Hip Mobility and Movement Preparation
- Dr. Vinh Vuong, PT, DPT, OCS, FAAOMPT
- 2 days ago
- 6 min read
Movement Preparation
In this post we will discuss proper warm ups and how they can be utilized for specific activities/sports. We will then take a deeper dive into preparing the hips for activity and improving hip mobility. For additional information on stretching please see the previous blog post titled “When do I stretch?”
Many people are familiar with the concept of warming up prior to physical activity. But what is the correct way to warm up, and why do we do so? Some benefits of warming up include increased blood flow and oxygen delivery, increased body/tissue temperature, increased joint lubrication/mobility, nervous system preparation, and mental preparation. If the activity you will be performing is of moderate to high intensity, a warm up helps to gradually increase the heart rate prior. All of these things not only prepare us for the activity but they also help to prevent injury.
In an article written in 2011 they found that “a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities.” (Behm et al 2011). Examples of a submaximal aerobic activity include biking, rowing, jogging, jump rope, ski erg, or brisk walking. When it comes to stretching the conversation is typically around static vs. dynamic. The traditional static stretching routine has been challenged and research has shown it may have detrimental effects on performance. Static stretching has been shown to decrease peak force/strength up to 8% (Kokkonen J et al 1998). With that being said, that does not mean there is not a time and a place in which static stretching is beneficial. When warming up for an activity that necessitates high levels of strength or explosivity a dynamic stretching routine is a better option. If purely working on mobility or control through a desired range of motion then static stretching is appropriate. When it comes to sport specific dynamic activities the options are endless. They also may vary greatly based on the demands of the movement or sport. For olympic lifting preparation you may do part practice for the specific lift (i.e. Burgener warm up for the snatch), or whole practice at a lower/progressive weight. For baseball you may perform a banded throwing warm up, and for soccer you may utilize an agility ladder/change of direction drills. As you may see, the components of a warm up are well researched and specific; while the contents of each component have some room for creativity and individualization.
Mobility Exercises
Shifting gears to discuss specific mobility exercises targeted at the hip joint. We will cover hip mobility exercises, banded hip mobilizations, CARs (controlled articular rotations), PAILs/RAILs (progressive and regressive angular isometric loading), and stability/strength exercises. By no means is this list exhaustive, but it covers multiple muscles, directions, and methods.
Static hip mobility exercises:
Pigeon Stretch
Couch stretch
Dynamic hip mobility exercises:
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Banded hip mobilizations:
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Functional Range Conditioning
Functional Range Conditioning or FRC was designed to improve mobility, strength, and control. To do so a combination of mobility drills, stretching, and isometric exercises are utilized. FRC was developed approximately 10 years ago by Dr. Andreo Spina, DC. Benefits include expansion of usable range of motion, improved joint resilience, and improved overall joint health. FRC principles we will discuss include controlled articular rotations (CARs) and progressive/regressive angular isometric loading (PAILs and RAILs).
Controlled Articular Rotations (CARs)
Controlled articular rotations are a great starting point when implementing functional range conditioning (FRC). Benefits include improved muscular and neurological control for increased joint stability and kinesthetic awareness (awareness of joint position in space). Improving control through the available range of motion will help you to maintain that end range mobility. For the purpose of our discussion, we recommend utilizing CARs after mobility is improved through one of the previously discussed techniques. The technique involves circular movements of the joint trying to reach the outer limits of the joint, trying to make “larger” circles each time you pass through. These should feel difficult; as we create the tension/contraction we are sending signals to the brain telling it that we are able to control through these outer limits of motion. CARs can be performed for most joints in the body and in multiple ways. A good version to start with for the hip can be performed in a quadruped position (hands and knees). The leg being worked will be lifted from the floor coming forward to its limit, then you will begin the lateral movement (fire hydrant position) to create that circular movement. As you move further laterally and begin to move backwards your foot should be kicked up towards the ceiling (donkey kick position). Finally bring the leg back forward and repeat approximately 5 times per leg.
PAILs and RAILs
Progressive and Regressive angular isometric loading or PAILS/RAILs are an Isometric loading strategy used in (FRC). They help to achieve a new active range of motion while also teaching your nervous system how to control the movement and produce force in that new ROM. During PAILs the isometric targets the tissue in a stretch/lengthened position. During RAILs the isometric targets the tissue that pulls you into that stretch (shortened position). These isometric contractions help to build strength and tissue adaptations in both the shortened and lengthened position. Next I will go through the steps to improve hip ER via PAILs and RAILs. To begin, take the joint into the desired stretch position and hold for 1-2 minutes (i.e. seated hip 90/90 position). When performing the PAILs/RAILs it is helpful to create whole body tension or irradiation; this can be done by bracing the core, squeezing the glutes, and even tensing the fists. You will then start with a round of PAILs; engage the muscles which would perform the opposite action of the stretch (i.e. activate internal rotators by pushing your front shin into the floor). You are going to perform a 10-20 second hold with either high intensity throughout or progressive intensity (10% intensity progressing up to max effort if tolerated). Then without fully relaxing you are going to switch to a RAIL. For this you are going to engage the muscles which would perform the same action of the stretch or close the joint angle (i.e. think about pulling shin towards chest- it should not actually leave the ground). You are going to perform a 10-20 second hold with either high intensity throughout or progressive intensity (10% intensity progressing up to max effort if tolerated). Fully relax and deepen the stretch finding your new barrier (i.e. bring your chest closer to the floor). Repeat steps.
Stability and Strength
After completing hip mobility exercises and improving your available range of motion, you can capitalize on these gains by performing stability and strength exercises. This will help to improve your control and strength through the new available ROM in addition to helping your nervous system to recognize the new boundaries.
Stability Exercises:
Lateral heel tap down
Hip airplanes
Single leg DL
Bulgarian split squats
Strength Exercises:
Hip thrusts
Front/back squats
Deadlifts (conventional or sumo)
Step ups
Hip Flexors: To Stretch or To Strengthen?
Many individuals battle hip flexor tightness, yet this tightness does not improve with any amount of stretching. This is likely because the sensation of tightness is stemming more from weakness or overworking. Muscle fibers can have excessive overlap causing true tightness, which will respond to stretching well. Muscle fibers can also be excessively lengthened, in this case they will respond better to strengthening. When these muscles are already in a lengthened position, constant stretching will not be beneficial. A few hip flexor strength exercises that may help are standing marches (band or kettlebell on the foot), straight leg raises (can add a lift up and over component with a small item or kettlebell), or an eccentric KB lower (reverse march) while laying on a bench.
How Can Hybrid Physical Therapy Help?
At Hybrid Physical Therapy, we offer a variety of services to help you achieve that full squat depth or eliminate that nagging hip pain and tightness. The techniques we have discussed are a great starting place, but if you are experiencing pain or continued limitations we can help to expand on these techniques using manual therapy and exercise.
Let Hybrid Physical Therapy be the ones to optimize your performance.
References:
Behm DG, Chaouachi A. A review of the acute effects of static and dynamic stretching on performance. Eur J Appl Physiol. 2011 Nov;111(11):2633-51. doi:10.1007/s00421-011-1879-2. Epub 2011 Mar 4. PMID: 21373870.
Kokkonen J, Nelson AG, Cornwell A. Acute muscle stretching inhibits maximal strength performance. Res Q Exerc Sport. 1998 Dec;69(4):411-5.doi:10.1080/02701367.1998.10607716. PMID: 9864760.
Slaviero, C. (2024, June 23). Controlled articular rotations (cars) - what they are and why you should do them. https://www.physioinq.com.au/blog/controlled-articular-rotations
Buonforte, N. (2022, September 7). Introduction to functional range conditioning (FRC). [P]rehab. https://theprehabguys.com/intro-to-frc/
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