Jul 9th, 2013
Category: Functional Training
Hip Range of Motion and Lower Back Pain
Range of motion (ROM) limitations within the hip joint is a precursor for lower back pain (LBP), lack of gluteal musculature development, and altered lumbar spine kinematics (1). Normally, the first train of thought is to simply prescribe a comprehensive stretching routine. However, there are multiple forms of stretching, as well as flexibility. There is active / dynamic flexibility and static flexibility. Dynamic stretching or flexibility is more related to athletics and movement / exercise; static flexibility or stretching is more closely related to yoga and recovery. Individuals, who engage in a comprehensive training program with a goal of increasing hip joint ROM, as well as overall flexibility, must incorporate dynamic and static forms of flexibility training, core stabilization training, and eccentric resistance training (2, 3, 5).
Core stabilization training should focus on multi-joint complex exercises (i.e. squats, deadlifts, etc…). These movements require multiple joints to work in concert and focus on the core. Individuals with insufficient core strength often suffer from LBP, which leads to altered lumbar spine kinematics. Altered lumbar spine kinematics results in poor movement mechanics during complex movements (i.e. full ROM squats) and restricts results from any resistance training program. LBP athletes, fitness enthusiasts, and persons alike typically round their spine at the end of hip rotation during prone hip rotational activities (ROM squats, lunges, etc…). Core stabilization training, strength gains, local muscular endurance, motor control, and spine – hip positioning during squat movements should be the focus of any musculature correction program.
Less elastic lower limb musculature results in altered kinematics within the hip and spine. For example, participants who are unable to perform ROM squats often perform parallel squats. Parallel squats result in less-elastic lower limb soft tissue (6). The problem arises when individuals are unable to maintain posture and technique during squats, deadlifts, lunges, etc… Strength & Conditioning (S&C) coaches, as well as personal trainers, should remove their clients and/or athletes from movements that require full ROM until they can correct their musculature imbalances and weaknesses. Through comprehensive musculature correction, S&C coaches can save their athletes and clients from LBP and further injury. Once corrected, S&C coaches should incorporate full ROM movements back into the program and expect performance results to flourish.
I have found these four tips to be most efficient to allow for increased hip ROM and lead to reduced LBP, as well as more efficient movement patterns / exercise techniques.
1) Overhead Squats…
Overhead squats have been utilized by S&C coaches since the beginning of athletic performance training. Overhead squats have been shown to increase core strength, hip joint elasticity, latissimus dorsi flexibility, and improved strength and power within the lower limb musculature. Overhead squats should first be performed with an empty barbell or even better a broom stick. Place your hands wider than shoulder width apart with your arms fully extended and your feet slightly wider than shoulder width (feet angled out); hold the broom stick or empty bar fully extended above your hand and squat. As you squat, retract your shoulders backwards (posterior) while keeping your chest and eyes up. This exercise is extremely challenging and will highlight any musculature tightness, weakness, and asymmetry. If you cannot perform a full ROM overhead squat try sitting to a chair or a bench first. I find that utilizing this exercise before and after the main workout, with a prescription of 1-2 sets for 8-12 repetitions, to be very beneficial in increasing overall body control and flexibility.
2) Stability Ball Wall Squats…
This exercise involves squatting up and down while keeping constant pressure against a stability ball on the wall. The stability ball should start at the lower back and end at the middle to upper back at the bottom of the squat. To figure out the best position and distance from the wall you must start performing repetitions. The knees should move forward until they reach the very front of your feet, but not travel in front of the feet. This is the optimal squat movement pattern. If your knees do not travel forward at all, then your feet are too far away from the wall and your lower extremities will move through a false movement pattern. All real life movements move the knees forward over the feet.
Stability Ball Wall Squats are great for beginners because it restricts the spine during movement and places emphasis on the hip joint. The restriction of the spine during movement allows for active utilization of the hip joint axes, thus resulting in elastic symmetry of the joints involved. Symmetry within the joints involved during squatting will result in greater ROM within the hips and less rounding of the spine at the bottom.
3) Core exercises…
The benefit of core stability and strength goes beyond improvements in hip ROM. The core is the center of all movement. A stronger core allows for more efficient movements with little to no pain. However, select core exercises have shown to increase hip ROM and core stabilization with more efficiency. Here are 5 exercises that I have found to be most beneficial for aiding in increased hip ROM and core stabilization (they are in no particular order):
1) Hip Rolls
2) Turkish Get Ups
3) Farmers Walking
4) Blood Hounds
5) Stiff Arm Oblique Press & Twist
To see examples of these exercises visit www.functionalmusclefitness.com and click “exercise of the week.”
Incorporate these exercises at the end of your workouts weekly; some exercises, such as the Turkish Get Ups and Farmers Walking, should be incorporated into the main workout. Turkish Get Ups and Farmers Walking work multiple joints and require a high level of mastery, which means greater lean muscle and performance gains.
4) Self-Myofascial Release & Static Stretching…
Prescriptions to statically stretch the soft tissue surrounding the joint have far been removed. Although static stretching should still be utilized, there are various other forms of movement / techniques that aid in tissue elasticity. Recent research has looked into the fascia tissue and how it affects adjacent musculotendinous structures (3). A link between myofascial tissue connections and the coordinated transmission of force into those adjacent musculotendinous structures were found. Findings, such as the aforementioned, have resulted in an increasing popularity in the practice of foam rolling. A prescription of foam rolling, followed by static stretching, on soft tissue should be required following each workout.
First, apply near maximal tension to the fascia tissue (soft tissue) with the foam roller, or FMF’s deeper tissue roller. For the hip region, apply tension to the IT bands (sides of the legs), the quadriceps group (front of the leg), the gluteal musculature group (butt), and the erector spinae muscles and trapezius muscles (muscles that start at the lower back and continue to run along the spine). Once near maximal pressure has been placed upon these muscles, perform static stretching to that same tissue.
I have found that participants who stay consistent with the 4 aforementioned techniques increase hip ROM and reduce LBP significantly, some within the first two weeks. In Summary: perform 12 overhead squats before and after workouts; utilize stability ball wall squats as needed (a great warm up or correction exercise); incorporate the five core exercises weekly; and perform foam rolling and static stretching after every workout or at least once per day.
1. Barbee Ellison, JB, Rose, SJ, and Sahrmann, S. Pattern of hip rotation range of motion: A comparison between healthy subjects and patients with low back pain. Phys Ther 70: 540-541, 1990.
2. Offierski, CM and Macnab, I. Hip-Spine syndrome. Spine 8: 316-318, 1983
3. Huijing, PA and Baan, GC. Myofascial force transmission via extramuscular pathways occurs between antagonistic muscles. Cells Tissues Organs 188: 405-410, 2008.
4. Myer, GD, Chu, DA, Brent, JL, and Hewett, TE. Trunk and Hip Control Neuromuscular Training for the Prevention of Knee Joint Injury. Clin Sports Med 27: 430-440, ix, 2008
5. Mark A Wine. Eccentric Training for Athletic Performance. www.functionalmusclefitness.com: 2012
6. Mark A Wine. Squats for Performance: Range of Motion Squats vs. Parallel Squats. http://functionalmusclefitness.com/squats-for-performance-range-of-motion-squats-vs-parallel-squats-part-i/: 2012
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