The hip joints are a deep ball and socket joint. It is a very stable joint and is designed to move well, with a good level or flexion, extension, abduction, adduction, internal and external rotation. They are weight-bearing joints. Which we rely on for daily functional activities. When hips become dysfunctional, either due to injury, surgery or lifestyle, they tend to impact on many other areas of the body, particularly spine and knees. Read on for some further information and to learn a few of my favourite hip exercises.
Hip Flexors
Hip flexors are a group of muscles that flex the hip, they bend to enable the knee to come towards the chest or for the torso to come towards the legs. The main muscles of hip flexion are Psoas Major, Iliacus, Rectus femora’s, Pectineus and Sartorius.
Tight hip flexors are now a very common complaint with many of the people I see in my Pilates classes and my Biomechanics clinics. Caused by prolonged sitting, which puts the hips into a constant state of flexion, the hip flexors may become tight and weak, this in turn will reduce the range of movement, may lead to poor posture (see January’s blog about the plumb line), lower back and/or hip pain.
Muscles work in pairs in a process called reciprocal inhibition, which Wikipedia defines as “the relaxation of muscles on one side of a joint to accommodate contraction on the other side.”
The reciprocal muscle to the hip flexors is gluteus maximus, the powerful hip extensor (taking the leg back behind the body) of Kim Kardashian fame. In short, if hip flexors are tight, they will not be able to relax enough to enable the gluteus maximus to contract fully, which means that the muscles will become weaker and weaker over time as it is unable to reach its end range of movement and fully contract. So the pilot thickens.
The ‘Glutes’
Gluteal muscles comprise of three muscles, gluteus maximum, medius and minimus. Glute max is the most powerful muscle in the body and is the most superficial (closest to the surface) of the glutes. This is the muscle that gives sharp and definition. The role of the glute max is to extend the hip (think standing up from sitting in a chair or standing from a squat) and it is a powerful external rotator of the hip (the position your hips are in when sitting crossed legged).
Glute max is prone to inhibition (think tight hip flexors preventing full range of preventing full range of movement) and weakness which may contribute to pain and injury on other parts of the body as they compensate for the lack of stability and power from the Glute max. It will also result in reduced athletic performance, power output and functionality.
Glute medius is a smaller, fan-shaped muscle that attaches pelvis to the femur. When this muscle contracts it abducts the thigh (takes the leg away from the midline). It also has a stabilising role in that when you stand on one leg, for example when in the swing stance of walking, the glute medius muscle contract to create stability throughout the pelvis, preventing the side with no ground contact from dropping. If glute medius is weak, the walking gait may be affected, producing too much movement in the torso, pelvis and the lumbar spine (Trendelenburg Gait). Again, other muscles will try and compensate for the weak muscle, which may again lead to injury and pain in lumbar spine, knees and hips in particular.
Glute minimus is the smallest of the gluteal muscles and sits directly underneath glute medius. Its primary role is as a hip abductor but it also plays a role in internal rotation of the hip.
The Rotators
Internal and external rotation are a very important part of a healthy hip. Internal rotation occurs in many daily functional activities such as walking and running. The muscles involved in internal rotation are Tensor Fascia Latte, parts of glute medius and minimus and some of the adductor muscles. A lack of internal rotation may lead to gait issues, including a ‘rolling in’ of the knees and an over pronation of the feet.
External rotation is when the thigh and the knee rotate outward and away from the body (sitting cross-legged). We use this range of movement in many everyday functions, generally every time you stand on one leg you rely on external rotator muscles to stabilise the hip joint. External hip rotation helps to improve strength and mobility in hip and gluteal muscles. The external rotator muscles can become tight and weak due to prolonged periods of inactivity, which will increase the risk of injury.
Keeping hips healthy and strong
When trying to keep muscles and joints in tip-top condition it is important that they are regularly moved and strengthened in all of their planes of movement.
Below are a few of my favourite, go-to, exercises and stretches for hips.
The Proposal
Aim: To stretch the hip flexors
Start by kneeling on your left knee with your right knee at 90 degrees, as if you were about to propose to someone. From here, tilt your tail bone under, contracting your left glute max and putting the pelvis into a pelvic tilt. You may already feel a stretch in the front of the left hip and the front of the left thigh (one of the quads is also a hip flexor).
Gently lunge forward so the right hip flexes and the left hip extends even further. Lifting the left arm will intensify this stretch. Push back to the starting position and repeat three times further.
Shoulder Bridge
Aim: To strengthen gluteal muscles.
Start by lying on you back with your spine and pelvis in neutral and your feet hip distance apart. Engage the abdominals to keep the spine stable and the ribs and hips connected. Squeeze the glute max muscles together (imagine a £50 note between your bum cheeks and you’re not going to let go). Lift your hips up as far as you can without extending the spine. Your ribs should not flare up and away from your hips. The more you squeeze the glutes together, the more powerful this move. You can make so many modifications to this move, which makes it hugely versatile.
At the top of your range check the following:
1. Your knees are still parallel
2. Your hip bones (in the front of your pelvis) are level, both vertically and horizontally.
3. Your rib cage is not ‘flaring’, keep your spine in a neutral position.
4. You can move your neck from side to side, showing that you are on your shoulders, not neck.
Additions to this move include:
1. Add a glute loop band to thighs, at the top of your range take the knees wide and squeeze the glutes even more to create a tiny bit more lift and hip extension.
2. At the top of your range lift one leg, lower and lift the hips down keeping the pelvis level – repeat on other side.
Hip Rotation/Dog leg clam
Aim: To mobilise the hip in internal and external rotation, strengthen glute muscles and the deep rotators muscles.
On your side bring you hips and knees to 90 degrees of flexion, so your knees are in front of you and your ankle bones line up with your knees.
Lift the top leg as far as you can without moving the pelvis or rolling back. Internally rotate the hip so the top knee turns to face down and lower the knee to tap the bottom knee. Come up and out of that rotation and roll the hip into external rotation and tap your top heel to the bottom heel. Keep making the moves as big as your hip will allow, without moving any other part of the body.
With a little care and attention, there's no reason our hips shouldn't last a lifetime.
If you have any questions or would like more information, please get in touch.
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