In part one of our hip impingement series, we discussed critical themes for initial management with runners. If you have not had a chance to read that post, check it out HERE.
After we have removed the aggravating positions or movements and began challenging the hip with more “hip-friendly” exercise variations, we want to expand on how we are challenging the hip musculature. The hip joint is responsible for a wide array of movements in athletics. Running requires the hip to move in many different ways but doesn’t require large ranges of motion like gymnastics.
The video below shows the different motions that occur from the hip. Running requires a combination of these motions between the hip, pelvis, and lumbar spine. This video also displays how actively isolating pure motion at the hip is challenging.
RESTORING HIP MOTION FOR RUNNERS
Hip Extension
It is well-published in the literature that patients with symptomatic FAI display decreased hip extension ROM with day-to-day activities. Often, this is assumed to be due to a loss of actual joint or soft tissue range/extensibility. However, research tells us that even though the ROM might be less, patients with FAI do not have less available ROM in their bodies. They are simply using less of that motion.
This changes how we approach getting patients back to the ROM requirements of their sports. We should not be approaching this from an “I need to lengthen tissue” standpoint, but a “Let’s get them comfortable moving their hip”.
When we program exercises for runners, we shouldn’t focus on static, isolated motion but the coordinated movement of the hip and pelvis. we want dynamic flexion and extension. When our leg progresses behind us, our pelvis will dip forward, and we should be allowing that with the exercises we program.
Many runners are told anteriorly tilting their pelvis is terrible. They need to resolve this by stretching their hip flexors or activating their core more.
That’s garbage.
With running, the pelvis HAS to move with the hip joint. Having an anteriorly tilted pelvis while running is often vilified. Our pelvis has to move to progress our leg behind us and propel our body forward.
These are drills I like to use to promote dynamic, pain-free hip extension. I will incorporate these during the warm-up section of a workout before beginning the strengthening drills we will discuss later in the article. Keep the repetitions low as the goal here is to improve tolerance to the position, not further irritate the hip.
Comprehensive Hip Warm-Up
Complete two sets of 5 reps on each exercise
Hip Flexion
In Part I of this series, we discussed that hip flexion is often painful for runners dealing with FAI. Because of this, training hip flexion is often left out of most rehab protocols as it is a movement that can elicit pain. In the previous drills, when we work on hip extension, the opposite hip goes through hip flexion and a posterior pelvic tilt. We have already begun improving the runner’s ability to tolerate and maintain these positions as we work on restoring extension. Now our focus should be on building the capacity of the hip flexor group.
Creating force into hip flexion is essential for any runner, especially when talking about performance. The focus of the following drills is to build strength and endurance of the hip flexors while slowly working into more hip flexion range of motion. I break these drills into three levels based on the level of difficulty
Level I Drills
Level II Drills
Level III Drills
Comprehensive Loading Drills for the Hip
As much as we view running as a sagittal plane sport, the actual kinematics are much more varied. The hip joint must undergo motion in all three cardinal planes during running. Because of this, we want to challenge the hip complex with various contraction types, force vectors, and loading strategies. We want to build up the abilities of the hip with all motions.
Hip Extension
Hip Abduction
Hip Adduction
Hip Internal/External Rotation
Once runners have mastered the above drills and discussed above, we begin progressively returning them to running. If you found this helpful, be sure to sign up for my newsletter below, and check out the next post in this series on how FAI impacts our running form, training decisions, and strength training. Thanks for reading!
Nathan Carlson PT, USATF
Part I: Initial Management of FAI in Runners
Part III: Plyometrics, Training Progression, and Running Mechanics
Part IV: Long-term prevention, Strength Training, and Drills
References:
Griffin DR, et al. Br J Sports Med 2016;50:1169–1176. doi:10.1136/bjsports-2016-096743
Schache A, Blanch P, Murphy A.Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension Br J Sports Med 2000;34:279–283
Neumann D. Kinesiology of the Hip: A Focus on Muscular Actions. JOSPT Feb 2010; 40: 82-94.
King MG, et al. Br J Sports Med 2018;0:1–16. doi:10.1136/bjsports-2017-097839