Scott Webb (Host): Our hips are essential to moving and functioning normally, and my guest today has some great advice for how we can loosen our hips, prevent hip pain, and enjoy daily living and sports like golf. I'm joined today by Patrick Yoder. He's a physical therapist practicing at Franciscan Health .

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Patrick, it's great to have you here today. I was just telling you that I have a Division I basketball commit in my family, my daughter, and she struggles with tight hips. Everyone's always asking, "How can we loosen up those hips?" So, you are the right guest to have on. But before we get there and get into the hip pain and treatment and so forth, maybe you could just tell us, tell listeners, why are hips so important for our mobility, daily living, you know, especially as we try to do more intense activities and athletics? What role, I guess, do the hips play in all that?

Patrick Yoder, PT, DPT: A lot of times, I think we take our hips for granted, like we don't really fully realize all the vital ways our hips are necessary throughout our daily life. So, you can think of most basic movements like walking, getting in and out of a chair, rolling out of bed in the morning, picking up things from the floor, or maybe even as simple as putting on our pants while standing or sitting.

But you can also think about the importance of hips for athletes, as you were just talking about. This might include jumping to dunk a basketball or spike of volleyball, maybe quickly changing directions to miss a defender in football, or maybe even like developing the power behind a kick in soccer. So, you can see and you can think of how the hip plays such a vital role in each of these movements. It's important to have mobility in all the different planes of movement, such as like forward and back, side to side, that rotation as well, along with the strength and stability to be able to perform these activities both efficiently and effectively.

Host: Yeah. I think there's things in our body, maybe spleen would be at the top of the list-- nobody really knows what the spleen does, right? But when it comes to our hips, I think that we just take that for granted. We take for granted that, as long as they're working and they don't hurt, you know, we don't realize how essential they are to all the things that we ask of our hips and things that we do, pickleball, basketball, golf, whatever it might be. Let's talk about hip pain. Like, what are the culprits, what are the main causes of hip pain?

Patrick Yoder, PT, DPT: So really, the causes for hip pain can be quite broad and difficult to pinpoint a true cause. Now, sometimes, it might be a little more direct, such as osteoarthritis in the hip or maybe having a torn labrum. These are examples of conditions that could benefit from physical therapy, maybe pre and post-surgically, others might be a little more hidden with no clear medical diagnosis except for the patient having hip pain. So, this is where we, as physical therapists, can help further examine the condition from more of a human movement system perspective to see what all could be happening. So, let me give just a few brief examples. Just knowing there are lots of conditions for hips, but I'm just going to talk about three in particular for time's sake.

So, one would be a snapping hip. So, this could feel like it's more on the surface or maybe deeper inside the hip when the patient moves their hip in various positions. The reality is it could be muscles that are really tight either on the surface or deep in the hip. This repetitive snapping could lead to some inflammation and pain that is felt elsewhere in the leg or maybe even the back. And it also can cause some other functional limitations. In physical therapy, it is possible to address the tightness in those specific muscles through a variety of manual therapy techniques, maybe some exercises for these patients to return to daily activities with little to no pain.

So, the second one we're going to talk about is what we call piriformis syndrome. So now, there are times when a patient comes in and says they have sciatica because of these nerve-like pains. They're sharp, stabbing, numbness, tingling, burning, maybe going down the back of their leg, which could likely be the sciatic nerve or a spinal nerve root getting irritated.

While I would definitely evaluate the back, I would also be looking at the hip and the surrounding muscles. And one in particular that attaches at the hip is called the piriformis. So, what people don't realize is right around the piriformis is where that sciatic nerve travels, and where it could get irritated. Sometimes after alleviating the trigger points in the piriformis and other surrounding muscles, it alleviates their sciatic symptoms. So, that shows that radiating pain could be coming from the back, and it could be also coming from other areas too. So, that's why we, as physical therapists, look beyond just the immediate area, and also assess other surrounding structures for their possible influence on the patient's pain experience and their functional mobility.

One more cause of hip pain is simply due to the lack of hip mobility. So, I'm going to talk about this in relation to golfers. So as it's been mentioned already, I'm a physical therapist, but I'm also certified through the Titleist Performance Institute. So, my goal is to help golfers hit the ball further, more consistently and feel better while doing it. So with my TPI assessment, I specifically look at hip mobility with one of the components of the golf-specific functional movement screen. If a golfer lacks hip internal and external rotation, they're losing out on a lot of potential power with their swing. And this can also relate to other sports too. But they also might start relying more on their back for the power. And then, that causes lower back pain. So by the time they come see me with all their pains, I have to address their back and their hips, or else neither will get better. So for golfers, I might instruct them in a variety of exercises to improve their joint mobility and flexibility around the hip and the strength associated with those movements, before I reinstruct them in their golf swing mechanics, even specifically related to the hips with some weight shifting and rotation, for them, they might increase their distance by 10 to 20 yards or more with that. So as you can see, there can be a lot of causes to hip pain that can really cause some difficulties with our daily and even some recreational activities.

Host: Right. Just trying to do yard work or playing on the pro tour, whatever it might be, and everything in between, probably. So, it sounds like PT can be really beneficial to help decrease hip pain and, you know, try to avoid it in the future. So, maybe take us through like what's a typical session like, if we're going to come to you and say, "All right, Patrick, help me with my hips. Help me with my hip pain," what can we expect?

Patrick Yoder, PT, DPT: As for a physical therapy session, you can expect a PT to assess some of your mobility and strength in addition to the location of your pain. So, we wanted to see what could be that those likely causes of your pain. Could it be musculoskeletal, maybe even neurological or nerve related? We would then want to address each of those areas that we see as impaired to help optimize the movement. So, we could address these through a variety of hands-on manual therapy techniques specific to the joints and muscles and nerves being addressed. It could be actually treated through trigger point dry needling, which I don't know if you've heard about it before, but with dry needling, it's known to create some neurological and chemical changes in the muscle to help alleviate that pain and tension that patient may be experiencing. That allows the physical therapist to progress the patient in more like functional movement exercises for them to return to the activities that they really enjoy.

But now, some people might think of physical therapy as boring, low level exercises. I just want people to know that it's far more than that. There are many exercises. Physical therapists provide and instruct patients specific to their condition and the goals that are more functionally driven, so with the ultimate goals for them to return to the activities that they really love. Now, thinking back for golfers, I offer golf performance evaluations. That includes a Titleist Performance Institute Functional Movement Screen in addition to a golf swing assessment that fully assesses the golfer's what we call the body-swing connection. So, it was like TPI says, for the philosophy of a golf swing, we don't really believe there's one way to swing a club. We believe there's an infinite number of ways to swing a club, but we do believe that there's one efficient way for everyone to swing a club, and it is based on what they can physically do.

So if there's any golf pros that are listening to this at golf courses, if there are golfers that you might be working with that are unable to execute basics of the golf swing, likely because of physical limitations, I'm here to help. I want golfers and golf pros to know that I provide these services to help golfers play golf day in and day out for the rest of their lives. So as part of that golf evaluation, that golfer will be provided with a full result of their functional movement screen, common swing faults associated with their physical impairments. And even some initial exercise to start in order to address those impairments. What I do next then is I provide treatment sessions to further train the golfer physically while reassessing and giving instruction on their golf swing mechanics.

Host: I just want to finish up, Patrick, talk about preventing hip pain. Like, is that possible through exercises, stretches, things like that, how we can keep those hips strong and maybe a little less prone to injury? What can we do?

Patrick Yoder, PT, DPT: Yeah, absolutely. So, pain in general can be difficult to fully prevent. However, I want to say one of the best ways to prevent hip pain is staying active, even with as simple of an activity as walking. So, I believe that we were really meant to stay active and move and to work. And think of all the health conditions associated with a lack of physical activity or even like all the health conditions that are even preventable with physical activity.

So now, some people , this could be going to the gym. They love to go to the gym. gets them out of the house, provides them with a specific set of exercises to perform. It allows them to enjoy watching TV while on a machine, or maybe it gets them active around other people in a kind of a group exercise class. But for other people, going to a gym might feel like physical torture to them. So, I want those people to know that there's a lot of ways to get physically active. That might include walking in parks, grocery stores, or malls, maybe it's doing things around the home such as mowing the lawn, gardening, woodworking, home improvement projects, maybe doing dishes by hand and maybe even spending time with others. Cooking a healthy meal that takes time and energy, but is really kind of like worth it in the end. Now, I will say though, there could be some people that might be saying to me, "No, Patrick, that all sounds good, but I am in too much pain to do anything."

Host: It hurts too much to even try to avoid being hurt, I guess.

Patrick Yoder, PT, DPT: Right. Exactly. So first, I would say follow up with your doctor to see if there is something going on that they can help with. But next, if you are having difficulties with your daily activities physically, I encourage you to come see a physical therapist. Did you know in the state of Indiana, there's actually direct access to physical therapists for patients with private insurance or cash pay, meaning we can see you for up to 42 calendar days before the necessity for a physician referral? So, let's see what we can do together to help manage your pain to allow for more activity.

But then, I also want to briefly give an example of something I would educate a patient in that can be referred to as like pacing or graded exposure. So, let's say someone is saying that they are unable to mow their lawn, okay? So, I ask, "If you were to try today, how long do you think you would be able to tolerate mowing your lawn?" So just for the sake of our example, we'll say they responded 15 minutes, and it typically takes like a full hour, all right? So, I would tell them, "Well, what I want you to do is, on Monday, mow the lawn for 15 minutes. And then, Tuesday, move 15 more minutes and stop. And then, Wednesday, 15 more minutes. And then, the same with Thursday.

Now, the patient might be saying that they're unable to mow their lawn. But when in reality, by executing this task from a pacing and graded exposure perspective, the patient is able to achieve the goal of mowing their entire lawn now in four days. And later, maybe after finishing physical therapy, that same person might be able to now finish their whole lawn without rest breaks.

So as you can see, Scott, there's a lot of ways to prevent possible hip pain while maintaining your functional wellbeing. That's part of our goals as physical therapists, is it says like the American Physical Therapy Association, their vision is transforming society by optimizing movement to improve the human experience. So, what I would just encourage people is, if you are having these aches and pains, I hope you can come see a physical therapist that can help you achieve your physical goals and get you back on course to living the life that you want to live.

Host: Yeah. So, I get what you're saying, like it would be worth it to try this and have just sort of a weird-looking lawn for a week or so, but it would really help us. And as you're saying, like, you know, there are ways for us to prevent, whether it's pain or breaking down, whatever it is. Speak with our doctors, get referrals or come directly to PT, you know, and work with someone like yourself. So, all good stuff. Thank you so much.

Patrick Yoder, PT, DPT: Yeah, absolutely. Thanks for having me.

Host: And for more information about outpatient therapy services at Franciscan Health, visit franciscanhealth.org/rehab. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.