Hip Pain and Injury: Exercise with Kettlebells

Even chiropractors have to deal with pain and injuries. Find out how Dr Michael Snow who is a chiropractor in North Austin is tackling the troubles that haunt him after a car accident.

I have a condition called Femoroacetabular Impingement (FAI), related to a severe car accident I had in 2007. It can be painful, obviously, but often can be developing over a period of time without causing pain. In my case, I didn't have any pain to speak of until my accident. The X-Ray, and more specifically, the MRI is what revealed the condition. My exam showed limited motion in hip flexion and internal rotation, with a pinching pain in the lateral hip. There was positive Patrick Fabere orthopedic test. Squat test was positive and very difficult to perform. Again though, the most significant findings were demonstrated in radiology.

The hip joint becomes misshapen, and it can be either from the actual femoral head, which is the ball of the joint, or from the acetabulum, which is the socket of the joint. It can also create wear and tear of the hip musculature and tendons, leading to fraying and ultimate rupture. This is what happened in my case.

It ended up that I had both of my hips replaced, in 2011 and 2012. With this type of surgery, the rehabilitation post surgically can be very daunting. I completed months of rehab, both inside a swimming pool when I was learning how to walk again, and then land therapy to add strength and mobility. Despite completion of therapy, I have had some fairly significant limitations in function that I have tried to keep up with and improve.

I have tried several different exercise and workout protocols. Something I have recently discovered which has worked really well for me is working out specifically using kettlebells. Kettlebells seem to be the perfect exercise combination for my hips as a significant portion of the work is accomplished by the posterior chain, low back, glutes, hamstrings, etc. One of the problems I have had is balance in the hip and core musculature since my injury because of being an office worker, and sitting for extended periods of time. When not seated, I am bent over at the waist, treating patients, furthering the tightness of the anterior chain and stretching and weakening of the posterior chain. I needed a way to better balance the anterior and posterior chain.

Exercises That Can Be Done To Help Hip Pain

There are many different exercises with kettlebells, from the most basic to the most exotic and complicated. In the remainder of this article, I will list and explain a handful of exercises that I have found work well for me with my own hip issues. My hope is to help guide others that are dealing with similar hip issues that have not necessarily responded favorably to their own exercise and treatment plan. As always, I would recommend coming in and letting me evaluate your hip and pelvis before starting any of these exercises.

1. Kettlebell Swing. I believe it is said that the kettlebell swing is the king of all kettlebell exercises. This one exercise works a significant number of exercises, to include the hips and gluteal muscles, hamstrings, abdominals, strong muscles of the back, including the lats and traps, and it even works the pecs and forearm muscles for grip strength. It is literally a full body exercise, but it focuses mostly on posterior chain. When I first did this exercise, I was surprised at how difficult and taxing it was on my hips, but also my cardiovascular system. My first set, I was able to get about 10 swings with a 45# bell done before I thought my heart would explode and my hips burn off. To do this movement, start with weight on the ground in between your feet, which should be shoulder width apart. Bend at the waist, knees slightly bent as well. Grab the handle of the bell with both hands. The weight will be pulled back between the legs as you lift. Then, using your hips, thrust the weight forward, extending the hips, causing the weight to swing forward. The weight will come high to around mid abdomen height so your shoulders and arms are parallel with the ground. That is the natural arc of motion for the bell swing. Then let gravity take hold, letting the weight back down between your legs toward the floor. Repeat with the hip thrust and extension, swing the weight back up. This is a difficult movement to get handle of, so make sure the weight is small at first as you are learning the movement.
2. Goblet squat. It is obvious that doing regular barbell back squats is no longer a good idea for me, so I needed to adapt. When I was first injured, and after my surgery, I was not able to do squatting at all, even with just body weight. So, I had to focus on the movement mechanics first doing body weight only. Once I was able to fully squat, pain free, I was then able to add weight. Goblet squat is unique in that it adds weight to the front rather than the back, so it changes the mechanics and muscle recruitment that a traditional back squat does somewhat. As the swing described above works mostly the posterior chain, the goblet works mostly the anterior chain. Muscles targeted include mostly the front of the thigh, quadriceps and hip flexor and hip adductor muscles. For this movement, start with weight same position as the kettlebell swing. You will do a clean to get the weight up to chest level. From here, you start your squat, focusing on form. Push thru the heels to really engage the quadricep muscles. This will tax your grip strength and shoulders as well, so start with light weight.
3. Kettlebell windmill. This is a very difficult exercise involving core strength, and thoracic and hip mobility. Start out with weight overhead, feet shoulder width apart. With the free hand, you basically try to touch your toe while maintaining the weight overhead. This causes a twisting motion of the hip and thoracic cage, improving mobility in that region. You can start with the weight in the lower hand to make it easier. The movement is the same, but not quite as challenging. Goal is to be able to manage the movement with weight overhead in snatch position.
4. Turkish Get Up. This exercise is a combination of several moves, and is therefore a full body functional strength movement. For this, I would start with no weight at all, as the movements are hard to grasp. You start on your back, left arm extended up to the ceiling with bell lifted. The left leg is straight and the right leg is bent at the knee with foot flat on the floor. Use your core to lift head and shoulders up off the ground in a crunching motion, coming up to your right elbow and then hand, in a seated position. Next, you will extend your hips, bringing yourself into a bridge, still weight in the air overhead. From there, the right knee comes under your body in a kneeling position, right hand still on the floor. Use your core to tighten and bring right arm off the floor to now you are in a right kneeled position but your body is now upright. From here, you are basically doing a reverse lunge, and you stand up, still weight extended overhead. From here, you reverse engineer the get up motion, and do a Turkish get down.

I am finding it very useful to do these motions as a core foundational program at least three days a week. For the swing, squat and windmill I start with 3 sets of 10 and the get up I do 5 per side. I will add weight and intensity, rep range changing per work out, depending on how I feel that day.