 3: in walking, but you can certainly every time somebody runs.
Speaker 3: If any of you are like me and like to
Speaker 3: watch runners do their thing on the trail near us,
Speaker 3: I always like am intrigued by what's happening, you'll see
Speaker 3: it immediately because when they go faster, the second that
Speaker 3: leg comes off the ground to go into that stride forward.
Speaker 3: It'll either stay straight, which is I think of being
Speaker 3: more wrecked as famerous dominance. It'll latterly rotate, which is
Speaker 3: often extra rotator or sertorious dominance, or it will interally rotate,
Speaker 3: which or glutasmon in a sentence of fascial lot of dominance.
Speaker 3: And so sometimes too I can look at that and
Speaker 3: see where there where what is their strategy and hip flexion,
Speaker 3: and try to get them to change that, modify that,
Speaker 3: And a lot of times that is work on the
Speaker 3: so as and working on getting that rectusceemerist to do
Speaker 3: more of the job, because it's often the one that
Speaker 3: will really track at the straightest.
Speaker 1: Yeah, coming back to the whole working in three dimensions,
Speaker 1: I really want to sort of put a point on
Speaker 1: this and make sure that everybody really understands what that means,
Speaker 1: because even in something like hip flex hip flexion, you
Speaker 1: don't just necessarily have to have it come straight ahead.
Speaker 1: You can do some external rotation, you can do a
Speaker 1: little internal rotation, and if you find that one is lacking,
Speaker 1: you can focus maybe a few more repetitions or an
Speaker 1: extra set on that side. So really taking a look
Speaker 1: at every single motion and trying to figure out what
Speaker 1: is their weakest. The one that I bring up all
Speaker 1: the time to especially when I'm teaching PLATES instructors, is abduction.
Speaker 1: They're taught to do it with their hips very stacked.
Speaker 1: Well a lot of times though you watch it and
Speaker 1: their toes will turn slightly upward, and you can see
Speaker 1: that they're using a little bit more TfL they're using
Speaker 1: a little bit more of the anterior portion of their
Speaker 1: glute mead and the anterior muscles, as I would say,
Speaker 1: are getting a little more than the posterior. And sometimes
Speaker 1: you just need to remind them to bring their leg
Speaker 1: behind them, maybe put that hip in slightly inclined, slightly
Speaker 1: make it go forward just a little bit, or to
Speaker 1: put the toe down, just changing the position and all
Speaker 1: of a sudden, oh my gosh, that's so much more difficult. Well,
Speaker 1: it's just an area that you haven't trained necessarily as much,
Speaker 1: so we may need to focus on that just to
Speaker 1: balance it out. You don't want to just focus on
Speaker 1: one side and not the other. And I find that
Speaker 1: a lot of people go to whatever is their path
Speaker 1: at least resistance and whatever they've been doing is how
Speaker 1: they've always been doing it.
Speaker 2: Yeah, absolutely so abduction and then you know, to kind
Speaker 2: of mention it.
Speaker 3: A lot of times, the goat, the go to, the
Speaker 3: default is strengthen the glutes, right, Like, I always think
Speaker 3: of that that that's that's kind.
Speaker 2: Of where people typically go when they're working on.
Speaker 3: The hips of strength and the glute strength and glutes
Speaker 3: on the goods.
Speaker 2: Now, that's you.
Speaker 3: That's generally a good idea, honestly, Like, most clients are
Speaker 3: not that strong there, and I'm totally for that. Every
Speaker 3: now and then, especially some of my clients who are
Speaker 3: more athletic, more maybe antirely tilted or a little more
Speaker 3: loer dotic, overuse the glutes and that's causing their hip trouble.
Speaker 2: And that's not so common.
Speaker 3: You know, I don't know what the proportions are, but
Speaker 3: certainly that's not as common as just weak glutes. But
Speaker 3: they're not always the answer. So that's the other thing too,
Speaker 3: is just staying three dimensional?
Speaker 2: Is it hip flexion? Is it hip extension? In multiple angles?
Speaker 3: Right? If I'm thinking about doing one of my favorite
Speaker 3: simple ways to do that is all fours leg lifts, right,
Speaker 3: all fours, just lifting the leg up and playing with
Speaker 3: that in parallel, playing with it turned out, playing with
Speaker 3: it internally rotated, taking that leg and lifting it up
Speaker 3: and then happing it across the other leg right, so
Speaker 3: back and forth. So you're getting all those angles of
Speaker 3: that extension. And those are all again ways to three
Speaker 3: dimensionally train these complex systems because they don't work in isolation.
Speaker 1: Yeah, they don't. And that's something that I again, we
Speaker 1: have a tendency to forget about, and I think it's
Speaker 1: missing in a lot of rehabilitation. When people go through
Speaker 1: physical therapy, and it's a lot of times they just
Speaker 1: don't have enough time. They are told, get this person
Speaker 1: walking and get them as strong as possible in a
Speaker 1: short period of time as possible. And that's the insurance
Speaker 1: industry putting making those rules. So it's our job to
Speaker 1: really look at that. And sometimes I will say tell
Speaker 1: the person when they show me what they've been doing,
Speaker 1: I can say, okay, you've been doing it this way
Speaker 1: for now we're going to adjust this a little bit.
Speaker 1: I don't say that, oh man, what was your physical
Speaker 1: therapist doing, because I don't know if they've mutated the exercise.
Speaker 2: No, I don't blame them don't blame anybody.
Speaker 1: No, no, we have no idea unless we know the person.
Speaker 1: We have no idea what they've been doing and how
Speaker 1: they've adjusted it in the meantime. But I'll just say, oh,
Speaker 1: you're ready to take that next step, you're ready to
Speaker 1: move on. And it makes them feel good, Oh I've
Speaker 1: gotten stronger. Absolutely. Now let's roll your hip forward this way,
Speaker 1: or roll your hip back, or let's focus on this.
Speaker 1: Push through your big tone, more, push through your little tille,
Speaker 1: more small adjustments, and they'll say, oh, man, I really
Speaker 1: feel this a lot more. I said, Okay, we're going
Speaker 1: to do this for a couple of weeks. Then we
Speaker 1: change it up again, continue to change things. One of
Speaker 1: my favorite techniques that I will use is you I
Speaker 1: bought these dots, these flat dots you can put on
Speaker 1: the ground. You can get them really inexpensively online anywhere
Speaker 1: from I've gotten three inch ones all the way up
Speaker 1: to like nine or twelve inch ones, and I throw
Speaker 1: them out at different angles and they kind of look
Speaker 1: like Twister dots. Yeah yeah, yeah, And I will literally
Speaker 1: play Twister with them in that I will say right
Speaker 1: foot red and they have to find the red and
Speaker 1: then take a step toward it, or lunch toward it,
Speaker 1: or however we're doing it, and it'll be at a
Speaker 1: weird angle. Sometimes I'll have them go across the body,
Speaker 1: because we don't often do that. But if you're walking
Speaker 1: and you want to take a step, do we often
Speaker 1: cross our leg into the other one where we're changing
Speaker 1: direction sure all the time. So I'll call out across
Speaker 1: the body, I'll call out behind them, and I'll say
Speaker 1: right leg, you know, And it'll be if they're facing
Speaker 1: twelve o'clock their left leg, I'll say left leg, and
Speaker 1: really they have to go almost all the way to
Speaker 1: four o'clock. And they're like, how am I supposed to
Speaker 1: do that? I say, get as close as you can
Speaker 1: or find another way, And sometimes they'll go, oh, I
Speaker 1: can sneak it around behind, Yes, you can, all right,
Speaker 1: And you can see they have to use their brain,
Speaker 1: they have to figure it out. They have to sort
Speaker 1: of problem solve at the same time. But they're working
Speaker 1: their hips, they're working their legs in ways that they
Speaker 1: don't in a traditional fitness or plate's environment. But how
Speaker 1: we use it in a regular, every day environment all
Speaker 1: the time. So again, I want to take that from
Speaker 1: exercise into reality as much as we can. And those
Speaker 1: are real cheap. I get a package, you know, oftentimes
Speaker 1: I'll give them some I'll buy the small three inch
Speaker 1: ones that I can get like fifty of them for
Speaker 1: five dollars or something, and I'll stay here play with
Speaker 1: these at home, you know.
Speaker 3: And and so one thing that I love about what
Speaker 3: you do banks, I've seen you do a lot of
Speaker 3: these drills and they're just if you guys ever, don't
Speaker 3: ever play with these.
Speaker 2: They're super fun.
Speaker 3: And a lot of times, like again this is getting
Speaker 3: maybe to clients that are a little not in the prehab.
Speaker 2: Stage, but maybe it is. They're they're really great to
Speaker 2: do at the end of a session.
Speaker 3: So the last five minutes to do a lot of
Speaker 3: standing stuff, stepping over things, stepping up on things, stepping
Speaker 3: at different angles. Just it just takes all the work
Speaker 3: you're doing. And I'm thinking of this from a plot's perspective,
Speaker 3: you know, on the machines in the in the environment
Speaker 3: and taking it up into a more challenging, oftentimes more
Speaker 3: practical position. So the other thing too, that I wanted
Speaker 3: to just bring out about what you said is changing
Speaker 3: things up, because when something when we get really good
Speaker 3: at something, some movement, and it really doesn't take any
Speaker 3: attention anymore. We've gotten kind of as efficient as we
Speaker 3: can with that particular movement. We've stopped paying attention. Basically,
Speaker 3: our nervous system has gone.
Speaker 2: I got this handled.
Speaker 3: I can go on autopilot and start thinking about my
Speaker 3: laundry list, right or whatever it is.
Speaker 2: Yeah, so that's where shaking that up.
Speaker 3: Giving new input, new stimulus, different order, more resistance, different angle,
Speaker 3: all those are really important to keep the brain. And
Speaker 3: I think I think the motor control system like active
Speaker 3: and running instead of on automatic.
Speaker 1: And also I'm gonna I'm gonna throw this out there
Speaker 1: for my people who have my type, like my type
Speaker 1: A clients. You want to know exactly how many repetitions
Speaker 1: and how many sets before we ever start. And I
Speaker 1: just say, just keep going. What do you mean? Just
Speaker 1: keep going? You're not tired yet. But but but I
Speaker 1: did twelve. Hey, you can count good for you. Keep going.
Speaker 1: It doesn't matter. The number of repetitions, doesn't matter if
Speaker 1: you're going to fatigue. They get used to doing a
Speaker 1: certain number. Yes, but it suddenly I've had a client yesterday,
Speaker 1: I've done this many times when I'll say, okay, one more,
Speaker 1: and they'll do one more, and I'll say one more
Speaker 1: and I she looked at me and she said, you're
Speaker 1: not allowed to do that. I said, yes, I am,
Speaker 1: do another one. And then she did another one. I said,
Speaker 1: do another one, and she's given me this evil look.
Speaker 1: She did five more repetitions before she got tired, and
Speaker 1: I said, see, you could do more than you thought
Speaker 1: you could. But if we stopped there, you wouldn't have
Speaker 1: pushed and you wouldn't have realized that. And you could
Speaker 1: see she was proud of herself. She was still a
Speaker 1: little upset because she really wants to know the number
Speaker 1: ahead of time. And I say, it doesn't matter. It's
Speaker 1: going till your body tells you. Okay. I think I've
Speaker 1: had enough.
Speaker 3: And the world doesn't give you numbers.
Speaker 1: No, it doesn't.
Speaker 3: I mean if I'm like, I've been remodeling my office here,
Speaker 3: so I was doing like you know, sheet rock mud yesterday,
Speaker 3: Like it doesn't tell me, oh, I'm going to lift
Speaker 3: my arm up up four times at this height and
Speaker 3: do this, Like that's not what's happening. Right.
Speaker 2: I cook a lot.
Speaker 3: It's like it's not going to tell me I'm going
Speaker 3: to chop that that carrot seventeen times, four times in
Speaker 3: a row.
Speaker 2: Like that's not what happens.
Speaker 3: And if any of you have children out there or dogs,
Speaker 3: like that is an unpredictable situation.
Speaker 1: Yep, you know you can't.
Speaker 3: You can't count on on I'm going to do four
Speaker 3: of these and six of these. And now I appreciate that,
Speaker 3: you know, sometimes that gives you some structure to your workout,
Speaker 3: which could be helpful for sure, And I totally get that,
Speaker 3: but also understand, like that's not what real life does
Speaker 3: for us.
Speaker 2: It does not provide us with the numbers ahead of
Speaker 2: time that are going to be required to do the job.
Speaker 1: I remember I had a she was a chiropractor friend,
Speaker 1: and I was training her to do like a tough
Speaker 1: mutter sort of situation. And we would go into the
Speaker 1: parking lot and do walking lunges and if she'd think
Speaker 1: she was done it doing a certain number, and I'd say, okay,
Speaker 1: twenty more, and she would just look at me and
Speaker 1: I said, you want to do an ultra endurance type
Speaker 1: event that involves running, jumping, twisting, turn that's going to
Speaker 1: use your whole body in ways you've never done before
Speaker 1: you think ten more repetitions And immediately she said, got it,
Speaker 1: and it changed her mindset because she had a goal
Speaker 1: oriented Well, guess what life is? Goal oriented. We need
Speaker 1: to be able to do things. What if you have
Speaker 1: to carry something farther than you think, yep, you have
Speaker 1: to be strong enough to do that or be able
Speaker 1: to put it down somewhere. What if you have to
Speaker 1: do something or walk farther than you thought you did, Well,
Speaker 1: guess what. You got to figure it out. Like you said,
Speaker 1: life does not give you a certain number of repetitions.
Speaker 1: I've done drywall work. It's not going to say sand
Speaker 1: this twelve times and it's going to be perfectly smooth. No,
Speaker 1: it may be two hundred times, It maybe four times,
Speaker 1: and everywhere in between.
Speaker 3: Absolutely so domic This was a Hopefully this guy got
Speaker 3: you guys some ideas, right. We talked a lot about've
Speaker 3: got pretty practical here, a couple of case studies, and
Speaker 3: then a lot of just thinking about the hip three dimensionally.
Speaker 3: Ways to get out of our habits of you know,
Speaker 3: don't do this, do this, always do this, staying sagital again.
Speaker 3: Working with a hip, you want to make it as
Speaker 3: three dimensional as possible, really identifying where it's working, where
Speaker 3: it's not working, and oftentimes, as Brian said, and as
Speaker 3: Brian's experience in my experience, just by balancing those things out,
Speaker 3: sometimes in pretty simple ways, you may be able to
Speaker 3: help your client at least recover better from a hip
Speaker 3: replacement or even put that laper replacement off for a
Speaker 3: period of time.
Speaker 1: Yep.
Speaker 2: So hopefully that's been helpful to you.
Speaker 1: Yeah, and I think this gives you a like, like
Speaker 1: Norah just said, a lot of practical things that you
Speaker 1: may not have thought about before. Or I don't know
Speaker 1: about you, but a lot of times I've used to
Speaker 1: do something and it's oh, I haven't done that in
Speaker 1: a long time. So hopefully we may have reminded you
Speaker 1: of something to do and be like, oh, yeah, I
Speaker 1: guess I haven't been training my hip flexer as much
Speaker 1: as I used to. Maybe I should try that again.
Speaker 1: So even on your own body, maybe it's reminded you
Speaker 1: something that you can play with a little bit exactly.
Speaker 1: All right, Well, do us a favor again. Hit that
Speaker 1: like and subscribe button. We super appreciate every time you do.
Speaker 1: Check out the YouTube channel under my name Brian Ritchie.
Speaker 1: You can check us out Instagram, Moving Convos, or email
Speaker 1: us Moving Combos at gmail dot comes the best way
Speaker 1: to get in touch with us, and from Nora Saint John.
Speaker 1: I'm Brian Richie. We'll see y'all next week.
Speaker 2: By Guys