Best Exercises For Hip Flexor Pain - From a Physical Therapist
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- Опубліковано 31 тра 2024
- A collection of the best stretches for tight hip flexors and best exercises for hip weakness. Includes tests so you can tell which exercises will be the best for your pain and step-by-step instructions on how to perform them properly. All demonstrated by a doctor of physical therapy. Keep reading for more!
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STRETCH OUT STRAP USED IN THIS VIDEO (aff): urlgeni.us/amzn/stretchoutstrap
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Pain in the front of your hip can be a common condition. Most people think pain in this area is due to hip flexor tightness. While this is true in many instances, it's not true ALL the time.
Many of us have tight hip flexors. This is often a result of spending so much time in positions with our hips bent (sitting, sleeping in a fetal position, etc). With our hip flexors in this position, over time they can undergo what we call an "adaptive shortening".
This is where the muscles actually tighten up in this shortened position making movement very painful.
The recommended treatment for tight hip flexors is obviously stretching.
But what if the pain in your hip isn't due to hip flexor tightness?
Believe it or not, some people can actually have weakness in their hip flexors that manifests itself as anterior hip pain.
If that's the case, you absolutely don't want to be stretching them! In fact - just the opposite. If your hip flexors are weak and if that's what's causing your anterior hip pain, then the recommended treatment would be strengthening them.
This is best done via specific exercises that are going to work the muscles in this area in the best way possible to help alleviate your pain and discomfort.
In this video, I demonstrate some simple tests that you can do at home to assess whether your hip flexors are tight or weak.
You can then follow along with 2-3 simple exercises and stretches based on your condition to see what exactly are the best exercises for your specific condition.
HOW TO CHECK FOR HIP FLEXOR TIGHTNESS (3:24)
Lay flat on your back on the edge of a table or counter (this can be done on your bed, but if it's too soft the test won't be as accurate).
Hug both knees to your chest.
Slowly lower one leg down towards the table.
The lowered leg should lay flat (or almost touch) the table. If not, this is an indication of hip flexor tightness and you need to stretch it out.
HOW TO CHECK FOR HIP FLEXOR WEAKNESS (4:56)
Put your foot up on a chair - your knee should be at the level of your hip.
Raise your foot off the chair and then lower it back down.
Repeat this ten times.
Repeat on the other side.
They should feel the same on both sides. If one side is weaker or if performing this test is difficult, that would be an indication that your hip flexor is weak and DOES NOT need to stretch but rather needs strengthening.
BEST HIP FLEXOR STRETCHES
The stretches demonstrated in this video are as follows:
PRONE HIP FLEXOR STRETCH (7:00)
SUPINE HIP FLEXOR STRETCH (8:51)
KNEELING HIP FLEXOR STRETCH (9:43)
BEST STRENGTH EXERCISES FOR HIP FLEXORS
If you have hip flexor weakness, these are the best exercises for you:
STRAIGHT LEG RAISES (11:51)
INVERTED "L" STRAIGHT LEG RAISES (12:32)
STANDING KNEE RAISES (13:17)
I hope those help you out of some of the pain or discomfort you might be experiencing in your anterior hip! If you did find some relief from this video, do me a favor and hit that "thumbs up" button! Also, if you know anyone this might help please share with them by pushing the "share" button above.
Thanks so much for watching here on Tone and Tighten!!!!
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![Your Psoas Isn't Just Tight, It's WEAK [Don't Stretch, Do These Instead]](http://i.ytimg.com/vi/h_srhkcJxAY/mqdefault.jpg)
![Your Psoas Isn't Just Tight, It's WEAK [Don't Stretch, Do These Instead]](/img/tr.png)
As a runner having had several knee surgeries the awareness of asymmetry is critical to dealing with flexor issues. Many of these stretches were in my PT routine for months. This guy knows what he is talking about. The key is to make these a part of your fitness routine forever.
Thank you so much, timber_beast! It is definitely important to make these a part of your routine!
Yea I did the the stretch that’s on the bench and I got instant pain relief 🥲
where my weak hip flexor people at 😂
Burning hip squad 😭🙌
Fr
I can't even lift my leg up because my flexor is weak. Couldn't do the exercises.
Hands down one of the best hip flexor videos. Extremely easy to understand, no fluff or garbage I don’t need to hear. This is something will favorite and watch again.
Thank you!
Thank you for the compliment, Tyler Jones! I am glad you found this video helpful!
I did not quite get ‘’hands down ‘’ex. ...
100% agree
Thank you! Great content! I find it very helpful! 💖💖💖
Watched this vid the entire way through. Super informative, clear delivery, with no rambling. Thanks doc. My hip flexors were weak. Perhaps from being in a seated position for hours on end. Such is life while in student mode. Cheers.
Thank you, Nicknamed Sin! I am so glad to hear you found this video informative. I hope these exercises help!
Agree! Mine are weak too
Thanks. I have hip impingement.
Will hip flexor stretch help reduce pain
What happens if they are tight AND weak? Asking for a friend... lol
Great video, thank you 🙏🏻 😊
Thank you very much for your help sir
Thank you! This is wonderful, and I’m certain will help me quite a bit!
You're very welcome, DeathInvestigator! I hope they help you! Thanks for commenting.
Thank you very much for all your videos. Been very helpful. I have problems with hips, knees, neck. I had a few falls in the past, and I suffer from chronic pain in theses areas. Again thank you so much. From Maria S.
Hello Jared, I love your UA-cam exercise videos. Would you make a video about exercises for hip trochanteric bursitis,please? Thank you. Jana
Really enjoying your videos and finding them quite helpful. Love to see a video specific to cyclists, especially endurance riding, where much of the information is in one place.
Thanks
Amazing job!!! So much information 🙌🏽🙌🏽
Thank you, Anna Wasag! I hope the information helps you!
I LOVE this! Thanks for providing all the details and nuances for the beginner in understanding all this! I can't wait to try it out. Good stuff!
You are so welcome, Lisa! I am glad you found this informative and I hope it helps you!
OMG! I’ve been experiencing hip and low back pain for quite awhile now. This is the first time I’ve seen any information on weak vs tight, how to tell the difference, and what to do. I’ve been trying to self treat with stretching. I now know I need to strengthen. 💡Thank you!
You are welcome, Sharon! I hope you start to feel better soon!
I love these, especially the tips so I know I am doing them right. Thanks
You are so welcome, Jill! I hope they help and thanks for commenting!
Thank You so much. Throughout my hip pain I've been stretching it out. It never really seemed to help, after that quick test I realize just how weak my hip flexor is (could barely get to ten on my left side, right side I can go up and down all day). Very insightful and easy to grasp. Just the mental relief of knowing what the problem is feels amazing. I look forward to strengthening this left hip flexor and eliminating this pain.
Mate, you saved my life. I'm 44 years old, and I've been stretching the hell out of my lower back for the last 5 years trying to get rid of pain. After figuring I had to strengthen it instead in a week with few minutes daily exercises the pain is gone! Tks!
You are so welcome! I am happy to help!
Thank you! It's the first time I hear someone explain the difference so clearly. I've had 2 total hip replacement surgeries (anterior approach) on my right hip (had the first in 2016 and a revision in 2018 because it got loose). And the pain sometimes is even worse than before the surgery. I got nerve damage and meralgia paresthetica from the first surgery. I can't lift my right leg when lying down (can't do leg raise). Muscle atrophy, etc. The problem is that I haven't found a strengthening and/or stretching routine or treatment that doesn't cause a lot of pain and when I try squats or leg raises etc. and then stretch even if I do it with help of a strap I can't walk for 2 days after. Because I had anterior approach hip replacement there are no restrictions on the movement, no risks of dislocating when flexing or extending.
Please advise!
Exactly what I needed today. Thanks for being a great teacher.
You are so welcome!
So helpful! Thank you!
You are welcome, Jami B! I am so glad this was helpful for you!
Bro, that one where you pull your leg to your chest and let your other one just dangle really really opened up my hip after about 3 minutes or so. Thank you so much. Will be incorporating that into my daily routine.
That's awesome! So glad it was helpful!
Thank you! I've been stretching my weak hip flexor and couldn't understand why they felt worse after I stretched! Appreciate this
You are so welcome, Kristi Roy! I hope this helps and thanks for commenting!
@@toneandtighten i do exercise but it hurts my buttock down to my leg
@@judithmercado8162 You have sciatica
@@judithmercado8162 pppppppplpppppppppppppl
Thanks
Thank you so much..
Thank you so much for this video. I always thought I needed to stretch but after doing your simple tests I definitely need to strengthen. When doing the strengthen exercise you show in this video I can't even get my left leg off the floor (maybe an inch); right leg about 4 inches. I've got a lot of work to do. Again thank you.
Amazing, Linda! It's interesting how often this happens! You think you're doing the right thing but come to find out the best treatment is completely different. I hope this helps you! You'll have to check back in a couple of weeks and let us know your progress!
Just wanted to say thanks for making these videos it has helped me figure out why my hip has been numb for so long. Feels like Christmas came early for me.👍
Wonderful, victor pham! I am so happy to hear that! I hope you continue to feel relief!
Funny comment but true)
Fantastic video, thank you!
You're very welcome, MegaMusical10! I hope they help you! Thanks for commenting.
Enjoyed this v much. Thank you! Do you an exercise to prevent tail bone pain during sitting?
Love this! No fluff, waste of time, get right to it. YES! I’m following you now. 👍🏼
Yay! Thank you!
Brilliant. This nailed a longstanding concern -weak hip flexor, with great, simple exercises to fix. Thank you!
Oh, wonderful! Happy to hear that, Kevin!
Very informative video, thank you very much!!
You're very welcome, Irina Bobeica! I hope they help you! Thanks for commenting.
Thank you for making this videos 🙏
My pleasure!
Thanks a lot for explaining the difference between tight and weak hip flexors. I always thought I had to stretch even realising that I wasn’t getting any benefit and what I just learned is that my hip flexors are too weak 😓 thanks a lot 🤗
You bet!
This is perfect. I had pain from doing deadlifts in my upper right thigh. Thanks to your well explained video and exercises I discovered my hip flexor muscle is weak in the right leg. And now know exactly how to strengthen it in order to continue with deadlifts and improve in the gym. I hope everyone having problems with the hip flexor finds your video and receive your great advice!
Oh, good to hear! I am glad this video helped you so much and thanks for sharing!
Great tips on form. Its easy to let good form slide over time!
Thanks so much!
Ok. Now that I understand it, can you make a video of just the exercises? I use the 9 minute back video daily and it’s been a huge help. I struggle to remember these exercises and I don’t have time to try to find them within the educational bits. I surely would be helped by that kind of video.
Thank you so much! I have been trying to figure out my own routine for this when I developed a weakness in one side, but I think that I would have gotten much better targeting of the area and better effects if I had just seen this before. I will now start with this and see if it get better.
You're so welcome! I hope this is helpful!
10/10 video!! Thank you for sharing your knowledge, I’m a personal trainer and i implement about half of these with my clients! The test is a great tool 🙏🏼
Thanks so much, Kimber Dial! I appreciate your kind words!
You are a real wonderful teacher and a great problem solver!!! Thank you!!!😊
You are so welcome! I appreciate your kind comment!
Thanks!!!
This was incredibly helpful. I have been spending hours and hours trying to stretch what I thought was a tight left quadricep. I watched the video and did your tight-or-weak test. Bingo! I have a very tight left hip flexor... and I now have some great stretches to work with. You are so clear and concise. I've already subscribed. Thank you so much!
You're welcome!
Thank you , my hip flexors have been killing me for awhile. These exercises are what I needed.
Great, dawn0718! I hope they help and thanks for commenting!
Did they really work? And how long you've been doing the exercises
I am totally stoked to have found this particular video. Very helpful to figure out that I am tight and not weak. Here is a question: right now the pain in the front is really quite unpleasant when I lift my knee towards my chest. But I really do not not feel pain at all after a minute or two when trail running (my main exercise apart from weights). So I would hope I can just keep on running and ignore the brief initial period of discomfort and incorporate your stretching routines a few time during the day. Do you think that would be cool?
Amazing video, thank you so much for sharing!
Glad you enjoyed it!
Just back from my first PT session for hip flexor. Lots of pain, hard to walk. Your video was much more instructive!! I understand much more than what I was offered at PT. I’m starting your routines today. Thanks!!
Glad it was helpful and thanks for commenting!
This is so incredibly helpful! I have suffered with hip flexor pain for years and everyone has always just given me stretches, but doing the test, mine are super weak! So helpful to have this info and a way to move forward!! Thank you!!
You are so welcome!
Incredibly helpful. Thank you!
You are welcome! I am glad you found it helpful!
Love your channel! You have everything to help me❤️
Thanks so much! I appreciate your support!
Bro, you really save my life 🙏🏻🙏🏻 I was suffering for psoas pain, so bad and after watching this video, everything has changed.
It's the first day I made the exercises you said and I swear it's unbelievable, I do still have pain, but I can do a lot more movements
Thanks for sharing with us your knowledge 🙏🏻
I've tried everything, thanks bro, really thanks 🙏🏻🙏🏻🙏🏻🙏🏻
You are so welcome! Happy to help!
Hello Marlon, yours is psoas pain, so can the hip flexor stretches help your psoas. I need to learn from you as I have psoas problem.
Thx this is just what i need;())))))
You're very welcome, andrew swan! I hope they help you! Thanks for commenting.
Best hip video I've found trying to figure out this pain! Thanks for thorough explanation!
You're welcome, Jon! I am glad this helped you and thanks for commenting!
Thanks man will keep practicing and give you feedback later
Thank you. Helpful to find out my hip flexors are weak. After walking 12 miles the other day I had lower back ache and aching hips, also the same when sitting in the car for a long time. So I'm going to do your exercises to help. Thank you.
You are welcome, Julie! I hope these exercises help and thanks for commenting!
Incredible, day 2 of doing this and the pain in the front of my right hip that I have suffered for a year despite doing yoga every day and lots of physio , has gone! It's gone! Thank you so much. 💓
Wonderful news, Sara! Thanks for sharing.
Very informative. Thanks for sharing!
My pleasure!
Thank you for sharing.. I have been suffering from pain on my hip and lower back since 2013 and now just found the good exercise to help my problem 🙏💖
Best video on this topic, thank you!!! 👌 I passed the tightness test and my flexors seem to be strong enough (I could easily do 10 on both sides), so still not sure what the cause of my hip & lower back pain might be. I'll have a look at some of your other videos, maybe I'll find the answer there somewhere... 😊
Thanks for commenting!
Thanks for the video. I was somewhat aware of it, but this video and taking the test confirmed that I have one tight hip flexor and one weak one. I can relate to much of your overall program as I taught and coached gymnastics. Still today, many people comment on my flexibility, but I'm finding that I was flexible in some joints and tight in others and had mixed strength in my muscles. I wish I'd come across your program when I was younger. I was blaming much of my problem on spinal stenosis and the scoliosis that was created when they did surgery for it 20 years ago. While I'm sure the spinal stenosis & scoliosis are part of the problem, I think that by working on stretching my tight side hip flexors and strengthening my weak side flexors, I may be able to stand straighter. I've been working with a trainer & have pretty good overall strength, but it's easy to miss something that could help. When I walk for exercise, I've been using walking poles, which help me walk straighter and faster without pain.
I also love some of your basic skills program using animal movement, which I have used with children when teaching movement type gymnastics for elementary physical education. Since I'm retired and no longer teaching the classes, I had quit doing some of them, but have started again as I think they can be helpful for general movement, even for us old people. I know this isn't the place for a recommendation for your programing, but I would like to see something offered for older people, which may be similar to your other programs, but with modifications. I just make up my own modifications, but some would watch the programs and decide they couldn't do it. For example, the animal moves might be done by putting one's hands on something that is elevated so they don't have to reach all the way to the floor.(a block or bench) I think these moves could be very helpful to older people with modifications. I realize that you got more of a comment than you asked for, but thought you might be interested.
I hope you have come out of retirement to teach occasional workshops to young gymnastics teachers! So much useful information you could pass on. (Not bossing you around, just making a wee suggestion😁) My yoga teachers are oldish; one in her late 70’s and one is his late 80’s! They will never retire and the teaching keeps them young and supple. All the best to you.
Thanks Jared! Your videos are great. Really clear, simple, and great information. It's really helped me with multiple injuries.
You are welcome! I am glad you find my content helpful and thanks for sharing!
Always a great help! Thank you
You are welcome, Mabel! I am glad you found these helpful!
This is great info! When doing the exercises to strengthening the hip flexor, it cramps up my quad muscles. How do I keep from using the quad muscle so I can activate and strengthen the hip flexor?
I have same issue... I do it anyway. Maybe yours are worse? Eventually I expect the quad cramping to go away. We'll see.
Woah, how about that? I just started getting pain in my right hip up front (as well as on my lower back, right side) a few days ago and this video gets uploaded just now. This explained a whole lot and I can't wait to give these a try. Thanks so much for this I was starting to get worried. I'm on Team Weak apparently 😅
Haha! Crazy, right?! Everyone thinks stretching is the way to go, but that's not always the case. Sorry to hear about your pain, Chris. I hope these help you out, man!
This was a lot of info and very good. Thank you.
You are welcome, FlickerFlame! I hope this helps you and thanks for commenting!
Thank you, I cannot wait to do the strengthening exercises .
You are welcome! I hope they help and thanks for commenting!
Holy shit this was a life-saver, thank you for this content dude!
You are so welcome! I am glad it was helpful!
Can theses exercises be used for a hip flexor sprain ... please advise
Mine are weak. Thank you so much for this info. I liked and subscribed
Very well explained. Thank You
You are welcome, Tatiana! I hope this video helps you and thanks for commenting!
Mine were weak and I woke up in the middle of the night with the worst sharp pain ever! This really helps. Thank you
You're so welcome, Cat L! I am glad to hear these exercises have helped!
Hi! So I have recently strained my hip flexors. I have three questions that if answered, would make me very happy.
1. How long does it take to recover
2. How do I learn about the severity
3. What are ways to treat this?
Thanks for the video. My hip flexors are having some pain recently.
Great video, thanks a bunch!! Very informative, well explained and edited, all to the point. Thanks again!
Glad it was helpful! You are welcome and thanks for your comment!
I never knew about the possibility of weak flexors..... I tried the test and mine are tight! Thanks for the great information!
Awesome, VeiledDancer! I hope the stretches help you out!
Omg, thank you! My hip flexor is weak, but I have definitely been stretching. Stretching wrong at that. 😬
You're so welcome, Carrie B!! I hope you start to notice a difference!
Same!
Thank you for this informative video!
You are so welcome! I hope it helps!
These are good exercises...I wish I had found you earlier. Thanks Doc!
You are welcome, Maggy Ablor! I hope these help you!
According to your tests I don’t have neither weakness nor tightness in my HF but I still experience a lot of pain and discomfort in the front of my right hip while running or swimming freestyle with strong kick. This includes crunchy sounds and reduced ROM compared to the left hip. What would you suggest? Thank you!
I have the same situation! I mostly have pain when I am doing squat-type exercises. Could you find an answer to your question?
Tried doing the hip flexor strengthening exercise where I had to tighten my quads and raise leg. My right side is weaker than my left side and I experienced pain in my lower back when raising my leg. Any advice to help would be greatly appreciated.
Just following up to find out how you dealt with this strength difference, I am also actively trying to recover from this. Thank you!
Outstanding presentation, Thank you for sharing.
Glad you enjoyed it! Thanks for watching!
The instruction you provide is truly helpful. As I follow your instruction and feel discomfort I would like to pin point what exercises would help that area. So if you were to feel discomfort in an certain area as you preformed the task you could figure out what needed attention. Sort of a flow chart of that part of the anatomy that firers up when you perform the task in the discussion.
I never have lower back pain. However my hips hurt when I do floor ab exercises that require me to lift my legs while in an upright position
oh gosh, me too!! I have friends that do the same exercise but they seem fine. I thought I was the only one! when I do daily exercises of lifting legs for abs, I end up with what seems to be tight flexors.
I have the same problem, you guys find a fix for this?
I feel pain while doing crunches
I am also experiencing same problem. What worked for you ?
Hmm...Not really sure. I've always been pretty flexible and my leg came down on the table. I also was able to do the leg raise test without much difficulty. But my Hip flexors do hurt especially after a run. I'm leaning more toward weak but don't want to miss stretching if that is what I should be doing . Side note I'm not sure but my inner knee has been hurting after a run too. I know my chiro said one side of my pelvis is forward and one is back. Got any thoughts?
Depends on a lot of things... condition of the hip, mileage, running mechanics, etc etc. Could be anything from a hip flexor tendonitis (in which case all the exercises in this video would be good to perform) to an arthritis. I would try all these exercises daily for 1-2 weeks; if you're not seeing any improvement consult a local specialist. Good luck!
First time in the channel! This is really helpful! Thank you! I was in PT for almost two months due to tight hip flexor. It looks like I hurt myself doing aductor exercises with heavy weight at the gym, and my continued running hasn’t helped. I am still not recovered. Trying to do these exercises at the gym along with what my therapist recommended. Wish me luck!
Thanks so much for your comment and good luck!
Amazing!
What if you have weak hip flexors and they are also tight? Should we do all of this
He said if they’re weak. Don’t stretch them, just strengthem
@@user-ms9mq7ze7v he also said if they are tight, dont try to strengthen them just stretch them
At 2:28 he says the worst thing to do for a weak muscle is to stretch it. We need Tone and Tighten man to elaborate.
It would be nice to know the answer if you have both and do all the exercises at the same okay which one is best to start tight muscle are weak
when i do the kneeling hip flexors stretch there is so much pain in knee that is bent , even after using a cushion for support. could you give any suggestion for this problem?
Use pillow
AMAZING!!
Thank you so much for the techniques and your very clear presentation! I have been seeing a physiotherapist for myo-fascial release for a few times, but my exercise program for strengthening has been a bit slim, I am adding these to the mix. Thanks again!
You are welcome! I hope the addition of these exercises really helps!
I having been doing skipping and other exercises when ever I try to do mountain climber exercises or I raise my leg...my socket joint tends to make noise but there is no pain. Will this exercise be helpful and can I continue with my normal exercise such as skipping?
i have same noise when i do leg rise and what i being reading or watching its okey so far if u dont have any pain.
Stretches
7:20
9:04
Strength exercises:
Straight leg raise12:05
Leg raise 13:04
Thanks for helping others out!
Thanks so much.
You're welcome!
The most thorough video for hip flexor self-treatment. Thank you.
You are so welcome! I hope this was helpful and thanks for commenting!
Hello, just wonder if a muscle can be weak AND tight at the same time? Thank you!
Someone answer arghhh
@Tone and Tighten .....did u read this, if u did please a solution for this.
Someone please answer this. I injured my right back which is my weak side as well. And since then my right leg feels constant numbness. Q
tinaa719ify I’m pretty sure
Yes
What if I feel pain for both when I let my leg droop it kills but touches the table but when I do the chair exercise I can barely do ten then it kills
Love your explanation 👍🏽
Thank you, Blue sky!
Thank you so much. I am a high endurance athlete and I am so grateful for the stretch advice. It is literally helping me this second that I watched and followed the stretch. Seriously. Thank you
You're so welcome, Robbie M! I am so glad it is helping you!
Is hip flexor also related to back problem like slipped disc?
It can be, but not necessarily all the time, preeti rane.
No pain just a mild stroke effected my left side..almost fully recovered except for slight tightness in hip
Damn that’s tuff, but that’s a small thing to a giant Ik u got this fam 💯
Sending best wishes, take care of yourself and dont do anything too strenuous 💕
@@gillianm9367 thank you so much
Sending you support and good vibes for a solid recovery! :0)
Is always my left side
Very easy to understand it💕
I think your video is a bit misleading as you didn't mention that pain in the hipflexers can also be caused by a muscle strain, which might happen if you workout too hard. In your video it sounds like the solution to hipflexer pain is to either stretch the muscles if they are too tight or excercise them if they are weak. But a third scenario is that the muscles are strained and therefore can't correctly do the excercise with the chair, not that they are weak. In this case, excercising more will probably lead to even more damage to the muscles and resting should be recommended. If you agree with me please mention this in the video (or remember it for future videos) so you don't accidentally make people with strains hurt themselves more by excercising.
Very good information since I just saw this video and am having flexor and also knee pain (so I’ve assumed it is my Sciatica). But what I’ve expressed to my Dr and Chiropractor is that it feels almost like a muscle strain. So perhaps I’ll try to tone down everything and give that area some time off before trying to strengthen. Thx!
My left hip hurts from carrying my baby on that hip. I have always had loose hip flexors from yoga etc so I think I also have a strain. Thank you
He never said the issues listed were exhaustive. In fact he made a point of that repeatedly throughout the video.
He explains it from 2 minutes on
It depends on the severity of the strain. If it is a grade 1 strain, 72 hours of rest and ice would be sufficient time to start exercising it. Grade 2 slightly longer with an initial period of light stretches. He is giving general advice. Everybody is different and so should the approach to rehabilitation