Health / Sports Injury Filter: How can my girlfriend reduce/remove her hip pain?

July 23, 2006 8:29 PM

My girlfriend did ballet from early childhood up until the middle of high school. She was very much into it, doing everything she could to improve. Through doing so, she severely injured both of her hips (I believe it was due to "turn outs"). She still suffers from hip pain today, 1 semester away from her graduating college. What can she do to remove/reduce pain in her hips?

I ask this question for two reasons:
1) I want her to not have pain any more.
2) I want her to be able to be more active in our love life.

Her hip pain flares up quite often, especially during long car rides (as driver or passenger), whenever she works out (elliptical machine mostly), and during intimacy.

She has of course seen her doctor several times over the past few years about this. The doctor generally sends her to physical therapy.

Physical therapy helps relieve the pain, but it is not doing anything to heal her - that is, it does not reduce flare ups.

She has tried ibuprofen prior to working out, taken extended breaks from working out to remove stress on the hips, etc.

Nothing seems to help. She expresses interest all the time in wanting to be able to be more active in our physical relationship and also wants to lose weight (even though I find her very attractive and tell her so daily). The hip pain prevents her from doing both. It is just so hard for her to go work out whenever her hips hurt, which is a lot.

Please help me find ways to help her!

posted by anonymous to health & fitness (14 comments total)

One of the women in my Bikram Yoga class is a former ballet dancer as well. She swears by the class as a way to improve flexibility and reduce pain in her hips. A testimonial from the website is certainly not an unbiased source, but agrees with my friend.
posted by jeffmshaw at 8:34 PM on July 23, 2006

I've been taught that injuries like these it is exactly all about reducing the pain, especially if it is a chronic condition caused by a severe injury. I might recommend seeing a osteopathic physician to see if there's any skeletal/muscular misalignments that are keeping her from healing well. In my experience, one must approach it as long term pain management rather than try for an immediate rehabilitation. That is, one needs stretching and physical activity to increase flexibility and reduce pain and risk of reinjury (such is the point of physical therapy). Taking extended breaks from working out might not be too good if it leads to a reduction in muscular strength, but I imagine any exercise she does needs to be light enough to keep her from hurting. Does massage help with the pain? It might be useful to tell us what kind of pain it is. Also, I would finding a doctor that knows more about treatment for chronic pain, but that could be tricky.

Take a look at this website, maybe it'll be of use.
posted by Mister Cheese at 9:05 PM on July 23, 2006

There are a number of things which can cause hip pain. There might not be any one permanent cure. My recommendation is based on my own experiences with bursitis caused by a structural tendon problem with a somewhat funny name.

There wasn't pain constantly; if I was just lying there not doing anything it probably wasn't that terribly uncomfortable, but when I did sustained exercise like walking some distance it got very painful.

To fix it:

First, get really thorough with your stretching. Stretch well and stretch often. This helps.

Second, go on a sustained ibuprofen regimen. Take the maximum dose for as long as the label says you can. This is likely to be 400 mg three times a day for ten days. Don't just take it when you think you're going to be working out. Don't take it for longer than ten days, and mind all the warnings on the label and all that.

Third, work to develop the strength and flexibility of the hips. Do this via stretching and exercise. "The clam" (halfway down) is good.

Again, her problem might be a different tendon or arthritis or something, ianadymmv etc.
posted by thirteenkiller at 9:19 PM on July 23, 2006

I had bad turnout (big external rotation, limited internal rotation of the hips) from dance as well. I generally walked with my feet facing out in a wide V rather than in parallel lines, and found that my hip pain improved greatly when I retrained myself to walk with my feet parallel and back less arched. Alexander Technique, yoga and Pilates were all very helpful in realigning and reinforcing this for me. Definitely worth trying in addition to other more invasive treatments (medicine, surgery, etc.)
posted by judith at 9:37 PM on July 23, 2006

Has she considered seeing someone who specializes in either sports medicine or performing arts medicine?
posted by thomas j wise at 9:41 PM on July 23, 2006

Ex-ballet dancer with her own hip pain here....

I've found a combination of pilates, cardio exercise (walking, in my case and some time at the gym too) plus regular massage allows me to manage the pain. Having said that, maintaining the three is both time- and money-consuming.

I do pilates one on one with my physiotherapist. She knows all about my various aches and pains and has tailored a program that targets those issues. I've found building up the muscles on the inside of my legs has reduced my turnout considerably. I also occassionally see a massuer who does chinese cupping on my hips and that seems to sort out the pain, but usually only in the short term.

The key, I think, is managing it and being really consistent with all of those things and with exercises like the clam that thirteenkiller pointed out - that one's excellent.

One last suggestion: has she tried accupuncture? I've found that a useful short-term pain reliever as well.
posted by prettypretty at 9:45 PM on July 23, 2006

Thanks for the responses so far!

Mr. Cheese: Thanks for the link - I will look over it with her, see what description best fits and go from there. As far as massage - I know that massages during PT seemed to help her, but the effects did not last long enough.

13killer: Stretching is one thing she is very good about (probably thanks to dance). Ibuprofen helped - she just was bad about taking it consistently. Thanks for the exercise/stretch link - the clam looked like it could be helpful.

judith: I am not sure how she walks, but I will mention it to her and see.

t-wise: She tried getting help via sports medicine specialist @ college when she did crew, but they did not offer assistance since it was a "club" sport, not "varsity." I will mention to her about trying it again (through a normal dr. referal).

I recall seeing some hip joint medicine advertised on CNN (a non-Rx one) recently. Does anyone recall what it is and/or have any input on its effectiveness?
posted by criticman at 9:59 PM on July 23, 2006

go on a sustained ibuprofen regimen

so key to controlling flareups and allowing you to build strength.

I had bursitis and a funny tendon thing too as well as scarring of the IT band. I found that building up the hip muscles at the same time as the muscles around the hip (thigh, buttocks, lower back especially) made the difference. I've had hip problems since early childhood and I only really got them under control after a knee injury that forced me to do sustained weight and bicycle work at the gym as well as regular Pilates and stretching. For me the key things to stretch are the piriformis and the inner thigh, and I need to avoid over-stretching the hamstrings (so no downward facing yoga poses). Pilates is very good and Bikram is the best yoga method I've found and I wish I had the wast wealth and free time it requires to do it properly ;)
posted by fshgrl at 10:02 PM on July 23, 2006

It might be worth visiting a podiatrist and having orthotic inserts made for her. I have a friend who suffered severe hip pain after an accident and had orthotics made for his everyday shoes which support his foot differently and modify the way he walks to reduce the pain.
posted by cholly at 11:35 PM on July 23, 2006

I used to work in the health industry, and the company I worked for distributed SierraSil. I've heard many first-hand accounts of people suffering from terrible arthritis becoming mobile again after a week of using it and getting better the longer they take it. This was one of the reasons why my ex-boss decided to carry it, as it really helped him. It can be found/ordered through health food stores.
A note on ibuprofen: taking too much may cause ulcers. This actually started to happen to elizard, so your friend may want to be careful.
posted by Zack_Replica at 1:43 AM on July 24, 2006

Have a look at the 'trigger point therapy workbook'. Repetitive injuries can cause muscles to develop permanently tensed 'spasms' and this can refer pain to other places.
posted by lunkfish at 4:35 AM on July 24, 2006

If the 'hip pain' is really pain originating in the leg joints:

The theory a good physical therapist should be using: the body will often adapt to mildly 'broken' joints by changing the way it moves to avoid causing pain; so, for example, she may have a gait that on closer inspection is asymmetrical and/or a bit odd.

This unconscious adaption is about preventing the joint from getting into a configuration in which pain occurs, but because the range of motion has been restricted oftentimes the smaller muscles around the particular joint will atrophy dramatically after a few years. As a result of the atrophy, however, in those situations in which the joint is forced into the painful configuration there may no longer be enough force in those smaller muscles to lift the bones into a less painful variant of that position.

Put differently: the hip joint is a ball-and-socked joint, but the ball is supposed to be 'floating' in fluids and on pads; as a result of her injuries in certain configurations your girlfriend's ballcaps are now pressing too far into the padding and thus causing pain. Since the badding is busted she will have to use muscle strength to keep the ball joint roughly in the proper position throughout the range of motion, but due to the body's natural restrict-the-range-of-motion adaption strategy she most has had some of the necessary muscles atrophy.

If you cannot afford physical therapy this is the kind of thing that you can probe a bit yourself quite easilly -- and with her ballet background she probably has enough kinaesthetic sense to get a good reading of which specific leg muscles are weak. Consider having her lay flat on her back on a bed with both legs extending past the end of it -- her butt should be the last thing on the bed -- and you standing or sitting in a place where you can support both legs straight out (perhaps resting on your shoulders). For each leg try to get a feel for how easy it is for her to support its weight by herself in this position, and be sure to test 'a lot' of variations on the 'vertical angle' -- ie how high above 'flat' she has the leg -- the 'horizontal angle' -- ie how far to the side the leg is -- and the 'skew angle' -- ie how rotated inward or outward her foot is.

This can take some time but it should give the both of you a sense of where she is weak -- and what specific configurations are painful. Be sure to do this for each leg separately, because asymmetry is the norm for this sort of thing. Once she has a good measure of where she's weak it should be straightforward to find ways to exercise the muscles -- for most muscles on the inner thigh, for example, gently squeezing a softball between the knees and then slowly bringing in the specific muscles you want to work is sufficient at this stage.

Building strength in her abdominal core -- yoga, pilates, etc. are all excellent choices here -- as well as in her lower back, legs, and buttocks will all be helpful as well. The idea is to have a solid strength base surrounding the weak areas to better compensate for strength she may have lost in a couple places.

Physicaly therapy can of course be extremely helpful, but many physical therapists aren't, so if you go in for physical therapists don't be overly afraid of shopping around if one seems incompetent or unhelpful.
posted by little miss manners at 7:41 AM on July 24, 2006

One other thing: it's probably a good idea to take medical advice on the painkillers as well; apparently they're <smacks head> deciding that even the OTC stuff's not as safe as they'd thought.
posted by baylink at 6:07 PM on July 24, 2006

Pilates was actually invented to help injured dancers overcome their injuries, so should be a great place to start.

If she's interested in yoga, she might want to check out anusara style yoga. It very explicitly discusses inner and outer hip rotation as part of every pose. I certainly was not as much of a dancer as your girlfriend, but I did enough ballet that I pretty consistently walked like a duck until a few years ago (feet turned out, knocked-kneed when my toes pointed forward), and practicing anusara yoga has done amazing things to correct that in the past year. My knees actually face forward now!
posted by occhiblu at 9:47 AM on July 25, 2006