Recently there has been an influx in hip pain and hip issues coming into the office. They aren’t one of the most common injuries in chiropractic and sports medicine offices, but they do occur and are never fun for patients to deal with. From tendonitis, to joint pain, to sprains and strains, hip pain can be an annoying issue to deal with.
Obviously surrounding musculature and hip function plays a role, but all too frequently tight muscles are blamed as the sole problem. Usually the assumed culprit is “tight hamstrings” or “tight hips”, and for far too long patients were sent home with the same protocol. They were told to static stretch, ice and or heat the area, and rest. Sometimes this helps but it never gets to the root of the issue, and due to this that pain can return when you go back to your regular activities.
At Ridge Rehab and Chiropractic, we try to answer 3 major questions:
- Is any of the surrounding musculature actually tight?
- What exactly is tight?
- Why are they tight?
Hip Anatomy and Morphology
The anatomy and skeletal shape of the hip is a big reason for some of the confusion around hip tightness. The hip is what is known as a ball and socket joint. We have seen a skeleton, the ball is attached to the neck of the femur that sits in the “cup” shaped socket in the pelvis. What is under-appreciated is how different the shape, depth, location of that cup, and angle of the femoral neck can be. This variation we see can cause the “neutral” position of the hip to be very different from patient to patient. For example, someone with a deeper, and more forward facing cup may not have a ton of outward hip movement. Is this a tight hip? Or is that a hip that just isn’t naturally good at moving a certain direction? All the stretching in the world won’t change that. To make things EVEN MORE complicated, it is extremely common for the skeletal shape and positioning of these joints to be asymmetrical!
On top of the joint we have the thick capsule of ligaments wrapped around the whole area to add even more stability to the joint. All of these variables can play a role in the available passive and active range of motion, which can in turn create the illusion of “tight” or “loose” hips.
When true “tight hips” can exist
All of this is not to say tight hips don’t or can’t exist. As mentioned earlier, skeletal orientation can create certain range of motion restrictions or even pain. We can also get soft tissue changes to the hip joint depending on what our activities of daily living look like. One of the most common reasons we see muscular tension changes are due to high amounts of sitting down. In this day and age, we spend a lot of time on our butts. From eating, driving, sitting at our desks for work, we spend a lot of time in the same seated position.
Another common cause is overtraining or not having enough variation in our workouts. Many active individuals don’t have enough variety when they are in the gym. We tend to do what we like and what comes naturally to us, so it’s easy to fall into the trap of not training what needs to be trained.
How to combat tight hips
This may come as a shock, but the answer is not to do “sit and reach” stretches for days on end. Yes, mobility exercises are going to be helpful, but they should be active and movement based. Strengthening is usually the route to go down for help. If sustained postures or repetitive movements are the reason for your tight hips, strengthening the hip and regaining hip function is going to be the answer. A good assessment and exam is needed to find the true cause, but a few of the top hip exercises we use are:
Side bridge variations – The gluteus medius is frequently involved in hip issues, especially in rotational athletes. Everyday life rarely takes us in any side to side movements, and even amongst gym goers the lateral chain is often neglected. Side bridges are great exercise to target different aspects of the hip, (and entire lateral chain), and are easily progressed or regressed depending on what patients are ready for. When a patient masters the traditional side bridge, most “PT” clinics move on to another hip drill. For us, once you’ve mastered the traditional side bridge, the fun just begun. Our creative and highly effective modifications of the side bridge have helped hundreds of rotational athletes for over 7 years.
Copenhagen Planks – This is a similar story to the side bridges. Our hip adductors are the muscles that squeeze our knees together. Unless you still have your Thighmaster from the 80s, we don’t do a ton of squeezing movements regularly. The adductor groups being used less and avoidance on strengthening the groins have played a huge role in the groin strains we see in our patients..
2 great examples to read up on are this study by Thorborg et al in 2014. They looked at male soccer athletes both with and without groin pain. Those with groin pain were found to have increased weakness in eccentric hip adductor strength in the kicking leg.
Bourne et al in 2019 found that 204 elite level soccer who had higher hip adduction strength had lower odds of suffering a future hip or groin injury.
Many studies have confirmed the correlation of weak adductor and groin injuries, so these really should be part of any athlete’s routine.
Hip mobility exercises – Active mobility exercises can be helpful. Sometimes the hip tightness issue can be helped by more movement or novel neurologic input. Sometimes we need to work dissociation of the hip from the low back. Sometimes we need to mobilize the hip in a different direction. Regardless of this reason, mobility exercises (note: different from static stretching), are commonly part of hip rehab. Usually this includes some form of active and triplanar movements working in the sagittal, frontal, and transverse planes.
As I mentioned earlier, a proper assessment is key for any hip issue. If you, or someone you know is struggling with constant tight hips, then we have some good news for you. Our office can help identify and treat tight hips, so that you can continue to do what you love and get out of pain.
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“Share” this post with with anyone you know who may be dealing with hip tightness or hip injuries If you or anyone you know is dealing with hip pain, contact our office today to schedule your Complimentary consultation!
(Due to the increased demand, we are only accepting 5 requests. Don’t delay getting your appointment booked.)
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