The Power of the Hip Part 1

Years ago, we had a great 3 part series of experiential workshops at the Pilates Garage called The Power of the Hip, where I taught colleagues and community members how to find explosive power through movement. It was in the physicality of teaching that I really began to understand the relationship of the hip and back more as a unit, rather than in pieces.

Issues of the hip have become the majority of what I see in my practice, but that is certainly not only me. The healthcare community at large has gotten better at diagnosing hip disorders in the last 10-15 years, and so many people that were once diagnosed with back pain are finding underlying hip dysfunction.

On “Just Like That,” the new sequel to Sex In The City, Carrie Bradshaw exhibited such a typical patient story, I was blown away by the authenticity. Her pain was in her back, and she was surprised to learn that it came from a hip deformity, although she didn’t actually experience hip joint pain. Seemingly, the cause of her symptoms didn’t match her place of pain, and that really is where we stand with so many orthopedic issues in the body.   

If this seems confusing, it doesn’t need to be. Rarely, does the pinpoint- it hurts right here- model fully rid a person of pain anyway. This is why many physical therapists have learned to categorize “pain generating” areas separately from what we call “painful drivers,” meaning that in rehab, painful spots are only as important as the movements or problems that cause them. It also means that sometimes focusing on the painful spot can lead you down the wrong road. 

It’s human nature. When something hurts, we point to it, we massage it, we rub it, we stretch it… and if we are honest, we aggravate it.

Foam rolling repetitively over muscles can be a great example of this. Along the side of the leg is a band of tough connective tissue, that behaves a bit like a long and broad tendon, called the iliotibial band. It’s not meant to stretch, but we stretch it. It doesn’t change in stiffness, but we roll on foam trying to make it softer. It doesn’t change length, as proven in ultrasound studies, but sometimes we continue to inflame it by trying to make a dent because that is where it feels tight!

Clamshells are another example of where we can go too far with trying to isolate the hip. When you rotate your hip without moving your spine, it will cause the iliotibial band and the psoas tendon to rub back and forth over underlying bones, bursae, and tendons- causing friction where you may already have pain!

Let me drive this point home by saying that every time you allow your spine to move, you are literally changing the angle of the hip socket, and thereby your hip. When these areas are freed up to move in harmony, the femur can find it’s way closer to the center of the hip socket, and the muscles that spasm to protect the hip can let go. Taking the stress off the hip allows new muscles to work in better and more organized ways!