High School and College Athletes
While hip pain and hip issues aren’t one of the most common injuries in chiropractic and sports medicine offices, they do occur and are never fun for patients to deal with. From tendonitis, to joint pain, to sprains and strains, hip pain can be an annoying issue to deal with
Obviously surrounding musculature and hip function plays a role, but all too frequently tight muscles are blamed as the sole problem. Usually the assumed culprit is “tight hamstrings” or “tight hips”, and for far too long patients were sent home with the same protocol. They were told to static stretch, ice and or heat the area, and rest. Sometimes this helps but it never gets to the root of the issue, and due to this that pain can return when you go back to your regular activities.
To avoid this we try to answer a few questions in our office. The 3 big ones we want to find out are:
- 1Are your hips flexors actually tight?
- 2What exactly is tight?
- 3Why are they tight?
Hip Anatomy and Morphology
The anatomy and skeletal shape of the hip is a big reason for some of the confusion around hip tightness. The hip is what is known as a ball and socket joint. We have seen a skeleton, the ball is attached to the neck of the femur that sits in the “cup” shaped socket in the pelvis. What is under-appreciated is how different the shape, depth, location of that cup, and angle of the femoral neck can be. This variation we see can cause the “neutral” position of the hip to be very different from patient to patient. For example, someone with a deeper, and more forward facing cup may not have a ton of outward hip movement. Is this a tight hip? Or is that a hip that just isn't naturally good at moving a certain direction? All the stretching in the world won’t change that. To make things EVEN MORE complicated, it is extremely common for the skeletal shaping and positioning of these joints to be asymmetrical!
On top of the joint we have the thick capsule of ligaments wrapped around the whole area to add even more stability to the joint. All of these variables can play a role in the available passive and active range of motion, which can in turn create the illusion of “tight” or “loose” hips.
Why True “Tight Hips” Can Exist
All of this is not to say tight hips don’t exist. As mentioned earlier, skeletal orientation can create certain range of motion restrictions or even pain. We can also get muscular or capsular changes to the hip joint depending on what our activities of daily living are like. One of the most common reasons we see muscular tension changes are due to long amounts of sitting. In this day and age, we spend a lot of time sitting. From eating, driving, sitting at our desks for work, we spend a lot of time in the same seated position. Another common cause is overtraining or not having enough variation in our workouts.
How to Combat Tight Hips
This may come as a shock, but the answer is not to do “sit and reach” stretches for days on end. Yes, mobility exercises are going to be helpful, but they should be active and movement based. Strengthening is usually the route to go down for help. If sustained postures or repetitive movements are the reason for your tight hips, strengthening the hip and regaining hip function is going to be the answer. A good assessment and exam is needed to find the true cause, but a few of the top hip exercises we use are:
Side bridge variations - The gluteus medius is frequently involved in hip issues, especially in rotational athletes. At our office in Carol Stream, we’ve become one of the “go to” clinics for rotational sports, such as baseball, soccer, hockey, lacrosse and golf. Everyday life rarely takes us in any side to side movements, and even amongst gym goers the lateral chain is often neglected. Side bridges are great exercise to target different aspects of the hip, (and entire lateral chain), and are easily progressed or regressed depending on what patients are ready for. When a patient masters the traditional side bridge, most “PT” clinics move on to another hip drill. For us, once you’ve mastered the traditionall side bridge, the fun just begun. Our creative and highly effective modifications of the side bridge have helped hundreds of rotational athletes for over 7 years.
Copenhagen Planks - This is a similar story to the side bridges. Our hip adductors are the muscles that squeeze our knees together. Unless you still have your Thighmaster from the 80s, we don’t do a ton of squeezing movements regularly. The adductor groups being used less and avoidance on strengthening the groins have played a huge role in the groin strains we see in our patients..
2 great examples to read up on are this study by Thorborg et al in 2014. They looked at male soccer athletes both with and without groin pain. Those with groin pain were found to have increased weakness in eccentric hip adductor strength in the kicking leg.
Bourne et al in 2019 found that 204 elite level soccer who had higher hip adduction strength had lower odds of suffering a future hip or groin injury.
Many studies have confirmed the correlation of weak adductor and groin injuries, so these really should be part of any athlete’s routine.
And, yet, many youtube videos, instagram reels and tiktok videos will encourage the continued narrative of “stretching the groins” and “strengthening the glutes”. We’ve always been a curious healthcare office, which is why we regularly challenge the common narrative surrounding health. After all, science itself must be questioned. If one cannot question another’s method, then that is, by default, proclaiming one’s methods are superior to another. In the world of pain and performance, no one method holds the crown of superiority - no matter what anyone says. When dealing with human beings, expect unpredictable responses to care, which means no two patients can ever respond the exact same way when it comes to hip pain. That’s why we have helped hundreds (if not, thousands at this point) at our sports medicine clinic - because we tailor every patients’ exercise and treatment plan with their unique situation and their specific goals.
Hip mobility exercises - Active mobility exercises can be helpful. Sometimes the hip tightness issue can be helped by more movement or novel neurological input. Sometimes we need to work dissociation of the hip from the low back. Sometimes we need to mobilize the hip in a different direction. Regardless of this reason, mobility exercises are commonly part of hip rehab. Usually this includes some form of active and triplanar movements working in the sagittal, frontal, and transverse planes.
As I mentioned earlier, a proper assessment is key for any hip issue. If you, or someone you know is struggling with constant tight hips, then we have some good news for you. Our office specializes in identifying and treating tight hips, so that you can continue to play the sport you love.
Imagine this: Striking a ball without any reservations about if this is going to wreck your hip. Or going all out on the 1st tee shot on a par 5, where you normally “play it safe” to avoid hurting your hip when you go “all out”. Or, better yet, getting back to that running routine you so desperately want to but can’t because your hip still hurts.
We’ve helped hundreds of tight hips, and we are confident we can help yours, too.
Do This Next
If you or anyone you know is dealing with hip pain, contact our office today to schedule your Complimentary Movement Assessment*, where we identify how every muscle, bone, joint and ligament are moving in your body. Call or text us today 630-765-0575. (*Due to the increased demand, we are only accepting 10 requests. Don’t delay getting your appointment booked.)
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