Restoring Proper Hip Function: Part 1
Hip flexor and adductor related injuries (strain, tendinopathy, etc.) plague sports like ice hockey and soccer. In general, these injuries arise from one of two primary causes: under-preparation or overuse. The frequent development of these injuries among athletes in pre-season suggests that they may be caused by a combination of under-prepared neuromuscular and musculoskeletal systems with an inappropriate volume of training. When assessing athletes with these injuries, sub-optimal joint range-of-motion (ROM), tissue quality, muscular strength, and appropriate strength ratios among antagonistic movements across the relevant joints are frequently noted. These four findings are common in most non-traumatic injuries of all joints. While the main focus of this article will be addressing training variables to minimize the risk of hip flexor and adductor injuries, it is important to note that restrictions in hip ROM, poor tissue quality, and inadequate strength of the relevant musculature will also have profound injury implications for surrounding areas, most notably the knee and lumbar spine as the body seeks an immediate area of compensation. As a result, improving the overall health and function of the hip region will minimize the risk of non-traumatic injury in most joints in the body.
The formula for injury risk reduction is relatively simple: restore appropriate ROM and strength. However, writing this article has really made me think about which of these variables is most important. In other words, where should we start? Is it most appropriate to focus on restoring ROM then progressing to improving strength, or vice versa. An argument can be made that improving strength without adequate ROM is only building on a dysfunctional base. On the other side, it is possible that improving strength in the relevant musculature will also improve ROM. My thought is that neither is more important and that both can and should be addressed concomitantly. As a result, I take a three-pronged approach to restoring/improving hip function:
1) Restore adequate hip ROM
2) Emphasize dissociation between the hips and lumbar spine
3) Restore/improve appropriate strength following a logical progression from isolation to incorporatation
The remainder of PART 1 of this article will focus on restoring adequate hip ROM while emphasizing dissociation between hip and lumbar spine movement. PART 2 will address appropriate progressions for improving hip flexion and hip adduction movement patterns.
Shown below are examples of some of the exercises I've found to be the most effective in both restoring hip ROM and teaching the athlete to dissociate between hip and lumbar spine ROM. Many of the displayed movements are either relatively common exercises are slight variations of them. Because athletic movements involve both open- and closed-chain movements around the hip (femur on hip and hip on femur, respectively), I think it is important to incorporate mobilizations that address both types of movements. While I present the videos as being primarily geared toward a specific goal, I recognize that EVERY exercise presented below necessitates proper dissociation of the hip and lumbar spine as well as improves ROM around the hips joints. Also, while the open-chain emphasis exercises are geared toward improving mobility in the “up” leg, please note that the “plant” leg is also undergoing significant position changes. It is the nature of human movement that body parts work in unison. While it may be possible to truly isolate a movement pattern, I'm not convinced that is the most effective and consequently desirable way to approach improving these movement patterns in athletes.
Hip/Lumbar Dissociation
Glute Bridge*
Glute Bridge w/ Straight Leg Hip Flexion*
Bird Dog
*Hands placed on stomach to provide feedback on adequate abdominal contraction
Hip ROM
Open-Chain Emphasis
Standing Wall Hip Circles
Standing Wall 3-Direction Hip Mobilization
*I learned this movement from Andy Twellman, in his article “Movement Preparation”, first printed at StrengthCoach.com.
Closed-Chain Emphasis
Kneeling Adductor Mobilization w/ External Rotation
Lying Internal Rotation Mobilization
Lateral Half-Kneeling Hip Mobilization*
Rectus Femoris Mobilization
Standing Rotational Hip Mobilization*
Diagonal Standing Rotational Hip Mobilization*
In-Line Split Squat
Reverse Crossover Lunge
*Hands placed on iliac crests of hips to provide feedback that movement is actually occurring at the hips.
Incorporating these exercises into dynamic warm-ups will help improve ROM and awareness for the subsequent training session. Also, the end range of some of these movements can be held as a static stretch preceding the dynamic warm-up, following the training session, or during other non-training times. Stay tuned for PART 2, as we'll be discussing how to restore proper hip flexion and adduction movement patterns.
**Special thanks to Eric Cressey, Michael Boyle, and Brijesh Patel for teaching me many of the hip mobilizations presented above.
This article was originally published on SBCoachesCollege.com
Kevin Neeld, BSc, MS, CSCS is the Director of Athletic Development at Endeavor Fitness in Sewell, NJ, and the author of Hockey Training University's “Off-Ice Performance Training Course.” Through the application of functional anatomy, biomechanics, and neural control, Kevin specializes in guiding hockey players at all levels to optimal health and performance. For more great hockey training information, visit KevinNeeld.com.
