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HipImportant ConceptsKnee

SIT LIKE A MAN (S.L.A.M.)

 

I’ve been promising to put this blog on my site for a long time. If you’ve read some of my responses to blog comments in the past several months, you would have read references to my Sit Like A Man (S.L.A.M.) program.

Now S.L.A.M. is not a feminist movement. It’s not a how-to formula for board room strategies. Nor is it a rejection of “lady-like” behaviors. It’s not a drive to encourage women to wear pants and shorts in the work place. However, all of the above might certainly be the result of it.

SLAM small image

 

It’s a women’s’ health movement. And I’m starting it! I’ve seen an occasional reference to the idea of sitting like a man in a different context, but S.L.A.M. is my Sit Like A Man acronym and I refer to it on a daily basis for my patients suffering from conditions such as patellar malalignment and chondromalacia, greater trochanteric bursitis, piriformis syndrome, and gluteal tendonitis. The concept even applies down the calf with iliotibial band syndrome, and all the way to the ankle with posterior tibialis tendonitis. I’m even throwing in some freebees with peroneal neuritis and plantar fascitis, since they’re not really due to biomechanical stresses, but are related to the way we sit. Some of these conditions are seen almost exclusively in women. Frankly it’s my “gut” feeling that they’re all seen more commonly in my female patients. And an orthopedic surgeon’s gut counts for something.

So over the course of my practice, I have tried to come up with treatment plans for my many female patients who suffer from these disorders. I apply the commonly used therapies such as various types of exercise: both strengthening and stretching. I use cortisone (pills and injections, and non-steroidal anti-inflammatories (NSAIDS). And depending on the condition, I might try braces or orthotics. And of course, in a few situations, surgery is an option. In most cases there are no surgical remedies, and patients are often counseled that these conditions are usually self-limited and will eventually get better on their own. Or they won’t. And we are frustrated…

Lonely woman-1488617 (1)

Let me tell you that it is almost as frustrating to give that counsel, as to receive it. And during almost 30 years of private practice, I have contemplated alternative remedies for these frustrating conditions, almost as much as I have concentrated on the learning, updating and evolution of traditional solutions to other conditions.

Cheerleader picture

But it was actually the gradual aging of my own body, which honed my theories on the treatment, and even the prevention of these conditions.  I’m a woman, and therefore am more likely to suffer the conditions of women: gynecological as well as musculoskeletal. And let me tell you that my patients love it when I suffer, not because they are cruel, but because they know I understand.

When I was about 32, I began to experience knee cap tracking problems (patellar malalignment). Way back in 1987, when many in the almost exclusively male orthopedic community, pooh-poohed patellar malalignment as some kind of female growing pain, or just one of those female aches and pains, I was actually suffering from it…and knew that it was not in my head. It was in my knees, which were crunching with stair climbing, and aching when I did any kind of squat, deep knee bend or lunge for exercise. It was then, early in my career, that I decided to stop any form of these exercises. The pain and swelling resolved completely. I then began a course of exercise to strengthen the muscles which stabilized my knee cap. The pain never came back, and to this day, I do these exercises and continue to avoid the activities which might aggravate this condition.

But a certain number of women did not respond to this program. So I added some additional exercises to encourage the femur to rotate outward. I began to recognize that the use of the knee/lower extremity, in a slightly externally rotated position, angled outward to the 11:00 position on the left, and the 1:00 position on the right, more closely looked like the way men sit. And if you get up out of a chair that way, it approximates the way a man gets out of a chair.

And Sit Like A Man was founded…in my head anyway.

vintage-beach-ladiesFor academia’s sake, let me also say that women start out a little behind the eight ball. The alignment of women’s lower extremities predisposes us to these disorders, and without going into the boring detail, suffice it to say that our hips and knees are mechanically aligned in a way which rotates our femur inward and our knees into a kind of knock-kneed position.

I applied it to my own lower extremities. Let me tell you that after decades of training my legs to slam shut, sitting like a man was not easy and certainly did not feel “natural.” I slipped back into my old lady-like habits.

Woman sitting on chaise longue, holding scarf, (B&W), portrait

Then in my 50s came greater trochanteric bursitis, that scourge of the feminine aging process. I probably see at least 2 women a day with this condition, and I began to suffer from it as well. But I quickly recognized that if I resumed sitting like a man (S.L.A.M.ing), the pain subsided. Of course, you will read on my blog that I also did some stretches and ultimately sold a car with smaller seats, preferring to drive my four-wheel drive Ford F-350 Super Duty pickup truck, with huge seats to accommodate my hu…never mind. Suffice it to say, that in my humble opinion, a smaller seat almost forces your hips and legs into that lady-like position. When we rotate the hip inward, our knees naturally fall into a knock-kneed position, which increases the stress across our iliotibial band (therefore our hip bursa) and incidentally, our knees. So the larger seat limits that pressure. I highly encourage the use of an F-350 Super Duty pick up as part of the solution to hip bursitis.

Okay, making the assumption that there will not be very many women going out to trade in their little cars for a one-ton pickup, and that there are no practical operations which we can use to realign our legs, let’s stick with one thing we can do…

We can SIT LIKE A MAN!

couch-potato1

How do you sit like a man? Well, first you have to spread your legs a little apart. When I was a teenager we called that shooting the beaver. I was a teen at the time when skirt lengths first started coming up. You HAD to slam your legs together. The boys would drop pens on the floor during study hall in order to bend over and look up our skirts! We were just little teenagers and sometimes we lost concentration on our untrained thighs while we were trying to STUDY in STUDY HALL. Boom, next thing you know, you got a reputation. “Bergin shot the beaver. Bergin shot the beaver.” Hey, it wasn’t just me showing off the whitey tighties. And as if that wasn’t enough. Then you were sent to the school nurse for indoctrination!  Like it was our fault. Well, it didn’t take long before you learned to slam them legs together…tight. Never to spread apart again…at least while sitting in class.

Back to the S.L.A.M. technique. Let those knees drop slightly apart, with the left leg pointing essentially to the 11:00 position on a clock, and the right knee to 1:00. Sure 10:30 or 1:30 would be fine too. But it’s not necessary to reach for 10 and 2. That would be manspreading. Manspreading is not necessary. This is what men in NYC do in the subways. They spread their legs wide apart to cover more than one seat so no one can crowd in next to them. I’m pretty sure they also do it to irritate women. No manspreading is necessary to S.L.A.M.SLAM PROPER

But while you allow those knees to comfortably drift apart, don’t keep your feet to the outside of your knees. That would still be encouraging the knock-kneed position of the lower extremities. Honestly, you have only to look at your husband, dad or brother to figure it out, because that’s how they always sit. For them there is nothing standing in the way of sitting naturally: no skirts, no culture, no desire to make themselves look smaller. They sit with their legs apart, they rarely cross their legs, and when they do, they certainly don’t noodle them up tight. They never hike their leg up under their rear end when they sit down on a couch. They just sit, in a natural relaxed way, with their knees apart and their feet flat on the ground.

Trust me, if they wore short skirts, they would be keeping their legs slammed shut and maybe even suffering from piriformis syndrome. Honestly, I don’t think I’ve ever diagnosed a guy with that disorder.

Now let’s take this one step further. You have to use this technique for getting in and out of chairs, because a lot of stress is placed on your knee cap when you sit down and stand up. So just keep those knees pointed at 11:00 and 1:00 when you get up and down. Don’t allow them to collapse into that knock-kneed position again. And keep your feet flat on the ground.

That’s it! That’s all there is to it! I propose this as an adjunct to traditional treatment methods for all of the conditions I mentioned above. I also propose it as a way of life. I want women to Sit Like A Man, unless they are wearing short skirts. I don’t advocate unladylikeness. I advocate health.

So why is this healthy?

Because this is the way women were meant to sit!

Think about it. Any of you who have read my blog know that I always go back to the cave person when contemplating the natural human. We are hunter gatherers, and the further we veer from that form, the more likely we are to be damaged. Picture the American football player. He’s come a long way from his cave-dwelling ancestors.

039_14209~Raquel-Welch-PostersThough not having been there in person, I can almost guarantee that the cavewoman sat around with her legs apart. First of all, she wasn’t ashamed. It took social and cultural progression to give us that shame. But more importantly, she wanted to show off her business. So how do I know what was in her head…that she wanted to show off her stuff? You have only to look at the animal kingdom to know that the female of each species tries all sorts of ways to show off her business. When my female horses are “in,” they raise their tails way up in the air and literally wink their private parts at the male horses. It’s ridiculous.

So once we got all prude, we were taken out of our little Rachel Welch miniskirts, and forced into long dresses. That lasted a LONG time…probably tens of thousands of years. Why would women slam their legs together under long dresses? What difference would it make? So not only was there no need to do it, it was hot up under there. We needed breathing room. Legs apart please. So how do I know what position women put their legs in for thousands of years? Well, you have only to look at old paintings of women in longs skirts to see that they did so.

qv

It wasn’t until the 1920s when skirt lengths began creeping upward, that it was considered more pleasing and ladylike for women to have their ankles together. Then, when skirts got really short, slamming those legs together became a necessity. But Dr. B, how can you really know? 8362fb664b522b922b2e0aca10735950Because we have little daughters to watch.  Next time you’re around children, make some of your own observations. There’s no question that infants and toddlers S.L.A.M. And most girls S.L.A.M. until they get into junior high. I see them in my office, wearing pants and sitting like guys. And for each girl it’s different, but at some point, they start squeezing their knees together, tightly crossing their legs and noodling their legs, one coiled around the other.

And while it rarely contributes to painful conditions in the young, in my opinion, the long existence of this habit will contribute to problems as they age. I might go so far as to say that this sitting habit might even be related to the poor landing mechanics in females, which result in a higher rate of anterior cruciate ligament tears in this population. There has been a successful effort to teach young female athletes proper landing mechanics, in an effort to diminish the incidence of this devastating and life altering injury. So if an exercise program can modify the natural movement of women’s legs in a jump, why can’t a modification of sitting technique have a similar effect on some of the disorders from which we suffer throughout our lives?

So I’m here to tell you there is another way to sit. And that is to S.L.A.M. whenever possible: when you have pants on, when your legs are under a table or behind a desk, when you’re at home with those who do not care, or might prefer it. I believe you can S.L.A.M. 90% of the time.

grey t shirt girl SLAMMING

So go do it. And rather than teach your daughters to slam those legs together all the time, teach them to put them together when they wear dresses, or shorts, or when boys are around. And hopefully, for a while, that’s only 10% of the time.

So go S.L.A.M.! It’s the healthy thing to do.SLAM small image

 

 

 

48 comments
  1. Rattlesnake

    Dr. B this is so sensible and right on -thank you!

    your blog absolutely addresses my issues as I am again reminded how I automatically always sat like a man –
    and my grandmother constantly reminded me that I must sit like a lady or I would surely come to some great ruin!

    and my great ruin is totally wrecked knees!
    not to mention all the back and hip issues and that I walk like and feel like an old car going lop sided down the road that has been rear-ended a bunch of times!

  2. Pat Riordan

    Although I don’t know some of the medical terms used, and I’m not a female, I’m a believer as your information/advice sound so logical. I hope your female readers will comply……..and you can be so funny and practical in the manner you present the information.

    1. Barbara

      Dora,
      I’m so glad you’re trying to SLAM! I’m going to tell the world about this idea and hope that it results in a lot less lower extremity pain in women. Thanks for letting me know you’re SLAMMING!

  3. Mary Kay Tointon

    Thank you for this article. It was me to a tee! I have hip bursitis and the tendon problem plus tears in the gluteus minus. I will certainly. Start sitting like a man whenever I can. Thanks again!

    1. Barbara

      Please try to remind yourself to do it as much as possible. I’ve just done a press release on this and have a lot of interest on the part of the local press. Hope to be sharing my concept on TV in the near future!

  4. Stephanie Kirkland

    Great advice presented in an entertaining and practical manner. I’ll be recommending this to my female patients and referring them to this blog!

    1. Barbara

      Stephanie,
      Thanks for checking out my blog and for recommending this concept and my blog to your patients. What is probably most pertinent to your practice would be my RESPECT series. I plan to do many of these. I write them in response to the many simple injuries which cause damage to my patients. They’re situations in which making one simple little change might result in the prevention of many injuries.
      And Sit Like A Man!

  5. Dianne Harbeson

    I am currently going through physical therapy for all the above issues referenced. My doctor, physical therapist, and trainer are men so thank you so much for sharing the information on”S.L.A.M.

    1. Barbara

      I wish I could help guide you on your PT. Keep watching my blog. I’ll have more on the therapy for some of these conditions in the future. I’ll probably publish a “handout” on some of the exercises to try.
      Men will often be slow to acknowledge and treat conditions which mainly affect women. Hate to say it, because I have many wonderful partners and a wonderful dad, brother, hubby and son. But it’s true.

  6. Patricia

    “greater trochanteric bursitis”

    Yup, my doctor called it race car seat bursitis. The question is, how can I modify my little Corolla that is slowly torturing me? Is there a small car with a flat seat that ladies with this problem can buy?

    I did read where one guy hammered down the race car bolsters a millimeter or two, and that worked, but I don’t know how to do it.

    And note to car manufacturers: we can’t go fast enough in L.A. to need the bolsters. No danger of falling at 10 mph.

    Thanks for the blog!

    1. Barbara

      Patricia,
      I always like to hear that another doc gets it! I had two small cars, a Smart Car and a Fiesta, and they both bothered my hips. And on top of that, I have to lower myself down into those seats as well. I’m six feet tall, so that makes those seats doubly hard to deal with. No problems with the F-three fiddy, as I like to say down here in Texas. That’s like sitting in a Lazy Boy. I’ve heard that those beaded seat covers you see the taxi cab drivers using work really well. They kind of fit in between the bolstered part and might even the seat out. Frankly, any seat cover might do the trick. You just want to flatten out that seat. Might be easier than smashing something in there.

      1. Patricia

        “F-three fiddy: 🙂

        Too big for 5’2” me, but thanks. Maybe I will start a group called The Flat Seat Society, and beg car manufacturers to go back to flat seats!

        1. Barbara

          You go girl! Listen, all kidding aside, if S.L.A.M. has legs, and I can get the word out, I plan to do just that. Why not have an optional flat seat, or mechanical cushions that can go up or down, just like the inflatable lumbar supports in many cars. I plan to eventually encourage companies not to require dresses or skirts in the workplace or on TV! S.L.A.M. is working for so many of my patients, and I think the more we do it, the better off we are as a whole.
          Thanks for reading my blog!

  7. Susan Bowie

    Dr. Bergin,

    You know I just love you and your blog. I have been following you around and you have been fixing all my fixable stuff since you were over on 32nd and Red River. I have laughed so hard at your S.L.A.M. because for some us that just comes natural and it really works. As far as the Ford F 350, just remember never to put gas in diesel truck….LOL….remember that? Love ya, Susan

  8. Christine

    Doc,

    Where have you been all my life!?! I just had surgery for my labrum tear and spoke w Dayne at Torso about your mission. You get me! I went to so many medical professionals and they said I was always the mystery patient. I was once a fitness trainer and I knew something was wrong. My right glut & calf muscles were squishy and didn’t work, my quad and hamstring were always firing, I had hot poker searing groin pain, classic C pain. When I learned I had a labrum tear and was a classic case, I was thrilled to be “classic” for once! Looking back, I suffered for years and I kept asking practitioners “could it be my hip”?

    Looking back, I remember my mother putting me in a skirt and I could not keep my knees together at my school desk. I was SLAMing! I remember the effort to this day and of course, my mother was not pleased that I was better off as a tomboy.

    I also feel petite women have unique issues because our feet do not touch the ground often. I am 5,2″ so office chairs and desks do not fit me. Cars, too. I’d rather sit on the floor. I am one of those “best dressed, image conscious” gals so of course I have worked super hard to be a lady. I am going to focus on 11 & 1 and help myself get out of pain.

    I wish I could hug you! Thanks for all you do. I will be sharing your blog with my friends and colleagues.

    1. Barbara

      Christine,
      Ha! I’ve just been down here in Austin,TX, treating the sick and the very sick! I’m so glad you like my blog and it’s helping you in some way. I have a perspective on medicine which is different from many of my colleagues. I use my blog to get that message out there because otherwise my voice only goes to those who can see me here in Austin!

      The very first time I was able to wear pants to school “legally” was my senior year in college, when they allowed me to wear “pantsuits” after I had surgery on my feet. I had to wear those goofy post op shoes for 3 months and so the school gave me permission to wear pantsuits. The fabric of the top had to match the bottoms. So I spent the first 18 years of my life SLAMing too! It’s not good for us! Plus…we need some air up there!

      You’re absolutely right about short women. I’m 6′ tall so I definitely have an advantage. One thing I suggest to my patients is that they purchase a set of those old bench step aerobic benches and put one in front of their desk chair and under any chairs at home where they sit a lot. It’s easier than a block of wood, and bigger so you have room to move around on the platform. That allows you to put your feet flat on the ground and takes the pressure off the back of your thighs. That’s better for your back too!

      That’s one advantage of being tall. It’s payback for all the years I had to wear high water pants because no one made jeans and pants for tall women!

      1. Liba Strengerowski

        Dear Dr. Bergin,

        I just learned about your blog and recommendations, and I am reading it with a lot of interest. I am 59 years old, retired a year and a half ago (after 26 ys of seating in an office chair and traveling around the world), and since then made exercising a big part of my daily routine – 1 and 1/2 hours at the gym doing elliptical and treadmill plus weight exercises (5 times a week). I tend to believe that I might have been over exercising, and seating too much, as my lower back started to bother me daily when I seat and I developed chronic hip bursitis on my left hip to the point that I could not sleep or lean in my left side. In addition, after doing an MRI, I discovered that I have scoliosis, mild spondilosis and disk hernia on the L5/S1. The first doctor I consulted gave me a cortisone shot on the top of the hip and methylprednisolone (one box 21 capsules on a decreasing basis). The pain on the left hip decreased, but not totally – I still feel some discomfort and burning sensation when I sit or squish it, but it is less sensitive than before, and I still feel slight pain when touching it. I went to see a second doctor (spine specialist) and I started physical therapy for the back and hip, but it was so painful that I would literally scream from pain and I was so bruised that I could barely touch the lower back/hip area. I stopped going to the gym and to the PT for the past 3 weeks (PT’s recommendation), to let the bruises heal, as I could not discern between the back pain and bruises pain, and after seeing the doctor again, I will have an epidural procedure for the lower back (L5/S1) on July 8 to help me with the back pain. I have been doing stretching exercises daily on my own (40 minutes in the morning, 30 minutes in the afternoon), same exercises learned at the PT, both for the back and hip. My question to you is: can I take another round of the prednisolone and another cortisone shot on the hip (this time on the lower part of it)? I believe that I am starting to develop bursitis on the right hip too, but not bad yet. Can I do it after the lower back procedure? Will I be able to continue doing the exercises routine I am so used to at the gym? What would you recommend? I am 5’1 and weight 142 pounds. Should I continue with the stretches exercises? I will definitely SLAM and do the exercised recommended for the bursitis. Anything you could suggest will be highly appreciated. Many thanks, Liba

        1. Barbara

          Liba,
          I’m sorry, but your history and question are just too specific and extensive for me to answer. Because it is so specific, I can’t really speak in generalities, which is what I prefer to do because, needless to say, I can’t “treat” you as a patient via a blog comment. If people ask general questions, then I can respond for the benefit of all my readers, but I can’t tell you if it’s okay to have another shot or take more medication. Really sorry about that. It sounds like your docs are ernestly trying to address your symptoms, so I recommend you follow their guidance. I would never want a patient of mine to tell me that another doctor said it’s okay to do a certain treatment, especially if that doc had never seen my patient.
          It can’t hurt to SLAM. Always try to modify any activity that causes pain.
          I wish you the best in trying to get well.

  9. English Vellum

    I have read umpteen websites on trochanteric bursitis but only this morning have I stumbled across yours. All I can say…thank goodness! I mirror exactly all the symptoms described both by yourself and the contributors. I’ve been in agony for years from my left hip bursitis and, in spite of seeing numerous doctors, have only just received a proper diagnosis. Also I’ve had THE LOT in terms of treatments but still suffer the acute pain and the long term lack of sleep.

    So I am already SLAMming and putting my trust in the logic of what you describe and will look forward to reading your blogs which are so informative and give humorous light relief to such a wretched condition.

    Looking forward to some more entertaining and enlightening blogs!

    1. Barbara

      Anne,
      Are you from England! I have a number of blog followers from across the pond. I’m so glad you have found something to help you in my blog. I hope you get relief. You have to keep reminding yourself to SLAM. It won’t just happen overnight.

  10. Amy

    Hi Barbara
    I have had tb in my right hip 7-8 months and in my left as well for about 4 months. I am 46 yrs old, have 4 children under ten and work as a teacher and keep fit.
    Had mri, one cortisone injection, some specialist physio and saw a musculo skelatal specialist. All were helpful but your blogs are the best.!!!!!!

    Everything has been helpful but SLAM has has given the best long term relief. I do the stretches and walk up and down stairs similiarly to slam. Cycling (easy, no up hills, and in a more upright position on smaller frame bike) warms up the torn and feathery g min and med tendons. This pain has definately improved.

    Thank you so much for this and your other blogs. I am definately beating this horrible blight and anytime i have a set back such as carrying and lifting too much or bustling at work when i shouldnt i find comfort, such comfort!!!! in reading your comments.

    I also think that natural medications such as bromelaine, krill oil and glucosamine help (you certainly know when you don’t take them!)

    Thanks again for your website. I always recommend you favourably when speaking to medical practioners and any others who will listen to me here in Australia. I will always tune in to your blogs!!
    Many thanks Amy

    1. Barbara

      Amy,
      Wow! I’m so honored to be read over in Australia! I’ve never been there but through the internet I’m reaching out over there! I’m going to have to come for a visit one of these days.
      I’m glad my suggestions are helping you.
      Like me on Facebook and you can keep up with other stuff I’m sharing! https://www.facebook.com/DrBarbaraBergin
      blb

  11. Lindsey

    Hello Dr. Bergin,

    Firstly, thank you for being a resource for those of us who suffer from these ailments you write about.

    Quick background: 32 y.o. female, 2 elementary-aged kids, a Pharm.D. Longhorn living in San Antonio, play tennis and love Bikram and Power Yoga. Recently visited orthopedic surgeon’s PA. Diagnosed with trochanteric bursitis and tight IT band so did steroid injection followed by PT, which helped relieve pain. Few weeks later (yesterday) MRI revealed bulged disc at L4-L5 and herniated disc L5-S1.

    Sadly, I feel like I left the office of PA and PT with many questions and not many answers as to what excercises I should do and those I should avoid relating to both injuries and what treatment options I might have for the discs now or later (all I was told was lifestyle changes). Do you have any credible resources you’d recommend reading regarding activities to do/avoid? And how would you say that these two issues (disc and bursitis) are related?

    Thank you for your time as I’m worried about re-aggravating either or both conditions but want to stay active!

    1. Barbara

      Thank you for your kind words. Please send my link out into the blogosphere and encourage your friends and family to subscribe. It’s the only way I continue to get out the word…especially about SLAM!
      It helps me to hear that a professional diagnosed you with greater trochanteric bursitis and that an injection helped. It helps me to know this information if I’m to attempt to guide you any further. But understand that my recommendations are general, and not directive. I haven’t seen you as a patient, and so you must allow your doctor/PA to guide you toward specific treatment.

      Firstly, let me just say that a lot of patients don’t like seeing PAs or Nurse Practitioners, but I can assure you that they are well trained and are very knowledgeable and frankly, their help is necessary. We don’t have enough docs to service the growing burden of sickness and disease out there. I have had a PA working with me for 16 years! My patients love him and if it weren’t for him, I couldn’t see all the folks who want to see me, and I couldn’t get patients in for same-day appointments. Sometimes when you’re in pain, you really want to be seen THAT DAY, and not in the very-inefficient emergency room. Okay…just had to get that off my chest!

      Now to your situation. Many patients have both greater trochanteric bursitis AND sadly, neuropathic pain at the same time. When I say neuropathic pain, I refer to a global cause of pain related to nerve compression: herniated discs, spinal stenosis, piriformis syndrome, sciatica…to name a few. You’re very young to have a herniated disc. The significance of your herniated disc must be determined by your doc or PA. In most instances herniated discs are only significant if they are causing compression of nerve roots which in turn cause pain (usually down the leg) or dysfunction (motor weakness or bladder or bowel problems). In other words, if you had no pain, no motor or sensory deficits, and no bowel or bladder incontinence, but for some reason had an MRI which demonstrated a herniated disc, your doctor would likely not recommend treatment. In your case, you have leg pain. It is now necessary to determine whether or not your pain is related to greater trochanteric bursitis or your disc problem. But unfortunately…you can have both, and both might need to be treated independent of each other!

      I’ve already overstepped my bounds in terms of giving you advice from afar. You will have a follow up appointment with your caregiver. Keep in mind that 99.99% of people with greater trochanteric do NOT require surgery…and even when they have it, the pain eventually comes back! Sit Like A Man! It works.

      The same goes for the back. Patients and doctors should make all attempts to get results with conservative treatment: things like physical therapy, NSAIDS, activity modifications, and sometimes injections. Contrary to popular opinion, tennis, and yoga aren’t necessarily good for your back or your hip. If you can, WALK…on a flat surface…at a natural pace…in supportive shoes, and consider using trekking sticks.

      Best…and Merry Christmas!

  12. Kate

    I have just found your website and have signed up almost in tears with relief. I live in the UK, I am female, aged 52 and have greater trochanteric hip bursitis. I have it in both hips but it is way worse in my right. I have had it since I was 18 (I had an accident when I was 5 years old that caused a trauma to my right hip) but have had repeated X-rays over the years, which have resulted in me being sent away in increasing pain with no diagnosis. I love walking – and gradually the distance I could walk reduced from 20 miles, down to 1 mile. Orthotics helped for a while but the effects didn’t last, although the pain is a lot worse without them.

    Finally, in desperation last January I googled my symptoms and discovered I had bursitis, and realised that curing my problem through exercise wasn’t the way to go!

    I went to my GP, who has been very sympathetic and referred me to a consultant – who wasn’t. I have had physiotherapy, corticosteroid injections, and NSAIDS. Although I understand it is a self limiting condition, as far as I am concerned it is a chronic lifelong form of torture with interludes of acute agony.

    I have traded in my sporty car with bucket seats for a 4×4 with heated seats. I use a cane, and am OK as long as I don’t walk more than half a mile at a time. Stairs are an aggravating factor – so I avoid them wherever I can now. I have an adjustable desk at work so I am not standing or sitting for too long. When it gets really bad and I have to walk anywhere I take a codeine tablet with a high level of ibroprufen and it just about becomes bearable. For the record I had two of my children in my kitchen, so I’m not a wimp when it comes to pain!

    Now I have S.L.A.M to add to my pain management tools. And it works – just adjusting my sitting position has alleviated the discomfort! Brilliant – thank you so much. I tend to wear trousers under dresses anyway as tights are too painfully tight against my hip and upper thigh, so I am going to get into the S.L.A.M habit immediately.

    This is my best Christmas present this year. Thank you.

    1. Barbara

      Thanks for letting me know about your experience. It’s been over a month since you commented on my blog, and I’m sorry I didn’t reply sooner. I hope you are on the mend. Mark me, this condition can sometimes be recalcitrant to treatment. It took almost 6 months of SLAMming for me to get over mine. If you do indeed have hip bursitis, it will get better. Keep sitting like a man…forever. If it’s not getting better, return to your GP. Sometimes there are other conditions which can cause lateral hip pain…like gluteal tendonosis. This is diagnosed with an MRI. That’s even harder to get over…occasionally requiring surgery. No matter what the cause…sitting like a man will never hurt you. And if you read all the Sit Like A Man blog, you will see that there are about 6 other conditions it might help prevent. Best…

  13. Rhys

    Doctor Bergin: Let me add my name to the list of your fans! What a great site and resource. However, I have to confess that I am a man who apparently needs to re-learn (in late 50s) how to sit like one. I’ve been active much of my life, running, biking, triathlons, tennis, skiing, mountaineering, etc. but suffer from a recurring hip pain. Went to the ER a year ago a week with severe pain that got worse during the week after skiing; Dr. said my cartilage was in fine shape but that I likely sprained ligaments, which I’m sure I’ve done many times in the past. Unfortunately, it just never got better this year. Also diagnosed with “runner’s knee” 25 years ago. At any rate, trying everything, and a Google search combining all my hip and knee problems led me here a few weeks ago. Have I been sitting like a woman all this time? (p.s., I have no objection to men who sit like women. In my case, I think I sit so much I’ve had a tendency to roll over a bit on my left butt, which brings the legs together). So I tried your SLAM technique all the time. I also stretch like a frog now. Relief was dramatic and relatively quick. Not 100% and can’t do high-knee sprints at the track yet, but I am so encouraged! I don’t know if you have any further refinements to S.L.A.M. (e.g., whether any wider angle than 11-1 helps even more, where to point toes, feet closer together or father apart, changes if you lean forward or back, etc.,) but if you do, please post!

    1. Barbara

      Rhys,
      I have to admit, it’s a little unusual for a guy not to sit like a guy, but that being said, some men do have a lower extremity mechanical axis which is more similar to a woman’s mechanical axis and therefore might predispose to greater comfort sitting like a woman (ha…SLAW). Basically, just place your knees at 11 and 1, and try to keep your feet under your knees, and not outside or inside by much. I’ve got pictures on my blog. I’m glad you’ve recognized it and the change is helping!

  14. chris

    Hello Barbara,
    very grateful for this site – only just found it, although I’ve had trochanteric bursitis for 25 years!
    unfortunately I can’t subscribe to your blog – the website does not allow me to type into the ‘subscribe’ box…. what should I do?

    May I ask to what extent the SLAM method has done away with your bursitis? I have high hopes now, but maybe I should not expect too much. I’ve had to give up a number of sports/ activities; long distance mountain trekking was the most difficult one for me to drop. Although instinctively I seemed to have done the right thing when bursitis hit hard on a trek: I walked with my thighs in the 11-1 position, and minimised the pain caused by climbing by basically wobbling from one leg to the other … 🙂 !
    again, many thanks!
    Chris (U.K.)

    1. Barbara

      I don’t know why you’re unable to subscribe to my blog, but the other choice would be to friend me on Facebook. I’m under Barbara Bergin and Dr. Barbara Bergin. When I post blogs, I link them to Facebook. Also, if you do Instagram, I post there too.
      Thanks for your interest.
      Now to your hip. Frankly, it’s rare to have hip bursitis for so long. I might doubt that simple diagnosis. It could be a little more complicated than that, and I hope you have sought professional consultation. You might also have degenerative gluteal tendonosis, which is fairly common in folks (especially women), who are older than forty. Our gluteal tendons just wear out from sitting lady-like and standing with our hips cocked to the side. You have a name which could be female or male, so I don’t know into which category you fall. Hip bursitis and gluteal tendonosis are much more rarely seen in men.
      Occasionally, piriformis syndrome (a condition in which the piriformis tendon in the buttock, puts pressure on the sciatic nerve) can also cause something like lateral hip pain.
      But if your pain is exactly over the lateral aspect of your hip and when you put pressure there, it hurts, it’s most likely hip bursitis.
      It hurts more when you hike and walk long distances because of the mechanics of walking. You’re right to try to modify the way you walk, particularly if you walk in a more feminine stance…or a knock-kneed stance. Sorry if you’re a guy…but some guys do have a more feminine configuration of their lower extremities (more knock-kneed as opposed to bow-legged), thus exposing them to the same mechanical stresses.
      Continue to work on those changes, sitting like a man, etc. Also consider using trekking sticks when you hike.
      Make sure the diagnosis is correct!
      Thanks again for checking out my blog.

  15. Gina

    I have been living with hip bursitis on both sides since my son was born 14 years ago. I am 48. I am a teacher standing all day. I sit for awhile and it hurts to stand, wakes me up at night. I only sleep on my back & stomach. I have had xrays, PT for ITband, bursitis. I take 750 mg of Neubatrone 2x daily & Lyrica 150mg 2x daily for fibromyalgia. I am too afraid of injections due to my low pain tolerance to have them. I have arthritis & joint pain & long term planter fasciitis. So I am excited to read your blog.

  16. Jeni

    Hi Dr. Barbara,
    I have hip flexor tendonitis/osis in my right hip flexor. I have been in PT for 5 months without improvement. Would SLAM be helpful for me? Can you tell me what you typically advise for people with this issue? Mine is from overuse from too much treadmill & elliptical time.

    Thanks! Your blog is fantastic!

    1. Barbara

      Jeni,
      Glad you’re enjoying my blog! Please spread the word to your friends & family. The more folks who read it, the more people I can help.
      With regard to your question regarding SLAM for hip flexor tendonitis, I’m not sure that it directly effects that condition. Interestingly, I rarely see men with that condition…or rarely give them that diagnosis. But mechanically, it doesn’t make sense that it would help hip flexor tendonitis. That doesn’t mean SLAM won’t help you, and as you know…I think all women would benefit from SLAM…unless they’re wearing a dress. And I guess that would depend on your definition of “help.”
      Here’s my take on treadmills. I’m seeing a lot of treadmill related disease recently (stress fractures and repetitive strain disorders of the lower extremities, including hip flexor tendonitis). First let me say that treadmill walking is NOT natural walking. I think we should only use treadmills when we can’t walk outdoors on a nice flat surface. We tend to overwork ourselves on a treadmill, increasing our speed for long periods of time and increasing the angle of incline much longer and higher than we would naturally walk, unless we were trying to beat someone to Everest base camp. Since it’s not a natural way of walking, after heel strike we too quickly pitch over to our forefoot and subsequently throw our weight over our knees. Or something like that. No matter…it ain’t natural and we shouldn’t be doing it too fast, too much or too inclined. Use treadmills when it’s too hot, too cold or too ugly outside. Use it every other day only, and use it in moderation, slowing down to a more leisurely gait, and decreasing the angle of incline to the first level. Sorry. I know it’s boring. But I need to tell the world about this issue. I think I’ll use this for a blog on my http://www.1010parkplace.com/ blog entry pretty soon.

      Okay, all THAT being said, if it’s been going on for a while and not getting better and you’ve done everything your doctor told you to do, then make sure it’s not something else. Similar symptoms can be seen with hip arthritis and femoral neck stress fractures. Not trying to freak you out, but be sure it’s not something else if you’re not getting better, especially with rest.

  17. Jana

    Dr Bergin, as an older woman now suffering from TFL and bursitis . . . ouch . . . one other habit I started as a young girl occurred to me as a possible contributer. I also have severe femoral/patellar syndrome, both knees, and I distinctly remember as a kid playing around with my sisters walking like the ‘beauty queens’, level, head erect, etc. but there were also children that walked around like a duck or pigeon toed that were teased. I tended to walk with my feet slightly pointing outwards. So I concentrated and worked on walking perfectly straight. Always corrected the drift of my feet outwards to be straight in line. That’s the only way I can walk now . . . but what twisting and deviation of my knees and hips medially occurred as a result? hmmm.

    1. Barbara

      In general, it’s commonly felt by most professionals, that it’s not a good idea to try to alter one’s gait. We’re put together in a certain way, and in general…it works. Of course there are deformities, which we usually correct with surgery. But the rest of us need to live with what we have…especially in terms of gait. When I was a youth, kids were commonly braced for conditions we now no longer brace. A young man wouldn’t be admitted into the army if he was flat-footed, “pigeon-toed” or “slew-footed.” We now know these configurations to be normal variations, and not necessarily associated with the development of painful conditions. It’s best just to stand up straight and walk like you were meant to walk. Trying to modify gaits, is often associated with some kind of compensatory issue, which could be painful.

  18. orthopedic surgeon

    Really amazing information for orthopedic surgery. Thank you so much for sharing such kind of information. I’m from india and here are many best orthopedic surgeon who are providing best treatment.

    Thank you so much for sharing information related to health. Thank you again.

    1. Barbara

      Thank you for checking out my blog. I know I have many followers all around the world.
      Many of my patients are from India, and I have also had some patients seek medical treatment for things like total joint replacements in India. I have always been impressed with the care they get from their doctors in India.
      Like my female patients who were born here in the United States, my female Indian patients are often skeptical about my Sit Like A Man program because they think it’s unladylike. But once I explain my rationale to them, they are willing to start the program. Perhaps you can get it started in India!

  19. Jane

    I feel like I have tried everything for my hip bursitis, I always noodle my legs and cross them so I will giving S.L.A.M.I.N.G a go! I do have a question, my pain is by far at its worst when I sleep and of course when I first wake up, I have taken to having a pillow between the knees but I’m thinking it’s too thin, do you think it is a good idea to use an extra thick one so as to keep your knees at the 11:00 and 1:00 o’clock position ( as per your other blog?) Hope that makes sense,.

    1. Barbara

      A thicker pillow would be fine. Also try using a 3″ memory foam mattress topper to cushion the downside hip as well.

  20. Lucy

    I have searched and searched for information about trochanteric hip bursitis, and just found your blog!! I am a very active 49 year old with six children, the youngest is 8. I started having hip pain off and on after my last pregnancy. However, right now it’s the worst ever with noticeable swelling in groin and side of hip. My doctor gave me prescription strength NSAID. I am icing it and resting, but limping horribly. I will try your SLAM advice. How long does it take for swelling to go down? It started after our vacation where I swam relay races with my children. Been swollen for ten days. Help!!!

    1. Barbara

      Lucy,
      I’m glad you found my blog. I hope it can help you on this and on many of the other adult repetitive strain disorders from which we begin to suffer as we age. All that being said, you might not have hip bursitis. Also known as greater trochanteric bursitis, classic hip bursitis is experienced on the lateral or outside of the hip, and not in the groin. It is never associated with visible swelling, unless it’s swelling due to trauma, such as falling and landing on the outside of the hip. So if you’re having groin pain and swelling, you really must have your physician evaluate you for other sources of hip pain. Sit Like A Man is a treatment plan for those suffering from greater trochanteric bursitis, and not any of the conditions which might affect the groin (hip arthritis, labral tears, impingement, flexor tendonitis, stress fractures of the hip, to name a few). SLAM won’t benefit any of those conditions. NSAIDS might benefit some of them, but not all. Please follow up with your doc. Sorry I can’t be of more help on this one.

    1. Barbara

      I think it’s probably fine when you’re ten years old. As we age, our meniscus cartilages begin to weaken. And you never know if you’re the person who is going to tear their meniscus, or shear articular cartilage while sitting with your knee hyper-flexed, and then suddenly, trying to stand up. And don’t forget, that in order to sit like that, you have to squat to get down there and squat to get back up. This puts huge amounts of pressure on the meniscus cartilages and the articular cartilage. Unless you just have to do it, I wouldn’t.
      blb

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