The Hip Article
This article is a synopsis of a presentation that was given to Crossfit Las Vegas minus some of the real technical jargon and specific exercise training/corrective exercises. I’d like to thank the team at Crossfit Las Vegas, you are all top notch trainers and I get as much, if not more benefit from teaching you guys (and girls) than you do!
Let us start off with some basic anatomy; the hip joint is actually made up of the Femur or leg bone an
d the Ilium. Of equal importance when discussing the hip is mentioning the lumbar spine or low back. The two (hip and lumbar spine) should not be thought of as separate, they work together and when there is a problem with one the other will be affected.
The muscles most important for the sake of this discussion can be broken up into their functional groups. The muscles which flex the hip (bring the knee to chest) are most notably the psoas, iliacus, and the rectus femoris, I added the last because from a rehab standpoint this muscle is usually affected but often neglected. The muscles which work in opposition to the hip flexors would be the hip extensors, (moving the leg behind your body) mainly the Gluteus Maximus and secondly the Hamstring muscle group. The hip abductors (move leg outward to the side) for the most part include the Tensor Fasciae Latae, the Gluteus Medius and Gluteus Minimus. The opposing muscle group for the abductors would be the adductors (move the leg toward the midline). The most notable for this discussion is… ready for it…the Adductor muscle group, I love when stuff makes sense. There are other muscles that contribute to the hip joint and the movements the joint can accomplish, but for the sake of this article we will mention just one more, the piriformis. The piriformis is one of many of the hip rotators and its importance is discussed next in its relationship to a very important nerve.
The Sciatic nerve exits through some of the deep hip muscles specifically the deep rotators of the hip. The exact location of the Sciatic nerve as it exits the deep hip muscles can be different from person to person. Sometimes the Sciatic nerve exits from below the piriformis, sometimes it exits above the piriformis, and in some it exits though the piriformis. As mentioned earlier there are many other muscles, nerves and structures we could discuss; however for the sake of this article, this should do. So now that you have a brief understanding of the anatomy let us discuss its relevance to one of the most common conditions we encounter from a clinical standpoint.
Either due to previous injury or bad ergonomics or wrong exercise choices one of the most prevalent problems we see is a weakened Gluteus Maximus/Medius and lower abdominals, and a tightened Psoas, Iliacus, hamstrings, and low back musculature. This often presents to our clinic with one of or a combination of, low back pain, front hip pain, back of the hip pain, hamstring pulls, quadriceps pull, sciatica, knee pain, ankle and foot problems, loss of balance, and loss of range of motion or flexibility.
Let us now take a look at the importance of proper hip development in sports. We will separate the most common complaints of athletes into two separate categories “hip flexor” and “gluteal” muscle problems. In reality these issues are virtually never separate and are usually seen together.
Hip flexor strength is important for running, jumping, and kicking. The hip flexors and the lower abdominals work in unison to help provide midline stability. This is important if the athlete does anything overhead. Overhead activities can include: throwing, gymnastic moves such as tumbling, and handstands etc. If the athlete has difficulty with any of these activities, if endurance has decreased, if performance has diminished, or if pain is present this could be an indication of a hip flexor problem.
Gluteal weaknesses present themselves during weight lifting exercises such as the squat, lunge, and dead lift. If the athlete is unable to have proper knee placement and ankle placement during a deep squat often time the problem is in the glutes. If the athlete is unable to go to proper depth during a squat, lunge or dead lift the problem is often weak glutes. Long jump and vertical leaps both require the functional use of the gluteal muscle group. Obviously, if any of these activities cause pain the problem can often be traced back to the glutes.
From a non athletic standpoint it is important to have properly balanced hip musculature to do normal activities of daily living. Every time someone sits down in a chair or gets in and out of a car they are performing a squat. Anytime someone climbs stairs they are performing a lunge. Of course anytime someone picks something off the ground they are performing a dead lift. To continue to do these things without the risk of injury we need our hips to be properly functioning.
As we age the importance of properly balanced hip musculature is important to insure quality of life and independence. The old cliché “use it or lose it” comes to mind, osteoporosis will absolutely result from inactivity and not performing weight bearing activities. Again, flexibility will decrease and balance often becomes a problem. Combine all these issues and we end up with a person whom has weakened bones, is inflexible and prone to falls.
So what can be done to ensure proper mechanics and strength? The answer is dependent on how long the problem has been there. If there is no pain and normal range of motion exists then properly performed exercise and a well designed routine will be the key. Please refer to my previous article entitled “Exercise Outline”. If there is a problem due to inflexibility, loss of balance or pain, a clinical intervention is probably indicated, followed by….a properly designed and supervised exercise routine. For many, the thought of doing a dead lift, squat or lunge with weight seems scary if those exercises have hurt or if you have been hurt doing those exercises. The truth of the matter is I have yet to come across an athlete or non athlete who had pain or was hurt doing one of those exercises whose form was correct. In checking the movement pattern in which the patient or athletes complaint is related, there is always faulty mechanics involved.