Want to Improve Your Client’s Hip Stability?

Do you train clients with hip instability? Have you had your clients perform exercises such as clam shells and side walking with elastic tubing around their ankles and still they demonstrate instability when they shift onto one leg? Well, don’t worry – you’re not alone. A large portion of our clients demonstrate hip instability when standing on one leg or performing lower extremity exercises. While the causes are varied, the solution is often quite simple. If you want to improve their hip stability, improve their ability to centrate the hip. In this article, you will be introduced to several causes of the unstable hip and more importantly, be provided with a simple strategy to improve this common problem. After reading this article, you will have a renewed sense of confidence in working with clients that have unstable or tight hips.

Introduction

Before we discuss the solution for the unstable hip, it will be helpful to understand some basic mechanics of the hip joint and what makes this region such a problem area for many of our clients.

The hip joint is formed by the head of the femur (ball) articulating with the acetabulum of the ilium (socket). This socket is deepened by the fibrocartilagenous labrum which helps to deepen the socket as well as provide additional stability. The hip joint capsule, comprised of the iliofemoral, pubofemoral, and ischiofemoral ligaments, add increased stability to the joint. Along with the various muscles surrounding the joint, the joint capsule allows the individual to maintain a stable joint while moving through a dynamic range of motion.

While the design is inherently stable, many of our clients experience problems with stabilizing their hips. Although the causes of this instability may vary, they can essentially be linked back to one main cause – loss of joint centration. Simply stated, when the nervous system can no longer coordinate the activity of the musculofascial system to sustain the femoral head relatively centered within the acetabulum, the client will experience instability. Once the nervous system recognizes instability, it is forced to adapt compensatory patterns. There are no exceptions to this rule! In other words, the less stable they are, the tighter they will become.

While this may seem like a contradiction, simply think about walking on a slippery surface such as a wet grocery store floor. What is your response when you see that ‘Caution – Wet Surface’ sign on the floor? Do you walk tall, with confident, long strides? Or do you shorten your strides, slow your pattern, and even walk a little ‘guarded?’ As you will realize, our inherent response to walking on slippery surfaces is always the latter. The more unstable the surface, the more ‘guarded’ our posture or gait will be. Similarly, the more unstable our body, the more guarded or stiff our posture and gait will be. The nervous system’s response to instability is to over-activate or ‘grip’ through various regions of the body – one of the most common areas to grip from is the posterior hip region.

A Common Hip Syndrome

When I first began training nearly 14 years ago, I noticed a common posture among the majority of my clients – they had no back ends. In other words, their gluteals were quite atrophied. I termed this ‘flat butt’ syndrome not fully understanding the reasons behind this phenomenon. I attributed it to their lack of activity and increased sitting, each of which definitely contributed in part to the condition I was seeing. However, it wasn’t until several years later when I took a course from renowned physical therapists Diane Lee and Linda Joy-Lee that I discovered there was indeed a name for the condition I was seeing. These clients, as defined by Diane Lee and Linda-Joy Lee were known as the ‘butt-grippers’.

These are the individuals that are over-activating their posterior hip complex to increase their hip stability. This causes a loss of hip centration and the shift of the femoral head forward in the socket. While this may not seem like a problem, this gripping pattern leads to a loss of joint centration and a resultant loss of instability in the pelvis as well as the entire lower extremity. Think of this altered hip alignment as being analogous to the tire on your car not sitting flush on the axle. What would happen? You guessed it – a loss of efficiency and eventually wear and tear on the axle. The exact same thing occurs at our hips and is the one of the leading causes of premature degeneration of the hips.

There are several ways to tell if your client is gripping their hips. However, the following is the easiest method; perform this on yourself so you feel comfortable doing it with your clients. Always ask permission and explain what you are doing before you place your hands on a client.  Stand up straight and lightly place your hands over the lateral aspects of your pelvis just below the iliac crests and above the greater trochanters. If you are over-gripping through your hips, you will notice a divot or hollowing as you lightly run your hands from the top of your pelvis down towards your greater trochanter – this is a dysfunctional hip posture. If you do not notice a divot or hollowing, that is great! If you are not experiencing any divots or hollowing, simply grip or squeeze your gluteals tightly and you will feel the divot form. Unfortunately, this is the way many of our client are living their lives and most of them are not even aware of it. We have to change this pattern or else further loading and exercises performed that challenge your clients’ stability will only perpetuate and exacerbate their dysfunction.

While joint stability is a common reason clients will develop the ‘butt gripper’ syndrome there are three additional causes that can directly lead or contribute to this problem.

Over-gripping of the deep hip rotators due to pelvic floor weakness – Since several of the hip external rotators also assist the pelvic floor, any weakness within the pelvic floor will lead to over-activation of the deep external rotators. If you train female clients that have any degree of incontinence, they have a dysfunctional pelvic floor. Many of these women are over-utilizing their deep hip external rotators to control the loss of urine when they cough, laugh, or bare down as commonly happens during exercise.

Aesthetics – Many clients, more often women than men, will squeeze their posterior gluteals and tuck their pelvis under (posteriorly tilt their pelvis) to minimize the appearance of their back side. While this strategy accomplishes it’s goal, it also disrupts normal hip centration, alters pelvic posture, and makes it challenging for these clients to perform ideal movement patterns.

Cuing: Unfortunately, many of the cues we are giving our clients, directly lead to increased levels of butt gripping. Cues such as ‘squeeze your glutes’ at the end of hip exercises such as squatting, lunging, and bridging simply add to the likelihood that your client will be over-using their posterior hip complex. While these are not necessarily incorrect cues with someone who has normal functioning hips, it can be detrimental to clients who already possess an over-contracted posterior hip complex.

To change this pattern in our clients, we must not only address their instability, we must also reprogram how they are using the hip complex.

Improving Hip Function

The hips function as part of the lumbo-pelvic- hip complex. This means they influence and are directly influenced by what happens in the lumbar spine and pelvis. Many of our clients will experience hip dysfunction that is driven by altered alignment of the lumbar spine and pelvis. To change how they are using their hips, we have to change how they stabilize the entire lumbo-pelvic-hip complex. The following patterns can help your client develop stability through their lumbo-pelvic-hip complex while simultaneously improving their alignment and develop an overall feeling of ‘lightness’ within their body.

Have your client lie on their back with their legs elevated in the 90º position – the legs will be supported on a ball or bench. The legs are placed in this position to align the pelvic floor with the diaphragm as well as provide the client with tactile feedback on their spine position upon the floor. Their spine and pelvis should be in a neutral alignment.

Place your hands on their lateral rib cage and have them breathe into your hands while they focus their breath down towards their pubic bone and wide into their backs. This attention to where they are breathing allows them to take full advantage of the diaphragm while they expand 3-dimensionally through their rib cage.

Once you are confident in their ability to utilize diaphragmatic breathing, have your client activate their core. They should be able to achieve 3-dimensional activation without any drawing in or flattening of the spine. Have your client maintain this activation and continue breathing. This is key as many of our clients can activate their core or they can breathe – they don’t however do a great job coordinating these two activities.

Have them perform 3-5 deep breaths maintaining this coordination and then relax. Have the client repeat this pattern for 10 cycles.

Now that your client understands how to coordinate their breathing and core activation, you must teach them how to use it in functional activities such as squatting. Here is how to progress your client to the squatting pattern while ensuring they are not over-gripping with their hips.

Have your client stand with feet approximately shoulder-width apart. They will activate their core and breathe diaphragmatically in the same manner they did in the previous pattern.

As they descend into the squat, cue them to relax through the posterior hip complex and visualize the ball (head of the femur) sinking back in the socket (acetabulum).

They will then use the posterior hip complex to lift themselves back up to the starting position without gripping through their hips. Have them visualize maintaining a long spine and being lifted towards the ceiling (along the vertical plane) rather than driving the pelvis forward (along the horizontal plane).

Repeat for the desired number of repetitions and continually monitor for your client’s ability to coordinate respiration and core activation as well as to be able to use the posterior hip complex without gripping. It is often useful, with permission of course, to tap the posterior hip complex to make sure they are releasing as they descend and to palpate for any divots or hollowing which signifies over-contraction as they get to the top of the pattern.

Once they’ve mastered the squat pattern, progress them through the fundamental movement patterns including squats, lunges, and step-ups using the same cues. If you’ve identified your client as a ‘butt-gripper’, you will likely have to instruct them during these patterns as well. Additionally, be sure you educate them on keeping their hips relaxed during activities of daily living so they don’t undo the new patterning they are learning from you during your sessions.

What if you work in a group exercise environment or don’t feel comfortable palpating your clients? No problem, simply use the same cues and have them feel for the divots or hollowing on themselves. As they breathe, have them place their hands on their rib cage and feel for the expansion front to back and side to side as they take a deep breath in and feel it narrow as they breathe out. During their squatting pattern, have them visualize the posterior hip complex relaxing as well as keeping their hips relaxed as they are performing their exercises.

Conclusion

Improving your client’s hip function requires a combination of retraining and re-education. Essentially there are 3 steps to improving hip stability in your clients.

Get your clients to stop over-gripping their posterior hip complex. This must be cued while they are training and they must also be educated to not over-grip during their daily activities.

Improve your client’s ability to attain neutral alignment of the lumbo-pelvic-hip complex, encourage diaphragmatic breathing, and teach them how to coordinate core activation with diaphragmatic breathing.

Integrate neutral lumbo-pelvic-hip alignment, diaphragmatic breathing, and core activation into their fundamental movement patterns including squatting, lunging, stepping, pushing, pulling, and rotation.

By improving these functions and increasing their general body awareness, you will help your clients move more efficiently and experience a renewed sense of stability in their hips that can help them remain active and healthy for years to come.

About the Author

Audiences around the world have seen Dr. Evan Osar’s dynamic and original presentations.  His passion for improving human movement and helping the fitness professionals think bigger about their role can be seen and felt in every course he teaches.  His 20 year background in fitness and experience as a chiropractic physician provide a unique prospective on improving human performance in the fitness professionals that work with the general population. Dr. Osar has become known for taking challenging information and putting into useable information the fitness professional can apply immediately with their clientele. He is a regular presenter at ECA/OBOW and ECA World Fitness conventions and is the developer of the Integrated Movement Specialist™ certification. You can reach him at evan@fitnesseducatioseminars.com.