The Hip Joint: An Essential Component in Treating and Preventing Knee and Low Back Pain
The hip joint, in my opinion, is one of the most overlooked joints in the body when it comes to fitness and injury prevention. While hip pain is not nearly as common as low back or knee pain, it is the culprit behind both of these in many cases. The hip joint is a ball and socket joint. It is the articulation of the acetabulum in the pelvis (socket) and the head of the femur (ball). This type of joint allows for the maximum level of mobility as the joint can move in all 3 planes. Still, it also provides maximum stability compared to the other ball and socket joint: the shoulder. We will start with the importance of mobility of the hip and how it relates to the back and knee and then move to the vital role hip strength plays.
Hip Mobility and Flexibility
As mentioned previously, the hip can move in all 3 planes. It can move into flexion/extension, abduction/adduction, and rotate both internally and externally. The lumbar spine (low back) and the knee offer a minimal range of motion for rotation. The lumbar vertebrae can rotate only about 5 degrees, and rotation at the knee is minimal, particularly in the extended position. Many people are limited in hip extension and their ability to internally or externally rotate the hip. This restriction at the hip causes more significant rotational stress on the low back and knee, which are not meant to take on that demand.
Ensuring that your hips move within their full range of motion is essential in preventing your injury, not only to your hip but to your back and knees as well. The normal range of motion for the hip flexion is 110-120 degrees. Limitations in flexion can lead to excessive flexion at the lumbar spine as compensation when squatting or bending down or trying to bring your leg up to tie your shoe. Normal hip extension is 10-15 degrees. If you cannot extend your hip, it can alter your gait pattern and cause shortened strides or a more forward flexed posture to compensate. Normal external rotation (turning your knee outward) is 40-60 degrees, and internal rotation (turning your knee inward) is slightly less at 30-40 degrees. Limitations in either rotations cause added stress due to compensation at the lumbar spine and/or the knee.
In addition to injury prevention, having greater hip mobility can improve athletic performance as well. For example, you need a greater hip extension range of motion for a good stride when running or jumping. In addition, you need to improve hip flexion and external rotation for squatting or performing deadlifts. You also need mobility in all directions for things like agility, cutting, or turning when playing sports!
Here are some specific exercises to work on improving your hip joint mobility and flexibility for injury prevention and/or improved athletic performance!
Hip Joint CAR (Controlled Articular Rotation) - Quadruped
Start on your hands and knees with your core muscles engaged.
Lift one leg up and flex the knee as far as you are able, then bring the leg out to the side
Rotate your knee down so that your foot an knee are in a line
Next, your foot comes up behind you, extending your hip but keeping your core engaged. Repeat in reverse order. Perform 5 repetitions for 2 sets on each leg.
Hip Joint CAR (Controlled Articular Rotation) - Standing
Stand with 1 hand resting on a counter for balance. Lift the knee on the opposite side up as high as you can while keeping your back straight.
Keep your knee up and move your leg out as far as you can
Rotate your foot up to the level of your knee.
Keep the leg up and move it behind you, be careful not to arch your back. Then perform in reverse order. Perform 5 repetitions for 2 sets on each leg.
90/90 Hip Mobility Stretch - This exercise works internal rotation on 1 hip and external rotation on the other
Sit on the floor and bend one leg straight in front of your body with your hip rotated out so that your leg forms a 90-degree angle. Then position your other leg straight out to the side with your hip rotated inward so that your leg again forms 90-degree angles. Lean forward slightly, keeping your back straight. Hold this stretch for 1-2 minutes, and then switch legs. Perform diaphragmatic breathing to improve relaxation during the stretch! (Breath in through your nose into your belly, then exhale through your mouth). *If this is too difficult, start sitting on a foam pad or flat pillow to reduce the angles and work your way up to sitting on the ground
Hip opener from 90/90
Start in the 90/90 position from the previous exercise.
Actively press your front knee down during the movement. Move up onto your toe of the back leg
Lift the knee up until your foot is flat on the ground. Repeat for 5 repetitions, 2 sets on each side.
Hip Flexor Stretch
Start in a kneeling position, bring 1 leg forward into a lunge with your hips and knees bent at 90 degrees. Keep your core engage, squeeze your glutes so your pelvis tilts underneath you.
Lean forward until you feel a stretch in the front of your hip (the side that is on the ground). Hold 30 seconds, repeat 3 times on each side. I have other variations of this stretch in previous blog posts!
Hip Adductor Stretch
Stand with your feet apart, just further than your shoulder width, facing a counter or desk. Lean forward with a flat back.
Bend 1 knee lunge to the side until you feel a stretch in your inner thigh on the straight leg. Hold 30 seconds, repeat 3 times on each side.
Piriformis Stretch - Supine Position
Lay on your back with your knees bent. Cross 1 leg over the other, so your ankle is resting on your knee.
Reach through and pull the uncrossed leg back toward your chest until you feel a stretch across your buttock of the crossed leg. Hold 30 seconds, repeat 3 times on each side.
Piriformis Stretch - Seated (2 options)
Sit with your legs bent out in front of you. Cross 1 leg over the other so that your lower leg is resting on the knee.
Walk the foot of your bent leg back towards you or scoot your hips toward your foot until you feel a stretch across your buttock of the crossed leg. Hold 30 seconds, repeat 3 times on each side.
Sit on the edge of a chair. Cross 1 leg over the other so the ankle of 1 leg is resting on the knee of the other. Keep your back straight and lean your chest toward the foot that is crossed over. Lean until you feel a stretch across your buttock of the crossed leg. Hold 30 seconds, repeat 3 times on each side.
Hip Strength
As discussed previously, because the hip has more degrees of mobility, it requires quite a bit of musculature to perform all of these motions and take all the stress of weight-bearing. The easiest way to think about the muscles of this hip is by grouping them according to what they do!
Hip Flexion: The primary muscles responsible for flexing the hip are the iliacus and psoas muscles (commonly referred to together as the iliopsoas muscle). The rectus femoris (part of the quadriceps) is also responsible for flexing the hip and crossing the knee joint.
Hip Extension: extending the leg behind you. This motion is primarily achieved by the gluteus maximus and the hamstring muscles (semimembranosus, semitendinosus, and biceps femoris).
Hip Abduction: extending the leg out to the side (away from the other leg). This motion is primarily achieved by the gluteus medius, gluteus minimus, piriformis, and the tensor fascia latae (attached to the iliotibial band).
Hip Adduction: or crossing the leg over the other (or across the body's midline). This motion is achieved primarily by a group of muscles called the adductors (longus, brevis, and magnus, as well as pectineus and gracilis)
External Rotation: rotating your knee outward, like crossing your ankle over your knee to put on a shoe. This motion is achieved by the biceps femoris, gluteus maximus, and piriformis. This motion is also assisted by several other smaller muscles.
Internal Rotation: rotating the knee inward is performed by the gluteus medius, gluteus minimus, and tensor fascia latae.
As we discussed in the hip mobility section, optimal hip function is essential in treating and preventing injuries to the hip, back, and knee. For example, when you are walking, the gluteus maximus and gluteus medius muscles are responsible for preventing the pelvis from dropping when you are standing on one side. This ensures that the lumbar spine and knee remain in alignment and avoid undue stress or injury. The hip extensors are some of the most critical muscles for squatting and lifting mechanics. When the glute muscles are not strong enough, we overuse our low back musculature (when we bend over at our hips instead of squatting down). We can also overuse our quads or strain the knees if we forget to sink our hips back when squatting down to pick something up, bringing our knees too far forward.
When it comes to athletic performance, the large muscles of the hips are essential in achieving power and endurance with running, jumping, or different types of agility. The muscles must be strong not just at their regular length but also at all aspects of your range of motion. When performing the hip CARs from the mobility section, you ensure that the muscles have the strength and work at all aspects of your range of motion. Some exercises I will show you below involve strengthening the hips, particularly the hip flexors, in a more flexed position. This is ideal instead of leg lift exercises where the muscle is always starting at a fully lengthened position.
Hip flexor lift off - standing
Stand, facing a chair near a counter or somewhere you can hold with 1 hand to stabilize for balance as needed. Put 1 foot up on the chair.
Lift the foot up off the chair, hold for 2-3 seconds. Repeat for 10 repetitions.
hip flexor lift off - seated
Sit in a straddle position. You may need to start out sitting on a small cushion or pillow. Use your hands to balance and lift 1 leg a few inches off the floor and hold 1-2 seconds. Relax and repeat for up to 10 repetitions. *It is a good idea to sit up against a wall so that you do not lean back and use your abdominals instead of your hip flexors.
sidelying clamshells
Lie on your side with a band around your legs just above the knees. Bend your knees so that your feet are in line with your back. Engage your core, lift the top knee up against the band's resistance, slowly and with control. Ensure you do not let your hips roll back or twist at your spine during the movement. Repeat 10 times.
steamboats
Start in standing with a resistance band around your ankles (you can start without the band and work your way up to it if needed). You can stand near a counter so you can touch for balance as needed. Start with 1 leg bent slightly, then quickly move your opposite leg forward (flexion) 10 times.
Then move the leg out to the side (abduction) 10 times
Then back (extension) 10 times, keeping your leg straight and trying not to lean during any of the movements.
bridges with stability ball
Lie on your back with a stability ball placed under your heels and arms down by your slides. Lift your hips up off the ground. Hold just a second or 2 and maintain control, then relax your hips back down. Repeat 10 times.
To make this more challenging, you can perform with your arms across your chest. This will provide a significant challenge to your balance, so you may want to start with just 1 arm up and then work your way up to 2.
bridges with hamstring curls - stability ball
Lie on your back with a stability ball placed under your heels and your arms down by your slides. Lift your hips up off the ground.
While holding this position, bend your knees and roll the ball toward you, keeping pressure on your heels. Roll the ball back out and relax your hips back down. Repeat 10 times.
Band walking - sidestepping
Start with a band looped knees (easier) or ankles (harder). Squat down, ensuring your feet are pointed straight ahead, and your back is straight. Take 6 steps to 1 side ensuring you keep your feet pointed forward and keep some tension on the band the entire time. Stand up and relax and repeat to the other side.
band walking - monster walk
Start with a band looped knees (easier) or ankles (harder). Squat down, keep your back straight.
Walk forward, take large steps, and step further out to the side then you typically would. Walk forward 6-10 steps, turn around and repeat 5 times.
Single leg deadlift
Stand on 1 leg with your opposite leg straight and kick-standed behind you. Tighten your core muscles and hinge forward at the waist, raising the back leg so that your body and leg are in line with one another. Make sure your hips stay straight, and you are not rotating on that standing leg. *If you need to make this more difficult, you can add a weight in the hand opposite of the lifting leg.
If this is too difficult at first, stand at a counter and let your hand glide across the surface as you go down so that it can assist with your balance.
Please feel free to contact me directly if you have any questions via email: Cari@movementmatters-pt.com or by phone (704)247-1676. I also have more information on my website at: https://movementmatters-pt.com
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Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
