The Hip as an Interface for the leg and Core
The hip interfaces the core and the lower leg. Many muscles of the hip originate at the core and attach to the thigh. As such, the hip is pivotal in generating both stability and power and has large implications up and down the kinetic chain. Where runner’s hit the ground is largely dependent on where the hip muscles approximate the lower leg. Runners will often complain of issues local to the hip as well as issues farther down the leg that can often be traced back to the hip and its role to the core. Running related injuries local to the hip include hip flexor tendinitis, gluteal tendinopathy, and labral tears.
Gluteus maximus, medius and minimus all originate on the top of the femur and span various lengths along the back aspect of the pelvis. The glutes and deep lateral rotators work in all three planes of motion to both stabilize the hip as well as generate power at the hip. In running, glute medius and minimus work to stabilize the pelvis in the frontal plane. When these muscles are injured or not working correctly runners will demonstrate a hip drop while running that is easily visualized with gait analysis.
Deep Lateral Rotators
The deep lateral rotators are a group of six muscles that primarily move the hip in the transverse plane. These muscles include the superior gemellus, inferior gemellus, obturator externus, obturator internus, quadratus femoris, and the piriformis. While these muscles do move the hip, compared to the gluteals, they are very small muscles with not a great ability to generate power. These muscles function better as stabilizers of the hip- keeping the ball of the femur centered in the socket of the pelvis. Thus, when these muscles lose function runners develop instability issues within both the hip joint and the closely approximated pelvic floor.
The hip flexors are a group of muscles located in the front of the hip that work together to flex the hip, bringing the thigh closer to the torso. The main hip flexor muscles include the iliopsoas, rectus femoris, and sartorius muscles. In running, the hip flexors play a crucial role in propelling the body forward by pulling the thigh towards the torso during the swing phase of the stride and stabilizing the hip during the stance phase. Runners often complain of pain and tension along the front of the hips that is frequently attributed to hip flexor irritation. It is important to note that while the symptoms are located over the hip flexors, often this pain can come from within the hip joint itself or even be referred from the lower back.
The hip adductors are a group of muscles located on the inner thigh that work together to adduct or bring the thigh towards the midline of the body. The primary hip adductor muscles include the adductor magnus, adductor longus, adductor brevis, and gracilis.
In running, the hip adductors play a crucial role in stabilizing the pelvis and maintaining proper alignment of the leg during the stance phase of the running gait. Common running related injuries related to the adductors include groin strains and pelvic floor dysfunction.
Mobility at the Hip
Maintaining a healthy amount of flexibility at the hip is important for optimal muscle function and tissue recovery. Foam rolling muscles that surround the hip is an excellent way to decrease forces applied to the hip joint. Excessive tone can occur following an injury as the muscle guards or braces around a joint. A muscle can also demonstrate excessive tone following a workout or training block. Below are some exercises to work on mobility of the muscles surrounding the hip joint.
Foam Roll Glutes & DLRs
Sit on the foam roller and cross your ankle over your opposite knee to stretch your hip. Go back and forth until you find a spot that is sensitive.
Tac n Stretch Quads
Lay face down on the foam roller with the roller on the front of your thighs. Go back and forth until you find a spot that is sensitive. Hold pressure there and bend your knee up and down
In a half kneeling position prop your kneeling leg on a surface about a foot off the ground (ie couch). Engage through your core and lean forward to stretch.
Foam Roll Adductors
Lay face down in a frog-legged position with the foam roller perpendicular to your inner knee. With the roller resting on your inner thigh rock back and forth.
Lay on your back at the edge of the bed. Bring the knee farthest from the edge to your chest. Let the other knee fall off the bed to stretch your hip.
Standing upright bend your knee up to waistline, open your hip and raise your foot towards the ceiling. Reach back behind your body. Then return to neutral.
It's not your Bursa
Runners will commonly develop pain on the outside of the hip. This has been traditionally attributed to irritation at the bursa, termed greater trochanteric bursitis by medical providers. While it’s common to have pain on the outside of the hip with running it is very rare for this to be attributed to the bursa. More likely diagnoses include greater trochanteric pain syndrome, gluteal tendinopathy, referred back pain or a gluteal tear.
Stability at the Hip
The hip has three degrees of freedom, this is important because it makes it a very dynamic joint; however, this means that the hip requires quite a bit of stability to control movement in all three planes of motion. The muscles surrounding the hip joint are dynamic stabilizers that are used to work in multiple directions with a variety of angles of pull. Moreover, the muscles at the hip play an important role in mitigating forces down the kinetic chain.Weak hips can cause misalignment in the lower body, which can lead to imbalances and poor running form. Strong hips can help maintain proper alignment and prevent compensations that can result in injuries. Stability of the lower legs requires good stability of the muscles of the hip. Below are some exercises that work on achieving multi-planer stability at the hip.
Standing Hip Abduction
Standing on one leg, kick leg out into the band and hold for 30sec. Try to maintain your balance and keep your hip level.
Standing Hip Abd on Balance Board
Standing on one leg on a balance board, kick leg out into the band and hold for 30sec. Try to maintain your balance and keep your hip level.
Single Leg Balance
Standing on an uneven surface, stand on one leg.
Single Leg Pallof Press
Standing on one leg. Press a band anchored laterally back and forth from your chest.
Strength at the Hip
The hip connects the lower leg to the core. Ultimately having good strength at the hip allows runners to generate power through the core and move forward in space faster. Strengthening the quads, glutes, and hamstrings is pivotal in generating power for forward propulsion. The glutes, quads, and hamstrings are the largest muscles of the leg; thus they are capable of generating an incredible amount of power. Below are several exercises to strengthen the hip and thus provide stability through the whole kinetic chain.
Learning how to initiate movement through your hips will help engage your glutes during foundamental movements like squats, deadlifts, and hip thrusts.
4 Way Step Up
Initiating movement through your hip, step up to a march, step down ad tap your heel then march back up, step laterally and march up, step back and diagonally and march back up.
With trail leg propped on a box. Perform a split squat initiating movement through the hip.
Runner Banded Hip Flexion
Lean against the wall with a band wrapped around your feet. March one leg up into the band forcefully and hold. Then repeat on the opposite side.