4 Exercises To Improve Hip Mobility!

The hip is a ball and socket joint with 27 muscles that cross it to control its many planes of movement! Some muscles act as primary movers while others act as dynamic stabilizers of the hip. When the hip capsule is hypomobile or tight, your body may compensate from either up or down the kinetic chain to gain mobility. This has been shown to lead to pathologies in the lumbar spine (Reiman 2009, Devin 2012, Burns 2011) and lower extremity (Reiman 2009, Cliborne 2004, and Currier 2007). This article will show you 4 exercises to improve your Hip Mobility!

Additionally, hip mobility deficits have been found in people with hip osteoarthritis (Birrell 2001), sports related groin pain (Nevin 2013), and femoroaceteabular impingement aka FAI (Kubiak-Lankger 2007).

When FAI and labral tears are present, one typically exhibits reduced hip mobility into flexion, internal rotation, and adduction (Burnett 2006). Improving mobility in the hip joint does not require inventing new mobility; it simply means regaining what was lost in not allowing your hip to be in those ranges over time. This calls for [P]Rehab!

It is important to minimize the deleterious effects of hip mobility deficits. When hip mobility is adequate, there are better arthrokinematics, which leaves you with a happy hip.

Improving hip mobility will not only improve your performance, it will also help reduce risk of hip and low back pain down the road.

1. Supine Hip Flexion mobilization

There are various ways in which one can self-mobilize their hip joint. Achieving optimal client outcomes can be achieved with self hip-mobilizations (Weight et al. 2012). The goal here is to improve hip capsule and connective tissue mobility.

  1. Assess your current hip flexion mobility by using the inclinometer on your smartphone  within the compass application. You can use this feature to objectively measure your hip flexion range of motion.
  2. Tie a band around a stable surface on one end and bring it as close as you can to your hip joint on the opposite end (feel free to pad the band with a towel if the band alone irritates you). Scoot yourself back until you feel a strong pull from the band. Using a band here will help clear some space in the hip joint -> improve the hip joint’s ability to glide properly.
  3. Bring your hip into as much pain-free flexion as your hip will allow. You can hang out at the end or oscillate back and forth.
  4. Play around with moving yourhip into Internal or External rotation as well. Find whichever restriction works best for you.
  5. Re-test your pain-free hip flexion mobility with the inclinometer to assess if you have made improvements in your range of motion.
  6. Preserve this range of motion with exercises that put you into this newly acquired end range hip flexion.

Note: It is important to understand that this is NOT appropriate for anyone with hip mobility deficits. This is why it is important to seek a skilled clinician to consider if mobilizations are warranted. When hip mobility deficit is due to bony morphologic changes, mobilization may be INAPPROPRIATE.

2. Hip External/Internal Rotation With Forward Trunk lean

Limitations in hip flexion and internal rotation range of motion have been implicated as characteristics of hip pathology (Burnett 2014, Clohisy 2009, Sutlive 2008). Any activities that require squatting, pivoting, planting and cutting, and/or rotating your body will likely be hindered by limited hip flexion and internal rotation range.

Here is a drill that helps to improve both hip internal and external rotation simultaneously:

  • Keep both feet and knees touching the floor throughout this exercise. If you don’t have adequate hip mobility in this position, you can sit on a yoga block to decrease the amount of hip mobility required to perform this exercise.
  • Stretch the leg to your side into an abducted and internally rotated position and the leg in front of you into a flexed and externally rotated position.

To further the stretch you have two options:

  1. Increase the load by leaning forward toward your front leg.
  2. Rotate away from the leg on your side.

I particularly like this exercise because it focuses on flexion and external rotation AND abduction and internal rotation, two motions that are typically overlooked. A Systematic review by Dallinga et al in 2012 showed that limited hip abduction ROM has been suggested as a predictor of future lower extremity injuries.

-Limited hip internal rotation ROM is a strong predictor for presence of hip OA (Altman 1991, Birrell 2001)

Note: This is an advanced drill that requires a lot of hip mobility!! Make sure you are not reproducing any hip symptoms with this exercise.

3. Quadruped Inferior and Lateral Hip Mobilization

Research outcomes have demonstrated that clients with femoro-acetabular impingement (FAI) have limited squatting motion compared to patients in a control group due to limited pelvic sagittal plane motion (Lamontagne et al. 2009). Squat depth has been improved post-surgically in clients with FAI as a result of reduced acetabular coverage and an improved pelvic posterior inclination angle (Lamontagne et al. 2011). Theoretically, improving capsular mobility (in cases of limitations) may be beneficial as it also improved sagittal plane motion. Therefore, this technique is likely most beneficial for the client with limited hip flexion motion in a loaded position (Reiman 2013).

Here are 2 additional ways you can improve hip mobility by moving your pelvis over your femur:

-Begin on your hands and knees in a quadruped position. Put the mobility band as close as you can to the hip joint.

-Allow the band to pull either laterally (as shown on the right) or inferiorly (as shown on the left).

-Sit back until the desired stretch is felt. You also have the option to rotate the hip into external rotation (pigeon stretch) or internal rotation.

-To progress this exercise go into a loaded position of a squat and attempt to go into as much hip flexion as possible. You can use a band to provide lateral traction in the hip if required. This will help you learn and maintain your new hip flexion range of motion.

Note:  This position is great because your own bodyweight is providing the posterior glide of the femur on the acetabulum that will help with your hip mobility!

4.  Self hip mobilization into flexion and External rotation

Here is the last self hip mobilization!

-Find an elevated surface where you can perform a lunge to mobilize the hip.

-Anchor the mobility band by stepping on it at one end and allow the other end to wrap around your hip joint. Make sure to keep your foot on the band, you don’t want it to slip out from under you!

-Lunge into pure hip flexion. If you need, you can use your arms to assist by pulling your hip closer to your chest!

-In this position you have the option to either internally or externally rotate your hip. On the right, I demonstrate a variation with hip external rotation.

Following the self-joint mobilizations, it is critical that you perform several repetitions of isometric end range exercises and isotonic exercises through the end ranges of hip mobility to re-educate the musculature and maintain the newly gained ROM. Shown HereHere, and Here are a couple great ways to strengthen the hip in it’s new range of motion.  Finally, perform several dynamic drills to achieve neuromuscular control in the new hip ranges.

Note: The aforementioned self-hip mobilizations are meant to be integrated into a multimodal therapeutic home exercise program for a client by a clinician. Little evidence exists to describe the efficacy of these self-hip mobilizations or to demonstrate one technique’s value over another’s.

Note: It is suggested that you seek a skilled physical therapist or rehab specialist to perform this skilled joint mobilization!

 

 

Citation:

  1. Reiman MP, Weisbach PC, Glynn PE. The hips influence on low back pain: a distal link to a proximal problem. J Sport Rehabil.  2009;18(1):24-32.
  2. Devin CJ, McCullough KA, Morris BJ, Yates AJ, Kang JD. Hip-spine syndrome. J Am Acad Orthop Surg. 2012;20(7):434-442.
  3. Burns SA, Mintken PE, Austin GP. Clinical decision making in a patient with secondary hip-spine syndrome. Physiother Theory Pract.  2011;27(5):384-397.
  4. Cliborne AV, Wainner RS, Rhon DI, et al. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test fi ndings, and short-term response to hip mobilization. J Orthop Sports Phys. Ther. 2004;34(11):676-685.
  5. Currier LL, Froehlich PJ, Carow SD, et al. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favorable short-term response to hip mobilization. Phys Ther. 2007;87(9):1106 1119.
  6. Birrell F, Croft P, Cooper C, et al. Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford). 2001;40(5):506-512.
  7. Nevin F, Delahunt E. Adductor squeeze test values and hip joint range of motion in Gaelic football athletes with longstanding groin pain. J Sci Med Sport.
  8. Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458:117-124.
  9. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88(7):1448-1457.
  10. Wright AA, Hegedus EJ. Augmented home exercise program for a 37-year-old female with a clinical presentation of femoroacetabular impingement. Man Ther. 2012;17(4):358-363.
  11. ltman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classifi cation and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505-514.
  12. Birrell F, Croft P, Cooper C, et al. Predicting radiographic hip osteoarthritis from range of movement. Rheumatology (Oxford). 2001;40(5):506-512.
  13. Lamontagne M, Kennedy MJ, Beaule PE. The effect of cam FAI on hip and pelvic motion during maximum squat. Clin Orthop. 2009;467(3):645-650.
  14. Lamontagne M, Brisson N, Kennedy MJ, Beaule PE. Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoro-acetabular impingement. J Bone Joint Surg Am. 2011;93 Suppl 2:40-45.

 

 

 

 

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