It’s All in the Hips

How many times have you heard the words, “I naturally have tight hips” or “My hips have been tight my whole life”?

If we were in a room, I bet everyone in it would have raised their hands.  Before we go assuming tight muscles surrounding the hips are the culprits, let’s look at some different things here.  

This specific athlete may be tight due to chronic overuse and load they have put on their body without proper maintenance. This athlete could have had a previous injury requiring surgical intervention that may or may not have resulted in improper recovery/rehabilitation, giving them decreased range of motion/joint function. Or maybe their hips aren’t even in proper alignment, resulting in a rotation in the pelvis that doesn’t allow for full range of motion and has led to muscle imbalances. 

Now, you may be thinking, how am I even going to know where to begin with this athlete? Fortunately, there are a couple quick easy tests that can give you plenty of useful information.  

As an athletic trainer, I use these techniques on a daily basis when assessing athletes with either low back pain or lower extremity pain. Your hips are part of your “home base” as I like to call it. Your hips and your core provide a strong base for your body and all functional movements start with a strong core. If you’re unable to lock down your hips with your core, your stability will be thrown off. Keep in mind, if you are unable to get the desired range of motion from your hips for whatever reason, your body will try to get that range of motion from one of your other joints or your lower back. 

When looking at the hips, there are many factors that come into play.  If you have tight hip flexors, your pelvis will tilt forward, shortening your hip flexors and lengthening your hamstrings.

When you walk, your hips will naturally rotate; one side will posteriorly rotate as the other anteriorly rotates. Sometimes as you go through activity, one side of your pelvis may “get stuck” or may even become more mobile than the opposite side. This may just be caused from the load we put on our bodies, the “odd” positions we require our bodies to get into, or we could have an underlying muscular imbalance. 

Most commonly you will find that athletes have weak deep core muscles (transverse abdominis, multifidi) and weak external rotators (glute medius, glute max).  If your pelvis likes to get out of position, having weak muscles surrounding the hip exacerbates some problems. If your muscles cannot maintain proper pelvic positioning, your pelvis will continue to move out of position. 

Hamstrings also play an interesting role. When your pelvis is anteriorly rotated, it puts your hamstrings in a lengthened positing, thus tightening them in a lengthened positon. Due to the fascial tightness in the hamstrings, they also place stress on your lumbar spine. When addressing hip/lumbar pain, you must always assess the flexibility of the hip flexors and hamstrings, and the positioning of the hips. 

Now, I am in a unique positioning here. I do have the credentials and background to be able to assess the human body and determine what is injured. Just because you might not have a medical background, don’t let this deter you. These tests I am going to share with you are simple to perform and can give you and your athlete a great starting point and will allow you to share recommendations with them.

An easy way to test to see if your hip flexors are tight is to have the athlete lay on their back on a table with the top of their butt on the edge of the table. Have the athlete pull one knee into their chest and let the other leg relax off the edge of the table. This is known as the Thomas Test.  

Tight Thomas Test
Ideal Thomas Test

If the thigh is raised off the table, the hip flexors are tight. If the knee is extended, the quad muscle – which is also a hip flexor – is also tight. Ideally, you want the thigh to rest on the table and have the knee bent as close to 90 degrees as possible. 

To assess hamstring flexibility, have the athlete lay on their back on the ground pull one knee in to 90 degrees of hip flexion, extend at the knee, while maintaining contact with the ground on the opposite leg. 

90/90 Hamstring Test Tight

If you look at the ankle of the knee, you can see that due to hamstring tightness, this athlete is unable to extend fully at the knee.

90/90 Hamstring Test Ideal

 Hamstring flexibility is not impeding the ability the extend the knee fully.

The more of an angle you see at the knee, the tighter the hamstrings are. Ideally, you want the knee as close to an extended position as possible.

Now here’s the fun one: checking the level of the hips. Just because you may find the hips are indeed out of alignment, that does not mean they aren’t tight. They likely still are, so keep that in mind.

To assess the level of the hips, have the athlete lay on their back on a table and bend their knees with their feet flat on the table. Have the athlete bridge up – lift up their butt – three times, then pull their ankles toward you. Place your thumbs under both medial malleolus – inside ankle bone – and see if they are level. If not, have the athlete sit up and see if the ankle bones then line up. If they do, then there is a rotation at the hips.

What does this mean? This is called the long sit test. It is a quick easy way to see if there is rotation at the hips.  

If you do notice that one leg appears – emphasis on appears – to be longer than the other leg, have the athlete sit all the way up and see if the legs then even out, placing the ankle bones at the same level. You can use this along with the previous tests and provide recommendations to the athlete. If their hips are rotated, it would be worth seeing a medical professional to help “re-align” their hips. An athletic trainer, manual therapist or Chiropractor are good places to start. 

In my setting, I would use a muscle energy technique to put the hip back in the correct placement. Don’t fret though! If there are noticeable restrictions found in the hip flexors and hamstrings, start there. Below are some of my favorite hip flow/mobility exercises to use in conjunction with foam rolling and stretching of the hip flexors and hamstrings. 

By starting with these, the athlete will mobilize their hip joints as well as stretch their muscles, possibly allowing their hips to realign on their own. 

Then key is to address the mobility issues before strengthening. It may be a great idea for this athlete to have their own mobility routine to go through prior to group warm ups. That way, their hips are loosened up, hopefully aiding the hips in finding their correct position, and they can then go through the warm up or activation work helping to maintain that gained position and range of motion.  

The thing to continue to remember is every athlete is different. Every athlete moves differently and what works for one athlete won’t necessarily work for another. Luckily, there are plenty of tips of the trade out to there to find something that works for every body!

Rubie Gaudette
Rubie Gaudette MS, LAT, ATC, CSCS, CF-L1. Rubie is an athletic trainer at IMG Academy where she works with the boys soccer program on prevention, mobility, rehabilitation and return-to-play protocols. She received her Master’s Degree in Athletic Training from Western Michigan University. She is a certified strength and conditioning specialist through the NSCA and is also a CrossFit Level 1 trainer. Contact her at rubie.gaudette@gmail.com.

1 Comment

  1. Avatar

    Name *sebastian

    May 30, 2019 at 6:02 pm

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