By: Dr. Phil Wagner, M.D.
Go ahead, lie on your back with your knees bent, straighten one leg, and you’ll likely hear some hip pops as your leg is lowered to the floor.
If you don’t feel/hear that sound, you either:
a. Didn’t do the above correctly
b. Don’t exercise enough
c. Don’t sit enough
Since we are all guilty of the above, let’s move onto to the broader cause of that hip pop, which is overuse of your hip musculature. And yes, sitting qualifies as overuse too!
The Anatomy of Your Hips and the LPHC
That sound occurs when your muscle, tendon, or ligament rolls over a bony prominence in your pelvis. But really the issue goes beyond your hips, and involves a region called the lumbo-pelvic-hip complex (LPHC). Working from the ground up, your hip bone attaches to your pelvis, your pelvis then attaches to your sacrum (tailbone), and your sacrum attaches to your lumbar spine (low back). There are over 30 muscles anchored to this region, serving as the true center for all human body movement, hence the name “core” (see: Quick, where is your core? on Sparta Point). Many of the common injuries associated with the LPHC can be low back pain, sacro-iliac dysfunction, groin strains, sports hernia, and snapping hip syndrome just to name a few.
Bad Hips Are From Bad Ankles & Feet
However most of the athletes we see with the above complaints suffer from inadequacies in their lower leg, far below the muscles and joints of the LPHC. Since everything begins from the ground up (GRF), we will start with these athletes lack of RATE, the muscular strength (stiffness) in the gastrocnemius and lower leg muscles (see: More Force, Less Fit? on Sparta Point). The lack of stiffness here places significantly more stress on the hip muscles, particularly the hip flexors.
No problem is ever isolated though, so these athletes could also have a faulty motor program (see: What Sport is the most efficient? on Sparta Point). This means that even if the lower leg muscles are strong, the athlete may not initiate movements from the feet/ankle, instead starting the movement primarily from the hips.
The movement signatureTM with this athlete is called “turn out,” referring to the common position of the feet, since all force is intiated and transmitted through this region first. Athletes whose feet are turned out are generally a result of the hip being turned out, which can cause excessive loading of the hips instead of distributing the load evenly throughout the entire leg, hip, and trunk. So the inital problem with such individuals is LPHC muscle and joint overuse, especially the hip flexors which cause the hip pop.
Load Your Ankles & Calves More!
The solution is movements that improve the strength of the lower leg (gastroceniums), both through strength and sequencing. Focusing on sled drags with a neutral foot is a great start (see: Why you need to exercise backwards on Sparta Point). Another great combination we use to improve this RATE is one leg box squat combined with forward hop, shown below.
This pairing focusing on the strengthening of this lower leg and an immediate use of this motor program in a more dynamic setting like a jump to avoid overuse of the hip flexors and subsequent hip pops.
So be as clear with your exercise choices as you are with the direction your feet are pointing, they both dictate your outcome.