"I put my hand upon your hip, when I dip, you dip...."....

"The thigh bone's connected to the hip bone...the hip bone's connected to the back bone..."http://www.songsforteaching.com/folk/dembones.php....
While this song isn't exactly correct, it does give a good and simple explanation of how our body is connected from head to toe.

When someone says "put your hands on your hips" we generally see the hands go to the top of the pelvis-called the iliac crest. The hip is actually a joint, located about a hands length down from that iliac crest. It is a ball and socket joint and allows for 3 planes of motion.

An excess or a  limitation in hip mobility can lead to low back and knee pain or injury. The same is true for the reverse: a weak core may cause the hip to stiffen up. I tend to see restrictions in hip extension and rotation in my work as a physical therapist. Our culture is such that we either sit all day or limit our mobility to the sagital (front to back) plane. We actually have the ability to move in 3 planes of motion (sagital, frontal/coronal-side to side, and transverse-rotation).

You can improve your mobility in a lot of ways. The important thing to remember is to allow and encourage yourself to move in all directions. Staying in one position will only contribute to the stiffness and dysfunction. Try integrating these motions every time you stand up today:

• Touch your toes than lean backwards
• Lean side to side
• Twist

Mix it up with your arms overhead or by your side; widen your stance; put one foot forward and then back; stand on one leg and do the above; raise a leg and kick it forward and back/side to side/across and behind your body; weight shift and step onto one leg then back in the 3 planes. Combine all the above and you will get your whole body moving in that 3D motion.

Strong and stable hips will support your back and knees. Taking your hip joints through full ranges of motion will allow the Glutes, Piriformis, Adductors, TFL, Obturators and entire Flexor group to do their job. 

Our hips carry us through most daily routines including squatting, putting on shoes, kneeling, picking something up from the floor, and climbing stairs. We start using our hips when we start rolling and crawling. We integrate all of these motions into higher level function when we start to walk. More advanced hip mobility integrates into our rotational power which is needed for any sport.

 Hip mobility should not hurt. If you have an pinch, ache or are tender to touch, you likely have some dysfunction to your hip mobility. If your back or your knee hurt, or you can't squat/kneel/sit/cross legs normally it could be stemming from a mobility issue at the hip. Having an assessment by a qualified individual can determine if you need to put your emphasis on mobility or stability and strength.

As the song implies, "everything is connected". Get your hips moving more efficiently and you may just improve your overall skill and function or decrease your pain. Why not take the steps to move and feel better?

*Title of blog quote from Freak Nasty's song "Da Dip

Improving Hip Extension

October is National Physical Therapy Month. Over the next few weeks, I will be talking about ways to improve your hip mobility. This week will focus on improving hip extension. This is my first attempt at a video piece, and I hope to get better at teaching the exercises as I go along. I welcome any feedback to help me get better.

I am in my car and sitting a lot these days. While I do get in and out frequently, I find my hip flexors are getting shortened and I am having a harder time assuming a clean ½ kneeling position. I notice it especially when transitioning from ½ kneel to stand and back down in the Turkish Get Up. I either hyperextend my back or place my knee too far forward. I also notice that in everyday activities, my back is a bit stiff and I have a harder time reaching overhead to put things away in my cabinets.

 I believe that muscle tightness can be due to a movement pattern and muscle group either over or underworking. I will usually recommend following a stretch or tissue release of one structure with an activation of a different structure. However, I also find that position will feed into stiffness and bodies are meant to move vs be in one prolonged position (i.e. sitting all day long). When we spend too much time in one position, structures will become shortened and feel stiff. It’s important to take these structures through different motions to keep the mobility. Sometimes isolated stretching is beneficial to get out of the same posture.

Since our joints are designed to move in three planes of motion and the muscles that move them control this motion, in order to improve my hip extension, and therefore positioning in the TGU and ½ kneeling position, I need to utilize a 3D movement pattern to effectively stretch.

We call the movement of bringing our knee closer to our trunk hip flexion. The muscles that flex the hip are called the hip flexors. Although it is thought that there is only one muscle there are quite a few muscles that contribute to hip flexion. These are the Iliacus, Psoas, Rectus Femoris, Sartorius, Pectineus, Adductors Longus, Brevis and Magnus and Tensor Fascia Lata. These muscles not only create flexion, but also adduct, abduct, internally and externally rotate the hip.

In the attached video, I demonstrate my current favorite hip flexor stretch. I like to do it first thing in the morning after I’ve been curled up in a ball all night. I start on my side with my knees at 90/90 flexion and my head and trunk in a relaxed/neutral position. I then bring my legs into a ½ kneel position while lying on my side. I alternate each leg forward on both sides. In this position I can get hip extension, adduction and internal rotation. While this is generally more of a static stretch, if I rock slightly forward and back or raise my arm overhead it will elongate and change the stretch while adding a multi-directional component. 

I would encourage you to change your position frequently throughout the day to take your joints through different movements. This hip flexor stretch can help if you are having a hard time coming out of a flexed position. It is normal to feel a nice stretch in the front and side of your thigh and into your lower abdomen. If it is painful ease back out of the stretch. If you are continually stretching and not able to make a lasting change, you may need to be activating a different pattern or actually strengthen your hip flexor pattern instead of releasing it. And as always, if you’re having pain or not making a lasting change I encourage you to get assessed by someone who specifically works with movement dysfunction.