Hip impingement issues and how to fix them
Conservative exercises which I'm trying to "pre"-hab before running in April
Top of the morning, sapien. Welcome to Common Sense Medicine, where I try and keep you up to date on the latest and greatest in longevity science.
This week, I’m focused on getting ahead of things. Whether it comes to the blog, writing, or monthly goals, it’s too easy to get reactive to things rather than being proactive. I always feel like there’s an ebb and flow when it comes to publishing. Every week, I’m focused on getting one article out, but I’d rather them be scheduled on a Tuesday or a Wednesday rather than a Thursday night, furiously writing.
I think that this weekend I’ve been scrolling, and relaxing whereas I should be focused on getting things out the door. So I refocused, put things in perspective, and started typing on this week’s blog post. I thought it would be very interesting to talk about one of the issues which I have been working on for the past few weeks, just because it’s something that does concern me a bit. So I’m using this long weekend to schedule this Friday’s article, and I hope that I can use the weekends to write more.
This week’s issue is all about hip impingement. I talked about the hip mobility project which I’m working on a few weeks ago and I wanted to expound on a paper which I’m using to dictate that and the exercises which I’m trying.
Other items on the differential:
I’m going to be running in a half marathon in October 2025! Have decided on one which is close to me, in NYC. I don’t really have any goals other than focusing on the form and finishing. I think that’s reasonable for someone who hasn’t run in a while. I’ve read a book about running programming by Hal Higdon, whose review I still have to get to, but now I’ve burned the boats. I’m going to do it and I’ve set a date.
https://journals.lww.com/techortho/fulltext/2021/09000/Prehab_and_Rehab_for_Femoroacetabular_Impingement.9.aspx
https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01885446/full
https://pmc.ncbi.nlm.nih.gov/articles/PMC8031040/
THE WEEKLY DOSE
Hips don’t lie
I mentioned a few issues ago that I was having some hip pain. Well, it hasn’t gotten better and I’m on my fourth or fifth week with this nagging pain in the hip. It’s mild and only shows up when I’m squatting heavy, but any imbalance and pain is sending up signals in my head that something is going on.
This week, I thought it would be interesting to explore some of the exercises which are focused on hip mobility and hip rehabilitation. I’m ramping up my preparation for the half marathon by focusing on the twelve standards that Kelly Starrett mentioned a la Ready to Run and I’m focused on making sure that I can be limber and flexible when getting to that point.
I found this nice primer about FAI (femoroacetabular impingement) which mirrors my symptoms pretty well. After chatting with ChatGPT and making a nice routine, I’ve started to avoid squats during the hypertrophy phase and switching to more glute-activating exercises to do some “pre”-hab to prevent injury in the future.
To get surgery or not to get surgery?
I have a bias towards non-surgical options, but there’s no doubt that surgery is probably helpful for some people. In fact, in a meta-analysis, they showed that physiotherapy is just as effective as arthroscopy in preventing FAI in a 24 month time period, although it slightly beat out physiotherapy (rehab) in 6-12 month time span. I suspect this has to do more with the adherence to the rehabilitation regimen, because I know it can be hard to be adherent with a busy schedule.
Part of the reason that spending money to do surgery to do a “quick fix” for FAI can be harmful (not in all cases, but some cases) is that the time and money spent for preparing for this surgery is not a quick fix to get the patient back to their earlier activity level. It’s more of a salve, and then the patient has to do the long rehab anyways. Might as well catch it earlier, try out physical therapy to see if it goes away, rehab it for some time, and then turn to surgery if it’s really needed.
What I’m doing to address this issue
I love progressive overload, especially when it comes to rehab. I think that it’s really helpful to see that I’m really progressing week after week, instead of just staying stable. Even though I had a setback, it’s encouraging to know that I have some ways to improve week over week. I found this page which really shows me a step-by-step way to improve, and I wanted to copy it here to show you what my routine is going to be for 2-3x a week. I’m going to try to wake up earlier, go into the gym, and get this done as a rehab routine.
Focus on activity modification: Do Box Squats instead of deep squats. I think I still need to progress and it’s becoming pretty ridiculous that I’m preventing myself from getting muscle hypertrophy if I’m only feeling the pain when I’m doing deep squats.
Add the exercises below (see the pictures on this page) to my rehab / stretching pre-workout routine, somehow.
Split-Squat Progressions (Isometric Holds to Deficit Rear Foot Elevated Squats)
Nordic Hamstring Curls
Glute bridge isometrics, and then single-leg hip thrusts with 5-10 lbs.
Copenhagen Isometric (Short, Long) and Copenhagen
Abductor progression - short side planks, then side planks
Hip flexion and banded isometrics for hip flexion
Add the exercises in lieu of squats for the next few weeks:
Barbell hip thrusts
Box squats
Practical takeaways
I think that whenever there’s a problem, it’s easier to reassess what’s going wrong, and coming back to the basics is not an issue if you’re trying to improve day after day. Like I say, it’s always about consistency. Even if you’re working on trying to get into the gym, it’s always good to have consistent progress and getting set back, rather than focus on something for a few weeks and then give it up. I think that rehab is always a continual journey, even though it feels like one day you’re going to be exercising with no issues, there’s always something to improve upon — whether that’s aches and pains, not gaining weight, or not doing the exercises the most optimally. I think longevity is an exercise in futility, but it’s helpful to know that if you’re focused, you’ll see results.
THE PRESCRIPTION
Q1 2025: Hypertrophy Cycle Progress
The upshot: This week has been slow in terms of weight gain, but we’re pushing onwards. The bulk might not be as successful (only reaching maybe 155 rather than 158), but we’re still pushing. I hit 154.2 on Thursday this week so we’re trying to really push for this last month to get to 158. As is the theme of this newsletter, consistency! Increasing calories this week again and pushing onwards and upwards. Time to lock in.
REMEMBER, IT’S JUST COMMON SENSE.
Thanks so much for reading! Let me know what you thought by replying to this email.
See you next week,
Shree (@shree_nadkarni)