Chapter 7

The Mobile Hip

The hip is another area of the body that tends to develop stiffness. A
sedentary lifestyle and excessive sitting are a couple reasons why we develop
stiff hips. Limited range of motion at the hips can limit our ability to squat to
full depth. Most of us could benefit from working on our hip mobility issues.
When the hips lack adequate mobility, a few things can happen. First,
the knees will lose stability and start to bow inward. Second, the lower back
will fail to remain stable and collapse into a rounded position. Each of these
movement problems wreaks havoc on our power and increases our risk for
injury.
Adequate hip flexion is needed to reach a full-depth squat (hips below
parallel). You can measure flexion of the hip by drawing a line with the torso
and another line with the outside of the upper leg. The smaller or more closed
the angle is, the more hip flexion the athlete has.
7.1 Screening for Hip Stiffness
If you are unable to squat to full depth with toes relatively
straightforward, hip mobility is likely a limiting factor. I now want to
introduce one of my favorite tools for assessing hip mobility. It is called the
Thomas test.1
This test is performed while lying on your back. The Thomas test’s
main purpose is to look for tightness of iliopsoas (hip flexor muscle), rectus
femoris (quad muscle), or iliotibial band. All of these soft-tissue structures
can contribute to hip mobility issues.
Start by standing next to a bed or a bench. Your hips should be in
contact with the edge. Grab one of your knees and pull it toward your chest
as you gently fall backward. The knee you grab should be pulled as close to
your chest as possible. As you lie on your back while holding onto your knee,
allow your other leg to relax completely.
What position does your body end up in? Having a friend help you with
this screening is extremely beneficial. Once you screen one leg, perform the
same movement on the opposite leg and see what you find.
Movement Checklist:

Pass Fail
Able to pull knee fully Unable to pull knee to
to chest chest
Unable to keep
Able to keep opposite
opposite leg flat on
leg flat on bed
bed
Opposite leg lies in a
Opposite leg is turned
straight position on
out to the side of body
bed
Opposite knee is
Opposite knee is
relatively straight and
flexed and relaxed
tight
 Did you have checks in every box of the “pass” column? If so, you
show adequate hip flexion mobility. However, if you had any checks in the
“fail” column for this screening, you have a hip mobility restriction.
If you were unable to pull your knee fully to your chest, we are dealing
with a possible hip flexion mobility issue. This could be caused by a number
of factors including tight or restricted soft tissues or even hip capsule
restrictions.
If you were unable to pull one of your legs as far toward your chest as
the other, you have a possible asymmetry in hip mobility. This is a red flag.
Asymmetries are very important to take care of as they can negatively
influence barbell squats. Often these small side-to-side differences go
undiagnosed. Left untreated, asymmetries can lead to overuse injuries.
The Thomas test also allows us to screen for mobility restrictions in the
opposite hip. An inability to keep your opposite leg flat on the bed and in a
straight line can also point toward hip stiffness.
Remember to always assess movement first. If you found a problem in
your single- or double-leg squat, we can then use different tools (such as the
Thomas test) to find out the cause of the breakdown in the movement.

7.2 Joint Restriction or Soft-Tissue Stiffness?

With adequate mobility at the hips, our knees and lower back remain
stable. The main idea behind the joint-by-joint concept is that our bodies
consist of ever-connecting parts. A weak link in our chain of movement will
cause a breakdown in the entire system. Stiff hips limit our ability to squat
with good technique.
Let’s now discuss the results of the Thomas test. After performing the
test, what did you notice? Did you pass? Don’t worry if you failed! It is
important to understand the different reasons for developing stiffness at the
hips so that we can appropriately treat the problem. There is no one-size-fits-
all approach to fixing stiff hips.

Stiff hips are primarily caused by two different factors.

1. Joint restriction
2. Soft-tissue restrictions

Joint Restriction
 Joint restriction is simply defined as a loss of space between the bones
that connect at the hip. Essentially, they stop moving appropriately over one
another. This tightness creates a roadblock in the joint. This bony blockade
halts the forward movement of the femur (thigh bone) in the hip joint when
we try to bring our knee to our chest (like in the Thomas test). This
movement restriction is called FAI or femoroacetabular impingement.2 This
mobility problem is usually the result of repetitive strain, such as the wear
and tear effects of pushing through pinching pain in the bottom of a squat. It
can also be caused by long-term adaptation to a sedentary lifestyle.

If you had difficulty pulling your knee up to your chest and felt a
“pinch” in the hip, there is a possibility that you have FAI. We previously
discussed the analogy about the roundabout in a restricted ankle joint. With
FAI, the femur will actually hit a “blockade,” causing that pinching sensation
in the front of the hip.
Our bodies, however, are a little smarter than we think and will
naturally compensate our movement pattern in order to get the job done.
Because of the hip restriction, the lower back is forced to move! This lower
back movement decreases our stability during squats, preventing optimal
power and strength gains.
 We can go about resolving this problem through two methods. First, we
can use joint mobilization exercises to increase space in the hip joint. Second,
we will ensure our posterior chain (glute and hamstring muscles) is working
efficiently. An inability to properly activate the glutes during movements like
the squat is commonly seen.

Soft-Tissue Restriction
Soft-tissue restrictions at the hip joint include muscles (iliopsoas and
quadriceps), the IT band, and fascia. These structures can become stiff and
inflexible over time. For example, a sedentary lifestyle such as sitting for
long periods will often lead to stiffness and tightness. Excessive inactivity
can cause fascia to lose its elasticity, thereby making it difficult for
surrounding tissues to glide easily over one another. Plain and simple,
excessive sitting decreases our natural hip flexibility and degrades normal
movement patterns (such as the squat).
This type of limitation will usually be felt as tightness in the front or
lateral part of the free hip during the Thomas test. Some common findings
during the Thomas test are that the free leg remains off the bed and falls out
to the side or your knee is unable to relax into a bent position. If this is the
case for you, we will go about addressing these types of restrictions with two
different tools: stretching and foam rolling.
Hip mobility is a very important aspect in achieving a full-depth squat.
Stiff hips decrease our ability to properly activate the appropriate muscles in
our hips. Essentially, we bleed out a good amount of power during heavy
squats. Understanding the cause of our restricted hip mobility is the first step
in establishing effective ways to fix the problem.
7.3 Mobility Corner
I now want to share with you my four-step process in dealing with hip
stiffness.

1. Mobilize
2. Foam roll
3. Stretch
4. Posterior-chain activation

Hip Mobilizations
A restriction in joint mobility should be the first area to address. During
the Thomas test, a “pinching” sensation felt in the front of the hip when
pulling your knee to your chest indicates possible impingement. This
sensation is felt when the femur hits the joint “blockade,” halting the
movement at the hip joint. These types of restrictions will not resolve with
conventional stretching and foam rolling. Therefore, any pinching sensation
in the hip joint must be addressed first before moving onto possible soft-
tissue stiffness.
One of the easiest ways to improve joint restrictions on your own is to
use a band for mobilization. The rubber material of the band is elastic and
strong enough to affect the tough joint capsule of the hip.
Band distraction joint mobilizations assist with the way our bones glide
over each other. A joint glide is sustained while the athlete actively moves
into the specific range of motion we are trying to improve. During the squat,
the end of our femur glides backward in our hip joint as our thigh moves
toward our chest. These types of mobilizations (simply termed mobilizations
with movement) have been used for years by physical therapists. The goal is
to alleviate any painful or pinching feelings deep in the joint.
Start with the band pulled close to your hip joint. Assume a lunge
position with the band around your forward leg. The band should be pulling
laterally in this position. Research describes the lateral banded mobilization
as the most effective way to alleviate a pinching sensation in the front of your
hip during a deep squat.3
From this position, rock your knee inward and back ten times. With
enough tension on the band, this should cause a light stretching sensation in
your lateral hip. You are performing a small lateral glide of your femur in the
hip socket. This is providing more space for the femur in the socket and
eliminating the amount of bone-on-bone contact that creates the pinching
sensation in the bottom of the squat. Next, push your knee out to the side and
back. In these positions, squeeze your glute muscles for a few seconds and
then relax.

Foam Rolling
Once joint restrictions have been addressed, the next step is to clear up
any soft-tissue stiffness. This starts with using a foam roller. I usually
recommend athletes spend at least two minutes on each area they are trying to
address. Every athlete should foam roll on a daily basis!
Our goal with the foam roller is to decrease the stiffness the Thomas test
was able to expose. This means addressing our hip flexors, quads, and lateral
hips. Start by moving slowly up and down the lower leg muscles until you
find a tender area. Pause on this area and “tack it down” with your
bodyweight for about ten seconds before moving again.
 I like to use the analogy of kneading bread with a rolling pin. You want
to use the foam roller to knead your tissues, rolling back and forth in small,
rhythmical movements. Lying on the roller and moving quickly in large
passes will have little effect on your stiff tissues. You can also add in active
knee movement during this pause to increase the effectiveness.

Soft-Tissue Stretching
Once foam rolling is complete, stretching the muscles is the next step.
My first go-to stretch for opening up our hips and improving our mobility
prior to squatting is called the “world’s greatest stretch.”
This stretch has four parts to it. First, start by assuming a deep lunge
position with your left leg forward. Squeeze your glutes and drive your hips
toward the floor. This movement should cause a stretch to be felt in the front
of the right hip. Second, drop your left elbow to the ground. Hold for five
seconds.
Next, use your elbow or hand to drive your left knee out to the side.
Make sure to keep your foot firmly planted on the ground. Finally, rotate the
entire upper body up and to the left, ending with the left arm in the air. This
last movement helps address the mobility of the thoracic (midspine) that is
also prone to stiffness.

Another stretch I like to use is the half-kneeling hip flexor stretch. This
is a great tool for addressing the muscles in the front of our hip. The hip
flexors and/or quads can become excessively tight as an adaptation to sitting
all day.
 To start this movement, assume a kneeling position. While keeping your
chest upright, squeeze your glutes and pull your pelvis under your body. This
should elicit a good stretch in the front of your hip. Hold this stretch for ten
seconds before relaxing.
The last stretch I want to share with you is a more position-specific
movement and therefore has good carryover to the squat itself. To start, drop
into a deep goblet squat. This can be performed with either a kettle bell or a
weighted plate. Holding a weight in front of us allows us to worry less about
balance and more on the deep-squat position we want to improve.
After reaching full depth, drive your knees out to the side of your feet as
far as possible with your elbows. Make sure the entire time that your feet stay
firmly planted on the floor in the good tripod position. Driving the knees out
to the side with your elbows will increase the stretch felt in your hips.
 As you open your hips up in this position, you can also work on
activating your glutes. The glutes are the primary muscle group that drives us
up and out of the bottom of the squat. While you sit in the bottom of the
goblet squat, try to squeeze your glutes and drive your knees out to the side
as hard as you can for a few seconds (make sure to keep your feet flat). Next,
relax and allow your body to drop into the stretch again.
This specific type of stretch is called a “contract-relax” technique.
Physical therapists and strength coaches commonly use these techniques
because they are so effective in improving our mobility compared to the
classic long-duration stretches. After holding for about thirty seconds to a
minute, stand up and take a break. I like to perform this movement two or
three times before moving on.

Posterior-Chain Activation
The inability to properly activate the posterior chain (glutes and
hamstrings) during the squat is a common finding in athletes. For this reason,
I recommend athletes perform a quick exercise to prime these muscles after
addressing their mobility issues.
The movement I want to show you is called unilateral abduction. The
layperson’s term for this exercise is banded lateral kicks. To start, place an
elastic band around your ankles. Next, assume an athletic single-leg stance.
Once in this position, push the hips backward and allow the chest to move
forward. This small movement allows us to engage our posterior chain and
remain balanced. The cue I like to use for every squat (even small ones like
this) to solidify this idea is “squat with the hips—not with the knees.”
Once we are in position, kick the nonstance leg out to the side and back
in a slow and controlled manner. The distance the leg moves out to the side is
not our main concern. Focus on keeping the stance leg in a stable and
unwavering position during the entire exercise.

This exercise not only primes the glutes for the squatting we will
perform after, but it will help address core and knee stability problems.
Perform two to three sets of fifteen repetitions. This should leave your lateral
hips fatigued.

Test-Retest
After you have addressed your stiff hips, it’s time to check and see the
progress you have made. Always employ a test-retest strategy when
performing mobility exercises. This allows you to see if the tools you are
using are effective in addressing the change you desire.
Performing a deep bodyweight squat is a great way to assess any
changes. Also attempt a deep pistol squat. Do you notice anything different?
Our goal is to make a lasting change in our overall movement pattern of the
squat. Mobility tools are only effective if they carry over to an exercise we’re
trying to work on.
 My hope for this chapter is to give you the tools necessary to address
any hip-stiffness problems. If you want to remain competitive or move
around pain free, it is vital that you improve and maintain good hip mobility.
Notes

1. D. Harvey, “Assessment of the Flexibility of Elite Athletes Using

the Modified Thomas Test,” British Journal of Sports Medicine
32, no. 1 (1998): 68–70.
2. M. Leunig, P. E. Beaule, and R Ganz, “The Concept of
Femoroacetabular Impingement: Current Status and Future
Perspectives,” Clinical Orthopedics and Related Research 467,
no. 3 (March 2009): 616–22.
3. M. P. Reiman and J. W. Matheson, “Restricted Hip Mobility:
Clinical Suggestion for Self-mobilization and Muscle Re-
education,” International Journal of Sports Physical Therapy 8,
no. 5 (October 2013): 729–40.

Photo Attribution

1. The Hip Joint: AlilaMedicalMedia/Shutterstock.com