As a physiotherapist in an orthopaedic and sports medicine setting, I find myself spending A LOT of time assessing and treating hips… even (especially!) when the client didn’t come in for a hip injury. Why you may ask? Because a large majority of the clients I see have either a knee injury (traumatic or “wear and tear”) or suffer from low back pain. Both the knee and the low back have a close anatomical relationship with the hip and therefore are commonly impacted if the hip isn’t doing its job.
The hip is uniquely positioned at the top of the leg to help set the alignment of the knee and foot and absorb ground reaction force throughout the lower kinetic chain. Very often, the hip is not functioning optimally and can be an underlying “silent” culprit in chronic low back pain as well as repetitive strain injuries of the lower body such as arthritis, tendonitis, and plantar fasciitis. Additionally, hip dysfunction can be a cause of more acute, traumatic injuries such as ACL and meniscal tears.
There are 3 ways this can happen:
- Decreased hip flexibility and active mobility
As a ball and socket joint that operates in 3 planes (forward/backward, side/side, and inwards/outwards rotation), our hips SHOULD have quite a bit of mobility. However, what we’re seeing is a major loss of hip mobility in our population. One of the main limitations that I see clinically, is a lack of hip rotation passively (how much I can rotate or twist your hip when you relax) and a lack of hip mobility (inability to actively using your muscles to take the hip through it’s full range of motion).
Now, our hips NEED to be able to rotate to achieve a normal walking/running pattern and absorb forces from the ground effectively. If there is a lack of mobility at the hip and you continue to walk, run, climb stairs, etc., on a day to day basis, our body will compensate and gain this rotation elsewhere – likely shearing through an area that really doesn’t like rotation – the low back or the knee! That stiff hip can cause wear and tear in these joints that takes years to become symptomatic. We need to catch this early!
- Weak hip muscles
Another common clinical pattern is weak hip musculature – specifically the hip abductors and extensors. Our hip abductors (back and side of the hip), help control the alignment of the knee. When they are weak, the knee can excessively cave inwards, causing a traumatic (think ACL tear) or wear and tear (runner’s knee) injuries. If you see someone running with “knock knees”, they likely need these muscles assessed.
Our hip extensors (eg. gluteus maximus) help us push off during walking/running, preventing excessive strain on the lower back. Weakness here means potential increased lumbar disc or joint compression. Ouch!
- Poor motor control
Some people have fairly good strength in their hip muscles, however, they have trouble coordinating and controlling the hip and pelvis in space. This can be for a number of reasons, including habitual postures and movement patterns reinforced in our sports and/or day to day activities. Our bodies are really good at taking the path of least resistance, and if the hip flexors or hamstrings, for example, are the strongest and easiest for the brain to recruit, even if the strength in the other hip muscles is adequate, the brain will do so. As you can imagine, this leads to sub-optimal movement patterns, faulty biomechanics and potential injury.
OK – so hips tend to be tight, weak and poorly controlled. But why does this happen?
There are many reasons. A major cause of hip muscle tightness and joint stiffness is sitting. Many of us sit with our hips in the same position several hours a day. Many people drive to work, sit at work for 8 hours, drive home, and then sit and relax at home afterwards. That’s a lot of time in one position! Our hips will adapt to retain this position – becoming tight at the front in hip flexion and weak and inhibited through the glutes at the back.
“But I’m an athlete!” – This is exactly what I said to my physiotherapist, when he told me I had these issues after tearing my ACL years ago. Well – athletes are really, really good at whatever movement patterns are common in their sport, and really, really bad (and frankly, weak), in positions that are outside their typical planes of movement. For example, runners are really good at using their hip muscles in a straight line, but controlling knee twisting motions in the frontal plane (using the muscles at the back and side of the hip) is something many runners lack, leaving them vulnerable to injury up or down the chain.
Do you have healthy hips? Part 2 of this blog post will cover how to do a self-check, and if you find your hips are tight or weak, there will be solutions.
Hip hip hooray!