The hips, in my professional opinion, are very underrated when it comes to maintaining low
back and lower extremity health. The back, knee and ankle cannot work efficiently or be aligned
correctly if the hip is weak, stiff or misaligned. Hip stiffness can be hidden for a short period of
time due to compensations, however, when the compensations finally take its toll - the hip
problem will always make itself known. Hence the title of the blog, they don’t lie (for too long)
and they cannot hide!
When hip pain or stiffness arises, it is likely that the issue has been going on for a long time. It
likely corresponds with back pain and/or knee/foot pain. If the gluteal muscles are not properly
activated, they can contribute to pronation of the foot (foot flat/fallen arch) and genu valgum
(knock knee posture). When this posture is present, it leaves the individual at risk for plantar
fasciitis, degenerative meniscus tears, ACL tears during landing and/or cutting, low back pain
Even prior to COVID-19, our society sets our hips up for failure. According to The U.S. Bureau
of Labor Statistics, over 13% of jobs are considered sedentary, and another nearly 37% are
referred to as “light work.” This means, these jobs require a whole lot of sitting for 8+ hours a
day. During “busy season”, accountants can find themselves sitting behind a computer screen
for nearly 70+ hours a week - nearly 50% of their week in a seated position. Children have to sit
for nearly 8 hours a day at school, with only 3-5 minutes between classes to be erect. Because
of this, our hips and back are constantly in a flexed posture. This allows muscles to adapt and
become shorted into this flexed position while contributing to weakness of the extensors since
they are lengthened and unused.
This may seem negligible because most people like sitting, but then try to squat, do house work,
pick an item off the floor or even exercise for 30 minutes after sitting for so long - it is not going
to workout well. Like stated previously, for a short period of time, you will be fine compensating.
But when your body realizes it cannot compensate anymore, it leads to injuries all over the
place. Our hips need to move to perform basic activities of daily living!
For example, if we are unable to move properly and strongly into hip extension, we will have
difficulty with ascending stairs, getting up from a chair, jumping, running, walking and bridging
for bed mobility. We often fail to realize that hip extension is crucial for efficient walking and
running! Additionally, if hip and trunk flexors are shortened into a flexion position, we develop
what is called anterior pelvic tilt - which will lead to poor low back posture and can lead to
degenerative disk disease and disk herniations.
Below, we reiterate basic hip anatomy and basic changes to your daily routine that can help
create better hip health, which will in turn lead to back and lower extremity health!
Important hip anatomy and body responses:
The hip and its muscle groups are some of the strongest in the body. There are three major
muscle groups: (1) the glutes, (2) the hip flexors and (3) the hip rotators.
(1) The glutes are responsible mostly for hip extension - the act of bringing the leg behind
the body. Hip extension is needed for ideal running and walking. When the leg goes
behind the body, it creates tension in the front of the hip which in turn causes a reflexive
contraction to bring the leg forward. Commonly, hip extension is limited because the
front of our hip is tight.
(2) The hip flexors are the group of muscles that bring the hip forward and/or knee up
toward your chest. They are located in the front of your hip and as stated previously, the
front of the hip is often very tight. This is because we sit way too often (still more to come
on that! Be patient!) with our hips flexed at 90 degrees. Sitting 8-10 hours a day, we
barely experience any hip extension. Tightness in the hip flexors often lead to what we
call anterior pelvic tilt. When an anterior pelvic tilt is present, the glutes cannot fire
properly, creating a genu valgum or pronated leg posture.
(3) Finally, the hip rotators are located deep in the tushy. The most common muscle we
hear about is the piriformis. The piriformis causes several pain patterns, including sciatic
nerve pain The piriformis and surrounding muscles externally rotate the hip. External
rotation is the act of rotating outward (ex = right toes out to the right). If these muscle
groups are tight or weak, the leg can fall inward which alters the alignment when you hit
the ground (genu valgum). When this happens, the infamous iliotibial (IT) band, which
attaches to the hip and the outside of the knee, gets tight and painful.
How Can You Fix It?
(1) STOP SITTING SO MUCH - sitting is the worst thing we can do for our bodies. As
humans, we are some of the most beautifully moving creatures when our bodies work
right. We have opposable thumbs, we can throw a frisbee, we can squat, run, jump, etc.
WE CAN DO IT ALL..... when we can move right. However, the average human sits
approximately 10 hours/day. I’ve outlined just a few scenarios below.
(a) Work - 7-8 hours
(b) Car/Commute - 1 hour
(c) Eating breakfast/dinner - 30min
(d) Reading morning paper - 30min
(e) Watching television - 1 hour
As you can see, sitting is WAY more than just the work day. Walking and/or exercise for
only 30 minutes, cannot counteract 10 hours of sitting. We have to be changing
positions and moving all day long. Sitting is OK in doses (just like salt), however, we
need to be more fluid. Below are suggestions on how to change positions more
frequently throughout the day.
(a) For every 1 hour of sitting at work, stand and stretch at least 1 minute.
(b) When you are sitting, explore different seated positions. Cross one leg into
figure-4 position, and then the other.
(c) Take conference calls while standing.
(d) Standing desk - even if you are standing long periods of time, make sure you are
changing positions. For example, one foot in front of the other, wide stance,
narrow stance, etc.
(e) Put a yoga mat in front of your TV and watch your shows in butterfly or the hip
(2) Stretch often! Do Yoga! - Here is a short list of stretches to help counteract the
consequences of sitting. It is recommended to join a yoga class to get proper stretching
and stability education. It is a great way to counteract all that sitting!
(a) Hip extension stretch
(b) Figure-4 stretch
(c) Prone extension - with or without/out a press-up
(d) Frogger stretch
(3) Practice balance and stability - When our hips aren’t aligned well, our muscles are
unable to work well. When they are weak, they force others to work harder.
TAKE HOME MESSAGES:
(1) MOVE WELL, MOVE OFTEN - do not simply sit all day because you feel you have to!
Phone calls can be taken standing, TV can be watched while stretching, etc. Explore all
the positions your body can be in - it can be beautiful!
(2) Improve Stability - Improving stability in our hips will take pressure off the rest of the
body. You can also practice standing on one leg while watching your favorite reality TV
(3) Listen to your pain and stiffness - Pain and stiffness in back or hips while rising from a
chair is not normal! This means your body is not liking that position.