I was talking to someone a couple of weeks ago. let’s call him Ben, and in the course of the conversation, he said, “My right hip feels tight” and that his hip often hurt. He was in his mid-30’s, fit, active. Plays tennis once a week, lifts weights three times a week, and does some running.
I asked Ben what he was doing for his right hip and he said, “Oh, I stretch it a lot. You know, I figured that’s what you’re supposed to do when your hip feels tight.”
And yet the stretching didn’t solve the problem. That’s because when a joint feels tight, it’s not usually a muscle problem. It’s a joint problem.
One biomechanical argument to explain the hip feeling tight is that your gluteal muscles are weak or contract too late or insufficiently allowing the femoral head (the top of the thigh bone) to slide forward banging into the front of the hip joint capsule. The tightness you feel is coming from the irritated hip joint capsule.
With this logic, the solution is to get the gluteal muscles to work correctly. For this, you do exercises that isolate the gluteal muscles forcing them to contract.
The problem with this thinking is that the feeling of tightness of the joint capsule is from inflammation or swelling. When there’s even a small amount of fluid in the joint, the gluteal muscles won’t work properly. This is called “arthrogenic inhibition”.1)Freeman, S., Mascia, A., & McGill, S. (2013). Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech (Bristol, Avon), 28(2), 171-177. doi:10.1016/j.clinbiomech.2012.11.014
Arthrogenic inhibition happens in most synovial joints – joints with articular cartilage and a joint capsule. Joints like the knee, shoulder, ankle, spinal joints, and even the jaw.
It could be that the swelling in Ben’s hip is from a biomechanical fault or it could be that something else irritated the joint and in turn, dialed down the gluteal muscles like a light dimmer switch turning down the brightness of an overhead light, which, in turn, aggravated the situation.
Either way, the thing first thing to do is get rid of the fluid in the joint.
You can check for possible fluid in the hip by doing something called a “glute set”( for the knee, a similar check is done by performing a “quad set”). In the glute set, you lie down on your back, legs out straight. Staying with the example of a right hip problem, first tighten the left gluteal muscle as tightly as you can. You’ll likely also tighten the quadriceps which is fine. Pay attention to the quality of the contraction. Notice how firm the muscle becomes, how much of it tightens. Do this a few times to get a good picture in your mind.
With this result in mind, now do the same thing on the right side. In almost every case, if you have hip pain or tightness, the gluteal muscle on that side just will not tighten as much as the other side. No matter how hard you try, you just can’t quite get the same level of contraction.
So, now what?
For the knee, we use light, repetitive motion to help move fluid out of the joint. You can do the same thing for the hip using one of the same exercises for the knee: a foot slider.
Here’s how you do it:
The elastic band, a light resistance, makes moving the leg a lot easier. Almost effortless. You do this movement, slowly, for three minutes, take a short break, go again. Repeat the process up to five times over the course of a day and then repeat the glute set test.
Most of the time, the muscle contraction will be better and sometimes, normal.
Now, the next thing to do is to figure out what is causing the irritation. My suggestion is that when you hear hoofbeats, think horses, not zebras. Think too much load or too much volume of activity rather than trying to find a biomechanical flaw. Change the load and duration levels first and see if the irritation subsides. If not, you can chase down the biomechanical faults but usually, you don’t need to.
For Ben, I would remove tennis from the routine for two weeks, observe what happens and re-check the glute set. If the results are the same, he will need to remove something else from his routine. Once you find an activity level that doesn’t irritate the hip, then you start rebuilding the strength and capacity a little at a time checking for any fluid in the joint regularly.
And, by the way, the toughest thing to do is remove an activity from your routine. Joint problems are mostly overcome with a sound mental strategy. The ability to not get emotional over changing your activity level and instead, be curious is key.
That’s all I have for now.
Thanks for reading.
PPS – If you like this article, why not share it with a friend?
References [ + ]
|1.||↑||Freeman, S., Mascia, A., & McGill, S. (2013). Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint. Clin Biomech (Bristol, Avon), 28(2), 171-177. doi:10.1016/j.clinbiomech.2012.11.014|