In The Spotlight- ‘Hip Extension’

Welcome back

As we already know, the problem of glutes amnesia has reached epidemic proportions. Our lifestyle is not like what it used to be. More work gets done sitting on our behinds all day than ever before. Spend too long in sitting  and we slowly start to lose the important movement of hip extension. In this blog post I would like to discuss two conditions that I have often seen in the past which can be directly or indirectly related to loss of hip extension (both lack of active control and loss of ROM). Seen in the general population and often perpetuated in runners. Lets begin-

  1. Low back pain– while the causes for LBP could be endless, we will discuss the role of inhibited glutes and lack of proper hip extension in LBP. If we spend  8+ hours a day sitting on a chair (hip flexion), the glutes will be in an overstretched position and often inhibited. To add to those woes, the hip also gets stuck in a flexion position with classic ilicaus and psoas tightness. Now to maintain a upright posture and to compensate for tightness caused by excessive prolonged hip flexion which would put our trunk in a forward lean,  the back extensors have to work harder to keep us upright. This often manifests as an increased lumbar lordosis (low back curvature). Prolonged time in this position can cause increase in tone of the lumbar erectors and could potentially cause low back pain. I see this often with recreational runners or those who are new to running. During running, if your hip do not go in to enough extension, the back begins to arch and the erectors being part of the posterior chain have to work extra hard. Remember the body is a great compensator but over time this catches up. This, I believe is often one of the common reasons why recreational runners come to see us for low back pain with running.  If you are an athlete or a runner, this is not the best situation for running.  Your glutes have lost their VIP status.  No one likes weak glutes, unacceptable.
  2. Plantar fascitis– I often find people with plantar fascitis have well developed calf muscles. It appears like its ‘calf raises’ day everyday for these folks however on further questioning you may find that they might not have been doing any calf strengthening exercises. If such is the case, I implore you to  check for their active hip extension in walking or running especially during the midstance, heel off and toe off of the stance phase. This is the time when the leg should start to cross back behind the body due to hip extension. This is the primary movement that propels us forward. Now if the body lacks this crucial movement, due to weakness of the glutes max or tightness of the ilio-psoas etc the calf seems to become a more significant driver to push the body forward. Now multiply this a few thousand times a day (even more if you are a runner) over a few weeks, months or years and we have a overworked calf complex. As we all know, the calf exerts a pull on the plantar fascia (remember its a two joint muscle) and that irretates the PF blah blah, we all know this. So improving active hip extension and utilizing the full potential of the glutes is crucial to give the calf a break and in turn might relieve some stress of the PF.

The take home message is simple-  Hip extension is a crucial movement for many daily activities and a lack of which might cause LBP or PF. When treating these conditions, don’t make the mistake of running after the symptoms like I have so often in the past. Here’s a little video to give you an idea of my thought process when analyzing hip extension in running.


(PS- this is not the only thing I look for, I’m only focusing on Hip extension here).

You know the drill.

Pursue excellence-

Abhijit Minhas


Considering a Physio Career Abroad?


We are shifting gears for this one. I have received too many questions from students/physios aspiring to pursue Masters/Career in Physiotherapy in the US/Canada etc that I feel I have a duty to oblige.  It has also become extremely difficult to answer the same questions over and over again so I will try to cover some of the most common and pertinent questions in a FAQ format. Here goes-

  1. What are some of the best colleges to pursue masters in sports/ortho/etc physiotherapy in US/Canada?

Most of the colleges in the US offer a 3 years DPT program which is a Doctor of physical therapy program. This is an entry level program which means that this is the minimum degree of education that one must have to practice as a physio. So the DPT is like our BPT program. There is no specific university which offers just sports/ortho/cardio-resp etc training. Depending upon which school (college) one gets admitted into and upon the interests of their professors, there can be some emphasis on some specialization but all in all this program covers the basics that one need to practice physiotherapy safely. To get better in your preferred field will require you to take CME/CEU’s (continuing education), work experience working in your field, internships etc. Also, there are hardly any programs in the US that offer Masters anymore. Canada has Masters in physiotherapy but that is an entry level program as well and will mostly cover topics we have studied in BPT already. The Canadian masters is a two year program

2. Is Masters in exercise physiology/Kinesiology (KIN) similar to a Masters in physiotherapy?

No, its a different field and a different profession. There is a lot of overlap in terms of what we learn. However, we have a broader scope of practice than a kinisiologist/ exercise physiologist. While, passing the NPTE exam in the US and the PCE in Canada is a mandatory requirement to practice as a physio; to practice as a KIN/ exe. physiologist one does not require to pass a national exam. Some gold standard certifications which might give one an edge are ACSM, ACE, NASM, PES etc. An exception here is the CSCS which is required to practice as a Strength and Conditioning Specialist. Please refer to my previous blog (Masters in the USA- Are you confused? Part 1) and MASTERS IN THE USA- Are you confused? Part 2 to know more about these fields/programs.

3. Can I practice as a physio after a Masters in exercise physiology degree?

You could take a masters in fine arts or business degree but as long as you have a Bachelors in Physiotherapy and pass the board exam you can practice as a physio.  YOUR MASTERS HAS NO INFLUENCE ON YOUR ABILITY TO PRACTICE AS A PHYSIOTHERAPIST (in Canada). However, recently US has changed its requirements to practice as a Physical therapist. Please check with FSBPT (Here) and NYSED (Here) for more details.

4. Is the NPTE/PCE very difficult?

While I haven’t given the PCE yet, it is somewhat based on the NPTE from what I hear. Yes they both are difficult but not impossible. Many international physios have passed this test. It requires a lot of hard work and dedication but its doable. The PCE has two parts, written and practical. The written component has 200 MCQ’s passing which one can appear for the practical. The NPTE is a 250 MCQ format exam. The hard part here for us is getting tested in a MCQ format rather than a essay format that we are used to.

5. What is the average salary of a physio in the US/Canada?

It depends. On a lot of things. Ones preferred practice setting, overall work experience,  North American work experience, language proficiency, interpersonal skills,  certifications after college, location, immigration status(unfortunately) etc. Pediatric physios working with children with disabilities in schools are  most likely compensated more than an outpatient physio. Depending upon where you practice salaries will change. Generally speaking, Physios in NYC have higher salaries than in physios in Idaho or West Virginia. Or in Canada, Physios in Alberta might make more than physios in Quebec. On the flip side if you take up a contract in the North Western territories up north in Canada where it gets very cold, you most likely have a higher salary than a physio working in Toronto. But to give you a rough estimate, a new grad physio or a new internationally trained physio can expect a starting salary of $32/hr as a starting point in both US/Canada in outpatient setting. Again, these number vary depending upon all the factors I mentioned above. I have added some links here to help you navigate this topic. Find them HereHere and Here. Again, at the cost of sounding repetitive, these are some estimates, use them as a guide.

I’d love to hear your feedback on this one. If I get a good response and more questions, Ill make this into a series of blog post. So send me your questions here.

In the mean time..

Pursue excellence-

Abhijit Minhas