The hip is a very powerful joint with 17 muscles involved in movement of the hip joint (+/- a few). The hip moves through 6 different ranges of motion: flexion, extension, medial rotation, lateral rotation, abduction (movement away from midline) and adduction (movement towards the midline). As the hip plays a major role in transferring forces between the lower extremities, core and spine, any disruption in joint motion can cause quite an effect on locomotion and gait. As we are a bipedal species, having the ability to move around and weight-bear is very important not only to our activities of daily living but also our independence.
Some interesting hip statistics
- 22% of women and 33% of men who suffer a hip fracture will die within 1 year (1)
- 1 in 3 hip fracture patients will refracture within 1 year *
- Decreased hip abduction has been indicated and been used to predict the occurrence of future lower extremity injuries (2)
- Limitations in hip flexion and internal rotation are characteristics of hip pathology (not necessarily indicative of) (3)
- An increased BMI (body mass index) and obesity are directly related to hip OA (4)
- History of hip developmental disorders increases risk for OA of the hip
- Past hip injury increases the risk for hip OA
- Adults with Hip OA have decreased physical function that can affect balance. (5)
Hip mobility is an important motion to maintain as it is used in 5 out of the 10 movements we assess during our movement screen. These include: spinal flexion, spinal extension, spinal rotation, the deep squat and even in the single leg stance.
When hip range of motion is severely reduced, compensations will be made at the knee and at the spine or pelvis. I often assess what appears to be a knee injury, when the problem is actually weakness in the hip muscles or a severely reduced hip range of motion. And not only do I see this in the over 50 year olds, but also in teenagers.
How do you know if you have reduced hip ROM?
When you lay on your back and bring both knees to your chest without tilting your pelvis your thighs should touch or just touch your rib cage. This equates to about 120d.
Sitting on the edge of a chair or raised surface, so your feet are dangling, keeping your knee bent, turn your foot and leg outwards. This checks your hip internal rotation. We want to see about 30d. Next, rotate your foot and lower leg towards the midline. This checks hip external rotation and should be around 40d. How did you do? Do you feel any restriction anywhere?
Hip internal rotation
Hip external rotation
Next, test out your hip extension. We can do this with what is called a Modified Thomas test. Seated on the end of a table or bench, grab one knee and bring it to your chest and lay back dropping your head to the surface, letting your other leg hang. Does your thigh of the hanging leg touch the surface? Have someone check to see if your knee naturally bends to 90d without you contracting it. Do the same on the other side. If your knee on the side you are testing does not get to 90d, and/or your thigh does not touch the surface you are laying on there is likely some hip extension issues in the hip of that side.
How did you do with these tests? If you are noticing tightness or have completed the above tests and find that your motion is restricted or painful, please give us a call for further assessment. To work on your hip mobility, please see our newsletter for 3 hip mobility exercises.
* Osteoporosis Canada website
- Nikitovic et al, Direct health-care costs attributed to hip fractures among seniors: a matched cohort study, Osteoporos Int. 2013 Feb;24(2):659-69. doi: 10.1007/s00198-012-2034-6. Epub 2012 Jun 27.
- Dallinga JM, Benjaminse A, Lemmink KA. Which screening tools can predict injury to the lower extremities in team sports?: a systematic review. Sports Med. 2012;42(9):791–815
- Prather H, Hunt D, Fournie A, Clohisy JC. Early intra‐articular hip disease presenting with posterior pelvic and groin pain. Pm R. 2009;1(9):809–815
- Holla JF, , Steultjens MP, , van der Leeden M, , et al. Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort. Osteoarthritis Cartilage. 2011; 19: 411– 419.
- Arnold CM, , Faulkner RA. and Does falls-efficacy predict balance performance in older adults with hip osteoarthritis? J Gerontol Nurs. 2009; 35: 45– 52.