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FAI FIX 2.0
Content
DISCLAIMER
FROM THE AUTHORS
FIRST ATTITUDE
OUR VISION OF THE FAI (FEMOROACETABULAR
IMPACT)WHAT REALLY DETERMINES YOUR HIP
HEALTH?YOU CAN GET BETTER?
HOW THE TSR SYSTEM WILL HELP YOU
LIBRARY OF EXERCISES
AUTO­PRUEBAS
KNITTING EXERCISE
QUADRICEPS
ADDUCTORS
FLEXORS OF THE CHAIR (PSOAS AND ILIACUS)
GLUTEUS / HIP ROTATORS
TFL / GLUTEUS MEDIUS / ITB
hamstring
LOWER BACK
STRETCHING
QUADRICEPS
PSOAS / ILIACUS
ADDUCTORS
hamstring
GLUTEUS / HIP ROTATORS
TFL / ITB / GLUTEUS MEDIUS
REACTIVATION
SEATED HIP ISOMETRIC
SEATED HIP ROTATION ISOMETRIC STANDING
GLUTEAL CONTRACTIONS
SUPINE ADDUCTOR PRESS
DONKEY KICK QUADRUPED
HYDRANT
SIDE LYING LEG RAISES WALK THE CRAB WITH
BAND
BRIDGE
90 90 POSE WITH ISOMETRIC CONTRACTION 90 90 POSE
WITH FRONTAL TILT
CLINICAL ABDUCTION IN 90 90 POSITION
FOOT ICE SKATER WITH BAND
ABDOMINAL REACTIVATION
HIP ROTATION WITH FLEXED LEG HEEL TOUCH
TABLE POSITION
HUNTING DOG
PRESS PALLOF
FULL BODY MOVEMENTS
SPLIT SQUAT
STRIDE BACK
SQUATS / GOBLET SQUATS
ROMANIAN DEADLIFT
ONE LEG ROMANIAN DEADLIFT
SQUATS FOR ADDUCTORS
CONCLUSION
Above
DISCLAIMER
WHEN CARRYING OUT THE EXERCISES THAT YOU WILL LEARN FROM OUR SYSTEM,
YOU WILL BE DOING IT "AT YOUR OWN RISK", BECAUSE IT IS THE ONLY WAY IT CAN
BE. YOU MAY BE SPRAINING A MUSCLE. YOU MAY DO SOMETHING THAT CAUSES
MORE PAIN. YOU MAY EVEN FIND A WAY TO CAUSE YOURSELF SEVERE INJURY (WE
DON'T REALLY EXPECT THAT, THOUGH). WE HAVE BEEN HURT IN THE PAST, AND WE
KNOW IT IS NOT PLEASANT. HOWEVER, THESE ARE THE RISKS OF LEARNING WHAT
YOUR BODY NEEDS TO MOVE AND FEEL BETTER. IF YOU ARE NOT WILLING TO TAKE
THE RISKS, UNFORTUNATELY WE WILL HAVE TO ASK YOU TO CLOSE THIS BOOK.
NOTHING IN THIS BOOK SHOULD BE TAKEN AS A MEDICAL RECOMMENDATION OR
AS A SUBSTITUTE FOR PERSONALIZED MEDICAL ATTENTION. THE AUTHORS ARE
NOT DOCTORS AND DO NOT DECLARE HAVING ANY MEDICAL EXPERIENCE.
FIRST PUBLICATION: 4/2015
LAST UPDATE: 6/2017
FROM THE AUTHORS
Shane Dowd y Matt Hsu
We both suffered from serious hip problems.
Shane's dream of being a lifelong athlete seemed impossible after his back "failed" for the second time in two years. He was unable to
put on his own socks and shoes, and was forced to rely on his girlfriend to help him get dressed each morning. His recovery was
inexplicably slow, and all his mentors pointed to the immobility of his hips as the cause of all his problems. “You have FAI
(femoroacetabular impingement). You need to have surgery before it gets worse!”
Matt used to wake up every morning with pain all over his body. Her feet, knees, hips, shoulders, and wrists ached with the slightest
movement. Years of rest, ice, and pills never seemed to help. Doctors and alternative medicine practitioners offered solutions, but none of
them were long-term. Even tasks as simple as getting in and out of the shower caused painful popping in her hips.
We both spent years wandering in the dark looking for a solution to our suffering. It was a frustrating experience for years, but ultimately a
rewarding experience for us. Every setback was torturous, but every relief and extra mobility was a huge win. When our paths eventually
met, we found that we were in common on many of the things we had been doing to get rid of the pain and get back to the sport we loved.
And so we share the solution we found.
To get started, we want to share the most important piece of our hip recovery puzzle: high expectations. We both wanted to get our athletic
lives back and excel in activities we enjoyed. Being able to play once a week on painkillers was not acceptable. Being able to run with two
weeks of recovery was not an option. Not doing “high impact” activities again was not something we were willing to change in our lives.
Shane can now do splits and lift weights like a champ. Matt is playing ice hockey goalie again and is learning to rock climb as I write this.
You must be willing to aim for goals that others will tell you are unreasonable. No matter what a person with a fancy medal or title tells
you, there is nothing unreasonable about wanting to live your life with vigor and excitement, no matter your age.
There is only one condition. You must be willing to take responsibility to get there. When the hip contracts, immobilizes, and causes pain,
there is nothing they can do to "heal" you for you. It depends on you. The difference between where you are and where you could be is just
a matter of time, attitude, and effort.
If you are willing to take the risks, face this challenge, then pay close attention. Take your time, learn and remember PAIN SUCKS – LIFE
DOESN'T HAVE TO.
Above
FIRST ATTITUDE

You will never be successful until you turn pain into greatness. Until you allow the pain to propel you from where you are, to where
you need to be. Stop running from pain and embrace it. Pain is going to be part of your prize, part of your product. I challenge you
to push yourself.
~Eric Thomas
We know you want to jump in and start helping yourself.
This is the first stage: Get 100% mentalized.
It is important that you have a clear understanding of your hip problems and why we do things the way we do. A clear understanding paves
the way for a clear goal of training your hip to move like it's supposed to. And that clear goal means that you are capable of achieving things
that might seem impossible.
BEFORE YOU CONTINUE READING, PLEASE DOWNLOAD AND PRINT THETSR TROUBLESHOOTING TRACKER PDF
or TSR TROUBLESHOOTERNOW.
Above
OUR VISION OF THE FAI
(FEMOROACETABULAR IMPACT)
Femoroacetabular impingement sounds pretty scientific and scary. It is believed to lead to arthritis and requires immediate surgical
intervention. It destroys cartilage, causes pain throughout the hip and back, and can make something as simple as sitting very difficult. To
stop the spiral of pain and a hip replacement, you must undergo surgery to reshape the bones of your hip joints.
That is the conventional story behind the FAI. Fortunately, none of this appears to be true.
We will try to make this as clear as possible, but in case you want a doctor's opinion, you can readthis summary of a radiologist on all
the problems with the current theory of the FAI here.
We want you to understand the truth because with a true knowledge of the problem, you will be able to solve your problems with a
clearer and calmer mind. That way, you'll be able to see your true options and see why the current approach of “surgery first, questions
later” may not be sane.
First, you will need to understand how it began to be diagnosed. As with any new disease/diagnosis, a consensus must be reached about
the symptoms that constitute the condition and what treatments might be used to combat it.
This is when an almost invisible trend comes into play. We are all familiar with the phrase “if all you have is a hammer, anything you see will
look like a nail”. In the case of the FAI, historically the investigations have always been carried out by the field of orthopedic surgeons.
Orthopedic surgeons have encountered situations where patients cannot fully flex their hips without pain, and no one has known what to
do about it. Surgeons theorize that bone growth is causing movement problems, and they use X-rays and MRIs to support the idea. They
assume that the bones are too long (or irregularly shaped) and obstruct movement, so they proceed to perform surgery on patients and
report that the results have been satisfactory. They began performing this surgery in increasing numbers and continued to report
satisfactory/positive results based on patient response.
At no time did they conduct studies of the efficacy of hip impingement surgery with placebos. Study
samples were initially small, and all research into the "disease" was conducted in the context of justifying
surgical intervention. No one bothered to do studies testing the bone hypothesis as the cause of the
problem until recently.
Is it for that long? Actually yes. It is the same story that was heard for spinal surgeries. (Randomized
controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation program
for patients with chronic low back pain: the MRC trial of spinal stabilization) and knee surgeries (Atroscopic
Partial Meniscectomy vs. Placebo Surgery for a Degenerative Tear of the Meniscus).
The record of these surgeries seemed great for a while, and for decades surgery to “fix” pain was widely
recommended. When the studies finally looked at the relationship between X-rays and MRIs, the results
were not so good. When they compared surgeries with more conservative options, the results weren't as
good. And when studies were done to compare the surgeries with sham surgeries (where an incision is
made to make the patient believe they had surgery), the surgeries didn't turn out to be as good. In the end,
all justifications for performing surgery in such cases turned out to be weak and unsubstantiated. Is there
any reason to believe that things will be different for hip surgeries?
Here are the facts you need to know related to your hip and current beliefs about the FAI. 1) The use of
X-rays, MRI, and CT to identify hip impingement means nothing.
Throughout various studies, no relationship has been found between having the so-called “FAI
morphology” and any symptom. This means that the shape of your bones is NOT the cause of the problem!
In fact, all the recent studies indicate that the FAI morphology is nothing more than a variation of the natural
shape of the bone.You can get more information here.
2) There is no correlation between range of motion, pain, and hip impingement on X-rays.
In a 2011 study, a group of researchers took patients with severe adductor/groin pain and ran some range
of motion tests and compared them to their X-rays. The study looked at 34 athletes with groin pain. 94% of
the hips showed FAI on X-rays.
Only 13% of the hips were positive in the previous hip shock test.
This means that the evidence of FAI on X-rays, range of motion, and pain are NOT related to each other.
You can read about this study in the British Journal of Sports Medicine here:Prevalence of radiological
signs of femoroacetabular impingement in patients presenting with adductor-related groin pain.
3) Hip impingement has NEVER been shown to lead to arthritis.
The original FAI theory proposed that the shape of the bones caused pain and arthritis. Surgery to correct
the shape of the bones was believed to prevent arthritis. However, it has been shown that the shape of the
bones is not related to pain. And, in recent studies, it has been shown that the shape of the bones is not
related to the development of arthritis! In fact, in one study, pincer femoroacetabular
impingement!lookshave a preventive effect!You can get more information here.
4) Finally, there is no proof that surgery to correct the FAI avoids the need for a second surgery later.
In one study, 112 people underwent surgery to correct the FAI. Ten of these patients (9%) underwent total
hip replacement within 26 months. You can read this study atthe Bone and Joint Journal aquí. Even studies
that have been done to show that surgery improves hip problems are based on inaccurate measurements
like the Harris scale. you can get more
information inhow poorly designed measurement systems make you believe that hip surgery may be a
good option when in fact it is not.
In summary, there is no correlation between the proposed diagnostic criteria and the symptoms.
If poor bone formation is causing the problem, there should be at least a modest relationship between
X-ray evidence of FAI and movement problems, but there isn't (if you've done internet research on the
experience of people who have been diagnosed and treated, it is likely that you have come across many
cases where their totally healthy hips show the worst signs of FAI on X-rays). If the bones are the problem,
why doesn't CAM type femoroacetabular impingement lead to arthritis and surgery leaves patients with
unsatisfactory results?
We believe that the conventional belief of FAI as a diagnosable disease based on bone malformations is
most likely unfounded. The diagnosis doesn't make sense. The results of the treatments have been
unsatisfactory.We believe that the
“”
explanation of the "FAI" must be deeply revised.The belief that hip pain can be cured with surgery is not based on evidence, and we really
hope that it will soon be considered as a bad idea as spine surgery for back pain.

I am a physical therapist in Massachusetts, and I was diagnosed with FAI on the left hip in 2013. My artograms showed a small
tear in the labrum, but no arthritis. I was told by two orthopedists that I would have to have surgery because my hip was
retroverted with a deep socket and would need to be lowered. This made absolutely no sense to me because the right side of my
hip was exactly the same shape and caused me no pain at all! …I followed Matt's recommendations and changed my exercises
and within just a week, I was in less pain than I had been in two years! Now I run and sleep better and on my way to a better life
thanks to Matt.
~Evie
WHAT REALLY DETERMINES THE HEALTH
OF YOUR HIP?
Your muscles are responsible for all the movements of your bones, and any malfunction of them will immediately result in a malfunction in
the movements.
Think of it this way: if you stripped your lower body of all its muscles but kept your bones, would you be able to walk? Of course not.
Muscles are responsible for the positioning and movement of those bones.
Current technology does not allow us a precise measurement of muscle function to quickly determine a dysfunction in it. Manual muscle
tests can't account for natural variations between people, and you can't just cut open a muscle and expect it to do what you want.
Muscles are not easy to assess with measurements that insurance companies accept, and in the medical world, where 10 minutes is the
most time you can have with a doctor and very few people will take the time to listen and help you with your problem, a thorough
investigation is simply not possible.
So now you're going to learn how to identify and fix problems with your own body and muscles so you can avoid unnecessary surgeries
and the never-ending “recovery” process that goes with it. Keep in mind that a "full recovery" from surgery may mean that you will
probably never fully function again.
With our training philosophy, our goal is that you will eventually move better than before. It will take time. It will take effort. And it's 100%
worth it.

When I first started working with Shane, my hip range of motion and mobility were a huge barrier to my CrossFit performance,
but now my range of motion and mobility has increased dramatically thanks to Shane's experience. ~Josh A.
YOU CAN GET BETTER?
Short answer: yes, you can improve.
Long answer: You will need to work to overcome the activities and stimuli that make your muscles dysfunctional. You will need to retrain
movement patterns gradually, and you will always need to be aware of whether you are moving your body in a certain way.
healthy or in an unhealthy way.
Let's take a step back and look at the big picture. You have reached this state after many years. The really irritating and debilitating
things could start suddenly, but that's just the start of a long process.
Over time, problems appear slowly and insidiously: one group of muscles stops working for some reason, other muscles compensate, and
the process is done in motion. Maybe one day you take a "false step" and pass that point where it becomes difficult for you to do anything.
It wasn't that "misstep" that caused it. It was a long chain of events. To reverse all this, you must gradually work on your recovery. The good
news is that you and only you are able to determine what your progress has been and how much progress you maintain (by keeping
exercising appropriately with the intent of maintaining balanced strength and mobility in your hip).
Think of it this way: if you consume six sticks of butter, two liters of soda, and a large amount of potato chips every day, do you expect your
body to look or feel good? After a month, you will be feeling some effects. At 10 years old, you will be paying a heavy price. No pill, surgery
and no one on the planet can help you fix the accumulated problems in an instant.
Or think of it this way: You take out a $300 loan to pay for your house (in fact, that's a great deal for being in California!). You can't
expect to pay it all off in a week or a month. It will take time to gradually pay off the debt!
For many of us, modern life has created many unhealthy situations for our hips, and years of exposure lead to problems that are difficult
to solve. Weak muscle pain. Muscle fatigue. Certain postures cause pressure near or on the joints. It's hard to debate the different
sensations. We are in debt, and it is time to start working.
But as you start working on your hip, the different problems will disappear. In some moments you will achieve great results in a short time,
and in others your progress will be very slow. Sometimes part of the process requires you to consistently work very hard to determine if it
is helping or not.
All hip problems have something in common, but they all have unique differences as well. You must be able to recognize this or you
will end up wasting time and energy getting frustrated that you don't have the body like everyone else. Your body IS NOT like
everyone else's, find what works for you, and repeat it until your body stagnates and you need to change.

Negative results are just what I want. They are as valuable as the positives to me. I can never find what does the best job
until I find those that don't.
~Thomas Edison
We believe that muscles are just rubber bands that we stretch. This is a convenient way to view them, but
their actions are more complex. Their actions are the result of the interaction between the strength of your
muscles and the firing patterns to which your nervous system has become accustomed.
Muscles can react differently to different positions, angles, and movements, even when they appear
completely healthy and strong in similar positions. This often happens in the hip due to the large number of
muscles involved in the functioning of the hip joints.
A pose can feel good, but a few degrees to the side and a few degrees back with your femur, and suddenly
it feels like your body has no idea how to handle the new pose.
What makes it more complex is that the hip muscles – and particularly the groin muscles – don't just
contract when they're not used to a position; rather they feel like pieces of wood that will never fit. This
feeling usually causes people to panic. Don't let this feeling discourage you. Be careful but persistent,
aware that your hips were made to be flexible, mobile, and strong.
HOW THE TSR SYSTEM WILL HELP YOU
The TSR system is focused on three pillars: Tissue work, Stretching, Reactivation. There is a logic behind
the order of these three pillars: we have listed them in the order of importance for themostof people.
However, each of these three pillars will be more or less important to you depending on your experience
and variables. Our program is designed to help you make informed decisions instead of blindly hoping that
what works for one person works for everyone.
Generally, tissue work is the first component to regaining pain-free range of motion and the ability to
reactivate muscles for Stage 1 individuals. It is of limited importance for Stage 2 individuals.
for people in Scenario 1. It is of limited importance for people in Scenario 2.
Tissue work is the act of intelligently massaging yourself. Many of the people we have talked to have received massage for their hip pain
and the results have been disappointing. If this is your case, do not allow disappointment to take over you and prevent you from giving
yourself the self-massages that we recommend.
There are many reasons why massage would not be very helpful for FAI symptoms, but the main reason is that the vast majority of
therapists avoid touching hip muscles that might help (and generally work on muscles in ways that might help). worsen your
situation).
The most obvious example of this is the tissue work in the adductors (the inner thigh muscles). The inner thigh muscles are usually an
important component in hip movement problems. Some therapists do not work on this area with their clients because of the risk that it will
be perceived as a sexualization of the session. But for us who want to improve our ability to move our hips, someone or something must
treat this area. Without tissue work in this area, it's likely impossible for you to regain the ability to move the way you should. So, we'll
show you how to start making this area (and others) healthier.
Another big reason why massages don't seem to help is because of the emphasis of massage on one spot. More re-education and
active strengthening of the muscle is necessary to make progress (this is where the third pillar comes in), and thecorrect musclesthey
need to be taken care of (this is where many conventional physical therapy regimens go wrong).
Tissue work is the first step in treatment because it is generally the easiest way to release muscle function. For many people, "knots" and
"triggers" can make it impossible to activate the muscle fibers you need to work to feel good. Weaving work in the appropriate place will
help you awaken those fibers.
To properly perform knitting work, think of it as a process of gradually training your body to relax in different postures. Don't think of this as
something to destroy your scar tissue. The sensation of pain you feel when doing knitting work is usually a reaction of your brain to new
situations. Just as a child throws tantrums when forced to do something they don't want to, your brain/body protests (quite loudly) when you
try to adjust to a new situation.
When you do knitting work, you are always “looking for tension”, moving slowly and finding places that feel tight and dense. Once you get
those spots, stop byat leastfive seconds and allow those places to relax before moving on to other tense places.
Our muscles are creatures of habit. They are good at what we ask them to do. With tissue work, we ask our muscles to learn to accept
pressure, relax, and lengthen so that they can be used with a greater range of motion. You will find that your brain/body is able to relax
quickly once you have trained it.
This tissue work section will give you a list of muscle groups to work and techniques to do so. The places you will look for will be where you
feel burning and pain when you put pressure on them. They are the ones who feel like a "spark" of pain. And they are also the ones that
you can slowly rejuvenate as the tissues relax and better accept pressure. Sometimes these places will produce sensations in other areas.
For example, you might feel your inner thigh relax as you do tissue work on your gluteus medius, or feel your back and buttocks relax
when you do tissue work on your quads. This is normal, and this is the complicated relationship we want to normalize.
The first time you do tissue work exercises, do two minutes of each set on each side. If, for example, you are working the quadriceps with
the foam roller, you should perform the exercise for two minutes on your right leg, and then two minutes on your left leg. For later times in
your routine, you can adjust the time based on effectiveness. A minimum of 1 minute is recommended for any tissue work on any muscle
group. When we're feeling ambitious, we'll focus 10 minutes on a single area to find the hardest spots in the muscles.
If at any point you find a point that causes electrical pain and numbness in your leg, stop and find another place to work. You're most likely
on a nerve, and you won't accomplish much by hitting them. If you find a spot that vibrates and throbs against the massage tool as your leg
becomes numb, stop and find a new spot. It is very likely that you are in an artery. It is totally unlikely that you will cause damage to these
structures by accident when you use the roller a few times. Don't be scared, just know that you won't achieve anything by constantly hitting
nerves and blood vessels. We're looking for muscles!
The second pillar is stretching. This pillar, as well as the knitting work, is very important for people in Scenario 1 but of limited value for
people in Scenario 2. Many people see stretching as torture that must be done without any obligation or something that can be done
quickly to get rid of it. This is not the way we are going to approach stretching.
Stretching is an opportunity to know where your limitations are. It is an opportunity to retrain your brain and body to accept a new range
of motion in a safe and controlled manner. It is absolutely vital that you take your time and pay close attention to what your body is
telling you when you stretch.
These are the three keys that we want you to remember to obtain good results in stretching.
First: Stretching is all about teaching your body to handle situations it's not used to.
The fact that you can't make the split or touch your feet is not a sign of disability due to genetic predisposition. A lack of flexibility is a sign
that your muscles and brain don't think it's safe to be in that position. Your mission is to think about what you want to achieve when you
stretch and stay focused while doing it.
Second, you have to hold the stretch long enough for your body to learn. Hold it for at least a minute!
This means that you should hold the stretch for at least a minute or more. Especially if you suffer from hip pain, you will benefit from
stretching for at least two minutes to allow your body to relax and become more comfortable with the new range you are teaching it.
Five seconds of stretching does not count as such. Twenty seconds of stretching does not count as such. Performing stretches
quickly is the most common way that people fail to achieve stretching results.
Third: you must add variety to be effective.
Do you remember how boring it was to be in the classroom when your teacher only read the textbook and followed a routine? Don't be
that teacher to your body.
Here are three ways to add variety and effectiveness to your stretching:
contract and relax. The contract/relax method teaches your brain to allow more stretch and to change the relationship between
muscles. For example, if you are doing a hamstring stretch, you can consciously contract the hamstring while keeping it stretched. Hold
the contraction for a count of 3 or 5 (or even longer if you feel that helps), then relax. This “exhausts” the hamstring and allows it to
stretch further. Otherwise, you could contract your quadriceps and hip flexors as you perform the hamstring stretch, holding and
counting to 3 or 5. This sends an activation signal to the antagonist muscles, which send a relaxation signal to the hamstring. For any
muscle that you are stretching, you can use this method to achieve further relaxation.
Change the angle of your stretches. A 10 degree shift in your upper body as you stretch can make a big difference in the stretch you
feel at your hips. Don't be afraid to bend over and move around a little while stretching to see if a little variation can make a big
difference. Go through the movements slowly and make sure you don't engage your spine and shoulders.
Try different exercises and stretches all the time. This is why we give you so many stretches to perform and why we hope you will try
and retry stretches to see the effects on your body. The more you stretch, the more things will change, and you'll have to do more
different exercises and stretches to keep making progress. Sometimes your hamstring will feel tight because it's fighting your quads for
pelvic position. In this case, you will need to stretch your quads in order to relax your hamstrings. Sometimes the inner thigh will cause
your buttocks to spasm.
In this case, knitting and stretching your glutes won't help much, it will help your adductors. This is counterintuitive, but it is a way of
working with a well-known neuromuscular phenomenon calledreciprocal inhibition.
The third pillar is reactivation. This pillar is key for Scenario 1 and Scenario 2.
For the vast majority, knitting and stretching alone will not solve the problems with their hips.
While doing stretching and tissue work can improve movement patterns, you most likely need to engage the right muscles on a
regular basis to form good habits of using the right muscles at the right time.
Many people with symptoms of femoroacetabular impingement suffer from what is affectionately known as gluteal amnesia. This happens
when you are neurologically disconnected from the glutes; you can't activate muscles when you want to - let alone when you want toyou
need.
If, for example, your body is used to using the adductors to stabilize and control your hip joints, relax and
stretching the adductors is a good start. This will help alleviate the tight and squeezing sensation in your groin and probably your back as
well. However, if you don't train the lateral and posterior hip muscles to do more work, your relief time will be very short.
If you are someone who is very flexible, the lack of muscle tension will cause your hip joints to be unstable. Your glutes and hamstrings
may be too weak to correctly position the femurandextend the hip Reactivating and strengthening those muscles can help you keep things
in the proper place through a full range of motion without pain.
Reactivating muscles is a process, and it is made more difficult with our modern lifestyles. When we sit, we tend to push blood into our
buttocks, and the short time we spend standing or walking we generally use other muscles instead of the buttocks. We don't use the
muscles we want to, and muscles that are already fatigued will continue to be.
This is why common physical therapist treatments often exacerbate hip problems. There is usually a lot of focus on strengthening the
abdominal muscles with exercises that actually engage the muscles that worsen hip problems (ie plank without proper preparation usually
engages the adductors and hip flexors). The hip exercises that are used are generally performed without the proper progression and
without focusing on the reactivation of the muscles that would provide relief.
We have seen treatment plans where patients are expected to perform wall squats after four weeks of starting treatment. That seems
crazy to us because it engages even more quadriceps, more anterior pelvic tilt, and more movement of the femur in an inappropriate
position.
Using the wrong muscles at the wrong intensity level and at the wrong time can result in a coordination problem in the range of motion of
your hip joints. The exercises we've included in the reactivation section are sequenced to help you target the appropriate muscles before
performing more complicated exercises like lunges and step-ups. Don't jump into the more difficult exercises thinking you'll get better
results. Learn how to hold the golf club before you hit that 400-yard shot.
We'll say it one more time: learning to use the right muscles at the right time is a slow process. You will need to pay close attention to
gradually learn the correct movement patterns. As your movement patterns and strength in those patterns improve, the relief and extra
energy you gain will start to last longer and longer. And your life will start to improve.Above
HIGH
IF YOU HAVE NOT DONE YET, DOWNLOAD AND PRINT THE TSR TROUBLESHOOSTER NOW. YOU WILL
BE ABLE TO START PERFORMING A ROUTINE THAT MATCHES THE DESCRIPTION OF YOUR PROBLEM
KEEP THIS PAGE OPEN SO YOU CAN EASILY REVIEW THE INSTRUCTIONS, PICTURES, AND VIDEOS OF THE EXERCISES
THAT WILL BE GIVEN IN THE TSR TROUBLESHOOSTER.
LIBRARY OF EXERCISES
HOW TO SEE THE VIDEOS
All exercises have instructional videos. Click on the blue name of any exercise, and the corresponding video will be played. The following
video will serve as a guide.
01:04
SELF-TESTS
1. The quadruped rocking(Quadruped
rocking) is an excellent exercise for
test your range of motion
hip and see how the muscles
posterior and lateral hip
affect your comfort levels and
movement skills. To do
this test, place yourself on your four
limbs on a comfortable surface
like a yoga mat and place your
neutral spine. Placing the spine neutral means that you will have a slight curve in your lower back, and your head and neck will be in
a straight line with the rest of your spine.
Keeping your spine neutral, slowly move your body back so that your shoulders and hips move toward your heels. Your goal is to be able
to lean back so that the angle between your torso and femur (the angle of the hip joints) is less than 90º. If you have serious mobility
problems, it will be very difficult to reach even 90º. As you begin your recovery, you may feel tightness in your upper hamstring and inner
thigh, or you may simply feel stuck and not be able to move anymore.
Now, to illustrate how the posterior and lateral muscles as well as the abdominals are involved in the range of motion of your hip, we are
going to focus on two points: tone your abs and use your glutes to improve the range of motion of your hip.
This is the way to tone your abs properly. For many people in Stage 1, they are likely suffering from anterior tilt with a large round in the
lower back and an upturned chest. Don't "put your belly in" to figure this out. First, make sure your chest is not tilted too far up (tilt it down
slightly). Second, make sure your jaw is tilted so that your head is neutral (not looking up or down in relation to your neck).
Third, make sure your pelvis is neutral by doing a slight posterior tilt. Finally, imagine that someone tries to push on your belly with their
fingertips. You want to prevent it.Rather than "tuck your belly in" or push it out, you contract your abdominal muscles to make them
rigid.This is similar to flexing your biceps to show off your muscles.
To squeeze your glutes and activate them, imagine trying to catch a lottery ticket between them. It's a 200 million dollar bill, so you have
to squeeze real tight! Practice this until you get a good glute-brain connection.
Now, back to the quadruped swing. Focus on squeezing your glutes and strengthening your abs as you lean back with a neutral spine.
Have you noticed that you have managed to lean (at least) a little more back? (Note: If you didn't notice a difference or just weren't able to
activate your glutes, your hip muscle health is quite low, and you'll need to pay close attention to awakening your glutes in the Reactivation
section.)
To experiment a bit more with how muscle activity can affect your hip, you can try changing the position of your foot and playing around
with the rotation of your hip joints.
If, for example, your knees point out a bit (external rotation), you'll notice that you can achieve a bit more hip flexion. This is just one
example of how small changes can make big differences in your hip mobility.
As you consistently work through the TSR system, your hip musculature will work with less mental effort. This self test will gradually
get better and easier.
2. The vertical leg flexion(Standing Hip Flexion) is a great test that simulates real life activities. Standing up, bring your knee up to your
chest. Keeping the spine neutral at all times. Your goal is to bring your knee higher than your hip, forming a less than 90º angle between
your torso and femur.
If you need to tilt your lower back and tuck your pelvis to perform this test, this indicates limited hip mobility.
Again, to demonstrate the importance of proper activation
hip and abdominal muscles, try this test again,
keeping your abs and glutes tight, with your spine
neutral. You will notice how you are able to reach a little higher with the
knee and/or feel less discomfort while doing it.
As you consistently work on the strategies presented in
this book, you will find it easier to raise your knee when performing
this test without having to consciously contract your buttocks.
For other movements where you feel restricted or uncomfortable,
you can use this glute crunch strategy to see what
much that proper muscle activation can help significantly
immediate.This is a quick example.
SELF-TESTS, GO TO THE TSR TROUBLESHOOSTER FOR
This is the correct way. This is the wrong way.
IF THIS IS THE FIRST TIME YOU PERFORMED THE
WRITE YOUR FINDINGS AND CONTINUE TO START YOUR FIRST ROUTINE.
Above
KNITTING WORK
Quadriceps
The quadriceps are the muscles responsible for both knee extension (stretching) and hip flexion (bringing
the knee up to the chest). Due to the way this muscle group is attached and the way it works, it can cause
excessive forward tilt in the pelvis.
The anterior inclination of the elvis reduces the space between the acetabulum and the femur resulting in
one of the
The anterior tilt of the pelvis reduces the space between the acetabulum and the femur, resulting in one of
the
classic symptoms of so-called FAI – being unable to flex your hip. Very tight quadriceps will make it difficult
use your glutes and hamstrings (this is part of the phenomenon known asreciprocal inhibition).
Doing tissue work on your quads will help you use your glutes and hamstrings better and
It will improve the position of the femur through the full range of motion of the hip.
Foam roller or Quadballer(Foam roller or Quadballer)
Lie on your stomach placing one leg on the foam roller or Quadballer. Always keep your abs slightly tight
and your spine neutral. It works all sections of the quadriceps from below the kneecap, the kneecap, and
all the way to the pelvis. The upper lateral quadriceps (upper outer thigh) and upper medial quadriceps
(upper front thigh) have a tendency to become tight and irritable, so pay special attention to those spots.
Dumbbell massages(or with Body Back Buddy)
This is a very useful exercise if you are in the gym and not
you have a foam roller or if you are an athlete who does a lot of
squats with heavy weights. Do not perform this exercise with a barbell at
unless you are an athlete or have no choice. sit on the
ground and place the Tiger Tail or the barbell on your quadriceps. Works
each area by “rolling” or massaging along the femoral region.
To work the lateral quadriceps, lie to the side,
slide your free foot under your knee and step away from the leg you are going to
work.
This exercise can also be done sitting on a bench or in a chair.
chair to work more on the middle quadriceps. You can find
detailed instructionsin this videoof theFAI Fix for Athletes.
If it is not possible for you to perform tissue work on the quadriceps with
a foam roller and/or would like to do knitting work on the
quads throughout the day, you can use a Body Back Buddy or
a massage stick like himTiger Tail. This will make less pressure but
it will still be effective.
adductors
The adductors are known to be responsible for pulling the femur toward the midline of the leather a
The adductors are known to be responsible for pulling the femur toward the midline of the body (a
movement known as adduction). It is important to know that the adductors do more than just adduction.
They also help with hip flexion and extension, depending on the position you are in and the
activity you are trying to do. They can also limit internal and external rotation.
Also, when the adductors are very tight, neurologically they make it difficult to move the muscles.
outer and posterior hips – primarily your glutes and hamstrings. You can drastically improve your hip range
of motion in all directions and reduce groin crunching by doing tissue work on the adductors.
foam roller(Foam roller)
Lie on your stomach with your hips flexed
approximately 70-90 degrees leaning on the roller
foam. Make sure your thigh is perpendicular to the roller.
Keep your abdominals slightly tight to avoid arching
your lower back a lot, and gently begin to roll the muscles
inner thighs on the foam roller. Work only the area
above the knee as close to the groin as possible. take breaks
on tender or painful points, and breathe to allow those
areas.
“Hydrant” position in a ball box
lacrosse(Lacrosse ball "fire hydrant"
position on a box)
Use a box (or bench or chair) that is 15-18 inches (3845cm). Place a lacrosse ball on the rim. put yourself in one
position where the knee that is on the ground is as close
out of the box as possible. Put your other leg up like a dog
urinating a fire hydrant, and places the inner part of the thigh on the
lacrosse ball. Try to get the ball as close to the point of
connection of the adductors as possible (in the groin near the
pelvis) and work down to the knee. At first, it's
It may be intense, but it will get easier.
Body Back Buddy out the back door(Body
Back Buddy through the back door)
Sit in a chair with a cushion (a couch or exercise bench works
good for this exercise). Place the tip of the hook of the Body Back
Buddy under your leg. Push the end out so that
the hook “digs” into the inner thigh. work going down
from the groin to the knee, looking for tender or tight spots.
Reclining adductor kettlebell punch
side(Side lying kettlebell adductor smash)
Lie down on the floor next to a kettlebell so that
that its handle is parallel to your body. flex your
hip and bring your upper leg over the kettlebell handle and place
the inner part of the thigh over the handle so that it makes contact with
the internal muscles near the groin attachment points.
Breathe and allow tense and sensitive points to relax.
This helps train your adductors to relax when you flex the
hip so that the adductors do not pull on the femur anteriorly and
towards the middle when you flex the hip. Be sure to explore the
adductor area in its entirety by placing the kettlebell
progressively downward until you reach your knee. never try
hit your knee!
Hip flexors (psoas and iliacus)
Whether sitting or standing, the hip flexors are the muscles responsible for
bring your knee up to your chest. When these muscles are very tense, you can
feel discomfort in your lower back and groin. Whether one or both muscles
are tense, make sure you are doing tissue work on both muscles.
to find you psoas
The iliacus is a muscle that
functions similar to the psoas,
lie on your back and place
your fingers
about two inches (5 cm) to the
side of your belly button. Press
hard without causing
discomfort. Raise the leg on the
side you are pressing by sliding
your ankle on the floor towards
your buttocks. You should feel
a muscle move under your
fingers from north to south
but its major connection is
along the inner rim of the pelvis
(ilium bone). You can think of it
as the rim of the bowl of your
pelvis. To find this muscle, start
at the bulge.
point of your ilium. This is the
bulge where
the waistband is usually worn.
Work along this bone, and
you'll be touching the ilium.
(head to toe direction).
Congratulations, you've got your psoas. When you do weaving work on it, you can go from that point to
your pelvis.
Face down with softball (for psoas)(Softball prone for
psoas)
Lie on your stomach with a softball at the point on your stomach where you placed
your fingers to meet the psoas. Gently breathe in and relax until you feel the ball sink
deeper into your body. The goal is to relax and gradually place more and more
weight on the ball.
Body Back Buddy
para psoas (Body
Back Buddy for
Psoas)
Body Back Buddy
para iliac (Body
Back Buddy for
iliac)
Lie on your back with the round
tip (or narrower tip for precision)
of the Body Back Buddy aligned
over your iliac. Take the bow of
Lie on your back with the round
the Body Back Buddy and
tip (or narrower tip for precision)
gently apply pressure to any
of the Body Back Buddy aligned
dense spots you find. Focuses
over your psoas. Take the bow
pressure on the bowl of the
of the Body Back Buddy and
pelvis. As the dense spots
gently apply pressure to any
relax, look for other dense
dense spots you find. As the
spots.
dense spots relax, look for other
dense spots.
Kettlebell Wing for Iliacus(Kettlebell handle for iliacus)
Place the handle of the kettlebell (or a similar shaped object) inside your ilium so that you feel the handle align with the bone. The goal is
for it to fit comfortably and as symmetrical as possible. From here, you have three techniques to relax the muscle. First, just breathe and
relax.
Second, bend your knee and move your foot from side to side like a windshield wiper.
Third, gently extend and bend the leg.
Keep trying and alternating methods to get the ones that give you the best results. Stresses can migrate and hide, so you have to
experiment.
Gluteal / Hip Rotator
The glutes (and the hip rotator below them) are extremely important when it comes to combating hip and back discomfort. When these
muscles are weak and/or tight, they can contribute to inefficient movement patterns (eg, inability to flex the hip without a strong desire/need
to externally rotate the femur).
Tight glutes and hip rotators not only cause
hip discomfort. It also stresses the lower back.
when you flex the hip joint (example: bending over
to pick something up off the ground or lift your knee up to your chest) and
it can cause referred pain and tension in the knees. By helping
By relaxing these muscles, you will reduce tension and pain in many
places on your body
Pellet lacrosse or softball for glutes(Lacrosse ball or softball for glutes)
Sit or lie on the floor with a ball under your buttocks. If the ball is under the left side of your hip, lean over and add weight to that side to
increase the pressure. Look for sensitive spots along the buttocks and on the sides of the hips. Breathe and relax on any sore spot you
get.
To improve your hip range of motion, you'll need to work your glutes and rotators from different angles. To do this, let the knee drop to the
side to reach different muscle fibers.
Experiment with different angles and locations on your glutes and rotators.
Jack Knobber II for Glutes(Jack Knobber II for glutes)
To reach deeper layers of the gluteals and hip rotators, use the Jack Knobber II. Due to its small size, this tool can give you greater
precision in locating small tight spots in your hip muscles. get in the same position
This tool can give you greater precision in locating small tight spots in your hip muscles. Get into the same position as the drill with the
lacrosse ball in this area, and look for different spots on the lateral hip. Allow the tool to gradually sink in as you breathe and relax.
Moving the pelvis a little helps to relax more easily.
This is another position that can help you fully relax and
work other deep dense spots. lie on your back
with the Jack Knobber under your buttocks and a foam roller at your
side. Position yourself so that your knee can relax into the roller.
foam as the Jack Knobber sinks deeper and deeper into your buttocks and
lateral rotators.
TFL / Gluteus Medius / ITB
Tightness in the tensor fascia latae, gluteus medius, and IT band can cause a
great feeling of compression in the hip joint and discomfort in the knees.
It can also interfere with full and smooth internal and external rotation of the hip joint.
hip.
TFL/Gluteus Medio/ITB with Quadballer or Softball Ball(TFL/Glute Med/ITB with the Quadballer or soft ball)- Stand on your shoulder
with your lower leg extended. Place the foot of your upper leg on the ground to stabilize yourself. Your top knee can be extended or
flexed, depending on what is most comfortable for you.
Rolls up and down the side of the thighto reach the IT band.
To reach the gluteus medius, rolls on the side of the pelvis, just below the crest. Apply pressure to the front and side of the upper thigh to
find the TFL. This is the area where your pants pocket opening would be.
hamstrings
The hamstrings can feel extremely tight for many people. Remaining seated for very long periods contributes to its malfunction. Tension can
be caused by staying in a crouched posture and also by being extremely weak. Doing tissue work on the hamstrings can help improve their
function so you can start training them again.
When the hamstring is tight and weak, we assume that the femoral head is pulled anteriorly while standing, sitting, and actively flexing
the hip. If the femoral head is free to migrate anteriorly, the clearance between the femoral head and socket is reduced and you lose
range of motion. By retraining the hamstring, you will reintroduce a femo posterior head motion.
Lacrosse or softball ball for the
ischiosural(Lacrosse ball or softball for
hamstrings)
Sit on a chair or bench and place the lacrosse or soccer ball
softball below the top of the hamstring (near the point of
insertion of the pelvic bones).
To work the lateral hamstrings, sit up straight with your
legs open and works the outside of the back of the thigh
(from the inside out/from the middle to the side). You
The objective is to decrease the sensation of density and improve the range of
movement of your hip. You can try this exercise with the test
standing hip flexion.
To work the middle hamstring, place the ball on the
inner thigh and move your body so that the ball
roll from the inside to the outside of the
hamstring (from the inside out/from the middle to the
lateral).
You can work the entire hamstring up to the knee, looking for
tender points. Don't work directly behind the knee.
Hamstring Body Back Buddy(Body
Back Buddy for hamstrings)
Sit on a cushioned chair (couch or exercise bench)
works well for this exercise). Take the round tip of the Bodysuit
Back Buddy and place it under your leg at the hamstring. push the
upper end to leverage and increase pressure on the
ischiosural.
Works the entire area from the pelvis to the top of the rear
of the knee, in the medial and lateral part of the hamstring (same as the
exercise with the ball). Don't work directly behind the knee.
Lower back
The lower back can become stiff as it compensates for your hip dysfunction. Generally, working on your hip will release tension in your
lower back immediately. If the tension in your back doesn't go away after working on your hips or your lower back musculature keeps you
in an anterior bend, you may need to do tissue work on your lower back. Anterior pelvic tilt also produces FAI-like symptoms.
Body Back Buddy for the Lower Back(Body Back Buddy for Lower
Back)– Lie on your side with the Body Back Buddy under your
side so that the round nose end contacts
directly with the muscles that lie along your
spine. To increase the pressure, simply push the handle
(which is in front of you). This will push the rounded tip
towards the muscles of your lower back. never push the tip
directly into the bones of your spine. if you don't have much
musculature to press, you probably don't need
perform this.
Above
STRETCHING
The following stretching exercises are listed in relative order of importance. Your experience may be
different, so be sure to pay attention to how each exercise affects you as an individual by trying it several
times.
Quadriceps
As we mentioned before, when the quadriceps are very tight, they can cause an anterior pelvic tilt. They
can also stop the activity of your gluteals causing the femoral head to move forward, adding further
impediment to hip joint rotation. Quadriceps stretches can be helpful for back pain that occurs when you lie
on your back or in the days after biking, running, or squatting. Quadriceps stretches need to be done very
frequently in the early levels to make a big difference.
Side Lying Quad Stretch with Band
(Sidelying quad stretch with strap)
This is the easiest quadriceps stretching exercise to perform. Is
especially helpful for people whose hip is so tense and
sore that you are unable to perform a standing quadriceps stretch (shown
next). It can be done on the floor or even in bed.
Lie on your side, take the band and place it around the foot of your upper leg.
Pull the band up over the back of your shoulder and toward
forward to bring your heel up to your buttocks. Keep your lower back flat and your chest
down. If you allow your lower back to arch, you are cheating on the
stretching. Hold the band taut and breathe calmly to allow your
quadriceps to relax.
If you are tense enough to need to perform this version of the stretch, it is very
this is likely to be very intense. You will need to perform this stretch at least
three times a day for two minutes.
If you are able to perform the stretch below, you can
also perform this exercise for convenience when you are traveling or need
a good stretch to the quadriceps.
Standing Quadriceps Stretch(Standing
quad stretch)
This is the beginner's version of the quad stretch.
It helps a lot if your quads are extremely tight and you don't
you can perform the kneeling quadriceps stretch presented
next.
Stand on one leg (use some support to keep
balance if necessary). Bend the other leg back and take your
foot or ankle with your hand. Keeping your body upright and thigh
of your leg flexed in a straight line with your other leg pull your leg
of your bent leg in a straight line with your other leg, pull your foot
towards your buttocks. Keep your tailbone pointing toward the ground to
avoid arching your lower back. You should feel the stretch in the
front of thigh.
If you can't catch your foot or have to lean forward,
so much that you lose your balance trying this exercise, stand on
back to an elevated surface (such as a chair) and place your foot
about her. Keep your tailbone pointing toward the ground to begin the
about her. Keep your tailbone pointing toward the ground to begin the
stretching.
Kneeling quadriceps stretch with foot on a bench, wall or cushion(Kneeling
quad stretch with foot on bench, wall, or couch cushion)
Place your calf against the wall (or on a sofa/chair) and get into a "stride" position. Your calf should be
vertical and your foot should be flat. With both hands on the floor, gently bring your pelvis forward until you
feel a stretch in your quadriceps. Generally this will be very, very strong. Breathe and relax.
Position two involves placing your knee a few inches from the wall and then bringing your body into a more
upright posture without arching your lower back. If you can't keep your knee off the wall – and many people
won't – move it a little further off the wall until you can stand upright.
Keep your chest down and your glutes tight to make sure you don't arch your lower back. Having tight
quads usually causes you to compensate with a very large curvature (anterior lean).
The most common mistake made in this
stretching is arching the back a lot
low (first image below). in second
The most common mistake is to allow your hip
perform adduction (second image below).
psoas / iliacus
psoas / iliacus
The psoas and iliacus are known as the main flexors of your hip. If they are kept constantly tucked in, you will have poor hip joint
movement with a lot of forward tilt of the pelvis and a lot of forward movement in your femur. You will find it very difficult to rotate your
femur internally and even externally. Combined with tightness in your quads and adductors, you may end up feeling a “catching” sensation
in your groin when you flex, extend, and abduct, or internally rotate. If you feel cracking in the front of your inner thigh, stretching in this
area can be helpful.
Kneeling Hip Flexor Stretch(Kneeling hip flexor stretch)
Kneel in a long stride position with your front foot flat and the shoelaces of your back foot on the ground. If holding that position on your
back foot is uncomfortable, try tucking your foot in a bit so that your toes touch the ground instead of your foot. Squeeze your glutes so
that your tailbone curves down and keep your chest down to minimize the curvature in your lower back. Gently move forward until you
feel a stretch in the front of your inner hip (where your psoas and iliacus meet). Keep your pelvis bent so that your lower back does not
arch.
To stretch the hip flexor from different angles, you can extend your arm
the side of the hip you are working toward the ceiling. From that position, too
you can lean to the side, opening up the side you are stretching. You can too
rotate the rear foot toward or against the midline to change the
stretch angle.
Hip flexor stretch
standing(Standing hip flexor stretch)
Get into a long-stride stance that
feel stable. Your back foot can be supported
on your fingers Keep your pelvis bent while
lower to your front leg. hold the knee
back as straight as you can and focus on feeling the
stretch in the psoas/iliac area and also on
stretch in the psoas/iliac area and also on
the high adductors. This is an exercise that can be
very very useful during the day. you can extend your arm
the side you're stretching to the ceiling just like
you did with the kneeling stretch.
To work from different angles,you can rotate your
hind footso that your foot points to the side and
heel is on the ground to give you a stretch throughout
along the hip flexor and a little on the
adductors.
adductors
The adductors are often neglected when stretching, and that's a shame because they can drastically alter the mechanism of your hip.
Tightening your adductors too tightly can cause your lateral and posterior hips (read: your buttocks) to stop working and move your femur
toward the socket saddle. You may feel cracks in your groin and feel tension throughout the hip joint from tight adductors.
goalkeeper stretch(Goalie stretch)
Kneel on one knee and with both hands. Extend the other leg out to the side, perpendicular to the body. Keep the foot of the
extended leg on the ground and your spine neutral.
Slowly move your buttocks back while keeping your spine neutral. You should feel the stretch and tension in the inner thigh of the
extended leg. You may feel a stretch in the middle of the hamstring. This stretch works the entire adductor muscle extremely well and can
feel very intense.
If you feel “pinching” on the outside of your hip when attempting this stretch, try tissue work first in the areas where you feel the pinching,
then try the pigeon pose and glute stretch against the wall. If this doesn't reduce the pinching, focus on doing more tissue work on the
adductors for about two weeks. Look for hidden areas of tension in the upper groin. After two weeks of heavy tissue work on the
adductors, try this stretching exercise again.
You can vary the stretch by moving the ball of your foot up off the ground a bit, or even pointing it all the way up toward the ceiling. You
can try bending your knee a bit to help you stretch different points on the inside of the buttock.
frog stretch
Kneel with your knees as far apart as possible and your heels touching each other. Gradually rock back and forth and progressively spread
your knees further apart. You should only spread your knees as far apart as possible feeling a stretch in your inner groin WITHOUT feeling
pinched in your hip.
Experiment lifting your chest up, rocking back to your heels, then gradually lower your chest toward the floor. Also experiment with
squeezing and releasing your glutes, or pressing your knees into the floor and releasing tension with an exhale. The goal is to gradually
gain symmetry in the hip.
Making a few modifications to the Frog Stretch can go a long way in increasing the effectiveness of the stretch. Squeezing your heels
into each other and contracting your adductors to bring your knees down to the ground can help your hip muscles work better at the
end of their range of motion.
butterfly stretch(Butterfly Stretch)
Sit leaning your back against a wall and the soles of the
feet touching each other symmetrically and exerting pressure.
Move your heels in as close as you can and squeeze
your buttocks slightly to bend the pelvis. Use your hands to
gently push your knees away from each other.
Another option is to rest your elbow on one side and then push the
another knee to get a deeper stretch in the groin.
If you want to make a more passive version, you can use some weight
(dumbbells, kettlebells, etc.) to push the knee up.
below. This stretch should feel muscular. If you feel pain in the
joint, you need to bend your pelvis a bit more, or rotate
externally the femur. This stretch works the joint in the
end of their range of motion, so you have to be very careful and
work slowly and only as far as you feel comfortable.
Upside down spread eagle(Prone Spread Eagle)
This stretch is a good start if
notice that the other adductor stretches
they cause sensations of pinching or
hip irritations. to help you
activate the rotators to stabilize the
hip joint and relieve tension in
adductors, be sure to try the
Contract/Relax technique. To achieve this,
push your heels into the ground, count
to 3 or 5, then relax, count to 3 or 5, and
repeat.
Standing anterior adductor stretch(Standing anterior adductor stretch)
Stand tall with a raised surface in front of you (such as a
bench or chair). Place one foot on the surface a little to one
side so that the distance between your feet is the width of your hips.
Move your pelvis forward and keep the gluteus contracted on the side
of the leg that is touching the ground. This exercise is very similar to
standing hip flexor stretch This will stretch the flexor of the
hip and anterior adductors.
To focus more on the anterior adductors, place your foot on the
surface a little more to the side so that the distance between
your feet is greater than the width of your shoulders.
reverse ballerina(Reverse ballerina)
It is convenient to perform this stretch from a standing position, but it is easy to accidentally put pressure on the knee, so you must be very
careful when performing this exercise and make sure to maintain a position whereonlystretch the adductors
Stand next to a padded surface such as the arm of a couch or a plyo box and place your knee, calf, and foot on the box as shown. Move
your supporting leg slightly away from the box and begin to experiment with leaning your torso toward the box, away from the box, forward,
and/or backward.
You can also experiment with twisting your torso so that your chest is facing toward the box, away from the box, and so on; as you bend
over to discover the position that will help you stretch your adductors the most.
If you don't get the stretch with this exercise or feel cramping on the outside of the hip, try doing more tissue work on the inner thigh for
a few days or weeks and try again.
hamstring
The hamstrings are responsible for helping you maintain proper pelvic position, extending the hip joint, and flexing the knees. It also aids
in rotation or stabilization against rotational force and helps pull the femoral head into its socket. If the hamstrings are too tight from lack
of stretch, the hip, like the lower back, can end up with an astonishing amount of pain.
Supine Hamstring Stretch with Band(Supine hamstring stretch with band)
Lie on your back with a belt or band around the ball of your foot and hold the band in your hands. Keeping the knee bent, pull your foot
toward your face so that the knee moves up toward your chest. Slowly extend the knee so that you feel the stretch in the back of the thigh.
Another variation is to keep your knee straight as you bring your foot toward your head. You won't be able to bring your knee up to
your chest (unless you're very flexible, in which case you wouldn't need to do this exercise!).
A third variation of this stretch is to keep your knee bent as you pull your foot toward your face and your knee toward your chest. Once
in that position, practice extending and flexing the knee (referred to as "kicks" in the video).
A fourth variation is to pull your foot and leg out at an angle instead of up toward the ceiling. For example, you can pull your foot and leg
toward the midline of your body as you bring them toward your face and chest, accentuating the stretch on the outside of the hamstring and
hip. For even more accentuation, try pulling the band so that the side of the foot (thumb side) moves more toward your face. This version
can beextremelyUseful for releasing tension on the lateral hamstring if you do it enough.
If you pull your leg to the side, you'll feel more tension in your mid-hamstring and groin.
Supine hamstring stretch with gate(Supine hamstring stretch in doorway)
The supine hamstring stretch with a band can tire your
hands and torso; this stretch is a convenient passive variation
that will not tire your arms.
Rest your back against a door or wall with your buttocks as
close to the frame as possible. Place one leg on the wall, and the
another leg extended on the ground. keep both legs
extended with knees locked and toes
pointing towards your face.
The leg that is on the ground must have the knee and foot
perpendicular to the ground, and the leg that is on the wall should
have the knee and foot perpendicular to the wall. If you feel that your
buttocks lift off the ground or the leg that is on the ground
leans to the side, flexes the knee of the leg that is
lie on the ground OR stand a little further away
of the door frame. You should feel the stretch throughout the
hamstring of the leg that is on the wall.
Standing Hamstring Stretch(Standing
hamstring stretch)
Stand in front of a chair, sofa, or a raised surface. place both
feet pointing forward and parallel. keeping your spine
neutral dorsal, place the heel of one foot on the surface
raised and pull the ball of your foot towards your knee. You should feel the
stretch in the back of the upper leg. For
intensify the stretch, use a higher surface and/or
lean forward so that your spine stays
upright and your chest is close to the knee.
Another useful option is to aim for the lateral hamstring and slightly to the
lateral rotators. To stretch the lateral hamstring,
simply rotate your chest and pelvis toward the leg you're stretching,
then begin to lean forward from the hip. Naps
stretching the left lateral hamstring, you twist to the left and
you lean forward.
Another variation to work the lateral hamstring is to rotate
sideways your leg (turn your leg so that the ball of your foot
point to the side).
This should feel like a very strong stretch in the upper part.
lower outside of thigh.This is an example of how to do it
down on my knees.
Runner's Stretch(Runner’s Stretch)
Kneel in front of a chair or table to stabilize and support yourself. To stretch your left leg and right hip, place the back of your left heel in
front of your right knee.
Keep your left foot, right knee, and right foot in line. Slowly rise to your feet and begin to tilt your hips forward while keeping your lower
back arched.
You can play around with the amount of knee flexion in the front leg to find out what the maximum stretch is in the hamstring. You
can also play with the rotation of your front foot. By pointing the foot in or out you can discover tension in different places on the
hamstring.
You can also adjust the rotation of your rear leg and foot to explore other angles of tension.
GLUTEUS/HIP ROTATORS
If the gluteals and hip rotators are not able to stretch, your ability to flex, adduct, and internally rotate the hip joint will be greatly
reduced. Shrugging in this area can cause lower back tension, tenderness, and/or pain when you try to flex the hip.
Gluteal Stretch with Wall(Wall Glute
Stretch)
Lie on your back with both feet on the wall. come closer
enough so that your hip is at less than 90 degrees. move your
buttocks up.
Cross one leg over the other, grab your calf and lock the knee
with your elbow Keep the ball of the foot pointing towards the knee to
protect the joint. Maintain a curve in your lower back and
allow your buttocks/back to slowly move toward the floor.
You should feel the stretch in your glutes (leg rotators).
that is crossed over the other).
Feel free to gently sway to the left
or right until you discover the most noticeable angle of
stretching.
The second variation is to move the hip in, slide the
ankle slightly toward the thigh and hug the knee toward your chest.
Release your hip and pull the knee up toward your body to deepen the
stretching.
Paloma (Pigeon)
The pigeon pose in yoga is performed on the floor, but many people do not have the flexibility to perform it, and stretching can become
dangerous and/or ineffective. You also don't want to do it on the floor wherever you go, so here are some versions of Pigeon Pose that you
can do anywhere and whatever your flexibility level.
Standing(Standing)
Place your calf on the edge of an elevated surface such as a
table, sofa, or bed. Try to lay your calf, foot and knee flat
on the surface. If you cannot do this, leave your foot dangling in the
edge or use a surface with lower elevation. keeping your
chest raised so that your spine is upright,
gradually move your buttocks back on your exhales. For
To intensify the stretch, gently lean forward (without
arch your back) on your inhalations. You can tilt your chest up
your knee, calf, or foot – whichever direction you
help stretch more.
Standing pigeon pose with
contraction/relaxation(Pigeon standing
with contract/relax)
These variations of the Contract/Relax technique can help you
gain better control of the inner hip muscles that
allow you to lean forward. Think of these variations as
a way to increase your control at the end of your range of
motion. As you strengthen these internal muscles of the
hip, you will be able to increase the intensity of the stretch.
Sitting (also known as the
executive stretch)
(Sitting also known as the executive stretch)
Sit on the edge of a chair and cross one leg over the other with your
Sit on the edge of a chair and cross one leg over the other with your
ankle resting on the thigh. Keep your spine upright
then lean forward until you feel the stretch in your buttocks.
Feel free to move left or right to
get different angles of stretching. you can point your
chest toward your foot, calf, or knee to feel for different angles
of stretching.n.
Seated Pigeon Pose with Contraction/Relaxation(Pigeon sitting with contract/relax)
These variations of the Contract/Relax technique can help you gain better control of the inner hip muscles that allow you to lean forward.
Think of these variations as a way to increase your control at the end of your range of motion. As you strengthen these inner hip muscles,
you will be able to increase the intensity of the stretch.
On the floor
For more advanced people, you can perform this exercise on the floor just like in yoga.
Also, if you have a healthy back and move slowly, you can bend your back if
it helps you to improve the stretch, but always keep in mind that you should not apply pressure
on the back or knee.
It is important to note that all these variations, if your glutes are weak, can
be a bad stretch for you. If you feel pinching in your groin, or on the front of your thigh,
first try to mentally relax the inner thigh muscles with slow breaths and
deep. Try modifying the stretch angles as well. If the pinching doesn't stop
after you
After three or four attempts, stop and do not perform this exercise for at least two weeks. focus
in reactivating your hamstring glutes to improve the balance between the internal muscles of the
thigh and external hip muscles.
Hip internal rotation with upside down abduction(Prone hip abducted internal rotation)
This stretch can dramatically help you improve your internal rotation. It will teach your external rotators to allow internal rotation, as well as
teach your frontal adductors to relax to allow internal rotation of the hip joint. It is important to use the Contract/Relax technique as shown
in the video to ensure that you improve.
Contract/Relax technique as shown in the video to make sure you improve.
You want to make sure you never feel this exercise in your knee! Once you get a better range of motion, you can perform the exercise by
grasping your foot or ankle with your hand instead of using the band.
Sets: 2 per leg (definitely try this on both sides) for 1 minute on each side.
Frog Pose with Banded Internal Rotation(Frog with internal rotation with strap)
This is a more aggressive stretch of the internal rotator. It is important that you use the Contract/Relax technique as shown in the video to
gradually increase your range of motion. This exercise can feel extremely difficult and even dangerous. Go slowly and very carefully. While
you may feel some strong tension points, this is usually caused by extremely tight adductor and hamstring bands trying to prevent internal
rotation.
Sets: 2 per leg (definitely try this on both sides) for 5-10 contract/relax cycles for about 1 minute on each side.
TFL/ITB/GLUTEUS MEDIUS
If your TFL/ITB/GLUTEUS MEDIUS is tight, you may find yourself stuck with your torso leaning forward and feel pain and tension in your
back.
Kneeling TFL Stretch(Kneeling TFL
stretch)
The Fascia Lata Tensor can ruin the hip of many
people and is generally overlooked. It is a secondary flexor of
people and is generally overlooked. It is a secondary flexor of
the hip that can block rotation (in both directions)
such as flexion and extension. It can be very difficult
stretch it. Many of the so-called TFL stretches don't even
they point to the TLF, but this exercise does.
To perform the TFL stretch, start on one knee with one foot
forward into a stride position. This exercise is similar to
psoas stretch, but we'll do it a little differently to
make sure we work the TFL. Move your buttocks behind
so that your hip is flexed. Then move your pelvis in
direction of the kneeling leg. At that point, move your hip
forward.
You should feel the stretch in the area where the "fifth
pocket” of your pants. If you feel knee pain, you are
pushing far forward, very fast. back up and lend
pay close attention to the feeling of stretching in that area of ​the fifth
pocket. If you still have knee pain, you may need
perform more tissue work on the lateral quadriceps and ITB/gluteus
half. If you don't feel the stretch, you probably don't need
perform this exercise!
Supine ITB/TFL Pretzel Stretch(Supine ITB/TFL Pretzel stretch)
To hit the ITB/TFL (and even some of the deeper hip rotators) - Lie on your back with your knees bent, feet fist-width apart and parallel.
Place your arms out to the sides with the palms facing up. To stretch your right hip, take your left leg and hook it over your right. Pull your
right leg toward the ground, keeping your pelvis level with the ground if possible. Just pull as far as you can while feeling the stretch in your
hip. If you feel pressure in the knee, decrease the intensity until you feel it only in the hip. If you feel tightness in your groin/inner thigh, try
to mentally relax that area. If you can't, don't do this stretch for two weeks. You can try this stretch sitting down but doing it slowly, being
careful not to stretch or put pressure on the knee ligaments.
Above
REACTIVATION
The first group of reactivation exercises is made up of simple exercises to create the foundation for better movements. They are designed
to help you restore the lines of communication between your brain and the muscles that are usually asleep. As you perform these
exercises, be sure to activate the correct muscle group. If you feel like the wrong muscles are doing the job, you need to review your form
and focus your mental energy on using the proper muscles. When just focusing doesn't work, sometimes it's helpful to keep doing the
exercises using the wrong muscles until you fatigue them and allow the correct muscles to work.
As these exercises get easier, progress to more difficult versions and the more complex full-body exercises. You may start cutting easier
exercises out of your routine or using them as a short warm-up for full-body movements when you feel like they're no longer a challenge.
They can also be used as short rest exercises throughout the day when you feel like you've been sitting too long and need to reset your
hips (HIGHLY recommended for people in Stage 2).
Seated Hip Isometric(Sitting hip isometrics)
It can be really helpful to do this exercise throughout the day. This exercise trains the muscles around your hip joint to activate while sitting.
Sit on a chair or bench and use your hands, forearms, or elbows to create resistance in all three movements. You will try to lift your leg up
(hip flexion), out (hip abduction), and in (hip adduction). You will need to hold each contraction and count to 3-5, then move on to the next
movement. The goal is to feel the contraction of the correct muscles. You should feel your upper quadriceps, lateral hip muscles, and inner
thigh muscles respectively.
Sets: 2-3 Reps: 5-10
Seated Hip Rotation Isometric(Sitting hip rotational isometrics)
This exercise is extremely helpful if you feel a lot of muscle tension or pain around the TFL or in the upper part of the quadriceps. It will also
help you improve your ability to rotate your hip internally and externally. Two of the three positions focus on improving internal rotation: the
raising knee position and the raising ankle position. Generally the best way to perform this exercise is sitting on a sofa or a bench. A
low-slung bed can also be helpful as long as it's not too soft. Make sure you never feel irritation in your knees. If you feel cramps in your hip
muscles, don't worry. Most people haven't used these muscles in a long time, so sudden activation of them usually results in very bad
cramps.
Sets: 2-3 Reps: 5-10
Standing Gluteal Contractions(Standing glute squeezes)
Despite how simple it may sound, there are an impressive number
of people who find it very difficult to contract their buttocks at will.
To find out how connected your brain is to your glutes,
try this simple exercise.
Stand with your feet parallel, one foot apart
they. Place your hands on your buttocks. Keep your stomach and thighs
relaxed and contract only the gluteal muscles. Can
help you imagine that you are trying to pick up a piece of paper between your
buttocks. You should feel your buttocks contract under your hands.
If you can't activate your gluteal muscles, rotate the tips of your
feet sideways about 30-45 degrees and try again. This
it should reconnect you with your glutes. as you feel
an even contraction in your buttocks, place your feet parallel
again and repeat the exercise.
If this exercise is difficult for you, then repeat it several times at a time.
throughout the day until it becomes easy for you to contract your buttocks.
Series: 2-3 Repetitions: 20
Supine Adductor Press(Supine abductor presses)
Lie on your back with your knees bent and a fist apart with a band around them. When you pull out against the band with your thighs, your
thighs should be parallel to each other. Pull out against the band and release. Initially you will feel the thigh muscles working. Continue
until you feel the outer gluteal muscles (gluteus medius and maximus) working. Focus the effort on the glutes, making sure not to
compensate with your belly or quads.
This exercise helps activate the posterior lateral muscles that help move the femoral head into the proper position.
Series: 2-3 Repetitions: 20
Donkey Kick Quadruped(Quadruped Donkey Kick)
Get on your hands and knees with your hips on the
knees and your shoulders over your wrists. This position is
similar to plank yoga.
Keep your spine in a neutral position with a
slight curvature in your lower back. keeping knees
flexed 90 degrees, lift your foot up so that
that the sole of your foot points towards the ceiling.
Hold this position and count to 3-5, then return the
leg to the starting position. Perform each set with a
leg at a time (for example, don't switch legs between
each repeat)
This exercise encourages the buttocks (and in a certain way the
hamstring) to participate in hip extension.
It also helps activate the glutes to stabilize the
femoral head during hip flexion.
Sets: 2-3 Reps: 5-15
Hydrant(Fire hydrant)
Get on your hands and knees with your hands directly under your
shoulders and your knees directly under your hips. Lift one knee
to the side, mimicking the way a dog urinates into a fire hydrant.
Keep your hips and spine neutral (minimizing any twisting).
Slowly return your knee to the starting position. Repeat on the
same side for the entire set, then switch sides. You should feel
the gluteal muscles of the leg you are raising working. You may
also feel work in the gluteal muscles of the leg you are balancing
on.
To add difficulty, extend your knee after raising it.(like kicking to
the side). Try to achieve a 90 degree angle between
your leg elevated and your torso.
Sets: 2-3 Reps: 5-15
SIDE LYING LEG LIFTS(SIDE LYING LEG
LIFTS)
This is a MANDATORY exercise. Almost everyone with hip problems will find this exercise very difficult. Believe it or not, even NFL players
Matt has worked with have had an unimaginable amount of trouble with this drill. Building strength in this exercise helped those football
players; it will most likely help you too.
This is a two-position exercise to force your gluteus medius to work. You will perform both positions that will be counted as a series.
Position 1: Lie on your side with your head on your hand and support your body on the floor with your other arm. Bend both knees 90
degrees keeping your hips open at a 135 degree angle.
Extend the top leg so that it is straight. Bend the foot of the upper leg back and tense your thigh. Slowly raise your leg toward the ceiling,
keeping your foot parallel to the ground. You should feel the muscles behind the greater trochanter (the bump next to your hip) working.
This is the gluteus medius. If you feel muscle activity in your thigh or near the top of your quadriceps, point your toe down slightly to focus
the muscle activity in the gluteus medius. Hold your leg up for 1-2 seconds, then slowly return to the ground.
Position 2: Bring your knees close to your chest (hip at 90 degrees) and lift your leg toward the ceiling. This position is generallya lotharder
than position 1. Again, focus on activating the gluteus medius.
You can switch legs between sets (and most likely will need to).
Like the fire hydrant, this exercise engages the gluteus medius in stabilizing the femur in the joint and moving the femur through its range
of motion. This is a crucial function that many people have lost after spending childhood and adulthood sitting in chairs.
Sets: 2 per position Reps: 5-15
Banded Crab Walk(Banded crab walks)
This is another MANDATORY exercise for its efficiency when it comes to working the posterior gluteus medius. Just make sure you feel
the gluteal muscles working when you do it.
Place a resistance band around your thighs, above the knees. Squat down, keeping your shoulders back and chest open. Keeping your
knees from collapsing toward the midline of your body, take a large step to the side with one foot. Once your foot is on the ground, bring
your other foot back to resume the squat for the next step.
Your knees should remain bent at all times so that the height of your
your shoulders do not change (without moving up or down). If you have space, do the
exercise throughout the entire room and then return to work both sides.
If you're short on space, go back and forth.
This activates the gluteus medius and other lateral hip muscles so they can
stabilize the hip in a very common type of athletic movement.
Sets: 2-3 Reps: 5-15
Bridge(Bridge)
Lie on your back with your knees bent and feet on the floor, keeping your spine
neutral lats (a slight curve in your lower back). Lift your buttocks off the ground, keep that
position and count to 3-5. You should feel your gluteal muscles contract.
Keeping your spine neutral, slowly lower your buttocks back to the ground.
If you feel tension/work in your thighs while doing the bridge, try moving your feet around a bit.
further away from your glutes to help your body use your glutes more. If you feel tension in
hamstring, try to move your feet closer to your buttocks. This exercise is to work the glutes, focus on feeling the contraction in them.
Regression: If you can't feel the work in your glutes, use a belt or yoga band and
place it around your thighs, above the knees. Push your thighs into the band and hold the tension as you
bridge. This will help you activate the glutes and should make it easier to feel their work.
If this causes discomfort in your lower back, make sure you are using your glutes. Allow a friend to touch your
buttocks to help you target the correct areas. You can also imagine that you have a lottery ticket stuck
between your buttocks that you want to keep there. Perform the bridge while squeezing that ticket as hard as
you can!
You should try to progress on this exercise as soon as you feel yourself doing the bridge.
properly. Glutes that can produce hip extension properly are glutes that can also anchor the femur to the
hip socket properly.
The first variation that you can use to work the glutes more fully is to raise your back to perform thehip thrust. Position your upper back on
a cushioned sofa or bench so that the bottom of your shoulder blades meet on the sofa or bench. Keeping your spine upright, bring your
buttocks almost to the floor (you don't have to touch the floor), then contract your buttocks to bring them up. This works your glutes
through a greater range of motion than a conventional bridge.
The second, a highly recommended way to progress doing the bridge isput weight on your lap(with a cushion underneath if necessary).
The additional weight will force your glutes to work harder. Start with at least a 15lb (7kg) dumbbell or kettlebell, then add 5-10lbs each
week until you reach 50lbs (22kg) with good form. If you have access to a barbell, you can do this with a good cushion anda dumbbell on
your lapwith great weights. You can also do thebarbell hip thruston your lap.
The next two ways to progress on the bridge are to focus on strengthening one side only. You should try this exercise at this time to see if
there is asymmetry between your two sides. This will help resolve the asymmetry.
To perform theSingle Leg Drop Bridge(Bridge with Single leg descent), you push your buttocks in the way described above. Before
beginning the descent, lift one leg off the ground, then slowly lower your buttocks down, using one leg and your buttocks to stabilize the
movement. This is a particularly good exercise to help you target the weak side of your hip. For example, if your right glute is weaker than
your left, you can perform an additional set or two of lowering single leg bridges to help strengthen the right side.
To intensify single leg work, turn it into a single leg exercise with theOne Leg Bridge. Before performing the bridge, lift one leg off the
ground, using only one side to lift your buttocks.
It's a good idea to perform bridges with both feet on the floor with additional weight (if you can) for 3 sets, then perform 2-3 sets of the
one-legged version to address any asymmetry.
Series: 3 Reps: 8-20
90 90 posture with isolated isometric contraction(90 90 isolated isometrics)
This exercise will help you activate those deep stabilizers of
the hip. You can use this as a warm up before the
90 90 Posture with Frontal Bend or any other exercise.
Doing this throughout the day can be very helpful for
comfort your hip during a long work day.
Series: 2 Repetitions: 5 in each position. hold and count
up to 3-5.
Posture 90 90 with Forward Bend(90 90 forward leans)
This exercise is both reactivation and stretching. He
The objective is to teach the internal muscles of the joint of the
hip to work and stabilize as you lean forward.
in front of. Activate the lateral and posterior hip muscles
stimulates muscles like the piriformis to relax so that you are
able to have a full range of motion when flexing the
hip.
Once you can bring your chest to your knee, begin to bring
your chest to your shin (bring your chest to your knee like
heating). Once you can bring your chest up to your shin,
heating). Once you can bring your chest up to your shin,
use it as a warm-up to bring your chest down to your foot.
If you find it difficult to be in the 90-90 position, please review the
Seated Pigeon Pose with Contract/Relaxin the section
of stretching.
Series: 2 Reps: 5. Hold and count to 3-5.
Clinical abduction in 90 90 position(90 90 Abduction Clinic)
This is as much a reactivation exercise as it is a stretch. He
The objective is to teach the deeper muscles of the joint of
your hip to work and stabilize as you abduct in
the hip at different angles. By adjusting your body, you will also be
adding various degrees of force of flexion, extension, rotation
internal, and external rotation. Your hip may feel "stuck" the
the first time you do this exercise. Focus solely on
work the contractions in various directions as shown in
the video to make sure you gain control over those muscles. The
stuck feeling will disappear as you gain
control muscular.
Series: 2 Reps: 5-15 Hold and count to 3-5 (also
you can keep longer while you improve)
Standing ice skater with band(Standing banded ice skater)
Anchor a band to something low like a piece of furniture or tie a knot in the
band and closes a door on the knot. Place the band around
a foot. Keeping your body as upright as you can with a
good posture, pull your foot diagonally back and to a
side. As you pull, squeeze the glute on the same side and rotate your leg
so that the toe of your foot points out a little. Can
maintain a slight flexion in both knees throughout the exercise.
You should feel the exercise in the gluteus of the back leg (it is possible
that you feel work in the supporting leg as well).
Sets: 2-3 Reps: 5-15
REACTIVATION - ABDOMINALS
hip rotation with leg bent(Supine hip flexed single leg fallout)
Lie on your back with your knees bent and heels about 10-12 inches (25-30 cm) away from your buttocks. Flatten your back by tucking
your tailbone in (rear-tilting your pelvis) so that the curve in your lower back is less. Place your fingers on the bumps in front of your hip
(Anterior Superior Iliac Spine) so that your pelvis does not move as you perform this exercise.
Drop one knee slowly and gently to the side until you reach the end of your natural range of motion. The goal is to expand your range
of motion over time.
Be sure to test on both sides to find out any discrepancies and keep things even. This exercise will help you train pelvic stability in a neutral
posture so that your femurs have a stable base to move from. If you feel that this exercise is tightening your adductors, quadriceps, or hip
flexors, do not perform this exercise for at least two weeks while you focus on stretching and tissue work in the adductors, quadriceps, and
hip flexors.
Series: 2 Repetitions: 10
heel touch(Very tap)
Lie on your back with your legs elevated (hip flexed) and knees bent 90 degrees. Contract your core so that your back does not arch.
Slowly lower one heel to the ground, then return to the starting position. Finish your set on one leg before working on the other leg. The
goal is to have full control of your lower back without arching it.
If you want to add difficulty, slowly extend your knee as you lower yourself so that "heel touch" occurs away from your buttocks. Once
this exercise becomes easy, you can perform the double leg version. This exercise is much more difficult.
Begin "heel touch" near your buttocks, and gradually move away, making sure to meet the main goal (not arching your lower back).
This exercise improves coordination between the muscles that stabilize your pelvis and the muscles that help you articulate the hip joint.
If performing this exercise feels tight in the adductors, quadriceps, or hip flexors, do not perform this exercise for at least two weeks
while you focus on stretching and tissue work in the adductors, quadriceps, and hip flexors.
Series: 2 Repetitions: 10
table position(Plank hold)
Stand on your forearms and toes. Slightly bend your “tail” inward (posterior pelvic tilt) to flatten the curve of your lower back. Contract
your glutes. Maintain this alignment for as long as you can.
Make sure you don't arch your lower back too much.
If you haven't done ab work for a long time, you'll need to start on an elevated surface like a chair or bench and/or do short sets of 5-10
seconds. Your goal is to perform at least 60 seconds at a time.
This exercise strengthens key pelvic stabilizers to help minimize the tendency to forward tilt. If performing this exercise feels tight in the
adductors, quadriceps, or hip flexors, do not perform this exercise for at least two weeks while you focus on stretching and tissue work in
the adductors, quadriceps, and hip flexors.
Sets: 2 Exercise time: 60 seconds (to make it easier: do shorter sets)
Hunting dog(Bird dog)
Start on your hands and knees with both forearms and thighs vertical. Bend your tailbone and contract your belly to keep your back
neutral. Use your glute to bring your leg up and back so that it is parallel to the ground (for example, if you move your left leg, you contract
your left glute). At the same time that you lift your leg, raise the opposite arm up. The arm should also be parallel to the ground.
The goal of this exercise is to be able to move the
extremities without compromising the lower back. Makes
all reps with one arm/leg pair
before switching to the other pair.
If this exercise is too difficult for you, decrease your
Difficulty raising only the leg. once you are
able to perform all sets and repetitions
only with leg movement, try to perform
a few repetitions raising the arm as well.
Series: 2-3 Reps: 10 per side
Press Pallof
This is an exercise that you will only need to perform if you have very noticeable asymmetry in
the muscles of the lower back. If the muscles along your
lower back are more developed on one side of the spine, this
Exercise can help regulate asymmetry if you do it on one side only. yes, for
For example, the muscles along the left side of the lower back are more
developed, perform this exercise so that the band pulls on your left side.
If the muscles on the right side of the spine are more developed,
perform this exercise so that the band is pulling on your right side. you can perform
this exercise for extra credit on both sides if you want to strengthen your
obliques.
Place the band at chest level, towards the left or right side of your
body. Stand so that the band is at a 90 degree angle in front of you. Take the band at the height of your chest. Come into a slight squat
with your tailbone tucked in slightly, then contract your abs before moving your arms. Hold the position for a second and return to the
starting position.
The goal of this movement is to teach your body to stabilize itself in rotation. This means that your obliques must work and coordinate with
the muscles that control your spine to fight against the rotational force exerted by the band.
Series: 2 Repetitions: 10 only on one side if you have asymmetry
Above
FULL BODY MOVEMENTS
These exercises are more demanding both mentally and physically. The goal of these full body movements is to achieve proper gluteal
and hamstring activation. While you will feel muscular effort in your quads, your goal is to use as much effort with your glutes as possible.
At this point, you should have a good sense of how to contract your glutes. This is your chance to apply that skill to more complicated
movements that occur in everyday life.
Be sure to watch the videos we provide (click on the name of the exercises) to make sure you perform the exercises correctly. It may
be a good idea to consult with a trainer to review your form and make sure you are using the correct muscles without extra
compensation.
Split Squats(Split Squats)
Get into a squat stance, with your front foot on the ground. Keep your back foot on the ball or ball of your foot. Bend in the back and front
leg simultaneously and lower until your back knee lightly touches the ground. Minimize any forward movement (this usually occurs when
you bend your front knee before or more than your back knee).
Think about the femur of your front leg sinking into the knee joint.
hip so that it is “centered” (for example, centered in the socket of the hip).
hip). Focus on feeling this exercise in your glute and hamstring on the side of the
front leg (for example, if your left leg is in front,
you should feel the work in the gluteus on the left side).
This awareness of your body will translate into a better positioning of the
articulation in other movements. To add more difficulty to this exercise,
use dumbbells in both hands. Start with 5 pound (2 kg) weights.
.
.
When you manage to perform 3 sets of 10 repetitions with good form, you can
add more weight and gradually work up to using dumbbells
15 pounds (7 kg).
This exercise tends to use a lot of quad activity if you're not careful, so we'd rather not use heavy weights
unless you're 100% sure you're using the glute and hamstring majority of your front leg to lift up.
Sets: 2-3 Reps: 6-10
Backward Strides(Rear Lunges)
Stand tall with your feet hip-width apart. Take a big step back with one foot, touching the ground with the
knee of the rear leg or close to the ground. Pushing your hip towards the front leg, bring your body back to
the starting position in one movement using the glute and hamstring of the front leg.
As you perform this exercise, keep the calf of the front leg vertical and do not allow the knee to move
toward the midline of the body.
If you find it difficult to perform this exercise, use a pole or piece of furniture for support to help you through
the movement. Use as much additional support as you need and try to force your hip muscles to do the
work.
To add difficulty to this exercise, use a 5-pound (2 kg) dumbbell in one hand. Grab the dumbbell in the
hand on the same side as your back leg (for example, if your back leg is your right leg, grab the dumbbell
in your right hand). Once you can do 3 sets of 10 reps, add an additional 5-10 pounds.
Gradually work your way up to performing this exercise with 35-pound (16 kg) dumbbells with good form,
and you'll find that you've developed excellent hip balance, strength, and mobility.
Sets: 2-3 Reps: 6-10
Squats/Goblet Squats(Squats/Goblet Squats)
Start with your feet shoulder-width apart with the balls of your feet slightly out. Experiment with the distance
between your feet and the angle of the balls of your feet to get comfortable. Everyone's “perfect” distance
can vary. You should be able to squat with your feet hip-width or shoulder-width apart and your feet parallel
or angled 15 degrees. For you lifters reading this, the maximum angle of 15 degrees is not a rule of thumb
for all squats. It is only convenient for us since we will not use large weights.
From here, keep your jawline tucked in with your abs contracted and push your buttocks back and down.
Try to keep your calves as vertical as possible so that your weight stays between your feet/ankles. We
don't want your weight to be directed towards the balls of your feet. Just go as low as you can while
keeping your spine perfectly neutral.
Do not allow your knees to come close to each other at any point in the exercise. If you have trouble keeping your knees away from each
other, use a small exercise band around your thighs just above your knees to force your brain and body to push your knees out.
If you feel your inner thigh muscles engaging in this exercise, focus on doing more tissue work on the adductor. Also, mentally focus on
squeezing the glutes and activating them rather than your inner thigh muscles.
Once it's easy for you to perform 3 sets of 8-rep squats with good form, begin using a dumbbell or kettlebell to perform the goblet squat.
This squat is the same as the conventional squat, but now holding a dumbbell or kettlebell in your hands with the palms facing the ceiling
(as if you were holding a "chalice").
Performed properly, squats are excellent training for proper mechanisms for a variety of movements needed in daily life. With the
appropriate amount of glute work, it can also help you achieve an aesthetically pleasing buttock.
A good idea is to aim to be able to squat 45 pounds (20 kg) in the first six months. Train carefully (always maintaining form) and gradually
work towards this goal, and you will find that you can achieve it, even if it sounds unreasonable. Age and/or gender is not an excuse to
exercise less. Just progress at a comfortable pace for you, and you will achieve your goal.
Sets: 2-3 Reps: 4-8
Hinge Pattern / Romanian Deadlift
Get into a normal standing position with your feet pointing forward and
apart a distance equal to the width of your hips. Bend slightly inward
chin up, keep your chest down, and contract your abs. flex
knees slightly (about 5-10 degrees). Place your hands on your thighs and
push your buttocks back, and allow your upper body to lean in
forward like a bow. To return to the starting position, contract your
glutes to push your hips forward. The key to a correct inclination
of your hip is to use your glutes and hamstrings. Mentally focus all your
energy in your glutes and hamstrings!
To go deeper, the goal is to be able to bring your hands below your knees.
(and eventually to the ground as you develop flexibility). At the beginning,
you will discover that you are only able to reach above your knees because your
hamstrings are very stiff. If this is the case, be patient and focus on
stretch the hamstring more. You are only allowed to go as far as you can without losing your
neutral spine position.
Once you feel like you've mastered this move (it can take weeks to
some people feel that they perform this movement correctly), you can
start by using dumbbells in your hands. Begin by using dumbbells
5 pounds (2kg). If you are able to maintain form after 3 sets of 8 reps,
you can add more weight and use 10-pound (4 kg) dumbbells.
Every time you are able to complete 3 sets of 8 repetitions with weight,
increase the weight again. Once you've mastered the move, it's
very common to be able to gain weight rapidly in the first 8 weeks.
Be sure to maintain proper form and not feel strained in the adductors. Yeah
feel work in the adductors, slightly tilt the tip of your feet out and
focus on contracting your glutes and activating the hamstrings to lift yourself up. if not
help, focus on stretching and tissue work in the adductors before
try this exercise.
A reasonable goal is to be able to perform this exercise with 40-pound (18 kg) dumbbells without
compromising form. Yes, that means 80 pounds (36 kg), and as you gradually work up, your age and
gender will no longer be an excuse to do less!
For some people, you may need to use a barbell as the weight gets heavier. Heromanian barbell deadliftit
is more stable in your hands and consequently easier to control. This allows you to focus on using your hip
muscles instead of focusing on controlling dumbbells that tend to wobble.
Sets: 2-3 Reps: 4-8
Romanian One Legged Deadlift(Single Leg Romanian Deadlift)
Begin as if you were performing the deadlift.
Romanian. Tuck your chin in slightly
keep your torso down, and contract your abs.
Bend your knees slightly (about 5 - 10
degrees). As you push your buttocks back
and lean in at hip level, raise one leg
behind you so that you are balanced on a
leg.
Use the glutes and hamstrings of the leg that is on the ground for balance and control. Maintain the
movement until your torso is parallel to the ground. Squeeze your glutes and hamstrings to help you bring
your body all the way up to the starting position.
Be sure not to allow your supporting leg to lean in or turn toward the center line. You should keep your kneecap pointing straight ahead or
slightly to the outside throughout the movement. For example, if you are on your right leg, your right kneecap should always point straight
ahead or slightly to the right. It should never point to the left.
If this exercise is too difficult for you, use a chair, pole, or wall for support so that you can practice the movement with assistance. Every
day practice this exercise trying to use the assistance less and less.
Once you can complete 3 sets of 8 reps, you can start using a 5lb (2kg) dumbbell in one of your hands (if your right foot is on the floor,
use the dumbbell in your left hand). Once you do, use two dumbbells. Every time you can complete 3 sets of 8 repetitions, increase the
weight of the dumbbells by 5 pounds.
Sets: 2-3 Reps: 5-8
Adductor Squats(Adductor Squats)
This is an advanced exercise that you don't need to do. We recommend it in the FAI Fix for Athletes. We're including it so you can discover
what you can do as your hip becomes healthier and more mobile. It's a nice optional adductor stretch and reactivation tool if you're feeling
ambitious. It can be very helpful if you find that your adductors are tight all the time.
Stand tall with your feet wider than shoulder-width apart. Keep both feet pointed forward. Keeping your spine and chest upright, push
your buttocks back and begin to shift your weight onto one leg. Bend at the knee and bring your buttocks close to the ground, allowing
your other leg to balance on your heel. The other leg should remain extended, but a small amount of flexion is allowed.
You should feel a strong stretch in your leg.
extended. If this exercise is too difficult for you to
perform, you can use assistance (such as a chair or something
where you can lean on) and just go down to the
half. You can also use it as a stretch
placing yourself in the position below and using the
contraction/relaxation method.
Series: 2 Repetitions: 5-10
Above
CONCLUSION
You have reached the end of the collection of self-care/self-training tools that most help our customers with hip problems. Use these tools.
Play around with these ideas. And find out which one works best for your body. We have prepared the exercises in the best way we could
so that you can identify your problems and work on the most common ones that we have found.
If you hit a wall, don't give up. There are always other things to try – more frequent use of stretching or specific tissue work, different
angles to challenge your body, or working on muscle groups you may have overlooked. Explore all possible paths before giving up. We've
been constantly experimenting with new exercises and stretches for ourselves and our clients for years, and we're still learning new things
every month.
We really hope this guide gets you on the path to happier, healthier hips. If this guide gets you there, please let us know!by emailing us
here! We love hearing success stories. If you come across a bump in the road and feel that you need more personalized help, feel free
tocontact usand we'll see what we can do.
PLEASE REMEMBER: PAIN SUNKS. LIFE HAS NO WHY. Matt Hsu and
Shane Dowd
This post is also available in: English (English)
English Spanish
PLEASE PRINT THIS BOOKLET NOW!
Having a hard copy of this booklet and the FAI Fix page on an electronic device is
the best way to combine materials so you can make progress with your hips.
If you do not printthis booklet, you’ll drive yourself crazy clicking back and
forth! Please printit now!
1
CONTENTS
PLEASE PRINT THIS BOOKLET NOW! 1 CONTENTS 2 THE TSR SYSTEM 3 TEST
NOW, THEN TEST AGAIN 4 GENERAL GUIDELINES 5 COMMON SCENARIOS 6
HELPFUL HINTS 8 SCENARIO 1 DETAILED ROUTINE 9
Tissue work 9 Stretching 10 Reactivation 11
SCENARIO 1 ROUTINE 12 SCENARIO 2 DETAILED ROUTINE 13 Tissue work 14
Stretching 15 Reactivation 15 SCENARIO 2 ROUTINE 17 MAKING ADJUSTMENTS
18 COMMON HURDLES FOR BOTH SCENARIOS 18 Tissue work and stretching
make the targeted muscle feel worse 19 Sitting is painful 19 Flexing the hip is painful
20 Abducting the hip is painful 20 DURATION AND FREQUENCY OF THE ROUTINE
20 Scenario 1 Tracker 23 Scenario 2 Tracker 24
2
THE TSR SYSTEM
A one-size-fits-all approach is not possible because everyone’s issues can be so
unique. However, there are some very common threads and two very common
scenarios that we see a lot, so we’re using these as your starting point. Over
time, you will be customizing the routine for your own needs based on your own
testing and retesting.
We’ve included detailed instructions with pictures in the online FAI Fix Exercise
Library. Each exercise has a corresponding video available online. Where you
see the name of an exercise in bold, blue, and underlined, you can click on it, and
you’ll be taken straight to a video so you can get a full demonstration of the
exercise.
The first time you go through the FAI Fix, just start from the very beginning of
the routine that matches your scenario in the order we’ve outlined it. Get a
journal or some paper to keep track of how each of the techniques affects you
personally. You can also use the corresponding hip routine worksheets that
you’ll find in the back of this manual.
After you’ve gone through your routine for two to three weeks, you will notice
patterns. Some techniques may be enormously helpful. Some may feel like they
make things worse. Some may feel too difficult to perform properly. We’ve
provided regressions and sequenced everything so that you should be able to
build towards the harder exercises, so if something’s too hard or too easy, adjust
what you’re doing.
Focus on the ones that help, and leave outthe ones that make things worse or
the ones that you can’t do properly yet. It’s that simple. Every two to three
weeks, revisit your routine and make changes.
3
TEST NOW, THEN TEST AGAIN
In order to gauge improvement, you need to know where you are starting. You
might get hip pain from flexion or external rotation or even hip extension.
Maybe it’s sitting. Maybe it’s standing up from sitting. Whatever it is, take note.
The diagnosis of FAI gets thrown on top of a wide array of hip problems, so it is
hard for us to know exactly what bothers you. But you know, so you need to
write it down and be clear about it.
If there is a specific movement or range of motion that doesn't feel comfortable
you will want to test that motion before and after each and every technique the
first time you go through your routine. As you progress, you’ll want to do daily
and weekly tests to see how your body is improving based on what you're doing
with the TSR system. Always be testing and retesting because some things that
you do in this routine may actually make your symptoms worse. Determining
what makes you better and what makes you worse is part of the process!
The two self-tests you’ll find in the beginning of the Exercise Library are very
helpful to gauge progress, so you will also want to use them to gauge your
progress over the coming weeks, months, and years.
Do the self-tests now, and make a mental note of how it feels. Write down how
they feel and what your range of motion is like so you can use this information as
a reference for the future:
4
GENERAL GUIDELINES
For tissue work​, you may work on any area for 1 to 10 minutes per side. Which
side should you work on the most? The rule of thumb for tissue work is to always
spend more time on the side that feels the densest / most painful. With that said,
it is also important to do at least a little bit of work on the less problematic side
so that you have something to compare the “bad” side with. This will allow you to
recognize which areas need more work as you routinely compare left and right.
As an example - if you only have one side that is a problem, start with roughly an
80/20 distribution of time. As you make progress you can shift towards working
on each side 50/50.
If one side is clearly more dense and tender, then put more time into that side
and less on the other. For example, you find the adductors on your right leg are
very tight and tender, while the adductors on the left feel loose and limber.
Spend 5 minutes on your right side and 1 minute on the left (or even 0 on the
left!).
If doing tissue work on an area makes your hips feel worse, do not do it on that
area.
For stretching, you must hold the position for a minimum of 1 minute if you
expect any change at all. 2 minutes is the strongly recommended minimum (5
minutes is for most people an absolute max). If stretching any area makes things
feel worse, do not stretch that area anymore. Make sure you use a timer to keep
yourself honest about the amount of time you’re holding stretches.
In general, it’s a good idea to pair the tissue work with the stretch that goes with
each body part. For example, after you do tissue work on your psoas, do the
psoas stretch. This may not always be true, however, but it’s a good way to start
your explorations.
Once you get familiar with your stretches, it’s a good idea to use the
“contract/relax” technique to help you get even more results. The contract/relax
method teaches your brain to allow more stretch and to change relationships
5
between muscles. For example, if you are doing a hamstring stretch, you can
consciously contract the hamstrings in the lengthened position. Maintain the
contraction for a count of 3 to 5 (or even longer if you feel like it helps you), then
relax deeper into the stretch. This “wears out” the hamstrings and allows you to
get deeper. Alternatively, you could contract your quads and hip flexors while
doing the hamstring stretch, holding for a count of 3 to 5. This sends an
activation signal to the antagonist muscles, which sends a relaxation signal to
the hamstrings. For any muscle you’re stretching, you can use these methods to
elicit deeper relaxation.
For reactivation​, the sets and reps are listed. Once you can successfully
complete the higher range of the sets and reps with good form, push yourself to
do the harder version of the exercise (if there is one) or move on to a new harder
exercise.
For creating your personal routine​, this is all about finding your individual
needs. The templates that follow will help you create your own routine. Every
two to three weeks, reevaluate what you’re doing and see which exercises work
well for you. What you are doing will change based on what feels most effective
for your body at the time you’re testing it. There are pages you can use in the
back of this booklet to help you keep track of your exercises as you update your
routine.
6
COMMON SCENARIOS
Everyone we’ve talked to is experiencing a variation of one of these two
scenarios:
1. Hip flexion (whether the standing hip flexion, quadruped rock, or squatting
tests we mention later) causes pain and popping in the groin (at adductor
attachments) or in the front of hip (hip flexors). Your hips feel tight all the time.
Your back may also feel very achy when you lie down on your back (face up).
Lying on your side may make your hips ache as well. Doing exercises like lunges,
squats, or biking tends to worsen your problems either immediately or with a
day or two delay.
2. You are extremely flexible and your hips still feel tight, achy, or pinchy. You
have been doing yoga for a couple years and suddenly your hips are feeling
restricted with some pinching or dull aching when you hit certain ranges of
motion. In this case, you’re probably a woman, and you need to focus on the
reactivation exercises to help your hip joints stabilize through the full range of
motion. There is such a thing as too much flexibility, and you have probably
achieved it. Focus on careful reactivation/strength training to build up muscle
tension to help keep your joints in the right place. You are unlikely to lose your
flexibility, but you will gain stability and mobility as you strengthen the glutes
and hamstrings. You may also need to do some careful, pinpointed tissue work
to keep your joints moving correctly as you build strength.
Choose the scenario that describes you best, and let’s get started getting your
hips feeling better!
If you have already had surgery that didn’t help your problems, choose based on
your current situation, not on what your situation used to be. You may also need
to do some extra tissue work or have a skilled manual therapist help you do
tissue work to restore movement that was lost due to the surgery and/or the
time spent recovering from surgery.
7
HELPFUL HINTS
1. Don’t try to do EVERYTHING in one routine. Go for the ones that are
obviously beneficial. The worst situation is if you assign yourselves too many
things, get overwhelmed, and then do none of the work. You'll have time to
reinsert the others next time around. Be choosy and diligent!
2. If you get popping somewhere (e.g. in the hamstrings or in the adductors), try
tissue work and stretching those muscles consistently for two weeks to see if
that helps reduce the problem. Also, make sure you are improving your ability to
contract the muscle on the opposite side of the joint (generally your glutes) with
exercises like the bridge and the side lying leg lifts.
3. If at some point you start to develop a sense of soreness, aching, or weakness
in one or both knees, try doing tissue work and stretching for your glutes/lateral
rotators and leave out or reduce the intensity of your glute reactivation.
Training the glutes can create trigger points that refer pain into the knees, so
you may have to back off for two or three days. If this does not help, your next
two areas to focus on with tissue work and stretching are your quads and your
adductors.
4. Once you are familiar with the stretches, remember to be creative. Try using
the contract/relax method. Try moving to different angles, different upper body
positions, different foot positions, etc. A small change in angle can make a big
difference.
5. Think of good movement as good food. The more you reinforce bad patterns,
the worse you feel. This means that sitting on the couch, sitting in a car, or doing
exercises that aggravate your symptoms are BAD. Any time you do something
that provides negative stimulus, make sure you do something from the TSR
System to help your body feel good.
Remember that this is a process. Your journey back to better hip health will take
time, and you’ll need to keep working on your hips to keep them feeling good!
8
SCENARIO 1 DETAILED ROUTINE
You’re someone with a combination of tightness and weakness in various places.
In this case, it’s important to first address the quads, hip flexors, and adductors
with tissue work and stretching. All three of these muscle groups pull in a way
that can reduce clearance between the femur and the pelvis. The hip flexors and
quads can cause anterior tilting as well as a forward migration of the femoral
head, and the adductors can contribute to forward migration while also pulling
the femur in toward the midline, narrowing space in the joint. This will cause
premature bone-on-bone contact and may also result in muscles cramping or
spasming (i.e. the “impingement” may be bony or muscular). The glutes and
hamstrings may also be causing you some issues, but the most bang for the buck
is often with the quad and adductors first. You can add in work on the
hamstrings and glutes if you notice that it helps you a lot during your later
experiments.
As you get these key muscle groups to relax their stranglehold on your hip
mechanics, you’ll find it easier to activate your butt muscles. Your long-term goal
is to shift work from the quads, adductors, and hip flexors to the butt muscles.
Over time, your routine should gradually shift toward more and more
reactivation while still paying attention to tissue work and stretching to keep
things balanced.
Below you’ll find a detailed run through of your first routine. Use the sheet that
follows to help you take notes your first time through.
Tissue work
So which side should you work on the most? The rule of thumb for tissue work is
to always spend more time on the side that feels the densest / most painful.
With that said, it is also important to do at least a little bit of work on the less
problematic side so that you have something to compare the “bad” side with.
This will allow you to recognize which areas need more work as you routinely
compare left and right. As an example - if you only have one side that is a
problem, start with roughly an 80/20 distribution of time. As you make progress
you can shift towards working on each side 50/50.
9
Quads – Spend at least 5 minutes (up to 10 if it feels okay) twice per day on
whichever side your hip is uncomfortable. If it’s both hips, do both sides for 3
minutes each.
Adductors – Spend at least 5 minutes (up to 10 if it feels okay) twice per day on
whichever side your hip is uncomfortable. If it’s both hips, do both sides for 3
minutes each.
Hip flexors - Spend at least 2 minutes (up to 10 if it feels okay and beneficial)
twice per day on whichever side your hip is uncomfortable. If it’s both hips, do
both sides for 3 minutes each.
Glutes - Spend at least 2 minutes (up to 10 if it feels okay and beneficial) twice
per day on whichever side your hip is uncomfortable. If it’s both hips, do both
sides for 3 minutes each.
Stretching
If any of these muscle groups are particularly tight, feel free to stretch them
more than twice a day. Sometimes an entire evening stretching in front of the
T.V. on one or two muscle groups can make a huge difference.
Quads – focus on being able to do each variation of the kneeling quad stretch for
2 minutes at a time. If you are extremely tight, you’ll only be able to start with
the sidelying quad stretch. Patiently work your way toward being able to do the
kneeling quad stretch. Stretch this muscle group at least twice a day.
Adductors – Pick two adductor stretches that are particularly tough for you and
focus on them at least twice a day.
Hip flexors – Do at least a total of 2 minutes of stretching for both sides. Glutes
and/or hamstrings – Do at least 2 minutes per side. (optional)
10
Reactivation
Standing glute squeezes – You may stop doing these daily once you can reliably
activate your glutes in this position easily.
Quadruped Donkey Kick / Bridge Variations - Choose two exercises that are
challenging but which still allow you to feel the butt muscles working properly.
Supine abductor presses/Fire hydrant/Sidelying leg lifts/Crab walks – Choose
two so that you are turning on the lateral hip musculature.
Abs – Choose any of the ab exercises that you feel you can do properly.
Once you have seen improvements in your range of motion in the hip and a
decrease in the tightness and impingement in the hip joints, you may begin to
replace the quadruped donkey kick and bridge variations with full body
movements. Be aware that you may need to increase the amount of tissue work
and stretching you do when you start introducing the full body movements as
your muscles will likely react strongly to a new level of work intensity.
11
SCENARIO 1 ROUTINE
Start date:__________- End date:____________
Use this sheet to keep track of what your routine is as well as what you notice
specifically about each exercise. Shoot for a maximum of 15 exercises total to
keep your routine manageable. Use the page at the end of this booklet for extra
copies.
NOTES
TISSUE WORK (1 – 5min. per spot)
1. Quads
2. Adductors
3. Hip flexors
4. Glutes/Hamstrings (optional)
STRETCHING (1 -3 min. holds)
1. Quads
2. Adductors
3. Hip flexors
4. Glutes
REACTIVATION (write down sets and reps for each)
1. standing glute squeezes
2. quad donkey kick or bridges
3. abductor presses/fire hydrant/ leg lifts/crab walks (choose one) 4. abductor
presses/fire hydrant/ leg lifts/crab walks (choose one) 5. abs (choose one that
you can do properly)
12
13
SCENARIO 2 DETAILED ROUTINE
In this case, you’re very flexible. You’ve probably done tons of massage and
tissue work with limited to no beneficial long term effect. You may feel tight all
the time in some spots, but stretching and tissue work don’t really relieve it. The
focus will be on reactivating muscles so they can relax their protective tension
and doing targeted tissue work only ​on areas that improve your symptoms.
Because this workout is focused on reactivation, dosage is key. Start with five
days a week. If this makes you too sore or uncomfortable, do it every other day
(3 to 4 times per week). As soon as you find yourself using weights that are
heavy enough to cause you to sweat and/or feel challenged, only do the full
workout 3 days a week. On the rest days, you may still do the bodyweight
reactivation exercises that do not include weights, as long as your body doesn’t
get tight and achy.
If you find an exercise with weight that is very helpful that you’d like to do every
day (e.g. Romanian deadlifts commonly fall into this category), use a weight that
is only 60% of the weight you use on the challenging official workout days.
Exercising periodically throughout the day to reawaken and stabilize your hips is
strongly recommended for those who are very, very flexible.
No matter what, no matter how ambitious you are, make sure you take one day a
week to just relax!
Below you’ll find a detailed run through of your first routine. Use the sheet that
follows to help you take notes your first time through.
Tissue work
Focus on the areas that feel the most dense. Sometimes this takes some
experimentation learning how to really “get in there!” Typically the areas that
need it the most are the quad and adductor attachment points and deep glute
and hamstring attachments points. Spend more time (maybe 80/20 split) on the
more
14
problematic side but always make sure to do a little work on the asymptomatic
side. If both are problems, work on both equally.
Quads – You may try any quad tissue work for up to 2 to 4 minutes per day on
the affected side (both if problems are on both sides) and test to see if there is
any difference immediately after doing it. If it does not affect you positively,
don’t do it initially. You may need to add it once you are using weights.
Adductors - You may try any adductor tissue work for up to 2 to 4 minutes per
day on the affected side (both if problems are on both sides) and test to see if
there is any difference immediately after doing it. If it does not affect you
positively, don’t do it initially. You may need to add it once you are using weights.
Glutes – It’s unlikely you’ll need this, but try it. If it doesn’t help initially, don’t do
it. Be aware that as you train with weights in the Romanian deadlift and the
lunges and squats, you may need to add this in to keep your hips and knees
happy.
Stretching
Quads – You may try a kneeling quad stretch, but if it has no obvious benefit,
don’t waste your time.
Adductors – You may try any of the adductor stretches, but if it has no obvious
benefit, don’t waste your time.
Reactivation
Standing glute squeezes – This is a relatively easy coordination exercise. You
may stop doing these once you can reliably activate your glutes in this position.
Bridge - Use weight in your lap to increase the difficulty of this exercise as soon
as you have mastered the movement without weight.
15
Hip thrust – You may replace the bridge with this exercise once the bridge is
very easy. Use weight in your lap to increase the difficulty of this exercise as
soon as you have mastered the movement without weight.
Sidelying leg lifts/Banded Crab walks – Do both and make sure you feel it in your
butt muscles.
Abs – Choose any of the ab exercises that you feel you can do properly and
progress to harder ones with proper form as you can.
Romanian deadlift – Get perfect form first, then add weight! This exercise with
weight is one of the most important exercises for you. Start light and work your
weigh up to at least 40 lbs. (18kg) in each hand.
Split squats / Rear lunges – Start with split squats focusing on glute engagement,
then progress to rear lunges when you’re capable. When you can do rear lunges
with 15 pound dumbbells in each hand, you can probably work fairly well at
squats. Once you can squat, squatting can likely replace the rear lunges in your
routine or rotate with squats every two to three weeks.
Squats/Goblet Squats– Pay VERY close attention to doing the squats with your
glutes activated. As soon as you can, progress to the Goblet squats with weight.
As you introduce the weight to the Romanian deadlift and to the Lunges and
Squats, you may actually need to do some tissue work on your quads, adductors,
and glutes to keep your body happy.
16
SCENARIO 2 ROUTINE
Start date:__________- End date:____________
Use this sheet to keep track of what your routine is as well as what you notice
specifically about each exercise. Shoot for a maximum of 15 exercises total to
keep your routine manageable. Use the page at the end of this booklet for extra
copies.
NOTES
TISSUE WORK (1 – 2min. per spot) OPTIONAL
1. Quads
2. Adductors
STRETCHING (1 -3 min. holds) OPTIONAL
1. Quads
2. Adductors
REACTIVATION (write down sets and reps for each)
1. Standing glute squeezes
2. Bridge
3. Hip thrust
4. Sidelying leg lifts
5. Banded crab walks
6. Abs
7. Romanian deadlifts
8. Split squats / Rear lunges (choose one based on difficulty)
9. Squats (as soon as capable)
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MAKING ADJUSTMENTS
Once you’ve gone through one of the common scenario routines for two weeks,
you need to start experimenting. Go through the other exercises that you
haven’t done yet and try each one. This can be time-consuming, so do it in
chunks. If you are very immobile and tight (e.g. Scenario 1), focus more in the
tissue work and stretching portions to begin with. If you are a Scenario 2, focus
more on the reactivation exercises. You can find the full list of exercises on the
FAITH Fix program page.
Be sure to use the following to gauge effects/progress:
◉ Any motion you know that causes you some discomfort, weakness, clicking or
popping, etc.
◉ Quadruped Rock
◉ Standing Hip Flexion
◉ Squat (once you can squat with good form and no compensation)
If you find an exercise to be helpful, add it to your routine. If you find that you
have too many exercises to reasonably keep, then narrow down to the ones that
feel the most beneficial.
COMMON HURDLES FOR BOTH
SCENARIOS
If any of the following sound like you, put the suggested exercises into your
routine.
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Tissue work and stretching make the targeted
muscle feel worse
If you’re a Scenario 1 and doing any stretch just makes the muscle feel worse,
you should experiment with contract/relax of that muscle and of the muscles
around it.
For example, if you find that adductor stretches make the adductors hurt more,
practice getting into the stretch, then contracting the adductors. Think of it
more as a strength exercise than a “stretch.” Attempt to build strength,
coordination, and control of those muscles. This will feel weak and a little
painful. As the strength builds, the pain will reduce. If you’re a Scenario 1, work
on increasing the range of motion this way. If you’re a Scenario 2, really focus on
gaining control. As you practice this more and more, the muscle should start to
feel more normal.
You should also experiment with contracting the muscles around the hip joint in
other directions. For example, if you are having trouble with pain in the goalie
stretch, work on contracting various muscles while in the stretch: try the
adductors (pushing the foot into the floor), the quads (squeezing the thigh
muscles tight), the hamstrings (pulling the leg back or down into the floor if your
toes are up), and the glutes (squeezing and/or pulling the foot back/down).
If these tactics do not help, do some of the exercises that encourage better
isolated control over the muscles around the hip joint.
Take a look at the sitting hip isometrics, sitting pigeon isometrics, and sitting
pigeon with contract/relax. You may also find benefit from the sitting hip
rotational isometrics, 90 90 isometrics, 90 90 with forward lean, prone hip
abducted internal rotation, and frog with internal rotation with strap.
Sitting is painful
Work on the sitting hip isometrics, sitting pigeon isometrics, frog with internal
rotation with strap, and sitting pigeon with contract/relax. Also look at the
sitting
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hip rotational isometrics, the 90 90 isometrics, 90 90 with forward lean, and
90-90 abduction clinic.
If you’re a Scenario 1, make sure you work toward building flexibility and range
of motion while you’re doing those exercises.
If you’re a Scenario 2, focus on the quality of the contractions. Experiment with
increasing the intensity and duration of the exercises.
Flexing the hip is painful
Take a look at the supine hip flexion isometrics exercise. It will help you learn
how to engage the muscles in the front and back of the hip as you get into
deeper and deeper levels of hip flexion. Do not force the range of motion. You
may find the 90-90 abduction clinic helpful as well if you focus on bringing your
chest towards the knee that is out to the side.
Abducting the hip is painful
There could be a lot of things you need to address. Here are two suggestions
that commonly work: 90-90 abduction clinic and the frog. The 90-90 abduction
clinic will gradually help the muscles around the hip learn to stabilize. The frog is
also helpful for building strength in the anterior adductors if you use
contract/relax method and focus on using the adductors to pull the knees into
the floor.
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DURATION AND FREQUENCY OF
THE ROUTINE
We expect you to notice some positive results within 3 weeks. Let’s be very
clear: you will not be magically cured in 3 weeks, but you should see some things
changing for the better. Put yourself in one of the following categories to
estimate how much time you reasonably need to put in daily to see those results.
Stage 1​: Great Deal of Pain / Interferes with daily activities – at least 45 minutes
per day, 6-7 days per week. For people in this situation, your time investment is
quite likely going to be fairly lengthy. You will find lots of tightness, tenderness,
and weakness all over your body. You are going to find many of the ideas in this
book to be very challenging, so you’ll be doing a lot of work. Just keep in mind
that over time you will make progress. Also, keep in mind that being proactive
now saves you from many, many months of agonizing and atrophying on a couch,
hoping that a surgery “worked” followed by months of rehab and the lifelong
warning that you should never “overdo it.”
In a best case scenario, you’ll find that there are only 4 or 5 exercises that are
necessary to make a huge difference to your hip comfort levels. In that case,
your routine will take you no longer than about 20 to 30 minutes. However,
since you have a great deal of pain, you should also do the routine multiple times
a day and/or pick two favorite exercises and do them throughout the day, so
you’ll still be putting in 45 minutes a day. This is especially important if you have
a job that tends to aggravate your hips (e.g. jobs with long periods of sitting or
standing).
Stage 2​: Moderate Pain / Only interferes with activities occasionally - With this
stage, you can expect to spend about 20 minutes per day, 4-7 days per week. If
you’re at this stage, you are likely going to find a few key things that really help
you, and you’ll want to be diligent about them. You’ll be able to take a few days
off a week so you don’t feel like your whole life is dedicated to your hips, but
regular maintenance is necessary to make progress. If you have a job involving a
lot of
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sitting or other activities that feel like they tighten up your hips, you’ll want to
use periodic stretches and tissue work throughout the day to keep your hips
happy.
Stage 3: Athletic Pain / Only interferes with sport or weightlifting activities - If
you’re in this stage, your timing may vary depending on how intense your
activity is and how much it tends to aggravate the situation. You may need to
spend only ten minutes a day with a few of the TSR tools, or you may need to
spend an hour or two over the course of the day working on the dense,
shortened muscles. Focus also on learning how to reactivate your hip
musculature properly. Many athletes – even professionals – get used to firing
the wrong muscles at the wrong time, leading to much discomfort. If you’re
training hard as a weightlifter or other sport athlete, you may want to look at the
FAI Fix for Athletes for more aggressive techniques to keep your hips moving
well while training.
No matter what stage you’re in, the more diligent you are about teaching your
body how to relax and how to move properly, the better off you are.
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Scenario 1 Tracker
Start date:__________- End date:____________
Use this sheet to keep track of your routine. Don’t exceed 15 exercises or you’ll
be overwhelmed. This is just a rough guide. You may adjust the number of
exercises to emphasize different stages based on your changing needs.
NOTES
TISSUE WORK (1 – 5min. per spot)
1.
2.
3.
4.
5.
STRETCHING (1 -3 min. holds)
1.
2.
3.
4.
5.
REACTIVATION (write down sets and reps for each)
1.
2.
3.
4.
5.
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Scenario 2 Tracker
Start date:__________- End date:____________
Use this sheet to keep track of your routine. Don’t exceed 15 exercises or you’ll
be overwhelmed.
NOTES
TISSUE WORK (1 – 2min. per spot) OPTIONAL
1.
2.
STRETCHING (1 -3 min. holds) OPTIONAL
1.
2.
REACTIVATION (write down sets and reps for each)
1.
2.
3.
4.
5.
6.
7.
8.
9.
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