Restoring Proper Hip Function: Part I

Kevin Neeld, CSCS
 

 
Hip flexor and adductor related injuries (strain, tendinopathy, etc.) plague sports like ice hockey and soccer.  In general, these injuries arise from one of two primary causes: under-preparation or overuse.  The frequent development of these injuries among athletes in pre-season suggests that they may be caused by a combination of under-prepared neuromuscular and musculoskeletal systems with an inappropriate volume of training.  When assessing athletes with these injuries, sub-optimal joint range-of-motion (ROM), tissue quality, muscular strength, and appropriate strength ratios among antagonistic movements across the relevant joints are frequently noted.  These four findings are common in most non-traumatic injuries of all joints.  While the main focus of this article will be addressing training variables to minimize the risk of hip flexor and adductor injuries, it is important to note that restrictions in hip ROM, poor tissue quality, and inadequate strength of the relevant musculature will also have profound injury implications for surrounding areas, most notably the knee and lumbar spine as the body seeks an immediate area of compensation.  As a result, improving the overall health and function of the hip region will minimize the risk of non-traumatic injury in most joints in the body. 

The formula for injury risk reduction is relatively simple: restore appropriate ROM and strength.  However, writing this article has really made me think about which of these variables is most important.  In other words, where should we start?  Is it most appropriate to focus on restoring ROM then progressing to improving strength, or vice versa.  An argument can be made that improving strength without adequate ROM is only building on a dysfunctional base.  On the other side, it is possible that improving strength in the relevant musculature will also improve ROM.  My thought is that neither is more important and that both can and should be addressed concomitantly.  As a result, I take a three-pronged approach to restoring/improving hip function:

1)  Restore adequate hip ROM

2)  Emphasize dissociation between the hips and lumbar spine

3)  Restore/improve appropriate strength following a logical progression from isolation to incorporatation             

The remainder of PART 1 of this article will focus on restoring adequate hip ROM while emphasizing dissociation between hip and lumbar spine movement.  PART 2 will address appropriate progressions for improving hip flexion and hip adduction movement patterns.  

Shown below are examples of some of the exercises I’ve found to be the most effective in both restoring hip ROM and teaching the athlete to dissociate between hip and lumbar spine ROM.  Many of the displayed movements are either relatively common exercises are slight variations of them.  Because athletic movements involve both open- and closed-chain movements around the hip (femur on hip and hip on femur, respectively), I think it is important to incorporate mobilizations that address both types of movements.  While I present the videos as being primarily geared toward a specific goal, I recognize that EVERY exercise presented below necessitates proper dissociation of the hip and lumbar spine as well as improves ROM around the hips joints.  Also, while the open-chain emphasis exercises are geared toward improving mobility in the “up” leg, please note that the “plant” leg is also undergoing significant position changes.  It is the nature of human movement that body parts work in unison.  While it may be possible to truly isolate a movement pattern, I’m not convinced that is the most effective and consequently desirable way to approach improving these movement patterns in athletes.  

*click on the "image" under the exercise name to view the video

Hip/Lumbar Dissociation

Glute Bridge*

Glute Bridge w/ Hip Abduction*

Bird Dog

*Hands placed on stomach to provide feedback on adequate abdominal contraction

Hip ROM

Open-Chain Emphasis

Standing Wall Hip Circles

Standing Wall 3-Direction Hip Mobilization
*I learned this movement from Andy Twellman, in his article “Movement Preparation”, first printed at StrengthCoach.com.

Closed-Chain Emphasis

Kneeling Adductor Mobilization w/ External Rotation

Lying Internal Rotation Mobilization

Kneeling Rotational Hip Mobilization*

Rectus Femoris Mobilization

Standing Rotational Hip Mobilization*

Diagonal Standing Rotational Hip Mobilization*

In-Line Split Squat

Reverse Crossover Lunge

*Hands placed on iliac crests of hips to provide feedback that movement is actually occurring at the hips.

Incorporating these exercises into dynamic warm-ups will help improve ROM and awareness for the subsequent training session.  Also, the end range of some of these movements can be held as a static stretch preceding the dynamic warm-up, following the training session, or during other non-training times.  Stay tuned for PART 2, as we’ll be discussing how to restore proper hip flexion and adduction movement patterns.

**Special thanks to Eric Cressey, Michael Boyle, and Brijesh Patel for teaching me  many of the hip mobilizations presented above.

Kevin Neeld is a Certified Strength and Conditioning Specialist (CSCS) holding a degree in Health Behavior Science with a concentration in Fitness Management, as well as a minor in Strength and Conditioning.  Kevin is the founder of Prodigy Performance Training, a company providing athletic development services for dedicated athletes along the East Coast, from Delaware to Massachusetts.  

After completing a successful college hockey career at the University of Delaware (‘05-’06: MVP; ‘06-’07: Team Captain, Lifetime Achievement Award, 2nd Team All-American), Kevin continues his work in ice hockey serving as a coach, educator, and program consultant in the sport.     

Kevin possesses the unique ability to combine his backgrounds in research, academia, and athletics to create highly effective programs for athletes and clients of all backgrounds.  Specializing in ice hockey training and corrective exercise, Kevin has helped guide athletes of all ages and abilities to optimal health and performance.

In addition to his writing for SBCoachesCollege.com, Kevin has written for peak performance training sites such as T-nation.com, BodyBuilding.com, SportsRehabExpert.com, and StrengthCoach.com.  He is also the author of Hockey Training University’s “Off-Ice Performance Training Course”, expected to release by Fall 2009.  To learn more about how Kevin can help you achieve your training goals, visit his site (www.KevinNeeld.com) or contact him via email at kn@prodigyperformancetraining.com.