How to figure out what’s wrong and how to fix it

Waking Up With Hip Pain

“A Pilates teacher wakes up with an extremely painful hip …” – no, that’s not the beginning of a joke. It was just the beginning of my week, less than 2 weeks shy of birthday number 51.

Now, this hip pain – I hadn’t had that in a while. But it wasn’t entirely new. Thankfully, I knew it wasn’t chronic.

And it got me thinking: How would I deal with this if I DIDN’T know how to approach this? As in, how would pre-Pilates me have perceived this? How to all the women (and men) in my classes and sessions who tell me their hips ache occasionally view this?

How To Approach Pain

So I decided I would break down for you how I approach pain in my own body. Spoiler alert: I don’t pop a pain pill first thing. (You may have heard me harp on one of my biggest pet peeves – ads promoting the use of pain medication for every little thing. Because it just masks the issue, but doesn’t do ANYTHING to help you get rid of it!)

Woman with hip pain

Now, you may have this notion that movement pros don’t have aches and pains. Alas, we, too, are human. We have pain-prone, aging and often uncooperative body parts. In fact, that’s often the reason that got us to start looking into Pilates in the first place, yours truly included. Our advantage is that we can often manage and relieve those issues a lot faster than others might. Which is not as mysterious as it may sound. So let me walk you through a real-life example of how that worked for me in this very real and quite painful situation.

The Scene

It’s early Monday morning, August 2nd, 2021. I spent a few hours tossing and turning because my hip just wouldn’t stop aching but fell asleep after all. When I fully woke up, my hip really hurt. I mean REALLY hurt. The pain radiated all the way into my foot, so I had a feeling my usual morning run would not be happening that day, which didn’t make me very happy. Especially since the temperature had just dropped a bit and it was perfect running weather, which never happens in Middle Tennessee in August!

A 10-step process

But mindset is everything, right? So I tried to be accepting and all that instead of getting grouchy. And since relieving pain and getting bodies fit is my job, I then methodically assessed what was going on and what was the best way to go forward with it. Here’s what I did:

1. I tried to really *feel* the pain.

(I can hear you saying “She has to be crazy! Why would you want to feel MORE pain??!” But hear me out.) That means that instead of reaching for painkillers to mask the pain, I tried to feel what EXACTLY this felt like. Did it feel familiar? Was it similar to something else I’d experienced or seen in my clients before? Where, precisely, did it start? Did it radiate anywhere?

I remembered having this type of pain before, although not with this level of radiating into my leg and foot. That last part made me a little anxious, since that can indicate nerve pain. But it wasn’t that burning, tingling sort of nerve sensation that nerve pain entails, so that was good. (If you don’t know what that feels like, think about your last toothache.)

2. I analyzed.

What were the structures of the body that were affected? What bones, joints ligaments, muscles? How do they relate to each other?

Looking at where the pain originated and where it went to, it was clearly my iliopsoas muscle acting up, a large muscle that attaches to your lumbar vertebrae and ends (“inserts”) at the femur. It REALLY wants to take over everything. And my left side had always been an issue.

You may wonder why I didn’t suspect bone damage or arthritis. Well, I know – from my clients’s descriptions – a little about what that feels like, and this was not that. It also wasn’t at at that precise location. Also, bone/joint pain of the chronic variety doesn’t tend to come on this suddenly, and things like arthritis are generally associated with some very specific movement restrictions and patterns. None of these were what i was experiencing, so I was able to rule that out.

3. I reflected.

What had I done in the past day or two that could have caused this?

This one was easy – I’d really pushed the running and hiking in the last few weeks and had sat too much all weekend finishing up a project. Bizarre as it may seem, running, walking and sitting can ALL make for a tight psoas. Also, I hadn’t done ANY of the things usually do to offset the problem, like mobilizing the hip, stretching the hip flexors and getting on my reformer for some much-needed offsetting exercise. (Another one of those things you might think Pilates teachers never lapse into … I can’t speak for other people, but I’m definitely all too human in that regard!)

4. I mobilized.

The next step was seeing whether movement would help it. I guessed it might, since it hat gotten worse over night, i.e. from NOT moving.

I got out my foam roller and stretched out the front of my hip. I did some lengthening exercises and moved the joint in all directions. It still hurt quite a lot, but didn’t seem to be getting worse. Ok.

5. I observed.

What made it feel better? What made it worse? Was the movement beneficial?

It still hurt, but movement seemed to make it a bit better. Or at least change the pain. Next step.

6. I got moving.

I knew running was probably not a brilliant idea, so I just started to walk.

I’ll admit I was pretty limpy at first. But at least I was out and about.

7. I observed more.

Did the pain change? Did it move around? Did it go away?

As I walked, I noticed the pain started to change a bit. (Good physical therapists will tell you that what they’re looking for is a change in the pain, not necessarily immediate relief. Why? Because it tells you that what you are doing is impacting the pain.) About half a mile in, I was moving a little more comfortably. A mile in, I was walking at a slow but close to normal speed. It still kind of hurt, but based on that, I decided to keep going. For reference, I average 8 miles per day total, so I wasn’t pushing it. If I averaged less, I would not have gone quite this far. After 3 miles, I started to feel almost back to normal. I felt it was safe to keep going and do my usual 4.5 miles – just not running. I did. 95% improved. No pain pills. Hooray!

8. I thought about how to stay in that pain-free zone.

Since sitting, walking and running can cause the psoas to get tighter, I decided to avoid those things for a bit and went to run some errands instead of getting to work right away. Thankfully, this particular morning, I had the leeway to do that. Then, I made a point of standing at my desk to type out my newsletter and taught all my sessions standing or moving around – not sitting.

9. I checked in with how I was feeling throughout the day.

Did it still hurt? Nope. How about if I moved. Not really. Forward fold? A little. Sitting – yikes, that made it tighter.

10. I made a plan.

Since I know a little bit about the muscles and the body, I know that psoas issues are NOT a quick fix. It takes consistency, not one all-out effort. (Yes, a massage therapist or osteopath may be able to sort that out temporarily, but trust me, that is not going to last. Been there, done that, ended up becoming a Pilates teacher.) So I recommitted to a program of doing psoas stretches and gluteus medius strengthening exercises daily. And doing them before and after runs and long walks. It’s not that they take long – I just have to actually do them! But there’s nothing like an acute pain episode to make you realize those minor inconveniences are so worth it!

Psoas Muscle

Luckily, this was not a chronic pain situation, and I was able to sort things out quickly. Of course, that is not always the case. But I hope this post will inspire you to look at any painful episodes you may have a little differently. And if you need some help, you know where to find me!