Pilates for hip pain
The biggest bang for buck strategies to help sore hips
People get sore hips, all the time. Every day in the studio is a constant barrage of aches and pain, and without fail 99% of clients will mention something going on in their hips. And fair call - we put them through a lot of work! Between sitting and compressing tissues for hours every day, to then asking them to suddenly go to the other end of the spectrum when running and jumping and generally doing vigorous activity, we don’t really give them the TLC they really deserve. But on the other hand, maybe we need to keep pushing them around to a greater extent? We know the body will always adapt to whatever environment you put it in consistently, so if you want robust hips, maybe you need to ask some robust questions of them?
Hips - understanding the why
When putting together movement and rehab protocols for certain areas of the body, I always find it super helpful to assess what is the generalized main role of that area - the Why - and then build out the accessory functions (the how and what). I prefer this to pulling apart specific anatomy as the harsh reality of our understanding of the body to date, is that it is all educated guesswork. Yes we’ve pulled apart cadavers and know where X attaches to Y, angles of fibres etc etc, but we don’t know what it looks like in a electrically charged and dynamically adjusting body. So many factors beyond what we can control, can have an impact on our body. So I find it’s best to look at the big picture to start with, and work with that you can control.
The ‘Why’ of our hips is to provide a stable platform from which we can transmit force from our legs to our torso, and stabilise our spine. By this, I mean when we walk our legs go one way, our arms go the other. When we stand, our legs may bend one way but our torso may do something entirely different. That may seem too simplistic to many of you, but I if you put some genuine thought it to it, you’ll find there aren’t many other broad spectrum functions that act as a why - maybe reproduction?
So with the Why in mind, now we can start to ask some questions of our clients about what’s going on for them. When are you noticing your discomfort the most? Is it sharp and short, or long and dull? What makes it worse, and makes it better? And through these broad questions, you’ll start to uncover information you can probe a bit more, and begin to pin down those key facts around what constitutes pain for them. Below is a list of generalised hip issues that we see a lot, and the general remedies for them. They are pretty broad spectrum, meaning they will take care of most issues in the impact areas, but unfortunately there is no golden recipe!
Stiff Lumbar Spine
Tight Hip Flexors
Tight Hamstrings
Sciatic nerve discomfort
Sore SIJ(s)
The How - understanding the basic anatomy
Now we know roughly what we’re looking at, we can start to pull apart the broad anatomy to see what pulls on where to help give consideration to what’s worth pursueing. Again, we won’t go in to minute detail on anatomy as it’s not as relevant as people think, but it is helpful to give us a language to work with.
The hips and the pelvis often get lumped together as one unit, from the perspective of the client. In regards to our anatomy, the hips reflect the femoral head connecting in to the Ilium, while the pelvis reflects the Ilium and Sacrum and it’s associated joints. The hip joint is deep and has a ring of cartilage (labrum) that helps hold femoral head in place and ensure smooth movement. It’s then supported by lots of massive, powerful muscles as well as a few fine tuners to help coordinate the movement of the leg. They are also massive bones and joints because they’ve experienced a huge variety of force through them thanks to walking and running, jumping and crawling. This all differs to the Sacrum which is smaller and held in place mainly by ligaments that allow tiny bits of movement. The pelvic floor musculature is also incredibly intricate and important to note here, as it pulls on the Ilium, sacrum and coccyx as well as links to the inner thigh via the adductor magnus, although it’s probably best to leave the corrections to this area to the pelvic floor experts!
The What - simple exercises
In terms of how we start working specifically with the pelvis and hips, some key strategies to keep in mind is off-loading the joints so that you can experience more freedom of movement. Exercises like lying on your back with a small, soft ball under the pelvis and gently moving the pelvis in different directions can be really simple, and an absolute game changer for some people learning they can move their pelvis at all! Once they understand they can move it, then bring them up to sitting, and eventually to standing doing the same movements, and start asking questions around what movements feel good or bad for example. This can then lead you to move specific exercises to help improve mobility and strength. Other excellent exercises include stretching the hips by lying at the of a bench and letting one leg drop towards the floor, or rolling the hips and legs side to side while manipulating having the legs in parallel or crossing one leg over the other to highlight tension in the hips, or lower back. They are all simple exercises but it doesn’t take much to learn what the body does and doesn’t like, which helps to identify key components around what areas need mobility, and what need stability.
And the last component to remember is that ultimately, we want to bring out clients back in to positions that cause them discomfort, and help them problem solve how to get out of this discomfort. Sometimes a few basic stretches loosening things up, and they are sorted! More often than not, there is a bit of specific strength work required around how to organise the pelvis and its relationship to the hip and lower back - this may include glute strength, hip flexor mobility, and lumbar spine mobility - but it may also depend on the feet, and how they provide a platform for the knees and legs to move. Ensuring someone can organise their entire body against the constant pressure of gravity is a must, as all the great work you do lying and sitting will be in vein if they can’t stand or walk for more than a few minutes without discomfort creeping back in!
Summary
The key take home points are to have a rudimentary understanding of the anatomy of the hips, but don’t get so caught down in the detail you forgot how it all links together up and down the chain. Once you’ve identified the problem sites, start with basic movements of the legs, pelvis and spine to drill a little deeper on to what does and doesn’t move, before starting to load the body up a bit more against resistance, and eventually gravity to drive home the blend of mobility and stability needed for healthy hips and lower backs!