NOT All Hips Need Mobility: Exercises for Hip Hypermobility

While we may be accustomed to working on stiff hips, not all hips need mobility.  And let’s face it, hip hypermobility can be just as problematic.

The other problem seems to be:

“What CAN we do about hip hypermobility?”

I mean, give me hips that need range of motion and I’m all set, right?  

But, 

hips that have too much range of motion can be trickier to manage.

Hip hypermobility is gaining acceptance as a potential source of pain and instability.  This is of particular interest if you are working with athletes and individuals involved in sports that involve repetitive movements in extreme ranges of motion.

Think dancers, gymnasts and the likes, or rotational athletes like golfers.

If you know me by now, it’s not about finding the “best exercises”.  

Exercises are just tools and as I like to say, don’t confuse your tools with your practice.

What it’s really about is gaining perspective on how you are going to improve your client’s overall functionality and what exercises you will select to get you both to this goal.

I’m here to offer that perspective, so read on!

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HIP HYPERMOBILITY: WHAT ARE WE TALKING ABOUT?

While hip stiffness is no good, neither is hip hypermobility.

Hypermobility really just means joint laxity.  Some people naturally have higher levels of general joint laxity than others and can function completely normally.  According to Clap p et al. (1): “a joint may be hypermobile yet stable, and the differentiating factor between hypermobility and instability is the presence of symptoms”.

The term “hyper” means this joint laxity is excessive or allows excessive joint range of motion. If excessive joint range of motion is coupled by an inability to dynamically control that range, you get functional instability.

Functional instability is the inability to dynamically stabilize a joint for proper movement and control

In sports like dancing, gymnastics, or golf, hip hypermobility can offer a competitive edge.  Perhaps individuals find themselves excelling in these types of sports BECAUSE of their hip hypermobility.  A sort of natural selection.

On the other hand, repetitive movements in extreme ranges of motion can cause microtrauma, which over time, may lead to acquired hip hypermobility.

Which came first the chicken or the egg?  There is an actual answer to that question on YouTube, but where hip hypermobility is concerned, it doesn’t matter so much.

What really matters are the steps we take to manage it.

For example, hip pain in golf can be the result of the repetitive rotational torques inherent to the sport itself, which may be difficult to manage and prevent.  

However, if an athlete has hip hypermobility, or low resistance to passive hip internal rotation, the momentum of the golf swing may be taking them too far.

This can become excessive and/or irritable.

What we need to do is create that fine balance where not only does the athlete have enough hip rotation to get into the position but also enough strength to control that rotation.

DISSOCIATION FOR HIP HYPERMOBILITY

When dealing with hip hypermobility, we definitely don’t need more range of motion.  As discussed earlier, one could argue that there is too much range of motion.  But 

remember that mobility is an emergent quality that does not only depend on range of motion

Mobility emerges when its individual components interact together, and these components are: range of motion, motor control and strength.

So even though we are not going to work on range of motion in the case of hip hypermobility, that still leaves us with two other components to work with.

Having range of motion is one thing, but in order to have a joint that is functional, individuals need dissociation capacity.  This means that each component of the joint needs to be able to move independently.

Dissociation is particularly useful for individuals with hip hypermobility because it requires them to fixate one end of the joint and move the other.  In turn, this targets the deep musculature of the hip and contributes to dynamic stability of the joint.

If we stick with our golfing example, we could use this torso-on-pelvis dissociation exercise:

By having the individual turn without moving the hips and legs, as opposed to letting them follow through, we create that stiffness in the hip, fixating the hip rotation as the torso rotates.

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE FOR MORE ON THIS EXERCISE.

ANTI-ROTATION FOR HIP HYPERMOBILITY

More range means more range to control.

This is where anti-rotation comes in.

When dealing with hip hypermobility, we want to create control so that momentum is not just slamming forces into the joint.

 Anti-rotation exercises are typically considered as “core” exercises for torso rotation, we forget that the hip is the central pivot for the torso moving on the pelvis.  

As such, 

anti-rotation exercises are great to create stiffness through the hip as the pivot point for rotation

I also discuss the importance of that pivot point in my article on Sports-Related Groin Pain, so make sure to read that if you want to know more.

Here’s an example of an exercise that will create internal rotation torque at the hip:

Because the band is pulling the torso towards the right and I am standing on the left leg, that left hip is working in internal rotation as I hold my torso in neutral.  

And if you wanted to, you could increase this demand by turning the torso towards the left and holding the end range.

MAKE SURE YOU WATCH THE MAIN VIDEO OF THIS ARTICLE FOR MORE ON THIS EXERCISE

THERE IS MORE WORK TO BE DONE

Of course, everything we do with high control and consciousness needs to transfer over to the more chaotic and dynamic sports environment.  This is why there is more work to be done.  

Dissociation and anti-rotation are a much needed first step, but athletes need optimal muscle activation patterns specific to the movements they will encounter in their sport.

This requires load progressions that replicate the strength demands as well as the kinematic sequences that are imposed by the athletic environment.  

Sticking with our golfing example, you might start with a loaded movement performed at a controlled pace, like a tall-kneeling landmine rotation:  

Then, you would move into a more dynamic movement like a rotational medball slam.

In my article Rotation in Sports: 3 Loaded Exercises Progressions for Maximum Efficiency, I specifically explain how to create optimal progressions through loaded and dynamic exercises.  You can also see how the two above-mentioned exercises are performed.

THE BIG PICTURE

Hip hypermobility can be difficult to manage, but it doesn’t have to be.

Dissociation and anti-rotation exercises are a great way to create motor control and activation

But just like the shoulder rotator cuff, the deep muscles of the hip need to dynamically stabilize the joint during movement

Integrating load progressions helps create the muscle activation, sequencing and timing efficiency that athletes need in order to have all this work translate optimal outcomes in the sports environment.

It is this idea behind the exercises you choose that make the intervention efficient, not just the exercises themselves.

With this perspective in mind, you are fully equipped to dealing with hip hypermobility and anything else that comes your way.

REFERENCES

(1) Clapp, I. M., Paul, K. M., Beck, E. C., & Nho, S. J. (2021). Hypermobile Disorders and Their Effects on the Hip Joint. Frontiers in surgery, 8, 596971. https://doi.org/10.3389/fsurg.2021.596971

(2) Bolia, I., Chahla, J., Locks, R., Briggs, K., & Philippon, M. J. (2016). Microinstability of the hip: a previously unrecognized pathology. Muscles, ligaments and tendons journal, 6(3), 354–360. https://doi.org/10.11138/mltj/2016.6.3.354

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U