Hip Joints: Power, stability, and mobility.

Dr. Jess assessing the hip
Dr. Jess assessing the hip at Ironman Kona

Hip Dysfunction: Often the cause of lower limb, low back, and shoulder injuries. By Dr. Jessica Greaux, DC, ART If I had to pick one area of the body that can cause many lower limb, low back, and even shoulder injuries, it would be the hip joints. The hip joint has to be very mobile and yet, withstand loading or weight bearing impact and large rotational forces. There are two types of movement pathologies associated with the hip joint: Restricted movement and excessive movement. Restricted movement can occur from previous injuries to the spine or lower limb as well as a hyperlordotic posture. More often than not, we find the patient has had a previous ankle sprain on the same side of hip restriction or hip pain. A hyperlordotic posture is usually associated with tight hip flexors and IT Band, causing reduced hip extension. Should the hip be restricted, as mentioned above, other areas must compensate for the lack of movement and thus become inflamed from overuse or inappropriate movement. Excessive movement can occur when a person has a swayback posture which consists of a forward sway of the pelvis, neutral or posterior pelvic tilt, a longer than normal thoracic kyphosis or rounding of the midback, and relative hip extension due to the forward pelvis. This posture will cause a forward movement of the femoral (leg bone) head and may be associated with poor control of the gliding movement of the femoral head. Excessive hip movement may present with clicking or clunking of the hip. Often times, we will find atrophy or weakness of the deep external hip rotators, or the hip’s “rotator cuff”. Low back pain can often be traced to insufficient rotation of the hips. If the hips are restricted in rotation, the low back is asked to do the rotation to complete a task. However, the low back is not designed to rotate excessively and therefore can become inflamed. Consider the rotational forces of a golf swing of a right-handed golfer. Should a golfer lack external rotation in the right hip or internal rotation of the left hip, the pelvis will not rotate fully towards the target, and therefore the low back will be forced to rotate and decelerate or control the swing. Lower limb injuries can occur due to either restriction or weakness in the hips as the hip movement determines where the knee and foot will land in gait and weight bearing activity. We often see restriction in one plane of movement in the hip causing the femur to adduct or move inwards excessively. This, in turn, will cause the foot to land crossing the midline of the body in gait- thus landing in a more supinated position, or on the outside of the foot. Since your foot will need to flatten and meet the ground, your ankle will be forced to hyperpronate rapidly, causing lower limb injuries. These are just a couple of examples demonstrating how hip dysfunction can cause injuries above and below the pelvis. In my practice, not only do we assess the hip joint for every hip, lower limb, or low back pain, but we often find hip dysfunctions in shoulder, elbow, and wrist injuries for throwing and swinging athletes. This is sometimes due to hip rotation restriction or weakness leading to overloading of the shoulder rotator cuff, elbow, or wrist muscles to decelerate the arm in swinging or throwing sports. For instance, with regards to a right handed tennis player, should he or she have restriction of the right hip during a one-handed backhand, he or she will not be able to completely follow through with the pelvis, trunk, and shoulder and thus may have to excessively flex the wrist backwards to accommodate the lack of hip rotation in order to make a good contact with the ball. This often times leads to “tennis elbow”. A proper assessment including flexibility, stability, strength and biomechanical function is imperative to determining hip dysfunction. Once a proper assessment has been performed, an individualized rehabilitation program is prescribed to correct dysfunction, restore normal mobility, strengthen, and stabilize the hip joints. Dr. Greaux is the owner and founder of Innersport Performance Therapy Clinic and Press Play Analysis in Berkeley, CA. She has been providing sports medicine care to athletes since 2001 and is a consultant to NCAA Division I Cal Berkeley Sports Medicine Department and Bay Area Track Club.