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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: hip exercise

All effective prehab and rehab programs for recreational and competitive athletes should include single leg stability exercises.  I like to use sliding exercises as one way to improve neuromuscular control of the core, hip and knee.  Frontal plane collapse is a common issue with respect to knee dysfunction.  Using sliders/gliding discs as well as theraband is an excellent way to improve strength and kinetic chain control.  Below is an exercise i recently featured for Personal Fitness Professional:

This exercise is effective in injury prevention and rehab programs for those with ankle instability, anterior knee pain, hip weakness, poor landing mechanics and higher ACL risk if playing pivoting and cutting sports.  It will improve core stability, hip and knee strength/stability, dynamic balance, groin flexibility and trunk control.

The band serves to enhance activation of the hip external rotators and further challenge stability of the hip and knee.  The band should not pull too forcefully, but just enough to cue the desired muscle activation pattern.  A slower cadence on the eccentric portion of the exercise is preferable to maximize stability and strength gains.  Do not force through any painful ranges of motion, and remember that form and alignment are paramount so limit the reaching based on the client’s ability to maintain adequate control.

I work with lots of patients and clients who consistently demonstrate inadequate hip and core stability.  I see this show up routinely as asymmetrical 1’s for the trunk stability push-up, in-line lunge, hurdle step and rotary stability movements on the FMS. Unfortunately, this has been a recurring them in many of my females recovering from ACL reconstruction as well as runners with persistent pain/dysfunction in one lower extremity.

I am always looking for better ways to train the body in whole movement patterns as well as functional positions.  One of my preferred positions is to test and challenge my clients in a split squat position.  I begin with an isometric split squat cueing proper alignment and muscle activation.  As clients master isometric postural control, I will allow them to add an isotonic movement by squatting in the position.

As they progress, I will add in perturbations to stimulate changes or challenges to their center of gravity.  Often, you will see them struggle much more on the involved side.  But to be honest, I find most people have an incredibly hard time maintaining proper alignment for long without cheating or falling forward or to the side.  Allowing clients to lose form is okay provided they are cued to fix their alignment or they naturally self correct.

An additional wrinkle I throw in for this training is using the BOSU Balance Trainer.  Below is a video that shows how I use this progressing from shin down to just the toes as a support on the trail leg.  The second version will burn up your clients’ thighs and quickly become one of their least favorite exercises.  The great thing is that you do not have to offer much resistance to create a significant perturbation.

For more detail on this exercise and application, click here to read my PFP column featuring it this week.

Mini-Band Hip Bridges

While I treat a vast number of knee ailments in my practice, the focus of my training and rehab is often more proximally directed at the hip.  Understanding the role of hip muscles and how the hips and pelvis work together to impact knee alignment and closed chain function is critical in resolving knee pain and dysfunction.

Below is a “go to exercise” exercise I use for gluteus medius activation and core/pelvic stability training.  Using a mini-band provides an adduction force cueing the client to abduct and activate their external rotators to maintain proper alignment. Additionally, they need to avoid a drop on one side of the pelvis (look at the ASIS).

Click here to read my entire column dedicated to this exercise in PFP’s online magazine.  I hope you find this exercise and information useful for you and/or your clients.

I have been a bit behind on blogging as of late.  I try to aim for one per week, but I also strive to deliver sound and relevant content.  Additionally, I do not seek outside contributors so finding time to write can be tricky with work and family life too.  So, forgive me for any apparent inconsistency in posting.  Just know that I will always try to provide valuable content.  Today’s post centers around an article in the July 2012 edition of AJSM.

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My work at the Athletic Performance Center has provided me an increased opportunity to work with FAI and athletic hip injuries.  This is an area of evolution and growth in our field, so I find it particularly interesting to see rationale and thought processes centering around the timing, contribution and selection of hip exercises for active patients/athletes.

This article comes from the Steadman Philippon Research Institute in Vail, CO.  The purpose of the study was to measure the highest activation of the piriformis and pectineus muscle during various exercises.  The hypothesis was that highest pectineus activation would occur with hip flexion and moderate activity with internal rotation, whereas the highest activation with the piriformis would be with external rotation and/or abduction.

anterior_hip_muscles250px-posterior_hip_muscles_1

Methods: 10 healthy volunteers completed the following 13 exercises:

  1. Standing stool hip rotation
  2. Supine double leg bridge
  3. Supine single leg bridge
  4. Supine hip flexion
  5. Side-lying hip ABD with external rotation
  6. Side-lying hip ABD with internal rotation
  7. Side-lying hip ABD against a wall
  8. Hip clam exercise with hips in 45 degrees of flexion
  9. Hip clam exercise with hips in neutral
  10. Prone heel squeeze
  11. Prone resisted terminal knee extension
  12. Prone resisted knee flexion
  13. Prone resisted hip extension

All of these exercises have been reported to be used in hip rehab following arthroscopy or recovery from injury.  The exercises were executed slowly and methodically with a metronome to reduce EMG amplitude variations.


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There seems to be consistent questions, debate and studies done with respect to stretching.  As the thought of more closely analyzing the quality of movement (FMS, Y-Balance testing, SFMA for example) moves to the forefront in the PT and fitness world, many search for the right mix of exercise to maximize mobility.

I count myself as a supporter and follower of the work of Gray Cook and Stuart McGill.  While I may not agree 100% with all of their ideas, I generally consider them to be brilliant minds and ahead of the curve.  I have been using the FMS in my practice for some time now and have also begun to incorporate Y-Balance testing as well (see pic below courtesy of the IJSPT)

le-y-balance-test

The Y-Balance test may not have significant relevance to hip mobility as much as it does limb symmetry, but I included it here to illustrate my point in observing kinetic chain movement to help determine where the weak link or faulty movement pattern may be.  It gives us valuable information with respect to strength, balance and mobility.

With the revelation that FAI is more prevalent than we knew (click here for my post on FAI), I am always interested in hip mobility and how to increase movement in the hip joint.  Limitations in hip mobility can spell serious trouble for the lumbosacral region as well as the knee.

I currently use foam rolling, manual techniques, dynamic warm-up maneuvers, bodyweight single leg and hip/core disassociation exercises and static stretching to increase hip mobility.  However, I am often faced with the question of what works best?  Is less more?  How can I make the greatest change without adding extra work and unnecessary steps?

Well, Stuart McGill and Janice Moreside just published a study in the May 2012 Journal of Strength & Conditioning Research that sought to examine three different interventions and how they improve hip joint range of motion.  Previous work has been focused on the hip joint alone, and they wanted to see how other interventions impacted the mobility of the hip.  Click here for the abstract


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