September 10, 2024

Exercise, Health and Wellness, Movement, Physical Therapy

Hip Hinging: What, Why and How?

September 10, 2024

Exercise, Health and Wellness, Movement, Physical Therapy

Hip hinging is a very powerful movement that our bodies can do, that allows us to bend, lift, squat, and even climb up stairs and hills. Learning what a hip hinge is and how to do it well helps us to move more efficiently, minimize pain and injury, and enhance our fitness routine.

What is a hip hinge?

A hip hinge is essentially any movement that involves… well, hinging at the hips! Typically, it refers to a movement in the sagittal plane (forward and back plane) that allows the flexing at the hips (creasing the fronts of the hips), and subsequently extending the hips (opening the fronts of the hips). Rather than the movement being initiated at the spine, knees, or elsewhere, the movement pattern is initiated at the hips.

The hips are a ball and socket joint, as the joint is the union between the socket provided from the pelvis (acetabulum) and the ball from the thigh bone (head of the femur). So hip hinging must involve motion relative to the ball and socket, typically the socket of the pelvis rolling forward and back over the ball from the thigh bone.

Examples:

Many daily movement patterns, as well as exercises that one might perform, involve hip hinging. Here are some examples of hip hinging:

Sit to stand: The act of getting up and down from the chair involves hinging at the hips, as to sit, the hips must flex, and to stand, the hips must extend.
Deadlift: Lifting and lowering a weight from the ground using a hip hinge
Squat: Sitting the hips back and down as knees bend, standing back up by thrusting hips up and forward
Step up: Single leg hip hinge involving putting one foot onto a step or platform which hinges the hip, and stepping up by extending through the hip/knee.
Kettlebell swing: Holding a kettlebell with both hands, hinging at the hips to send the kettlebell back and down, extending powerfully through the hips to send the kettlebell out in front
Sun salutations in yoga: A yoga practice is full of hip hinging. A traditional sun salutation, that involves going into a forward fold, lifting half way up, coming up to standing, etc involves a lot of hinging of the hips.

Why is it important?

Hip hinging uses the strongest, most powerful muscles in the body. This includes the gluteals, the hamstrings, the erector spinae, and the abdominals. Powerful coupling between these muscle groups helps create high levels of force, allowing us to move ourselves efficiently and lift heavy objects without injury. For this reason, getting to know how to hip hinge, and using hip hinges very often during daily activities and within a fitness regimen is an excellent way to stay strong and powerful.

Try these at home:

Here are several common cues that I use to teach people how to hip hinge-

“Buns in the oven”: Stand about 6 or so inches in front of a wall, facing away from the wall. Pretend the wall is an oven. Send your buns into the oven by sending your bottom back to touch the wall (hips go back, or hips are flexing, as your upper body leans forward. Once your bottom can feel the wall, pause. You are in a hinged position. Come back to standing by taking your buns out of the oven (hips go forward, hips are extending).

“Roll the roller”: Stand with a foam roller against your upper thighs. Roll the roller down your thighs by sending bottom back. Come back to starting position.
In kneeling: “Sit back towards your heels”: Knees on a kneeling pad, sit hips back towards heels as hands reach forward. Return to starting position.
Step ups: “Pull the thigh back”: Put one foot on a step or stool. Lean forward slightly. Step up, pulling the thigh back. Lower back down to starting position.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

https://orthoinfo.aaos.org/link/6e0531e00f714f43a2cb1f93fae0e762.aspx

Lorraine Davis

June 18, 2024

Exercise, Mindfulness, Movement

Back Away From Knee Pain and Balance Issues: Walk Backwards!

Lorraine Davis

June 18, 2024

Exercise, Mindfulness, Movement

Most of us are aware of the benefits of walking for a plethora of physical and mental health conditions. Walking is a necessary part of life for most people, and is what allows us to engage with the world around us. Walking allows us to explore our environment, is an excellent opportunity to spend time outdoors with our loved ones, and allows us to maintain healthy bones, muscles, hearts, lungs, and brains.

When we think about walking, we are unlikely to consider walking backwards. However, walking backwards comes with a host of additional benefits, as it allows us to use our bodies and minds in a different way.

Here are some ways that backwards walking might help you:

May Help with Knee Pain

When you move backwards, whether it is walking, running, or going down the stairs, it reduces the compressive stress at the patella-femoral joint (the knee cap) as compared with moving forwards. This is based on the biomechanics of the movement . You might notice that when you go down stairs forwards, especially if you have a sore knee, that the increased bending of the knee required to go down the stairs forwards could further aggravate an irritated knee. Go down the stairs backwards, and this completely changes the forces on the knee!

Be sure to do this only after practicing on the first 2 lowest stairs, becoming very confident and comfortable with what can be quite disorienting at first.

Many clientele might enjoy going on walks, but notice that the further they walk, the more it bothers their knees. Especially when walking down hills. For these individuals, walking backwards might allow them to walk further and more comfortably!

Be absolutely sure of the terrain as you walk backwards, appreciate that this is challenging to your neuromuscular system at first)

A six-week study comparing a forwards and backwards walking program for individuals with knee osteoarthritis demonstrated that the backwards walking group had significantly reduced knee pain, increased quadriceps (front of thigh muscle) strength, and physical performance compared to the forwards walking group.

Improved Balance

Walking backwards has been shown to improve stability and improve balance performance for those at increased risk of falling. Why might this be? Practicing backwards walking may help to improve posture for those that have difficulties standing more upright.

Additionally, our balance is controlled by many systems of the body, including vision, the vestibular system (inner ear), and the somatosensory system (sensory nerves). When we are walking backwards, we rely less on our vision (unless we have eyes in the back of our head!), and more on the other senses.

We must pay closer attention to the sensations from our feet on up in order to walk backwards, rather than relying on looking with our eyes at the ground with each step. If you alternate taking a step forward, and then backwards, compare the sensations in your feet – quite intriguing!

This can improve our spatial awareness and coordination, which enhances our balance and reduces our risk of falling.

Mindfulness and Awareness

Walking backwards is a practice in mindfulness and self-awareness. When we walk forwards, we are much more likely to go into auto-pilot, which in neuroscience is referred to as the default mode network. The little person in the control room (our brains) could be” reading a magazine” while we walk forwards, as we have been doing this our whole lives and it has become very automatic.

Walking backwards allows you to become more present with every step, rooting your attention in the here and now. This can be helpful for anxiety, as it produces a state of calm and presence. By shifting out of auto-pilot, we create new neural pathways and are more likely to experience learning and cognitive enhancements.

It is a neurophysiological fact that when we reverse a common function, we improve the skill level of that particular activity!

How To Implement Safely

When beginning to walk backwards, the most important thing is safety. Start at the kitchen counter: keep a soft hold on the counter, and practice switching between walking forwards and backwards.

Next, one could try walking throughout a room in the house, free of clutter.

Walking backwards on a treadmill is also an often. It is important to turn the speed down to the minimum, and hold on to the handrails to ensure safety. Try alternating between a minute of forward and a minute of backward walking, repeated in sets for as long as desired.

Walking backwards outside is also an option, but caution must be taken. One might start by only trying this when walking with someone else, who can serve as your eyes. Make sure you are in a clear path, free of oncoming traffic and obstacles!

The whole walk need not be backwards. One could mainly walk normally, but could try intervals of backwards walking (e.g. a minute at a time, 40 steps at a time, etc.) There is one area of my neighborhood walk that is about two blocks long, rarely has any cars, and has ample sidewalk and grassy areas. Whenever I get to this, I switch to walking backwards, which has become quite an enjoyable experience.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

https://pubmed.ncbi.nlm.nih.gov/30967128/

https://www.sciencedirect.com/science/article/abs/pii/S0966636218312906

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213492/

Images:

Lorraine Davis

August 22, 2023

Health and Wellness, Movement, Mindfulness

A Traveler’s Guide to Staying Supple, Comfortable, and Fit

Lorraine Davis

August 22, 2023

Health and Wellness, Movement, Mindfulness

Throughout the summer, many of us have been active traveling and will continue doing so through labor day. This could involve long car rides, flights, and disturbances in our usual movement and self-care routines. Some people specifically avoid traveling due to back pain or similar issues, or perhaps suffer through increased pain which detracts from the joys of vacationing.

Here are some tips to keep you and your body feeling happy and healthy throughout your travels!

Breaks from prolonged sitting

The number one most important thing is taking frequent breaks from sitting, no matter the mode of travel. Prolonged stillness, especially constricted in an enclosed space of a vehicle or plane, is the recipe for soreness and stiffness.

Rather than only taking breaks for the biological need of needing to use the bathroom, consider the biological needs of your musculoskeletal system. The body’s tissues do not like to be in the same position for too long, especially positions that involve increased pressures on certain areas (e.g. the low back).

In fact, studies have shown that prolonged sitting is associated with increased pressures on the intervertebral discs of the lower back. This study demonstrated that disc height, particularly between the L4 and L5 vertebrae, is significantly impacted by prolonged sitting without breaks. The loss of disc height was not present with brief positional changes performed every 15 minutes. Changes in disc height during prolonged sitting may be associated with low back pain, sciatica, and functional disability.

At the least, try to stand up and walk around once an hour. Consider setting timers so you remember to stop and move around. If you can do it every half an hour, great! If it is not possible to take a break this often, never go for more than two hours without getting up. If you’re not able to get up, change your position often! Trust your own experience and honor your body’s request for appropriate breaks.

Targeted movement breaks

Maximize your breaks from sitting with specific movements/stretches that help to reverse the effects of sitting.

Notice that in sitting, the hips and knees are flexed to around 90 degrees. Most people also tend to sit with some flexion in the low and mid back. This shortens certain muscles/tissues, particularly around the spine, hips, and knees. By specifically performing movements that lengthen those tissues, you can help prevent your body from getting quite as stiff and sore during long trips.

Consider trying some movement snacks (see our Movement Snacks blog) to break up your car trip, particularly the first three videos that you can do standing up (perhaps using your car or a picnic table for support).

Another favorite is a standing back extension, which involves pressing the hips forward to extend the back and hips. This movement can be done as shown below, or by pressing the hips forward into a support surface such as your car, a chair, or a picnic table, while gently holding on to the support surface.

I also love to do a version of a sun salutation that you can do while standing. This involves reaching up to the sky, down to the ground, and cycling through this while breathing.

You could also do standing pelvic circles, imagining you are standing with a small hula hoop around your waist, and you make circles with your hips within the hoop.

It may also be helpful to consider how the spine moves in space, and engage in movements in which you move the spine in each of the three directions (flexion/extension, side bending, and rotation). See our How the Spine Moves blog for more information.

At the Wellness Station, we will help you create specific, individualized movement routines that you can integrate into your travels.

Ergonomics and posture

While sitting for a while during travel, it can be helpful to enhance your ergonomics and posture. See our Posture Part II blog for more specific information.

The main factors to consider here are:

Appropriate back support

Consider having an inflatable travel ball to stick behind your back in the car or on the plane to help support your spine.

The above can be ordered from Amazon and deflated to the level that fits best for your body size and your seat.

Changing Position Often

Try not to get stuck in one stagnant sitting position. Cycle between being more reclined and less reclined. Change where you are holding your legs. Move the ball around to some different positions.

Sitting movement breaks

Similar to changing position often, try to incorporate specific movement breaks while sitting. You can be doing the pelvic clock. You can be gently pumping your ankles, stretching your hips, rolling your neck. Some planes even have specific in-flight videos for sitting stretches you can follow along to.

Establishing a vacation movement routine

Many people let their routines slip away on vacation. “I’m on vacation- why would I be exercising?” While of course you want to have plenty of time to immerse yourself in new experiences, or perhaps sit on the beach with an ice cold margarita, vacations are no time to be sedentary. Don’t you want to be feeling your very best to fully enjoy your vacation, rather than feeling stiff, achey, and out of shape?

How can you re-establish a movement routine while traveling? Bringing a yoga mat and some very minimal supplies (ankle weights, therabands) might be an option while traveling. If not, perhaps there is a hotel gym and/or pool that you could enjoy. When bringing equipment and gym access is not possible, think of what body weight movements you could do (e.g. variations of squats, lunges, push ups, cat cow, step ups, etc.)

Consider opting for an active vacation. How can you explore new places with your own two legs? Is there a hike in the area you would like to explore? A bike trail? Swimming in a pristine lake or a salty sea? Or perhaps a walking tour of the downtown must-sees.

Whatever your journey may be, try to prioritize staying active so you can make the very most of your vacation. At the Wellness Station, we can help to gradually progress your fitness to help you be able to move towards the trip of your dreams.

A biking exploration of Jasper National Park

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152382/

Lorraine Davis

August 8, 2023

Balance, Exercise, Health and Wellness, Movement, Physical Therapy

Balance Part II: Strategies for Improvement

Lorraine Davis

August 8, 2023

Balance, Exercise, Health and Wellness, Movement, Physical Therapy

Last month, we discussed factors that control and impact our balance. Consideration of these factors can help us become more aware of what to do to stay safe and prevent falls, as well as targeted exercises to improve our balance that are based on scientific principles.

How do we improve our balance and prevent falling?

If we recognize the influence that the physiological, psychological, and environmental factors have on our balance, we can be strategic in how we improve our balance and decrease our risk of falling.

Stay active, making sure you are keeping your muscles strong and healthy for life. Have a movement practice that incorporates functional strengthening and balance challenges.

Enhance your somatosensory system by regularly stimulating your feet. Think of your feet like antennas that provide messages to your brain about your balance. Massaging your feet with balance pods are a great way to keep the nerve endings responsive.
Consider more time spent barefoot, especially during balance exercises. This will allow your feet to feel the ground and your toes to spread out, creating wider points of contact with the ground. In daily life, consider shoes with a thinner, more flexible sole, and a wide toe box.

Ensure you are taking care of your eyes and vision by regularly visiting an ophthalmologist. Make sure you use a nightlight when going to the bathroom at night, and remove any trip hazards from your path.

You could also consider the role of vision to challenge your balance during exercises. Notice that keeping your gaze stable on an object in front of you helps your balance. Moving your eyes around will make balance more challenging. Closing your eyes will make it the most challenging!

Recall in Balance Part I, we discussed how being overly reliant on vision can contribute to a stooped posture, as many people will look down to the ground with their whole body rather than just with their eyes. When walking, practice looking down with just your eyeballs as needed to see the ground in front of you, rather than with your whole self. If you had a light shining from the tip of your nose, and a light from your chest bone, you should be able to maintain these lights at the level of the horizon while walking, rather than keeping the lights cast downwards.

Make sure your vestibular system is healthy, and recognize the impact that vertigo, seasickness, and certain medications can have on your balance.

Likewise, you can progress your balance exercises by introducing changes in your vestibular system. If standing on one leg has become easy, can you do it while slowly turning your head from side to side, or up and down?

Optimize your environment: Make sure your environment is conducive to not falling! If icy sidewalks, crowds, or uneven trails are not for you, make sure you modify appropriately, perhaps bringing an assistive device or a loved one to help you stay steady.

You can also use the environment to improve your balance, by intentionally walking on trails and standing on uneven or “squishy” surfaces.

Train your balance… but don’t overshoot it! A mistake many people make while training their balance is going past their edge. If standing on one leg consistently leads to excessive wiggles, wobbles, and you are unable to find your steadiness, then you are simply practicing being unsteady, rather than practicing finding steadiness. You want to be close to your edge, without going over it!

Find an exercise that feels moderately challenging, but you are able to find steadiness and ease with practice. If not, modify the activity to make it more or less challenging. Standing at the kitchen sink, by the counter, in the corner of a room, or in a door frame are excellent places to practice balance, as you have the option of supporting yourself with your arms as needed.

By finding this edge and achieving success with practice, not only can we improve the physiological components of balance, but we can also improve the confidence we have in ourselves, thereby decreasing our fear of falling and subsequent risk of actually falling!

Follow along with this video, which incorporates seven balance exercises and strategies, “Feldenkrais style”! It instructs in balance challenges including standing and walking with a narrow base of support, closing the eyes, getting up and down from the floor, dynamic weight shifting, and practice with “falling”. Best to do this video near something to hold on to as needed.

At the Wellness Station, we can help you recognize and make changes in the factors that could be impacting your balance. We will provide you with individualized recommendations and movement lessons to help you improve your balance, your confidence in yourself, and your ability to continue to do what you love.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Lorraine Davis

July 18, 2023

Balance, Movement, Physical Therapy

Balance Part I: The Science Behind our Steadiness

Lorraine Davis

July 18, 2023

Balance, Movement, Physical Therapy

A keen sense of balance is crucial for a full and healthy life. Our balance tends to decline as we age, but we can prevent this decline and even improve our balance over time if we equip ourselves with knowledge and targeted exercises.

Many people don’t realize that their balance has gotten significantly worse until they are put into a situation that reveals it. Older individuals may realize they are no longer able to get up and down from the floor, especially if they have nothing to hold on to. Or perhaps standing on one leg is no longer an option. Maybe we have become a “furniture walker”, always looking for the next piece of furniture to touch as we walk around. As balance declines, one’s life can get smaller and smaller, as fear of falling begins to impact decision making.

What controls our balance?

Our balance is an extremely complex interaction between many physiological, psychological, and environmental factors.

Physiologically speaking, balance depends on the strength and responsiveness of our neuromuscular system. How quickly, and with how much force are we able to respond to perturbations? Do we have the strength in our legs to balance on one of them, or the reaction time to catch ourselves if we fall?

Balance also depends on our somatosensory system, which are sensations that we receive and process from our skin, muscles, and joints. The ability to feel our feet on the ground, as well as the sense of proprioception (sensing the position of our joints in space) help us to stay balanced. This is why individuals with peripheral neuropathy (loss of sensation particularly in feet) have great challenges with their balance, because they can’t feel their feet too well.

Our vestibular system also controls our balance. This is the system in our inner ear that provides information to our brain regarding head position, motion, and orientation in space. We all know the feeling of being dizzy, perhaps due to a medication that affects the vestibular system, an amusement park ride that tosses your head around, or seasickness. When the vestibular system is impaired, balance is impaired.

Vision is a prime component of our balance system. This is why it is harder to balance in the dark, or with your eyes closed! However, some people become overly reliant on their vision for balance, and find themselves looking at the ground when they walk, as opposed to appropriately integrating information from the other systems. This is related to posture, as many people will adopt a stooped posture over time if frequently looking at the ground to maintain balance. Training your posture and training your balance can go hand in hand!

Psychological factors also greatly impact our balance. Of course, if we are feeling crummy, or perhaps are not well-rested, our balance will be worse. More significantly is the confidence we have in our balance. Any athlete will recognize the negative impact of anxiety/nervousness on performance, particularly in sports that require a keen sense of balance (e.g. gymnastics). Lacking confidence and having a fear of falling is actually the most significant predictor of a fall! Studies have shown that those with a fear of falling have more than twice the risk of falling than those who do not have this fear. With this fear comes diminished activity overtime. With diminished activity, a downwards spiral is set in motion that will negatively impact the functioning of all body systems.

Environmental factors also impact balance. What environment are we in, and how are we relative to our environment? Our base of support, and how we are able to keep our center of gravity balanced over our base of support will determine our stability (e.g. standing with your feet wide apart is far more balanced than standing on a tightrope).

The ground we are on will impact the position of our joints and contribute to perturbations that could throw us off center (e.g. sinking into the sand, walking on uneven rocks and roots, slippery ice, etc.) Additionally, disturbances from our environment (e.g. crowds with people rushing past you and bumping into you, high winds, loud noises) can create disorientation and perturbations that can throw us off center. In general, the less familiar we are with the territory in which we are engaging with, the worse our balance.

See Part II next month for specific strategies to improve your balance over time.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03018-2#:~:text=Supporting%20this%20research%2C%20FoF%20is,those%20without%20FoF%20%5B6%5D.

Images: