KINETIC HYGIENE: HIP MOBILITY SUMMARY

Author: Dr. Zak Gabor

ANATOMY REVIEW

 

Type of joint: Synovial

Degrees of freedom: Three (Tri-Planar)

Joint ROM norms:

Flexion- 120

Extension- 20

Abduction- 40

Adduction- 30

External Rotation- 50

Internal Rotation- 35

While these are the norms for hip range of motion (ROM), a crucial thing to understand is how much variance there is from person to person! Everyones ROM will vary. Another important thing to understand is the angle of the femoral head as it sits into the acetabulum. Retroversion vs anteversion as well as its implications.

 

 

Retroversion: Tends to have more of a “toed out” stance. Because of this, we might see folks have more external rotation ROM.

 

Anteversion: Tend to see a “toed in” stance. Because of this, we tend to see folks have more internal rotation ROM.

HIP MOBILITY: WHY?

Once we understand how much variance there is in the hip, now we can take a look at why hip mobility is so desirable. Simply put, this joint is extremely dynamic and powerful, and the king of motion when it comes to lower extremity movements such as a squat and deadlift. If we lack hip mobility, we consequently get range from other joints, like the lumbar spine.

One of the major concepts we talked about in the first post, is how sometimes lack of stability can actually cause surrounding muscles to be “tight.” Conventional stretching might not be the best tool to address improving hip ROM, we will probably have better luck with a neurological approach to unlocking the hips. Besides for dosing stability training, using a neuro based mobility protocol can help reduce the resting state of tone in the surrounding muscles. See post below for more on tone, as well as the routine to help improve hip flexion and internal rotation!

Here is one of my favorite sequences below….

1/2 kneel hip flexor mobilization-> Shin box -> Deep Squat with prying

1. 1/2 kneel hip flexor mobilization: 1/2 kneel position, without arching back, squeeze your down leg glute as you gently drive your hip to its first end range, oscillate back and forth x10, and then switch

2. ER/IR mobilization (Shin box): begin with your right thigh directly in front of you, and your left thigh out to the side at 90 degrees, with both knees bent roughly at 90 degrees. Spend some time exploring end ranges and oscillating into your right hip, followed by going onto your left forearm, and exploring end ranges of your left hip.

3. Deep Squat with prying: drop it like its hot (but controlled) into a deep squat and explore your hip mobility by prying your thighs in and out, as in the video.

The hip joint is almost a hybrid in the joint by joint approach, as it is understood to be closest to a 50/50 split of mobility/stability. This helps us segway into an AWESOME concept. (Key takeaways: hip mobility is hard fought secondary to bony contact, AND stability might have a lot to do with “tightness” in our hips) . 🤔CONCEPT ALERT🤔 . TONE: “The internal state of muscle-fiber tension within individual muscles or muscle groups.” . I want everyone to open their minds up to the concept of tone. Often times, we see that muscles are “tight.” Sure, they might be tight, but endless stretching, a lot of times, is not the answer! This is because we have REGULATED tissue tension by the central nervous system. ••• If we understand that there is a reason behind tone, it can help us start to have more intelligent INTENT behind our mobilization (or strengthening/stability*) strategies. . What’s my generalized approach if not dosing strength/stability for mobility? (dosing strength for mobility?? Say what???🤔🤔🤔) . I will dose mobility drills for the soft tissues, vs static stretches, in order to open up a neurological window, and then follow it up with reinforcement! . Gentle oscillations can actually help decrease tone for a short window of time, in which we follow it up with loaded movements! ••• Here is one of my favorite sequences below….1/2 kneel hip flexor/Shin box -> Deep Squat with prying . 1️⃣1/2 kneel hip flexor mobilization: 1/2 kneel position, without arching back, squeeze your down leg glute as you gently drive your hip to its first end range, oscillate back and forth x10, and then switch 2️⃣ER/IR mobilization (Shin box): begin with your right thigh directly in front of you, and your left thigh out to the side at 90 degrees, with both knees bent roughly at 90 degrees. Spend some time exploring end ranges and oscillating into your right hip, followed by going onto your left forearm, and exploring end ranges of your left hip for roughly 10 passes each 3️⃣Deep Squat with prying: drop it like its hot (but controlled) into a deep squat and explore your hip mobility by prying your thighs in and out, as in the video. @strong_by_science @joegambinodpt @stren

A post shared by Dr. Zak Gabor — DPT, CSCS (@simplestrengthphysio) on

 

IMPORTANCE OF HIP INTERNAL ROTATION

 

Let’s discuss some of the implications that hip internal rotation has from an everyday life lens to performance lens.

 

For walking, running, and squatting, we utilize some degree of closed chain hip internal rotation (aka acetabulum on femur). When we lack internal rotation at the hip, we can sometimes see compensations that occur up and down the chain and contribute to development of pathology.

 

We have to be careful, though, with the closing pain symptoms that occur with end range internal rotation. Generally this position can be provocative for anyone, so just keep that in mind. That being said, if we can improve our hip mobility into internal rotation in pain free manor, we can give ourselves a good shot at reducing our risk of injury.

 

Joe (@Joegambinodpt) does a great job taking us through an advanced way to help improve hip internal rotation. He integrates in concepts within the Functional Range Conditioning system. Basically, it utilizes a neuro-centric driven model that improves our strength and control at end ranges of motion. Check out Joe’s video below for further instructions.

 

Kinetic Hygiene: End Range Control for Improved Mobility and Control. ••• In our last post @simplestrengthphysio spoke how our hips need close to the same levels of mobility and stability. ••• What is known is that when it comes to mobility there is a huge difference between active and passive range of motion. ••• In order to build useful range of motion, we must try and convert our passive ranges into active motion. ••• One of the easiest ways (even though there is nothing easy about it) is utilizing passive range holds inspired by the Functional Range Conditioning system. ••• This drill is a Passive Range Hold for hip internal rotation in the 90/90 base position. Technique: 1️⃣Set up in the 90-90 position as shown above. 2️⃣Use your arm to passively lift the trail leg into hip internal rotation. 3️⃣Build tension through your hips and entire body then slowly release the trail leg. 4️⃣Try and hold the trail foot off the floor while trying to NOT lose the height in which you lifted it to. 5️⃣The less the foot drops, the more control of your end range of motion you are achieving. ••• Hip rotation is important to improve because of it's effect on the joint capsule. Better motion here can free up motion in other planes and help build better joint awareness. ••• Questions, comments concerns? Let's hear em' 👇. . STAY TUNED @strengthcoachtherapy IS UP NEXT!

A post shared by Joe Gambino, PT, DPT, CSCS (@joegambinodpt) on

 

The last post of the week was by Teddy (@Strengthcoachtherapy), he composed some really good exercises that he uses to establish good motor control for hip muscles as a warm up.

 

Remember above how I discussed the importance of stability for improved mobility? Well this triplet of “activation exercises” does a FANTASTIC job of allowing us to recruit the muscles of our hip girdle effectively before a workout.

 

Essentially, by utilizing the single leg bridge, we are able to get excellent stability through the planted leg, while recruiting our adductors and adductors in the contra lateral (opposite) hip. See video below for further instructions.

 

Kinetic Hygiene: Hip Warm-Ups — Ground based single leg bridges and "muscle activation" exercises. (3 🎥 's) — The single leg bridge is one of the best exercises for hip and low back health. It has a ton of indications including SI joint pathology, low back pain, adductor, glute or hamstring issues, and hip instability or pain. Here are 3 unique variations of the single leg bridge I use in warm-ups, rehab and prehab. ▪️ Exercise 1️⃣ is one my favorites: the bridge position supine leg whip (Supine = on your back). On this movement, make sure your hips stay level and keep the range of motion short while you're learning it. Huge stability/mobility combo challenge here. ▪️ Exercise 2️⃣ is a single leg bridge with miniband on the knees for abduction resistance. The miniband facilitates extra glute activation and increases the stability demands. ▪️ Exercise 3️⃣ is a single leg bridge with an addiction squeeze. Chances are you neglect your groin and adductors like most people, try working these in. This the opposite of miniband resistance. Squeeze lightly to hold an object in between your knees but don't try to crush it. I have an awesome mini foam roller from trigger point for this purpose. ▪️ Give these a try and challenge your hip stability and mobility in a new way. — Next up, Kinetic Hygiene Low Back @simplestrengthphysio @joegambinodpt ▪️ . . . . . #kneerehab #kneepain #aclrehab #aclsurgery #acl #jumpersknee #patellartendonitis #patella #patellatendon #dptstudent #dpt #doctorofphysicaltherapy #physiotherapy #physicaltherapy #pt #physio #therapist #massagetherapist #massagetherapy #chiro #chiropractor #chiropractic #exerciseaddict #physicalfitness #biomechanics #squatgains #sprainedankle #anklerehab #kinesiology #exercisescience

A post shared by Dr. Teddy Willsey DPT, CSCS (@strengthcoachtherapy) on

 

CONCLUSION AND KEY TAKEAWAYS

 

The hip is an extremely critical joint. While we must be able to express mobility into all ranges, understand that STABILITY can play a crucial role in allowing us to express our mobility. Utilize neuro-centric techniques to get improved joint ROM and make sure you OWN that new range, and load it to have better carry over.

Image Links

Hip) http://www.aafp.org/afp/2009/1215/p1429.html

Retro/anteversion) https://www.iadms.org/page/325

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