Dealing with hip pain – 3 ways to tackle it

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Recently, I was working with a lady called Jenny. She came to see me because she was gradually getting pain around her hip and it went down the thigh a bit. She had been through a bit of a rough time. After hitting 48, she was noticing she was gaining weight. Jenny felt this was a combination of factors. She had changed jobs which meant she had to drive longer to work and was sitting at work more. In addition, due to the training required for her new role she was not able to continue her usual exercise routine. She self-reported that it wasn’t an intense work out but she had been walking for 30-40 mins most days and had a small weights routine at home. Jenny also said she thought she was beginning to show signs of being peri-menopausal. Whilst we were talking, she confided in me that the hip pain she was getting worried her, now she was 48 maybe she was starting to get arthritis in her hips.

As we continued the appointment, and I assessed I was able to reassure her that the pain was unlikely to be arthritis and more likely to be lateral hip pain or tendonitis or a bursitis (this is either an inflamed tendon around the hip or bottom or an inflamed bursa). I was able to work on her stiff back and movement through her joints and tight muscles. From here we worked out an exercise rehab programme for her to do.

I love these sorts of interactions, where someone has a fear or concern and through assessing and talking, we can work out the issue and I can give reassurance, treat and provide useful, applicable advice, exercises and management techniques. I also had the time to explain that a big part may be her lifestyle change. Due to her reduced activity levels, she may have irritated the soft tissues. We talked about things she could do to avoid this. We also discussed that this is a common issue for women around the time of menopause. We looked at different ways the menopause and change in hormone balance can effect the musculoskeletal system. (Name was not real name)

3 Ways to head off this sort of lateral hip pain can include:

Exercises that get your gluteal (buttock) muscle working

Avoiding sitting for long periods especially in low seats

Break up long periods of sitting!

Stay in touch to read the next article about how menopause can contribute to aches, pain and sports injuries.

My philosophy of care

Published on by Caroline WhitehornLeave a comment

Let’s take a break from talking about sleep, food and activity goals. I am going to bring it back to why I do what I do the way I do!

I like to spend time with my patients. My appointments are longer than typical health care practitioners in similar fields such as other osteopaths, chiropractors or physiotherapists. Having worked in this industry since 2007, I have heard a lot of feedback from patients about what they value, often they have felt unheard or rushed by a health care practitioner. I have come to learn that a lot of pain management and pain resolution starts when a patient feels heard. This works in two ways;

One, the patient feels they have the time to say what they want to say about their experience of pain.

Two, as a practitioner it allows opportunity to really understand someone’s pain and their personal values and attitudes towards life, lifestyle choices and any treatment or rehab I suggest.

I see what I do as a partnership with the patient. We discuss and share the decision making of how to manage and treat. I want patients to feel empowered by what we discuss and how I treat. This enables me to help a patient develop the tools to often help themselves and really understand what is going on with their injury or issue.

My initial appointment, if we have never met, I allow an hour. This gives time for the niceties and a full assessment with lifestyle choices and previous history included, It allows for a thorough physical assessment. This may include special tests, recognised by any healthcare practitioner, range of movement, replicating things that aggravate the issue. Finally, I summarise what I have found or assessed for, and treat with manual therapy (AKA hands-on treatment ) and advice on appropriate rehab exercises to do. Because I allow a good length of time we have chance to really get to grips with more nuanced lifestyle choices and personal values.

A follow up appointment is up to 40 minutes. I give this time to be able to really check in with the patient and understand what has worked, how they feel they have improved and how the exercises went. I see a lot of people that in life just feel rushed and enjoy wanting to provide that extra time. This is about patients being individuals and having their own story to tell and I want to hear it.

FOOD!

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Feeding yourself appropriately for a physical goal you have set yourself is obviously important. What you consume needs to fuel you adequately, hydrate you and, hopefully, taste good. There are lots of ideas floating around about what diet people should follow depending on what you want to achieve. Some seem ridiculously extreme!

There does seem to be a general consensus on the more moderate side that eating plenty of fruit and veg (fresh meat if you are a meat eater) and pulses and reducing or avoiding highly processed food most of the time is not an awful way to go. My personal approach is along the lines of the 80:20 rule. 80% of the time eat the more natural foods that can be recognised by previous generations. I am not necessarily talking about paleo society specifically, more any generation prior to the last couple. Where food was made mostly from scratch and they had a rough idea where or what it came from. With 20% of the time (often less) eating less recognisable stuff to previous generations but easily available now, it tastes nice, often doesn’t contain a lot of nutritional value except calorific value. But my aim is to be fuelling myself in a way I can sustain for the long term.

I am not keen on meals in a bottle or a shake. They may work to limit your calorie intake for a period of time, often about 6 weeks, which is useful for purely aesthetic reasons, like trying to get into an outfit for a wedding or special event but I have no idea how people manage to survive on these indefinitely! (that is a question, if you do please let me know how you do it.) I don’t get involved in these because over the years I have seen friends and family devote plenty of time and money on these, enjoying great weight loss only to regain it all and more when the struggle has ended and they resume eating. Having learned no new way of eating or retraining their habits. Also, as a health practitioner my concern is with the weight loss how much of it is the actual thing we want to lose (fat) and how much if fluid or muscle. Healthy weight loss is thought to be approximately 1-2.5lbs a week anymore than that and it is fluid and/or muscle. So then you get into messing up your muscle to fat ratios which is a whole other story!

What does this moderate way of eating look like? I follow an array of nutrition related people and have read my fair share of nutrition and training guides. The general idea I get from them is eat a lot of colour. Consume multiple plants and seeds and nuts. I eat seeds on yogurts, nuts as a snack. I have veg or salad with most lunch and dinner meals. Even my breakfast I eat rye toast with crunchy peanut butter (made of only peanuts and some salt). This helps get in the fibre too, which is great for our digestive system.

I am also quite keen on the fermented food idea. I can not give you names of studies or research right now that back it up. But I believe Prof. Tim Spector has covered this a lot. But I feel good for it. The other thing I do is drink water. That and good coffee are my main drinks. I don’t drink much else, oh except for wine and maybe a gin and tonic, but not on a daily basis!

Over the next few months as my training gets more serious I imagine I will get a bit more detailed about calorie in take and meal planning. I have studied nutrition in my first degree and continued to read and study it, which I will put to use over the coming months. But at the moment, I am sitting with the 80:20 (or a little less than 20%) rule and enjoying where I am right now.

Goals!

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We are right at the end of the month and January is the time of reflection and resolutions and goal setting. Have you planned a new start or resolution what sort of thing have you gone for?

Have you chosen a new life choice, a job, place to live or hobby?

Have you gone for a physical goal?

Using the new year can be useful because if you make notes or journal entries in this month and plan to look back and evaluate how you did, a year is a good amount of time to get stuff done in. There’s a famous saying about over estimating what you can achieve in 6 months and underestimating what you can do in 10 years. I think a year is nice juncture to review changes you may have implemented throughout that time at all these new begin again points, such as a new day, a new week or a new month.

Using a goal can be a great way to gauge how you have got on. There’s lots of tidy little acronyms for goal setting like SMART, OKR, BHAG and my particular favourite WOOP. Goals are useful and help us have a direction to go in. I also think the process is pretty damn important too! It is, as they say, the journey.

For example, I am intending to do an ultra marathon in October 2024 (yes, this year). The idea of ‘running’ ( I say running a bit tongue in cheek because it will be a mix of running, jogging, walking and crawling) but the time between now and October will be filled with training runs, resistance training, eating well (I hope) and reading and resting and family time. All these things will involve a mix of people, some encouraging and some probably somewhat dispiriting. The point, for me, having this as a goal is I want some of the changes I will need to make to become habitual and stick.

For me this is the important bit of a goal. As I will need to develop a standard for this process and to be successful I will need to keep to this standard. My standard will be things I need to do every day for a step by step change to be ready for October. I have a running plan worked out, including time to do resistance training and Yoga. I have roped in some accountability buddies and exercise pals to keep me going. Some of these are in person and some is just a check in to say I am doing the workout. Each week I will set a meal plan for the week. I am sure I will have little hiccups along the way but the main thing I will be trying to do is avoid injury. If I prepare, train, sleep and eat adequately I will have done what I can to keep myself in good working order and to thrive on the event itself.

Now this is where the improvement is happening!

SLEEP

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In appointments, I tend to bang on to patients about how important sleep is. Lots of people realise at a superficial level it is important because we have all had that late night and felt tired or irritable the next day. But over time a sleep deficit can cause longer term problems to our general health and recovery from injuries.

The sleep we get between 10pm and 2am are key for repair. This is repair from injury, from day to day functioning of our bodies and organs creating free radicals which can be unhelpful lingering in our body. This time is optimum for beneficial hormone secretion such as growth hormone which is key in repair and growth or adaptation from exercise. A one-off night of poor sleep results in reduction of healing capabilities so over a consistent picture of repeated nights of low sleeping hours will magnify this.

Sleeping for more hours, the current recommended amount is between 7-8 hours, allows more sleep cycles including deeper more restorative period of sleep.

There are some severe issues affecting sleep and this often needs to be supported by a medical professional but if you are someone that recognises you have poor sleep habits but not due to a medical issue then some of these tips may be helpful to you and help you recover from injury, feel more refreshed and alert day to day.

Tips for healthy sleep:

Wake up at the same time every day – work out what time that means you need to go to bed each night. Often waking the same time every day helps create a bed time because if you aren’t having lie-ins (to make up for the missed sleep) then you can have a wake up and a bed time. As an early morning runner, I have quite consistent wake up routine, evenings have been more difficult just because having children and wanting some ‘grown-up’ time means my bed time slightly changes. 

Reduce caffeine intake after midday or, if you think you are particularly sensitive to it, after 10am. After 6 hours of consuming caffeine half of it is still present in the body. 10 hours later it may not have cleared entirely. I love a good coffee. I now limit myself to two cups in the morning before midday. I don’t think I am particularly sensitive to caffeine so I don’t seem to get affected by a late morning one. But I do know people that have one cup on waking and that is it!

Avoid screens for an hour before bed time – try not to use your phone, computer or TV. Give your brain a break from that rapid movement, flickering lights, constant feed. Also the light from screen acts like daylight on our brains and helps it believe it is daylight and time to still be awake. This can then have an effect on melatonin production which then effects getting off to sleep and remaining asleep. I find this one can be particularly difficult because I like to watch films and series in the evening. What I have found though is if I give myself 45 mins of screen free time before bed, by prep for bed and then reading I can manage that.

Limit alcohol – I like a drink in an evening but what I personally found was that if I had a glass of wine several nights in a row (and I am talking a 175ml size, not consuming excessive) I was waking during the night for no particular reason. When I made the connection and reduced it so only had a glass or two at the weekend my sleep improved significantly. But what I did notice is it wasn’t immediate. I stopped drinking for Dry January and I would say it took a good week or so to consistently have better nights sleep. So, don’t immediately assume that because you didn’t see a difference two nights in that it isn’t the alcohol. Hang on in there.

Avoid or limit naps – I love this one! if only I had time for a nap!! But I think this is probably more of an issue if you are trying to organise your sleeping pattern and it is a bit all over the place. Trying to establish a routine can throw thing off a bit, so if you are working on waking at 6.30am every morning but you still go to bed at midnight this may be how you manage by napping. If so, limit the nap to less than 90 mins (ideally no more than 20-30mins) and not in the mid-afternoon.

Being physically tired is important. Do you get enough exercise or activity during the day? Are you limited by injury or illness in what activity you can do? Is there something stopping you get out for a 30 min walk or bike ride? Can you do exercise at home, a YouTube video or some resistance exercises using body weight. Anything that gets your body active through the day.