It’s been nearly two months since my ““Hip Osteoarthritis CAN be Cured” self help book was published. I’ve been kept very busy responding to questions and trying to build up an understanding of the things that people are having difficulty with. I’ve now got some blog posts lined up to target these areas, and to help keep everyone motivated and on track when things feel hopeless (as will almost certainly happen from time to time).

I’ve decided to use this first post to explain the rationale behind the 6 week treatment plan in the book. If I can make this clear I think it’ll aid in your understanding of how to use the plan, and how to customize it to suit your specific problems, lifestyle and preferences.

My Challenge

Let’s start by looking at the challenge I faced in trying to create a generic treatment plan that will work for everyone regardless of their condition.

Whilst most cases of hip OA will broadly follow one of two patterns of muscle imbalance, there will always be differences in the details. Differing limb proportions, lifestyles and levels of fitness can and will result in variation. Equally hip OA can affect a huge range of people, from young elite athletes to elderly couch potatoes. A strong, young athlete will often cope better than an elderly unfit person with an identical dysfunction; a problem that absolutely cripples one person may present as a far less catastrophic impairment to someone with enough strength and fitness to work around it.

What’s more, many people will see their condition changing over time. In the years leading up to their diagnosis they may have been oblivious that anything was wrong; in the years following their diagnosis, they may see their symptoms of pain and stiffness migrating to different parts of the hip and leg. Back, knee, foot, neck or shoulder pain may also develop.

To summarize:

• Each person’s condition will be slightly different.
• Each person’s ability to cope with their condition will be different.
• Each person’s condition will vary over time.

Why a Six Week Iterative Plan?

Even with all the above diversity, the core approach to treating the muscle imbalance is always the same; it’s  the details, and the emphasis, that have to be adapted for each person. Additionally, as you treat your muscle imbalance you don’t switch instantly from “broken” to “fixed”; you progress through many stages of subtly different dysfunction. The treatment plan must be adapated over time to target the dominant issues at each stage.

In short, the basic treatment approach is the same for everyone, but the devil is in the detail.

Think of it as a complex logic puzzle. I can provide you with the pieces of the puzzle. However, you need to put the pieces together in the correct sequence in order to arrive at the solution.  Reason and logic can help narrow down the number of permutations you have to try, but at the end of the day you have to start experimenting – to try things and see what works.  That might seem overwhelming at first, but trust me – over time you’ll learn more about how your body responds. You’ll be amazed at how quickly your knowledge builds and you develop an ability to work out how to keep tweaking your program to keep things moving in the right direction.

Your first challenge is to figure out exactly where you are right now. You need to know what state your body is in: what exercises it can tolerate and which exercises help re-balance your body, reduce pain and restore normal function.  The best way to do that is to work through the plan. It covers the essentials – the core and the hips. Try the suggested exercises and learn for yourself what level you need to be working at.

Your second challenge is to keep things progressing. If you are successful in the first challenge you will make progress in correcting some of your imbalances. Your condition will be slightly improved. However, this means that the corrective exercises that you’ve been doing may no longer be the best for you in your “new state”. Essentially, you have to work through the program again to determine the level you now need to be working at. It may be the case you need to move onto a more advanced exercise, or focus more attention on particular body part or muscle.

The program is designed to help you with this process of constantly re-evaluating – covering all the bases – and moving things forwards. You don’t need to stick to 6 week cycles – it may be easier for you to do 12 or 18 week cycles. I suggest 6 weeks as your starting point. You may find a way of doing this that works better for you, but my plan will guide you until you feel confident enough to manage things your own way.

Repetitions, Frequency and How Much Time to Spend on Each Week’s Exercises

A lot of people have asked  for more guidance on frequency and repetition. I completely understand that need, but equally no one answer is going to be right for everyone. There is no point in setting a work level that’s too difficult for you or that doesn’t fit with your lifestyle or personality. The most important thing is that you keep working at correcting your imbalance for a long period of time – many months. You must find a sustainable way of fitting it into you life.  It might be half an hour every other day, 15 minutes every day, an hour every day or a minute or two several times throughout the day. Work out something you think you can manage and try it for a while. Over time you can tweak things until you have an approach that results in steady progress.

Factors include:

• The amount of time you have available
  If you can spare an hour a day to work on rehab, that’s great. If not (as will be the case for many) then work out what you can do and select your exercises and rep ranges accordingly. When you’re learning to do a new exercise you’ll need to give it extra time and effort, but once you have your routine worked out you can do it daily, every other day, twice a day – or even short 2 minute sessions several times throughout the day whenever you have a spare moment. For muscle activation little and often generally works best. For strength, 3 sets of 10 is a good guide (but not a rule).
  
• Your existing strength and endurance levels
  Once it gets easy you need to increase the reps, or increase the load (with weights or resistance bands) or move onto a more advanced exercise.
  
• Your boredom threshold/self discipline!
  For a long while  I tended to aim for 3 sets of 10 with most exercises. I think that number was put into my head by a physical therapist many years ago. Very often I’d be short of time, or there would be an exercise I really hated doing. The thought of having to do 3 sets of 10 would put me off and I’d end up doing nothing. It’s much better to aim for less and stick to it than aim too high and end up not doing anything.

Choice of Exercises

I included exercises that everyone should be able to do at home without special equipment.  Once you’ve learned to isolate and activate the target muscles you can choose other exercises to achieve the same result.  Over time I’ll post up descriptions and videos of alternative exercises that you can use. People that like to go to the gym and train hard will quite quickly get to the stage where they can replace a lot of the rehab exercises with standard strength training exercises. The important thing is that you understand what you’re trying to achieve and that you learn to activate the correct muscles. It’s not the choice of exercise that matters as much as how you do it – it’s vital that the right muscles contract in the right sequence.

I recommend sticking to the exercises in the plan for the first 6 weeks at least.

The Mistakes you’re Likely to Make (The mistakes I made)

Despite being well aware of what I *should* be doing I still repeatedly made mistakes. Even now that my hip OA is gone, I still have lingering imbalances. As I find them and correct them I realise that if I’d actually followed my own advice – my own plan – these things would have been put right long ago.

By recommending a cyclic plan where you constantly re-evaluate the key problem areas I’m hoping I can help you spot mistakes / omissions earlier and put things right. Here’s are the pitfalls that you should look out for at each iteration of the plan:

• Thinking about movement rather than muscles (aka doing exercises incorrectly)
  When you have a complex muscle imbalance you are incapable of using some of your muscles. Your body will always find a way to get things done by recruiting other muscles. You will often be able to produce a superficially correct movement, but you won’t be using the correct muscles and consequently the exercise won’t have the desired result. Don’t think about replicating the movement of an exercise. Instead focus on the muscle that the exercise is targeting and ensure that it is working. It is much better to make a tiny movement that contracts the target muscle than a big movement that *looks* correct but is actually using all of the wrong muscles.
• Focusing on symptoms rather than looking for the cause
  When you feel pain, stiffness and other symptoms in your hip it’s very difficult to accept that the problem can be caused by some distant and pain free body part. Even when you do accept this fact, your mind is constantly drawn towards the symptomatic hip. Spending time working on the symptomatic hip can prevent you from tackling the root cause of your problem which is likely to be elsewhere in your body. Don’t focus on the pain and stiffness when deciding what to treat. Take a step back and think about WHY your hip is stiff and sore. The book and treatment plan will guide you.
• Dismissing an exercise / approach because you tried it before and it didn’t work
  Your body is a moving target when you’re unraveling a complex muscle imbalance. Just because something doesn’t work one day doesn’t mean it won’t be highly effective a few months down the line.
  Don’t rule out an exercise because you’ve previously found it to be ineffective. Periodically retry exercises.
• Continuing to do something that clearly isn’t working any more
  When you’re able to do a corrective exercise properly it will typically start to work quite quickly. If it starts to feel easy you may need to add resistance/difficulty to make your muscles work harder. However, it’s equally possible that this particular muscle is now strong and in balance in which case you can phase out the exercise altogether. Periodically re-check to make sure things haven’t deteriorated, but don’t waste time doing exercises that are either unnecessary, or not challenging enough to have any impact.
• Stopping an exercise that’s still working
  Sometimes it may seem that an exercise isn’t working. However, think carefully before dropping it from your plan. It’s possible that the exercise is strengthening up a very important muscle. You might not see the benefit until further down the line when you’ve corrected other issues. However, that doesn’t mean you should stop the exercise. If the target muscle is still weak keep doing the exercise. If you don’t have enough time and feel the need to prioritize, at least take note of the fact that the weakness is still there and revisit it at a later date.
• Ignoring obvious problems because you assume they’re not relevant
  When you detect a weak, lazy or tight muscle that’s far removed from your painful hip it’s very difficult to accept that it could be contributing to your hip problem. When a muscle is healthy and unrestricted (as is often the case with muscles far removed from the site of pain) it will regain full strength very quickly. Whilst it’s important to prioritise and target muscles/exercises that you think are likely to yield the best results don’t ignore the seemingly unconnected muscles. If you don’t have time to treat them all, make a list and include them in your program one at a time. Trust me – it’s SO annoying to discover years down the line that a weak muscle that you’ve been ignoring for years is actually key to your recovery!
• Assuming you don’t need to do an exercise because you know (*think*) you’re already strong
  Your body will always find a way to get the job done – using the wrong muscles. It is possible to get incredibly strong and to *look* as if you’re moving correctly even while key structural muscles are dysfunctional. Never assume that extreme strength is an indicator that a muscle is working!
• Losing fitness because you’re focusing too much on rehab
  Fitness (endurance, strength, flexibility etc) help you to cope with a muscle imbalance. Often, if you’re fit enough you can work through many/most of your symptoms without addressing the underlying muscle imbalance. It is therefore a mistake to neglect fitness training (or to reduce activity levels) in order to spend more time on addressing the imbalance; doing so might just result in worsening symptoms and a reduction in your ability to do the corrective exercises you need.
• Neglecting rehab because you’re focusing too much on fitness
  It’s important to balance rehab AND fitness. The two go hand in hand. Sometimes it feels that an exercise program – walking, running, swimming, weight lifting etc – is doing such a good job of improving your symptoms that you don’t need to waste time on rehab. However, the likelihood is that the increased fitness is simply allowing you to cope better with your dysfunction. The chances are your joints are still wearing and soft tissue is still being stressed. There’s a good chance that the symptoms will return with a vengeance a year or two down the line.
• Thinking you’ve found the root cause – the solution – and focusing on it to the exclusion of all else.
  I think this is the mistake I made the most often. Anyone that has experience of hill walking will understand what I mean by false summits. You look ahead of you and see what you think is the summit; the end of your long, hard climb is in sight.  Your hopes are raised and you make a mad dash for the finish line, only to discover upon reaching the peak that there’s another daunting summit ahead. In the case of a muscle imbalance, there always tends to be one muscle in particular that’s taking most of the strain and that is always the one you’ll focus on. When you discover a way to loosen it off you may feel that you are on the verge of returning to full function; you abandon all your other rehab and fitness training to focus exclusively on fixing this one last problem. Having done so, you discover something else that is keeping your body locked down tight. Meanwhile, fitness has slipped back and you’ve lost ground on all of your other rehab exercises. If you’re anything like me you’ve also forgotten what you’d previously been doing and have quite possibly abandoned a very promising plan of attack to chase after this ‘false summit’.

In the next post…

I’ve had lots of questions from people asking more about my current condition and whether I know of other people that have achieved a complete resolution of symptoms. A number of people have asked if I think it likely that they’ll be able to return to competitive running or other sports. I share a little more information about that in my next post. I’ll then move on to some more practical help in the form of more exercises to try and some more detailed information on Self Myofascial Release techniques.

In the meantime please keep the feedback coming! I plan to set up an online “help desk” to streamline Q&A, but for now please feel free to contact me by email, via the contact form or to simply reply in the comments section of a blog post. I’ll send out monthly newsletters to let you know what new information has been added to the site that month – join the mailing list here.