Getting Better..Better - Part 7 - The Hip
As we go up joint by joint, the hips are the primary drivers of your kinetic chain. No other joint can create the magnitude of upstream or downstream affects like a properly OR poorly positioned hip.
Most common clinical hip pathologies such as FAI, hip labral tears, and premature hip degeneration, are all resultant, at least in part, to poor loading strategies as discussed in Part 2.
According to Janda, a centrated hip in static posture, is the result of a neutral pelvis, and combination of external rotation and extension of the hip, along with the maintenance of an active short foot.
Conversely, an anterior pelvic tilt, combined with hip flexion and hip internal rotation, tends to be the most commonly seen passive stability strategy, as well as the position clinically used to test for FAI(Femoroacetabular impingement, a common result of long term passive stability strategies).
Maintenance of the short foot is key; creating hip ER against the stable short foot, creates a healthy tension or co-contraction, resulting in the "centration" of the hip.
These positions work synergistically, with the short foot and neutral pelvis remaining constant and "anchoring" the actively stable pattern, and the extension and external rotation of the hip displaying an inverse relationship relative to each other.
As the hip goes into flexion and loses the inherent stability found in extension, that stability must be found through active external rotation. Conversely as the hip extends, the need and ability of the hip to externally rotate becomes diminished.
The visual presentation of this can vary greatly, with anatomical differences at the hip, torso and femur length ratios, and local mobility all playing a huge role.
One of the best ways we have found to assess for this in clinic, is to have the individual sit on a box or chair that places their hip roughly at or above parallel(an 18" plyo box usually works well for most). Placing the foot in line with the hip, we then have the individual create an active short foot(Part 5) and then maximally externally rotate the hips or "open the knees" without rolling to the outside of their hip or losing the active short foot.
In most cases this allows the individual to find the ideal active loading position for global lower extremity patterns as allowed by their specific anatomy and mobility limitations. For some people, this will present with their knees right over their toes as the squat has been classically defined. For others, the knee will travel outside of the foot as their hip anatomy and increased mobility allow. For a small group, the knee can present inside the foot, in what would classically be defined as a "bad" position. However, despite their anatomical and mobility limitations, the individual can always still progress loading, as long as they are meeting these active stability criteria:
1: Short Foot
2: Neutral Pelvis
3: Maximal Hip External Rotation relative to the degree of Hip Extension
These cues puts the individual in the best position to manage and adapt to the stress external loads, no matter if the load is postural, dynamic such as jumping or cutting, or a world record squat.
And as we stated in Part 1, As our Ability to Manage Load INCREASES - Injury and Pain DECREASE and Performance INCREASE.
As with any movement pattern or skill, the goal is to get the individual to be able to create this actively stable position unloaded, then loaded, then loaded dynamically, adding load and speed as their skill improves(ie: seated, then standing, then walking/running).
Obviously it depends on the context - different people have different goals, different anatomy, and different medical histories. If you are having pain, please, PLEASE go talk to a qualified medical professional who can evaluate YOUR problem. In part 8 we will discuss organization and stabilization strategies of the low back. As always the goal is to help make you better. Better.
If there is any specific topic you would like to see addressed or if you have any questions feel free to reach out to me(Jon) directly at firstname.lastname@example.org or contact our clinic at 816-554-6003.
Thanks for reading!!
Frank C, Kobesova A, Kolar P. DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy 2013;8(1):62-73.
Page, P., Frank, C., & Lardner, R. (2010). Sensorimotor Training Progression. In Assessment and Treatment of Muscle Imbalances: The Janda Approach(pp. 163-164). Champaign, IL: Human Kinetics.