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Tag: hip biomechanics

Mini Pause #60: The Hips Don’t Lie: Especially When They Have Bursitis

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Hip bursitis is a common source of hip pain, especially in women over 40. Yay us!

It occurs when the bursae—fluid-filled sacs that cushion the hip—become inflamed. Symptoms include sharp or aching pain on the outer hip, discomfort when lying on the affected side, and stiffness.

The good news?

A mix of movement modifications and training (hello glutes), rehab exercises, and targeted nutrition can significantly reduce pain and improve mobility.

WHY

Women in perimenopause and menopause are more susceptible to hip bursitis due to hormonal changes, particularly the decline in estrogen and testosterone, which impact collagen production, tendon elasticity, and joint lubrication.

These shifts can lead to increased inflammation and a greater likelihood of soft tissue irritation, making conditions like bursitis more common in perimenopause.

And whatever you do–don’t ignore it!

If you leave it, the persistent inflammation can lead to compensatory movement patterns, where other muscles and joints take on extra strain, increasing the risk of secondary issues such as lower back pain, knee problems, or even gait abnormalities. The ongoing pain can make weight-bearing activities more challenging, leading to muscle atrophy and further weakening of the stabilizing muscles around the hip.

WHAT

Hip bursitis is the inflammation of the bursae, small sacs of fluid that cushion the hip joint. The most common type, trochanteric bursitis, affects the outer hip.

It typically develops due to repetitive movements such as prolonged walking, running, cycling, and excessive stair climbing. Clinically, I would always see it in runners.

Poor biomechanics also can leave you susceptible–things like weak gluteal muscles, leg length discrepancies, improper gait patterns, and poor pelvic movement, all of which contribute to uneven stress on the hip joint and bursa.

Estrogen normally gives us great tissue resilience. But when this begins to decline, we are at a higher risk for bursitis developing.

Common symptoms include:

  • Sharp or aching pain on the outer hip and thigh.
  • Tenderness when pressing on the area.
  • Increased pain after prolonged standing or walking.
  • Stiffness that worsens after periods of inactivity.
  • Pain sleeping on the affected side.

HOW

MOVEMENT & REHAB

Modify Activities: If you are experiencing symptoms, avoid prolonged running or repetitive movements that worsen symptoms.

Strengthen Your Peach: Focus on glute-specific resistance training, including exercises such as:

  • Hip thrusts
  • Bulgarian split squats
  • Step-ups (these can be done on a box or a bench or even a Hack Squat Machine)

All of these work to strengthen the gluteus medius and maximus, both of which play a crucial role in stabilizing the hip joint and preventing excessive strain on the bursa. It also makes you look great in jeans…so there’s that consolation prize, too.

I would often add in activation and hip stability exercises like:

  • Clamshells
  • Glute bridges
  • Some sort of abduction movement like lateral leg raises or an abduction machine

Foam Rolling: I don’t know why foam rollers are so controversial (I literally see doctors arguing about foam rolling daily on social media), but I really like them as a way to help relieve pain.

Obviously do NOT roll directly on the bursa but some gentle (key word her Bettys, GENTLE!) release in the glutes and IT band.

Correct Posture & Gait: This one might need some in-person coaching from a chiropractor or physical therapist, but poor posture, such as excessive anterior pelvic tilt (overarching the lower back), rounded shoulders, or an uneven weight distribution while standing, can lead to improper biomechanics that increase strain on the hip.

A weak core and gluteal muscles contribute to instability, further exacerbating poor posture and inefficient movement patterns. Now, I’m not a fan of planks (I hate them if I’m being honest), but I do like hypopressives and stomach vacuums as a way to improve core strength. Core strengthening and improving walking mechanics both help redistribute load.

NUTRITION & SUPPLEMENTS

Anti-Inflammatory Diet:  First the basics: Don’t eat ultra-processed food. Drink lots of water and sleep. You KNOW this.

Key Supplements:

  • Omega 3 is the ultimate anti-inflammatory supplement. 2-4g daily
    • Try BodyBio Balance Oil or Fish Oil+. Click HERE and use code DRSTEPHANIE to get 15% off.
  • Collagen supports connective tissue health and repair. Aim for 25-30 g daily, ideally in a hydrolyzed form for better absorption.
    • Try Equip Foods Grass-Fed Collagen. Click HERE and use code DRSTEPHANIE to get 15% off.
  • Magnesium aids muscle relaxation and recovery. Take at least 400mg daily.
    • Try BiOptimizers Magnesium Breakthrough. Click HERE and use code ESTIMA to get 10% off.
  • Vitamin D & K2 is essential for bone and joint health. Ensure you get at least 2,000 IU of vitamin D daily with K2 for optimal calcium metabolism.
    • Try Adapt Naturals. Click HERE to get 20% off. (A code will appear in a pop-up box when you click the link.)
  • Creatine is an incredible compound showing promise around not only muscle and brain health, but it also has some incredible anti-inflammatory properties for muscles, brain, and bone.
    • Try Create Gummies (my new favorite!). Click HERE and use code DRSTEPHANIE to get 20% off.
    • Try mindbodygreen creatine with taurine+. Click HERE and use code DRSTEPHANIE to get 15% off.

NOW

  • Apply Ice & Adjust Activities 

If your hip is inflamed, apply ice (15-20 minutes) and avoid aggravating movements. This will at the very least provide some temporary relief.

  • Strengthen & Mobilize

Add 5-10 minutes of targeted hip and glute activation exercises (above) to your daily routine. Also, consider some of the glute exercises above in your next leg day session.

  • Nutritional Support

Incorporate anti-inflammatory foods and consider adding collagen, omega-3s, and magnesium to your supplement stack.

What I Recommend

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Right now, I’m loving their sunscreen, OS-01 FACE SPF. (I wore it every day of my recent ski trip. It’s truly an all-season product.) Not only does it give you broad-spectrum UV protection, but it also reduces the effects of previous UV exposure at the cellular level. [*]

All those years you spent baking in the sun? There’s a chance you could repair some of that damage. OS-01 FACE SPF goes after free radicals, too. It’s packed with antioxidants that neutralize oxidative stress, so your skin isn’t constantly under attack. It’s doing the job of your vitamin C serum while protecting and repairing your skin. [*]

Visit oneskin.co and use code DRSTEPHANIE to save 15%.

BONUS! While sun exposure is the biggest factor for premature aging, chronic stress also plays a role. Learn how stress speeds up the aging process and get four tips for mitigating how it impacts your skin in this article.

Health Optimisation Summit Comes to Austin

It’s official! I’m speaking at the Health Optimisation Summit in Austin, Texas! I'll be talking about perimenopausal strategies like muscle, meals, and stress management.

Europe’s biggest health event lands in Austin on April 12-13. You'll hear game-changing health insights from nearly 40 industry-leading experts covering topics from biohacking and nutrition to functional and preventative medicine.

Spend two full days at the Palmer Events Center surrounded by Paleo-inspired wisdom, innovative health tech, and a community that feels like family.

If you purchase your ticket now and use code DRSTEPHANIE, you'll save 10% on VIP or General Admission.

Mini Pause #59: It’s Not Your Squat, It’s Your Ankles

Posted on by stephanie-estima

TL; DR (Too Long; Didn't Read)

Squatting is one of the most technically difficult compound movements. A lot of people have compensations, and today, I wanted to address one of the more common issues–ankle mobility.

WHY

A full range-of-motion squat is a beautiful thing. Little hearts can be seen coming out of my eyes when I witness the rare perfect execution of one at the gym. Sometimes, I clap involuntarily; it is such a rare feast for the eyes.

And the truth is, there are a lot of things that can go wrong when you’re squatting. Everything from low back and sacral mechanics to hip impingement, muscular asymmetries and compensation patterns, and, of course, joint range of motion.

I wanted to focus on ankle mobility today because so many of us unknowingly struggle with restricted ankle flexion, which will predictably and necessarily affect our depth and quality of squat.

WHAT

If you’d like a masterclass in ankle and hip biomechanics, watch a toddler play. If they want to observe something on the ground, they simply perform a perfect ATTG (ass to the grass) squat and just … hang out there like the masters of movement they are.

Perfect ankle flexion, no knees or arches caving inward, and no need to widen or turn their feet out. They just sit in this position for as long as they please.

We lose this gorgeous pliability through the shortening of the calf muscle and Achilles tendon. This happens with extended sitting in school (which can start to deteriorate ankle mobility as early as age 6) or wearing running shoes with an elevated heel or excessive arch support.

Sitting in these shortened positions or walking and running in a slightly elevated heel shortens the calf muscle and the Achilles tendon that attaches at the bottom of the foot. This is one of the most powerful muscles in the leg, and as it shortens, it will prevent ankle dorsiflexion (when you bring the toes “up” towards you).

When you go to the gym for a leg session, this lack of dorsiflexion prevents the knees from continuing to track over the toe, causing compensations in the knee, hip, and spine. This can limit your ability to descend fully into a squat and potentially set you up for injury.

There are a few things that commonly happen with limited ankle flexion when squatting down:

  • The knees and feet will cave inward to find more room to move (think knock knees and flattened arches of the foot).
  • The feet will feel like they need to turn outward in order to descend further
  • The knees will stop tracking over the toes entirely, and only the hip will continue to flex
  • The sacrum has to move backward to compensate (the infamous “butt wink sign”)
  • We might track to our “better” side, meaning, we might lean toward the right or left side.
  • Some of us may also have the added insult of being told to push through the heels as we squat rather than the whole foot, which can exacerbate the above compensations as well.

HOW

The first and the most easy correction is to squat in bare feet, socks, or minimalist shoes. I either squat in Peluvas or my socks. (If you you're interested in trying minimalist shoes, use code DRSTEPHANIE to get 10% off any pair of Peluvas.) If you wear plushy shoes to the gym, that's fine. Just take them off when you deadlift, lunge, and squat.

Another easy correction is to push through your entire foot, not just the heel—the way God intended. Think about feeling the floor with your heels, the balls of your feet, and your big toe. Use all of these locations of the foot as you descend with control and push back up to standing. This will also help further activate your glute muscles during the movement.

The third solution is, of course, to work on your ankle mobility. Before starting any leg day, or as a quick break from seated computer work, find a place where you can get into a deep squat while holding onto something. I typically work on my ankle mobility at home, in a doorway or the edge of my dining table where I can hold onto the wall or the leg of the table.

I concentrate on keeping my heels down (if your ankle flexion is poor, the tendency will be to lift them), and just hold this for a few minutes.

If getting into this deep squat is impossible for you, you can also use some wedges under the foot while stretching and even squatting to help mimic better ankle dorsiflexion. I think this is a nice intermediary while you work on improving the pliability of the ankle.

PRO TIP: I sometimes also use wedges when I want to bias the quads during squats, so these are a nice tool in your squat arsenal when you want to change up the focus.

NOW

To start, film yourself doing a squat without weight and with a typical weight you use. Make sure to film one angle from the side (so you can observe the knee, ankle, and hip flexion) and one from the front so you can look for knee and/or foot collapse.

Then, incorporate any of the above suggestions into your squat routine–go barefoot, create a better mind-to-foot connection during the movement, and work on your ankle mobility.

Ankle mobility is typically slow to correct, especially if this has been slowly developing for decades. Go at your own pace, and don’t force progress. Just be consistent, and the progress will take care of itself.

What I Recommend

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  • Keep your mind calm and focused
  • Support healthy blood pressure
  • Maintain emotional balance
  • Strengthen stress resilience
  • Prevent stress-related fatigue

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Health Optimisation Summit Comes to Austin

It’s official! I’m speaking at the Health Optimisation Summit in Austin, Texas! I'll be talking about perimenopausal strategies like muscle, meals, and stress management.

Europe’s biggest health event lands in Austin on April 12-13. You'll hear game-changing health insights from nearly 40 industry-leading experts covering topics from biohacking and nutrition to functional and preventative medicine.

Spend two full days at the Palmer Events Center surrounded by Paleo-inspired wisdom, innovative health tech, and a community that feels like family.

If you purchase your ticket now and use code DRSTEPHANIE, you'll save 10% on VIP or General Admission.