The hip (femoroacetabular) joint is arguably the most important joint in the human body as it relates to biomechanics of athletic performance. In every sport in the world, one hip joint may be called upon to perform quick, powerful and oftentimes violent movements while the other hip provides the necessary coordinated stability around which these movements can occur.
There are 29 different muscles that are working in synergy to create effective movements around the hip joint. Due to the variability in movements and demands placed on this joint, it makes it an area that receives special attention in training to maximize mobility, strength and coordination to increase athletic performance and to prevent injuries that commonly occur here.
Think about what role the hip joint plays for a professional baseball pitcher, catcher, golfer, or tennis player. If there is compromised range of motion (ROM) at the hip joint in any of these athletes, the joint is unable to move through its full excursion which will, at the very least, either reduce the forces generated and/or create compensatory movement patterns.
The difference between succeeding as a professional athlete or sitting on the sidelines hinges on the athlete’s ability to create these optimized forces.
In many younger athletes with compromised mobility, these forces can still be generated through compensatory movement patterns. What long term effects will these inappropriate compensations have on the athlete’s performance and in avoiding career-ending injuries?
In the past 20 years, there has been significant research in the area of hip intra-articular pathologies such as Femoral Acetabular Impingement (FAI), Labral Tears and Osteoarthritis (OA). It is not the intent of this article to go into the anatomical and physiological detail describing these injuries, but to note the importance that these injuries or conditions can play on limiting the mobility of the athlete’s hip joint. These conditions can and do affect the joint capsule at the hip. The joint capsule is a deep, fibrous connective tissue that blends in with the ligaments to help stabilize and control the ROM at the hip joint.
When an athlete develops these intra-articular pathologies, it can lead to increased inflammation and compensatory movement patterns around the joint. This will oftentimes lead to a progressive tightening and restriction of the hip joint capsule. When this occurs, not only will it further decrease the mobility of the joint, but it will also create imbalances of the surrounding musculature including hypertonicity in some and progressive atrophy of others depending on the length of dysfunction.
As I stated above, it is when the athlete’s hip joint is restricted, either through capsular tightening and/or muscle imbalances, that decreased force production and increased compensations occur. In many cases, these are not detected early in many athletes and leads to significant dysfunction and decreased performance. Most professional athletes are monitored very closely, especially in the case of a major-league baseball pitcher. Significant data is kept on each pitcher monitoring their velocities, control and performance. They are kept on a routine maintenance schedule to try to stay ahead of any of signs and symptoms of dysfunction.
In other situations, it may be obvious to the athlete that they are having problems. For example, the baseball catcher may experience difficulty in getting down in a proper squat to receive the ball, either not getting low enough or leaning toward the uninjured side. If they cannot get into proper position, they are unable to effectively get up and throw out the runner attempting to steal second. The pitcher may notice that he cannot bring is lead leg up towards his chest during the wind-up phase or resist wanting to put all his weight through that leg during through follow-through which leads to velocity and control issues.
It is common knowledge amongst physical therapists, chiropractors and athletic trainers who work with elite athletes that when the hip joint ROM is limited, and compensatory patterns are developing, that the major joints above and below the hip are also vulnerable to injury. These joints include the lumbar spine and knee joints. In order to deliver optimal performance, all the systems in the body must be working at their expected and appropriate level.
Any dysfunctions in the system whether not working enough or working too much that are not addressed early will oftentimes lead to more serious injury and possibly surgery.
What can an athlete do to help optimize hip joint capsule mobility and muscle firing patterns before or after they are injured? There are many manual therapy techniques that healthcare providers can perform to the athlete as well as movements and exercises that the athlete themselves can perform.
In this first article in this series, I’d like to focus on the independent manual therapy techniques that the athlete can perform without the assistance of another person. These techniques can work passively and/or actively to improve capsular mobility, muscle balance and proprioception/coordination around the hip joint. They are most effective when used in conjunction with the entirety of the athlete’s strength, conditioning and/or rehabilitation program. Below I will discuss the two joint capsule mobilization techniques that I believe are the easiest and most effective for the athlete to perform independently. There are other techniques and tools such as inversion tables and belts but, in my experience, they are not specific nor strong enough to be super effective.
The HipTrac (www.hiptrac.com) is a light-weight and portable medical device that provides true isolated Long Axis Traction to the hip joint at forces between 0-1000 N. Long Axis Traction (LAT) has been used for over 150 years by healthcare providers and performance trainers to stretch and mobilize the joint capsule and decrease hypertonicity around the hip joint (see Figures 1, 2).
Only recently, over the last 5 years, has LAT been able to be obtained independently, without the assistance of a trainer or healthcare provider. HipTrac allows the athlete to obtain this self-mobilization when they want and how they want. In the case of injury or pain around the hip joint, HipTrac can quickly reduce pain and get the joint moving again. The athlete is not only able to feel better sooner, but also get back to their intensive practice and competition earlier.
HipTrac is also used regularly in the absence of injury as elite athletes appreciate the relaxation, recovery and restoration feelings around their hip and lower back following intensive practice or competition. It is part of this routine maintenance schedule that helps maximize hip mobility and prevent any unnoticeable decreases in capsular mobility.
For the athlete that has FAI and/or OA, this is especially important as the capsule is constantly wanting to tighten and restrict ROM. There are many athletes that have spoken publicly about the role HipTrac has played in helping to extend their career or help with recovery from injury.
Figure 1. Manual Long Axis Hip Traction
Figure 2. HipTrac Long Axis Hip Traction
2. SuperBands or CrossFit Bands:
They are thick, strong resistance bands that are looped and approximately 41” in length. They come in a variety of colors and resistance levels with the most common widths used for hip mobilization being 1” to 1.5”. Athletes will use these bands to perform passive and active mobility techniques. You can also use these for long axis traction, but they do not provide the amount of force one would need to create significant change in painful and capsular restricted hips. These bands are great for the hypermobile athlete that doesn’t need more mobility, just wants to some gentle unloading or discomfort relief.
The best use of these bands occurs when the athlete replicates some techniques commonly referred to as Mulligan Mobilization with Movements.
Optimizing hip mobility is essential for the elite athlete, in the absence or presence of injury. Using these tools and techniques to optimize hip mobility will assist in imbalances prevention, performance enhancement and injury rehabilitation.
In our next article on hip mobility for the elite athlete, we will focus on other self-soft tissue release techniques that can reduce hypertonicity around the hip and lower back, while helping to increase mobility.
Dr. Tony Rocklin is a licensed physical therapist with more than 20 years of clinical experience who specializes in orthopedic and sports medicine with a specific focus in the treatment of hip pathologies. He works at Therapeutic Associates, Inc in Downtown, Portland, Oregon, the largest physical therapist-owned private rehabilitation company in the US.
Dr. Rocklin attended Oregon State University, where he was a member of the OSU Basketball team, graduating with a BS degree in Exercise and Sport Science in 1994. He earned his Master of Science in Physical Therapy with distinction from Pacific University in Forest Grove, Oregon in 1998, and completed his clinical doctorate in 2008. He continued his advanced education with the North American Institute of Orthopaedic Manual Therapy, achieving Level IV Certification in Manual and Manipulative Therapy. Tony’s specialty, and the focus of the last 15 years of his career, is hip intra-articular pathology, including osteoarthritis (OA), femoral acetabular impingement (FAI) and labral tears. He has authored three published medical journal articles and is currently in IRB for his fourth. He is an active advocate for improvements in the conservative care of these conditions and how optimizing hip joint function can lead to improved human performance.