A Few Hip Tips

The hip joint is absolutely vital in the role it plays for proper lower extremity biomechanics and its relationship to the low back. The hip joint is a ball-and-socket joint and unlike the knee, has the ability to access much more global range of motion. Due to the amount of motion in the joint and the amount of muscles stressed around the hip joint, it is a common source of aches and pains. In addition, dysfunction at the hips can lead to symptoms in the low back and the lower extremity. 

One of the most common issues with regard to the hip is lack of hip extension due to tight hip flexors such as the psoas and the rectus femoris. Lack of hip extension manifests in decreased low back stability, causing symptoms at both the hip and the low back. Consequently, it is important to address low stability while decreasing tension in the hip flexors. We also need the ability to freely rotate at the hip joint. Decreased rotation at the hip has been associated with increased low back symptoms and increased impingement-like symptoms at the hip joint. 

Self myofascial release techniques can be effective tools to increase limited hip rotation. One of the best exercises to increase hip abduction is to cross your leg and place the affected side on a foam roller. Then move the hip into as much adduction as you can comfortably put the hip in and hold for about 8 seconds. The foam roller will help dig into the tight trigger points of the muscles at the posterior hip. After 8 seconds, relax the leg and let it move further into abduction. Repeat this process 2-3 times on each side.

In addition, the 90 / 90 Shin Box exercise serves as a simple yet effective warm-up for unlocking the hips with rotation. Start by sitting on the floor with your knees bent, then roll your legs to the left or right into 90 degrees (one leg internally rotated, one leg externally rotated). Keep your torso in-line with your pelvis and try to limit lumbar flexion and extension as you switch to the other side. 

To keep those hips moving and decrease both low back and hip symptoms, we need to work on strengthening our hip extensors and oblique abdominal muscles. These muscles play a large role in adding stability to the lumbopelvic complex. Dynamic Neuromuscular Stabilization (DNS)  exercises such as 5.5 month sidelying can be a great tool to work hip extension while also focusing on low back stability. Start on your side with the affected hip pointing towards the ceiling. Bend the knee of the affected side to 90 degrees and place the foot against the wall. As you press the got against the wall working the hip extensors, brace at the abdominal region. 

Similarly, the Bird Dog works the hip extensors and low back stability, but increases the demand for hip stability by making it an open as opposed to closed kinetic chain exercise. Start on all fours and begin bracing in the abdominal wall as done with the DNS exercise. Then lift the knee off the ground and extend the knee and hip while keeping all other extremities glued to the ground. You should not feel the pelvis or low back shift as you move the hip. To progress the exercise, see if you can extend the opposite arm of the hip extended to increase the stability demands. 

Alec Domjan, DC

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Works Cited 

Sadeghisani M, Manshadi FD, Kalantari KK, Rahimi A, Namnik N, Karimi MT, Oskouei AE. Correlation between Hip Rotation Range-of-Motion Impairment and Low Back Pain. A Literature Review. Ortop Traumatol Rehabil. 2015 Oct;17(5):455-62. 

Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk Muscle Characteristics of the Multifidi, Erector Spinae, Psoas, and Quadratus Lumborum in Older Adults With and Without Chronic Low Back Pain. J Orthop Sports Phys Ther. 2017 Mar;47(3):173-179. 

Tibor LM1, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008 Dec;24(12):1407-21.