The truth about hip mobility is that we always say athletes need it but what exactly do we mean? More often than not, mobility is being assessed as hip range of motion, which in reality is only part of mobility.
Many are assessing hip mobility in a “check the box” fashion:
Does the athlete have 30 to 40 degrees of internal rotation?
Does the athlete have 40 to 60 degrees of external rotation?
If you check the box, the conclusion is the athlete has hip mobility. If you don’t check the box, the athlete goes into the “needs hip mobility” category, and work is done to improve hip range of motion until they get the checked box.
(Which often winds up in athletes being jammed into a 90-90 position… not exactly what most of them need. More on that later.)
The question that begs an answer is:
Can these athletes use their hip mobility; hence, do they even have a hip?
This article will shed some light on how to better assess hip mobility in terms of what we need athletes to be capable of achieving with this mobility.
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WHY IS HIP MOBILITY IMPORTANT?
There are many answers to that question. For one, we are looking for athletes to be able to come in and out of positions: throwing, striking, cutting, pivoting, etc. All of these require hip range of motion, but they also require that the athlete actually has a hip.
What do you mean, do they have a hip?
The capacity to express independent motion at a joint is termed dissociation. Dissociation means that each component of an articulation (joint) can move independently of the other.
This relative motion between the two composite parts of a joint is not only important for joint health but is what it takes to actually have a joint.
The hip joint is the articulation between the head of the femur and the acetabulum of the pelvis.
For the hip to be a hip, the femur must be capable of moving independently from the pelvis and the pelvis must be capable of moving independently from the femur.
Suffice it to say that an athlete who doesn’t have this dissociation capacity is left with less than optimal biomechanics and less movement capacity. This makes it more likely that the demands placed on the athlete will exceed the capacity, increasing the risk of injury or at the very least, resulting in compensation and poor movement choices. In turn, these create movement that is excessive, imprecise or insufficient and eventually, pain or pathology.
ASSESS RANGE OF MOTION
While we don’t want to ONLY “check the box” or “not check the box” on hip range of motion, it is still important to assess. If there are articular restrictions at the hip, we will need to address these as they contribute to optimal mobility and of course, dissociation.
When performing your assessment, watch for movement of the pelvis with the femur near the end range of motion, or if end range of motion is restricted. This may mean there are some articular restrictions to work on.
When there are joint mobility restrictions limiting hip rotation, an appropriate intervention to address these limitations is joint mobilization of the appropriate portions of the joint capsule, most likely the posterior, inferior and lateral portions.
This is important because it will be difficult to dissociate the pelvis and femur if the two are tightly joined in passive motion.
Supplementing with appropriate self-mobilizations with bands provides great outcomes as it allows athletes to work consistently and frequently on improving restrictions. Here is a self-mobilization lateral traction using a band, which is helpful for improving general hypomobility:
WATCH THE MAIN VIDEO OF THIS ARTICLE TO SEE HOW TO CHECK FOR RANGE OF MOTION
An important side note here is that some athletes have hip joint morphologies that contribute to limited range of motion (1).
These are the ones with whom we don’t want to force-feed the famous 90-90 hip mobility position I mentioned at the beginning of the article, at the risk of irritating them, or at best, just not getting any results.
A trial of skilled hands-on mobilizations supplemented with self-mobilizations with re-assessment can help determine whether there is potential for improvement in mobility.
ASSESS AND ADDRESS DISSOCIATION
Improving tissue or joint capacity for range of motion without addressing other components of mobility is still not ideal. Athletes also need the capacity to dissociate the femur from the pelvis and the pelvis from the femur.
Femur on pelvis dissociation
The heel-to-knee/Knee-to-knee screen is a great screen to see whether an athlete can move the femur into internal and external rotation while keeping the pelvis relatively stable. While we use it as a screen to observe capacity, we often then go on to use it as an exercise to create this awareness and control.
Initially, you could also work on this capacity using internal and external rotation control exercises, which are performed in the seated position and isolate rotation of the femur on the pelvis. Here is an example of internal rotation of the femur on the pelvis:
MAKE SURE TO WATCH THE MAIN VIDEO OF THE ARTICLE TO SEE HOW ALL OF THESE ARE PERFORMED
Pelvis on femur dissociation
This airplane variation is a screen for pelvis on femur dissociation. What we would like to see is the entire torso/pelvis rotating on the fixed femur. Notice how on the first rep, only the torso twists, while on the second rep, the torso and pelvis rotate on the femur.
Again, the screen can then be used to create awareness and control. You can also use the airplane variations we show in the video attached to this article.
Remember, the more controllable range athletes own, the more movement solutions they have to get in and out of positions for the demands of their sport.
More usable range also allows for better distribution of load throughout the kinetic chain, which is ideal for injury prevention and efficient mechanics for performance.
FINE-TUNING THE MECHANICS
Speaking of efficient mechanics for performance, the logical next step is to bring this dissociation capacity into a more dynamic environment.
The hip joint serves as a central pivot for the body during complex and dynamic rotational movements like throwing, striking or changing directions. In fact, during these movements, dissociation occurs bilaterally to control one hip moving on the pelvis and the contralateral pelvis moving on the hip.
The hip is not the only player in making sure these movements are efficient. In previous articles on the blog, we discussed the importance of the obliques and the cervical spine for efficient and powerful rotational movements.
Working on loaded, multidirectional movements under control is a great way to start connecting the dots.
WATCH THE MAIN VIDEO TO SEE SOME EXAMPLES
MAJOR TAKEAWAYS
Why is hip mobility important?
While range of motion is part of mobility and therefore, having appropriate range is important, we are often too limited to this quantitative view. We forget about what it is we actually need athletes to be capable of doing with this range of motion.
An athlete can have a great amount of hip range of motion, but very little dissociation capacity and therefore, very little usable range.
Call it range of motion of sufficient quantity, but insufficient quality
What athletes really need is to have a hip. For the hip to be a hip, for range of motion to contribute to actual changes in the way athletes move, dissociation is key. Dissociation allows for loads and forces to be shared and for a greater scope of movement options.
All of these are key to injury prevention as well as performance.
REFERENCES
- Reiman, M. P., & Matheson, J. W. (2013). Restricted hip mobility: clinical suggestions for self-mobilization and muscle re-education. International journal of sports physical therapy, 8(5), 729–740
Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U
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