THE HIPS: The Monster Beneath the Bed
Joe Przytula ATC, FAFS
A few weeks ago, my six-year-old nephew was sleeping over at our house. I was awaken in the middle of the night by him exclaiming, “Uncle Joe, there’s a monster underneath my bed!” I went into his room and said, “Be nice to him and he’ll be your best friend. Give him a pop tart or something.” Okay, maybe I’m not the best uncle, but please read on.
The hip is the like a monster underneath the bed, minus a few dust balls and dirty magazines. If it’s working correctly, it can be your best friend. It can assist far away joints like the shoulder or ankle. Strength Coach Vern Gambetta called it, “The engine that drives the body.” No wonder, it has 17 of the thickest, longest muscles of the body directly attached to it. But do not look for them. They are superficially hidden by that big mattress we call the gluteus maximus. A few years back, researchers Porterfield & DeRosa discovered the monster even has tentacles! Well, sort of – we call it fascia. It functionally links the hips with pretty much the entire body.
This monster is tough all right. It has a deep suction cup of an acetabulum, with a head of the femur as round as Mini-Me’s head, and a thick synovial joint capsule to seal the deal. How does the hip stack up to other monsters, say Godzilla (he just spit fire)? The hip’s secret power is its contribution to three-dimensional loading (force reduction) and unloading (force production). Let’s use the ACL ligament of the knee as an example. Traditional rehab protocols have emphasized the quadriceps and hamstrings. However, physical therapist and biomechanist Daniel Cipriani makes the point that these muscles only become protective as the knee flexion angle approaches 90 degrees. But now look upstairs at the hips gluteus complex. By way of its multidirectional, multiplane orientation on the femur, it is well designed to control the 3D motion of the knee with the most critical being internal rotation, adduction, and flexion.
Let’s follow those tentacles up the kinetic chain to the shoulder. Can they protect the shoulder anterior instability that creates rotator cuff issues? You bet! Now we’ll call on the infamous “front butt,” including the iliopsoas, abdominals, adductors, rectus, etc. Try it yourself: Stand in a left stride stance with your right arm horizontally abducted at shoulder height with the elbow flexed. Feel the tug at the front of hips? This means they’re locked and loaded to explode, and so are the abs by way of chain reaction between the hip and shoulder. Now turn the front butt off by sitting on it. Do the same arm reach. Feel the difference?
We make the monster happy when we feed it. No, not with pop tarts. Hips love ground, gravity, and momentum. They prefer lunges, squats, and step-ups. Adding some arm reaches in with the mix is like whip cream on top. They love variety in the form of direction, plane, speed, and load changes. However, be cautious of feeding the hips with empty calories. Many exercises performed in the prone, side lying, or supine positions are what Gary Gray refers to as “isolated isolation.” They turn off the hip’s phone lines (proprioceptors) to the rest of the body and unhook those fascia links. They should be used sparingly. Dormant daily living does not nourish the hip. Sitting and activities that require prolonged static standing promotes injurious capsular patterns. Interrupting these patterns with frequent “snacks” helps reconnect those lines.