It’s all in the Hips, It’s all in the Hips

One of the first lessons any beginner learns when riding a snowboard is to point their hips in the direction they want their board to go.  The movement of the hips will cause the snowboarder to move onto their toes or their heels, therein, turning the board. This hierarchy of movement is seen in treatment plans with many of our own patients.  In the clinic, we see how the hip affects the alignment and biomechanics of the more distal joints of the lower extremities during running, ambulation and balance exercises.  A recent article in the JOSPT by Christopher M. Powers, discusses the  importance of hip mechanics in relation to the biomechanics of the knee.  Some highlights I felt could be used in the clinic immediately are listed below:

• During ambulation/running hip ADD and internal rotation excursion are greater than seen in the sagittal plane.  Increased hip ADD and IR can cause excessive valgus force on the knee.
• The stability of the tibia in weight bearing stabilizes the patella, therefore, it is the IR of the femur under the patella that is the primary contributor to the lateral tracking seen in patients with PFPS.
• Strong predictors of iliotibial band syndrome (ITBS) were increased hip ADD and IR on a weight bearing limb.  Furthermore, Powers cited research by Fredericson et al. that found a 6 week hip ABD strengthening program to reduce ITB pain in 92% of the participants during running.

Relevance: We can focus on Hip ABD and ER strengthening and proprioceptive training to get the most “bang for the buck” for our patients.

• Landing with a forward trunk (increased hip flexion) during a “Drop-jump” task, as described by powers, was seen to have increased activity of hip extensors compared to landing with less hip flexion which caused increased Quad activity.

Relevance: When plyometrics are appropriate we can use this assessment as an exercise.  Ask the patient to perform the “Drop-jump” task with emphasis on a forward trunk lean upon landing.  By forcing the Gluts to be used eccentrically we can also assess any femoral IR as well.

A hip strengthening program can include a variety of exercises, as we all know.  I invite you to share some of your own favorites.