101 in hip strengthening

hip

The hip joint is a joint that is completely vital to any movement that involves moving your legs. However the muscles and the idea of strengthening these muscles seems to be overlooked. Recently I have seen a lot of patients with hip imbalances where they feel that your pelvis just isn’t sitting right. The balance and strengthening of your hip especially your gluteal muscles is essential not just for patients that have problems with their pelvis or lower back but pregnant women, athletes especially with sports that involve running. It is a particular problem if you are constantly changing surfaces for example going on and off curbs or going up a lot of hills. So here is my overview to the hip and how best to strengthen it.

Hip Joint

The hip is a ball and socket joint and one of the most structurally stable joint in the body. This is because it has to hold our entire body weight and therefore it is supported by some of the largest and strongest muscles in the body. The exact biomechanics will be slightly different in everyone depending on the angle of your thigh bone which sits in the hip joint. It is the transitional area between the spine and the lower extremity or legs. It is the most common bone to break if you have osteoporosis due to increased falls in the elderly. However unless you have a major impact it is often very difficult to break.

Ball and socket Joint:

The ball of the joint is called the femur and is the top of the thighbone while the socket is called the acetabulum. It is multi-axial and is able to perform many different movements from the one joint. Similar to many other joint in the body the joint is covered in hyaline cartilage and a collar which acts as a shock absorber and cushion for the joint. The capsule of the joint will also produce synovial fluid, which will help to lubricate the joint and provide fluid movements.

anatomy-of-the-hip-joint

Bones:

The bony pelvis is made up of 3 different bones that are fused together they are called the illium, ischium, pubis. These bones will slowly fuse together throughout childhood. The Ilium is the largest of the hip part of the pelvis and is a fan shape, it is where the gluteal muscles attach to. The ischium is the bone that creates around one-third of the ball or acetabulum. The pubis is the bone that makes up the front of the pelvis and it also contributes around one twelfth of the acetabulum.

Ligaments:

The hip joint has 3 very large and strong ligaments they are called: iliofemoral ligament, ischiofemoral ligament and pubofemoral ligament.

  • Iliofemoral ligament: prevents hyperextension of the hip joint during standing by holding the femoral head within the acetabulum or the ball in the socket it is a Y shape.
  • Iliofemoral: Reinforces and supports the back of the pelvis and prevents hyperextension and holds the femoral head within the acetabulum.
  • Pubofemoral ligament: This ligament supports the pelvis around the front of the joint. It also helps too much abduction, which is when your thigh leg moves outwards.

Muscles:

There are over 20 different muscles that attach in and around the pelvis as the pelvis is involved in many different movements. The movements available at the hip include:

  • Hip and leg flexion: Iliopsoas, rectus femoris, sartorius
  • External rotation
  • Hip and leg extension: Glutes (maximus, medium and minimus, hamstrings (semi-membranous, semi-tendonous and bicep femoris).
  • Adduction: Adductors (magnus, brevis, longis), pectineus, gracilis
  • Internal rotation
  • Lateral rotation:
  • Hip abduction: Gluteus minimus, medius and deep gluteal muscles

The main muscles I am going to talk about in this article and are the most important to strengthen is the gluteal muscles.

muscles-of-gluteal-region
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Functions:

The function of the hip is to support the weight of your body but also to allow the movement of your legs. The hip is especially important in walking, running and going up and down stairs.

Weight-bearing:

This is the main function of the hip and there are many different structures that are involved in helping keep this joint stable. Weight bearing may seem simple but it is vital in trying keeping the pelvis stable.

The acetabulum or socket of the joint is built-in a way that helps keep the ball or head of the femur in place and stops it from slipping out. The labrum is a cartilage collar that surrounds the joint, which actually makes the joint deeper and more stable as a result. The ligaments are also there to stabilise the joint and prevent too much movement. The three ligaments together create a spiral and cause the joint to be tighter as a result.

Walking and running:

The hip joint works as a fulcrum with the centre of gravity being slightly medial to the hip joint, which creates a rotational effect on the pelvis controlled by the muscles around the pelvis. Therefore it is important to strengthen these muscles for stability. When you are walking the hip joint is put under 280% of the weight of your body and when you jog it increases to a staggering 550%. Proving why strengthening your gluteal muscles round your hip is beneficial to everyone.

The muscles that surround the hip are most active in the swing phase so when you are standing on one foot. In general the hip should not drop more than 5 degrees as you switch from one leg to another.

When you have a problem with your hip or the muscles around your hip it can make you feel like you have a shorten stride generally imbalanced. Furthermore it will cause you to lean more towards the weaker side in order to try to keep the pelvis straight and balanced. Also if your pelvis is not straight it can put pressure on your lower back as a result due to the back trying to take more of the weight, often increases the curve.

The hip muscles are essential in generating the drive of your stride when you run so whether you’re sprinting at the end of a race or simply running faster to get the bus the power is coming from your glutes. It is also essential to bring up the knee and create a high knee lift and longer stride. Therefore if you want to run more efficiently or just change gear faster these are certainly some of the muscles to focus on it will help make your gait more efficient and literally give you more of a spring in your step.

swing phase
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Glutes

These muscles are literally a pain in the butt. However they are one of the most neglected muscles to stretch and strengthen by the general public, after all many people regard their buttocks as a flabby area they don’t want to think about.

The main ones I am going to talk about in this article in the gluteal minimus and medius, which are smaller but play more of a role in maintaining a level pelvis. If you have a problem in your glutes you can also develop ITB syndrome, which is very common in runners. This is because the ITB or Illio-tibal band runs from your glutes down your leg therefore if there is a problem further up it will transfer down the leg.

glutes
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How to check if there is an imbalance:

Trendelenburg sign:

The trendelenurg sign is often used to see if there is an imbalance in the muscles around the hip. It basically assesses whether you have a hip drop on one side as the muscle round the pelvis struggle to keep your hip level. Therefore as a result you will not be able to maintain the height of the opposite side of the pelvis to raise the foot and transfer weight to the other leg. If you do have a hip drop then it will cause you to bend your leg at the knee more in order to compensate for the lack of lift at the pelvis.

trendelenburg
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Common conditions:

  • OA
  • Bursitis (Trochanicteric)
  • Tendonitis: Gluteal, illiopsoas
  • Labrum tears
  • Paget’s disease
  • Other symptoms of arthritis including: RA, Psoriatic arthritis and ankolyisis spondylitis.
  • Fractures
  • Osteonecrosis (Bone infection)

Hip symptoms:

  • Pain into the buttocks, groin
  • The hip can also refer pain down the front of the leg and to the knee.
  • Pain into the inside of the hip
  • Limping or altered gait
  • Feeling of your pelvis being unbalanced
  • Swelling or redness round the hip joint
  • Bruising round the hip if there was a trauma
  • Fever (if it is a bone infection)

Exercises:

Here are some of the most common exercises that I will prescribe for hip problems and imbalances between the glutes. However these exercises should be read with a word of warning they are not suitable for everyone individual case and you should consult a medical professional to make sure they are appropriate for you.

Single leg quat:

 

Single-leg-squat
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This exercise is similar normal squat however you want to complete the exercise on one leg. Therefore you wan to stand with your legs evenly apart and slowly bend on knee moving your centre of gravity backwards so they are in line with your toes you can do this with your arms. The reason to do this one leg is so that you can tailor it to any imbalances that you may have also it will make the exercise more intense. Often it is common to have one side stronger than the other so this way you can target your weaker side more. It will also avoid you unintentionally using your other leg to compensate unintentionally. If you feel uneasy or unsure of the technique you can place a chair behind and practice trying to sit back onto the chair.

Hip bridges:

glute_bridgeYou can use this exercise in order to stabilises your pelvis and help with core stability. Start with lying on your back with your knees bent exactly the same as the other exercises above. Then you want to simply lift your hips so they are in a straight line from your knees to your shoulders. As you progress and want to make the exercise stronger you can modify the exercise you can lift up your pelvis the same but keep one leg straight. You want to aim to start with reps of 10 and go up in 5’s as you progress. I would do 3 sets in total.

Clam

clam
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For this exercise you need to lie on your side with your head on your arm to make sure you are in a straight line. Then you need to bend your knees up to your chest at around 30 degrees and have you knee bent at a right angle. You want to make sure that one leg is over another. Then what you need to do is bring the top leg upwards opening up your knees similar to a clam. While you do this you want to make sure that your ankles stay together and it is just your hips that move apart. You should repeat this exercise 10 times in sets of 3. You should feel this exercise in your gluteal muscles.

Stretches:

Piriformis:

Piriformis stretch
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Place your ankle over your knee and then push down your knee. You should feel the stretch in your buttocks, hold for 30 seconds and repeat 5 times. You can do this on both sides of your leg. You want to try and sit up straight in the chair.

 

 

Psoas

hip flexor stairs
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The best way to do this is stand at the bottom of the stairs and place one leg on the second step so you are effectively doing a lunge type movement but up the stair this will again help you stretch out the hip flexors and groin. You want to hold it for 30 seconds.

 

or

Lunge
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You want to focus on the stretch and make sure you get them as deep as possible so that you feel the stretch through the front of your hip. We want to work on stretching and strengthening your hip flexors. I would do 25 lunges on each side before switching to the other side.

 

 

References:

  1. Bergmann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients. J Biomech. 1993 Aug;26(8):969-90. Review. PubMed PMID: 8349721.
  2. https://runnersconnect.net/running-training articles/hip-strengthening-for-runners/
  3. Drake, R.L, Vogl, W. Mitchell, A.W, Gray. H. (2010) Greys anatomy for students 2nd edition. Churchill Livingstone/Elsevier
  4. Byrne, Mulhall & Baker. 2010 Anatomy & Biomechanics of the Hip The Open Sports Medicine Journal, 2010, 4, 51-57
  5. Novacheck. 1998 Review Paper The biomechanics of running Gait and Posture 7 77–95
  6. http://www.physio-pedia.com/Trendelenburg_Test
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