BackHips don’t lie
From sitting up straight to walking and skipping, you use the pelvic and hip muscles for everything. Some exercises to stave off hip pain
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Sitting in the middle of the body’s anatomical centre, the hips play a vital role in our movement patterns—almost like a central defender in a football formation. The pelvis or hips are the lynchpin of our upright posture. The pelvis provides a solid platform for the spine—whether the spine is hoisting the body upright or bending it forward, the pelvis will provide the fulcrum for the movement.
A close associate of the hips is the sacroiliac (SI) joint. This is the joint where the sacrum (lowest part of the spine) or tail bone connects on both sides with the iliac (hip) bones. The pelvis, together with the SI joint, plays a dominant role in absorbing forces created or arising out of other parts of the body, like the arms and legs. For instance, when someone jumps from a height, there is tremendous force generated within the muscles, ligaments, tendons and fasciae, the thin layer of tissue around the muscles. The hips, along with the SI joint, “lock up" almost instantaneously on impact to absorb the shock. “It is not too far-fetched to say that the pelvis is the body’s other brain—that’s how important it is. Like the skull, the hips are built to endure incredible punishment while safeguarding essential functions," says pain management expert Pete Egoscue in his book Pain Free: A Revolutionary Method For Stopping Chronic Pain.
Why so many people get hip pain
Tightness of muscles, including the glutes, piriformis, rectus femoris and hamstrings can restrict movement of the SI joint and pelvis, causing irritation in the joints. This can cause inflammation in the joint and lead to a condition called sacroiliitis—not easily diagnosable and sometimes confused with lower back pain.
To protect both the joints, pelvic alignment is important. Visualize the anatomy of the pelvis: Basically, the pelvic bone is a flat bowl-like structure and the head of the femur, or thigh bone, inserts into it. It is important that the head inserts into the hip socket at a proper angle. If there is any misalignment, it can increase the load on the hip, sometimes 10-20 times more than that for a normal hip. Ignoring rare congenital issues, it is tight muscles that are the main culprit, causing misalignment and deformity.
According to Robert Haley, a US-based chiropractic doctor and certified strength and conditioning coach, a pelvis that is elevated on one side or rotated anteriorly or posteriorly can cause excessive stress on the SI joints. This can be caused by spinal or lower extremity misalignments or muscle imbalances.
Without oversimplifying the matter, know that 80% of all hip and SI joint issues can be resolved with proper stretching, strengthening and myofascial release, a soft tissue therapy. Intrusive surgery or replacement should be the last alternative, when all else fails—which is rare. Yet more people are opting for replacements, which are often termed “successful" because the hip feels stronger. Well, the hip feels stronger because it has no kinesthetic awareness, or feeling, left after surgery. The dysfunctions that caused pain and disability in the first place (tight or weak muscles leading to misalignment, for example) are still embedded in the nervous systems and still applicable. So, the pelvis will still operate at a faulty angle and have poor functional movement. But the person experiences no pain because metal, plastic and ceramic are impervious to pain.
The modern artificial hip has a life of 15 years. So a 50-year-old man or woman who has a hip replaced will be staring at a second surgery at 65 and a third if s/he lives to 80.
Exercises to keep hip pain at bay
Wall squat with femur abduction
Problem area: When the head of the femur doesn’t rotate freely at the junction owing to tight or weak muscles, the cartilage can get eroded and lead to pain. The squat with femur abduction, the movement of a limb away from the midline of the body, improves hip mobility.
The fix: Squat with your back against a wall, grab the left ankle with the right hand and place your right palm on the inside of your left knee. Push the left knee away and out as far as you can without feeling pain or too much discomfort. Expect to feel a slight stretch. Perform 5-10 times on one side. Then repeat on the other side for two-three sets.
Those with a good squat position need not take support from a wall.
Double knee to side
Problem area: This exercise teaches the association between the lower back and the hips. It is vital to understand this, for people generally use the lumbar spine for rotation, putting the spine at risk.
The fix: Lie flat on your back, bend both knees and flex your hips to about 90-120 degrees (normal hip flexion is 120 degrees). Keeping the pelvis flat on the ground, your elbows always in touch with the floor surface, roll your knees from side to side five to 10 times. Repeat for one-two more sets.
Gluteal stretch
Problem area: This is actually a stretch for the piriformis muscle, which lies deep within the gluteal muscles and is a powerful hip abductor. A tight piriformis can cause major hip pain.
The fix: Lie on your back, bend your left knee to a figureoffour shape (keeping the right foot flat on the ground, place your left ankle above your right knee). Now grab the back of your right thigh with both hands and pull towards yourself. At the point of feeling the stretch, both feet should be off the ground. Hold for 1520 seconds, and then repeat for onetwo repetitions.
Hip-flexor stretch
Problem area: According to Vladimir Janda, the late Czech neurologist and an expert in chronic musculoskeletal pain, the psoas muscle is perhaps the most prone to dysfunction in the human body. This muscle originates in the upper thigh and attaches to all the vertebrae in the lumbar spine. If this muscle gets short and tight, it has a tendency to tip the pelvis forward, distort the posture of the lower back and create an artificial arch in the lower spine. All these factors put the hip out of alignment.
The fix: Stand in a split stance. Ensure that you are on your toes in the trailing leg and the front knee never crosses the ankle at a vertical plane. Lower your body so that the trailing knee almost touches the floor, raise the same arm and tilt the body slightly towards the opposite side. You will feel a stretch in the inside of your rear leg upper thigh where it attaches to the hips. Hold the stretch for 20 seconds, then repeat on the other side. Two three repetitions are recommended
Glute bridge
Problem area: People with weak glutes tend to use the lumbar spine for hip extension, which tightens the lower back. This exercise teaches the glutes to be the dominant hip-extensor muscle.
The fix: Lie on your back in a bent-knee position, with feet flat on the ground and about hip-width apart. Tighten your glutes and gently raise your pelvis till the knees are about 90 degrees to the floor. Gently lower the hips to the starting position and do two-three sets of 10-15 repetitions.
Ranadeep Moitra is a certified coach from the National Strength and Conditioning Association of America and has worked with the Indian cricket team, the Bengal cricket team and the East Bengal Football Club. He currently coaches the Indian golf team.
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