It's All in The Hips

Shakira gets it. Happy Gilmore gets it. But unfortunately, many athletes don't get that when it comes to performance, it’s all in the hips. As a physical therapist, I’ve lost count of the number of patients I’ve seen with injuries directly related to weak hip musculature. While the hip may not always be the site of injury, weak or undertrained hip muscles can contribute to poor biomechanics. This in turn may cause injury to the low back, knee, or even ankle. Since the musculature of the hip has two different, specific functions, many athletes only tackle one aspect of hip strength in their training. Just because you can squat twice your body weight doesn’t necessarily mean you have strong, stable hips. For dynamic stabilization and proprioception that effectively prepares you for your sport, you must address both major functions of the hip.

Stabilizers and Movers

The gluteus maximum (GM) is the primary "mover" of the hip.

The gluteus maximum (GM) is the primary "mover" of the hip.

With regards to function, the muscles of the hip can be broken up into two groups: movers and stabilizers. Though they all technically perform both, it is easier to think of them in these two distinct categories. The main mover of the hip is the Gluteus Maximus, and many athletes do a great job of strengthening this muscle. The GM has a number of functions, including extension, lateral rotation, adduction, and abduction of the thigh/hip. Additionally, its insertion into the iliotibial tract helps to stabilize the knee in extension. Your GM generates a lot of power, which in turn makes it the most effective muscle for generating and accelerating joint motion in the lower body.

The gluteus medius and gluteus minimus help to stabilize the hip, and are often functionally weak.

The gluteus medius and gluteus minimus help to stabilize the hip, and are often functionally weak.

But the stabilizer muscles are smaller, and trickier to train. For strong hips, you must train both the muscles that move the hip AND the muscles that prevent unwanted movement at the hip joint. Unfortunately, in my professional practice, I find these stabilizers to be functionally weak more often than not.

The Adductor muscle group is also part of the hip stabilizer muscles.

The Adductor muscle group is also part of the hip stabilizer muscles.

The stabilizers of the hip are the Adductor group (Brevis, Longus, and Magnus) and the remaining Gluteals (Medius and Minimus). As Barr and Lewindon1 state in their journal article, these muscles help stabilize the hip by “envelop[ing] the trunk in a series of interconnected slings and resist trunk motion under load, speed, and limb motion.” You cannot effectively and efficiently resist trunk motion under load, speed, or limb motion without these stabilizer muscles. Your body’s ability to keep your trunk, your core, stable while in motion is crucial to athletic performancewhether your sport involves running, throwing, jumping, or tackling, you must have a stable trunk to produce efficient, effective force.

Training your hip stabilizers incorrectly is as ineffective as not training them at all. Think of the hip adduction machines you might see in the gym, the kind where you sit down and squeeze your inner thighs together against resistance. How often are you sitting and adducting your hips in your daily life? I hate to break it to you, but this movement in no way prepares your muscles for functional, sport-specific movement. All it usually takes for me to diagnose patients with weak hip stabilizers is to have them perform a lunge. Shakiness, knee dives, and loss of balance are all too common. Just look at how Robert Griffin III landed his broad jump during the NFL Combine. (Or, take a look at our popular article on RG3 and valgus knees!) You can be one of the best athletes in the world, but if you neglect your hips, preventable injuries are bound to happen.



How to Target the Hip

So how can you strengthen your hip stabilizers and prevent injury? Think of stabilization as maintaining good posture no matter what position your body is inmost people have poor awareness of their posture, so it is critical that postural awareness is targeted and reinforced in all exercises.

When I give my patients exercises to target theses stabilizers I want the exercises to: 1) be as functional and sport-specific as possible, and 2) incorporate strength, stabilization, and proprioception. Therefore, I love unilateral lower-body exercises, as Coach Jace talked about in his 2014 article on the importance of unilateral training. When playing a sport, you are almost never moving with both legs planted on the ground, which is why unilateral stabilization is important. Moving your body on one leg with stability is an extremely functional movement.

Additionally, I love both plyometrics and exercises incorporating the BOSU ball. I almost always give these to my patients in front of a mirror so that they can work to maintain an erect spine and visually hone in on their need to stabilize their hips. When you can see what it is you’re doing poorly, it is much easier to correct. This is why athletes watch film: to see their mistakes, so as not to make the same ones twice. Why not incorporate it into your strength training routine?


Here are 5 exercises you can add to your existing program to strengthen the hip stabilizers—do them in front of a mirror!

1. BOSU Ball Squats

Once you have mastered the bodyweight squat on the BOSU ball, try modifying the exercise to increase difficulty. Work on increasing the speed or depth of your squats, or try working until maximum fatigue.

2. Single-Leg Balance and Catch with Medicine Ball

Stand on one leg and try catching a medicine ball. It's pretty hard! Work with a partner or trampoline, and increase exercise difficulty by catching high, low, to the side, and straight on (all while maintaining a stable core).

3. Single-Leg Balance with Trunk Rotation

Similar to #2, this exercise will have you maintaining balance on one leg while rotating at the trunk. Increase the difficulty by adding a medicine ball, using a pulley or cable machine, or trying a diagonal chop range-of-motion.

Single-Leg Balance with Trunk Rotation

Single-Leg Balance with Trunk Rotation

4. Lateral (Defensive) Slides with Band Resistance

Starting with the band around your knees, practice lateral slides down a hallway to increase your hip stability. To add difficulty, progress to placing the band around your ankles, and get as low as possible during your slides.

5. Single-Leg Box Jumps

These are tough. Starting with a low box, explode off of one leg and focus on stick the landing. To progress, you can try jumping onto a higher box or performing faster reps (while maintaining a stable core).

Single-Leg Box Jumps

Single-Leg Box Jumps

Conclusion

Just to drive home the idea that poor hip strength and stabilization really are directly related to a higher incidence of injuries in athletes, I did a quick Pub Med search. In it, a number of articles came up that showed this has been, currently is, and will continue to be a problem. For instance, in a study of 163 NCAA Division 1 athletes (100 male and 63 female) it was found that hip muscle imbalance was associated with low back pain and injuries in athletes 2. I also found articles that found hip weakness was related to incidence of knee and ankle injuries in just about every sport you can play. Lastly, previous injury is the number one indicator of a secondary injury. Paterno et al 3 found that in 56 athletes, both altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after an ACL reconstruction were accurate predictors of a second ACL tear. Clearly the evidence is out there that functional strength and stability has a major impact on preventing injury. So, in conclusion, next time you hit the gym remember that if you want to reduce your risk of injury, be functionally powerful, and move with great efficiencyit’s all in the hips!

 


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Reference

  1. Barr A, Lewindon D: Stabilizing and Strengthening the Core. High-Performance Training for Sports 2014; Chap 4: 41-59

  2. Nadler SF, Malanga GA, Feinberg JH, Prybicien M, Stitik TP, DePrince M: Relationship Between Hip Muscle Imbalance and Occurrence of Low Back Pain in Collegiate Athletes: A prospective study. Am J Phys Med Rehabil 2001;80:572-577

  3. Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE: Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 2010; 38(10):1968-78

 

Dr. Adam Shildmyer, PT, DPT, OMT, is a guest contributor to the Volt blog. He is a Physical Therapist at MTI Physical Therapy, an Assistant Basketball Coach at King's High School (WA), and a former basketball player at Northwest Nazarene University.