Easing Chronic Hip Pain with Pilates
Hip pain is by far the most common complaint I hear about in my Pilates studio. Many, many people experience pain in their hips, whether they feel it on the side of the hip, in the groin or the low back. When I check in with clients at the start of a session, sometimes they'll say the pain is better, shrugging their shoulders as if to say, I have no idea why. Sometimes the pain is worse and they say they haven't been able to do the things they really love doing, like gardening, biking, hiking or just being as energized about life as they would like. Other times the pain has migrated, and they tell me, it used to hurt in my inner thigh and now it hurts in my low back.
So what can you do about all this hip pain and discomfort? Can Pilates make it go away?
No stranger to chronic hip pain, I take a three-pronged approach to help me soothe my aching hips:
Lower body strength and stability sessions, including single-leg accessory exercises
Mobility work to move my legs, hips and back through their full range of motion
Pain medication, heat, and body work to ease the discomfort
Picking Myself Up Off the Sidewalk, Or How I Hurt My Hip
Before I tell you the details of each of these tools, I have to tell you a personal story. (But if you just can't wait, you can jump to more details about the management plan.) About twelve years ago I took a fall on a concrete sidewalk. I fell onto my left side, but I immediately experienced pain on the right side of my low back. I was young (ish) and didn't take it seriously. I used a heating pad and took Advil for about a week and then declared myself all better. Sound familiar?!?
Every 8 or 9 months I'd experience a flare up for a few days. I'd apply heat and take Advil, and it'd improve. This went on for several years and during this time I thought I didn't have a real problem. I was still doing all the things I wanted to do, albeit with some pain and discomfort, but I could do them, right? I must be fine - or so I thought.
Eventually this lackadaisacal attitude caught up with me. The episodes of pain started coming more frequently, laster longer, and were more intense. Finally I got myself to a doctor who comfirmed that I had no structural problems in my hip (nothing broken or torn) and sent me to a physical therapist. After six weeks, the physical therapist told me I was good to go. I had followed her instructions, diligently did my exercises, and I was ready to graduate!
If this was the case, why didn't I feel strong and stable on my hips?
Cue Pilates to the Rescue - Or At Least the Starting Line
When I asked the physical therapist about this, she recommended I do Pilates, saying it would teach me to be more aware of my posture and to strengthen my core muscles to better support my low back and hips. I found an amazing instructor and invested in one-on-one Pilates sessions. If you had looked in at one of the sessions, you would have thought, she's doing nothing in there! What I learned in that studio was to breathe deeply, especially into the back of my ribs; to move my pelvis according to precise instructions without moving anything else; and to move my legs in their sockets without changing the rest of my posture.
So my physical therapist was right: I did become more aware of my body, especially the deepest muscles of my core, and I learned to use those muscles to stabilize my trunk. But did this resolve my hip pain?
Continuing the Race Against Pain
Well, the truth is, I thought it had until I upped my game. During my Pilates teacher training program, I found it nearly impossible to complete exercises where I had to balance on one leg. Whenever I had to use my right leg to stabilize in an exercise (ie, my right leg was the standing leg), I would wobble, my right knee and foot would collapse inward, and I'd lose my balance. Worse yet, the more I tried these exercises, the worse my hip pain got. So what was going on exactly and how would I ever improve?
For several years I tried to strengthen my hips and improve my balance, but every time my hip pain would flare, and I'd back off, thinking, I just can't do this. What pushed me over the edge was an honest-to-goodness injury - and knowing to call it that right away.
One Step Forward, Two Steps Back
In early 2021 I decided to start a running program, and I went about it methodically, buying new shoes and beginning with walk/run intervals. Looking back, I know now that I was running with a major muscle imbalance in my hips - my right hip was significantly weaker and as a result of compensating for this, my left hip was significantly tighter - and this was true whether or not I was feeling pain in my hip. In other words, it was happening and I wasn't even aware of it. It's not surprising that my running quickly resulted in a stress fracture in my right foot.
This time I took things seriously. As soon as I was able, I got myself to a physical therapist, and I told him on day one, we're not going to fix my foot problem unless we address my hip. What followed that first appointment was six months of weekly PT sessions, daily exercises that were hard to do, and yes, sometimes more pain. Four months in I was experiencing an intense bout of pain, and I requested an MRI to ensure we were on the right track. Sure enough, the doctor told me I had gluteal tendonitis as a result of poor biomechanics.
Now what does that even mean? It means my brain had responded to the pain signals coming from my right hip (and remember these had been coming from my hip for years and years) by utilizing my left leg more than my right. (An interesting experiment is to pay attention to how you're standing when you're brushing your teeth or chopping vegetables. Chances are you're bearing more weight on one leg than the other.) I had developed patterns of being and moving through my life that favored my left leg in order to avoid triggering pain on my right. These patterns, repeated over many years, resulted in a significant muscle imbalance in my hips, which eventually led to inflammation, pain, and injury.
Progress Isn't Measured By a Straight Line
So what was the remedy? More PT, more strengthening exercises and constant management of pain and inflammation. When the doctor who read my MRI told me this, I was gutted and I immediately came home and messaged my friend Sonia Ahmed, a physiotherapist in London. Was this really true?, I asked. Could this doctor really be telling me to just deal with the pain and keep exercising anyway?
Sonia assured me that I was on the right track. She told me it would be a long road, with lots of hard work and bouts of pain and inflammation along the way, but she was absolutely certain that I could do it.
That conversation was seven months ago, and last week for the first time, I did a hip workout that felt truly solid and strong and stable.
Creating a Healing Plan You Can Stick With
After my conversations with Sonia and my doctor, I realized I needed a plan that would set me on the right course, one that I could refer back to when things got tough. Having this plan helped me accept, and even embrace, the tough days. At the outset, I knew the tough days would come, and I chose to see them as a sign of progress, physical proof that I was doing the necessary hard work to strengthen and balance my hips.
Building Hip Stability and Strength - It Starts with a Squat
My stability work began with a basic sit-to-stand exercise using a chair, progressed to a bodyweight squat, and eventually a loaded squat holding a kettlebell. My Pilates work complemented these exercises by reinforcing the movement pattern (a basic hip hinge without rounding your back) and focusing on maintaining stability throughout.
I practice a lot of Footwork on the Reformer, both on two legs and one, which is a lot like a supine squat. I also use the Wunda Chair to practice all sorts of single-leg exercises, including Footwork, Pumping, and Mountain Climber. On the painful days, I do only an isometric hold; on good days, I add spring tension and up my pace to challenge my stability.
Mobility Exercises Keep You Fluid
As I started building hip stability and strength, I knew I needed to keep my joints mobile using a different type of exercise. My favorite Pilates exercises for loosening the hips are the leg springs on the Cadillac or Wall-Mounted Springboard. Lying on the mat supports your spine and the footstraps help you lengthen your legs away, creating a little more space around your hips. On a good day, I might add Front Splits on the Reformer, which provides a great stretch for both the hip flexors and extensors (the front and back of the hips).
Managing the Pain - Because You're Going to Feel Pain
Let's face it, getting stronger is an uncomfortable process, often resulting in muscle soreness and pain. You know you need to strengthen in order to heal, but you also don't want to be so uncomfortable that you feel like abandonning the process altogether. I worked with my doctor to create a plan that included oral anti-inflammatories, topical anti-inflammatories, heat, and body work. I take the pain medications as needed, and I schedule a monthly massage or chiropractic session to keep me feeling my best. If you're not sure who to call, ask! Your friends, co-workers, and definitely your Pilates instructor can recommend someone.
NOTE: It's always a good idea to discuss any pain management plan with your doctor.
There are also an increasing number of tools you can use at home to increase blood flow and relieve muscle tension and soreness. Some of my favorites are a foam roller, a vibrating foam roller (yes, it's a thing!), a massage gun, small massage balls, and the medium Chirp Wheel.
Let pain be your guide - a little tenderness is okay, but outright pain is a sign that you're too inflamed to be adding the pressure of any of these tools.
It All Starts with Pilates
Remember at the start of this article I said I had just completed a strength workout that felt truly strong and stable? That's a fact, but it doesn't mean I no longer have hip pain. This could be good news or bad news - I choose to see it as positive. Here's the thing...we all want to keep living vibrant, healthy lives. As we age, our joints deteriorate, we lose muscle mass more rapidly, and our neural pathways aren't as sharp. But the alternative to healthy aging is a whole lot less appealing! I had to drop the expectation that I should feel at 50 like I did at 20, and create a plan for active aging that includes multiple forms of exercise and pain management.
Pilates is the foundation of this plan; it underpins how I approach my healthy, active life. I practice it to build more stability, improve my posture, increase mobility and to feel more vibrant. When you practice Pilates with me, you'll feel these same benefits, and you'll have more body awareness and energy. My goal for all my clients is that Pilates supports everything else you do in your life - whether that's your desk job, taking care of your kids or grandkids, or performing better in your sport. We do Pilates to do life better!