May 18, 2013

Hip Extension For Runners: Importance, Restrictions, and Quickies for Improvement.


Sufficient hip extension is vital for proper running gait, form, posture and efficiency. Inhibited or restricted hip extension in running can result in:
  • Over-striding
  • Decreased running economy
  • Poor movement patterns
  • Potential risk for injury and/or compensation up and down the kinetic chain

The Gluteus Maximus is the primary hip extensor and the strongest muscle in the body. It is hypothesized that our massive glute max relative to other primates is due to an evolutionary adaptation. This allowed better bipedal locomotion and enhanced our running ability. Proper activation of the glute max and hip extension motion is needed for most primitive and basic movement patterns, especially skills requiring power. This is evident in many basic power skills such as:
  • Squatting/Deadlifting
  • Sprinting/Running
  • Throwing
  • Punching
  • Jumping
  • Bridging of the hips
  • Swinging an object like a club, baseball bat or golf club.

Limitations in hip extension or gluteus maximus activation can also affect static postures like standing by influencing pelvic tilt, motor control activation strategies, lumbar curve and ultimately the body's center of gravity. For more reasons on why "running is all in the hips", see James Dunne's great post, here.

Reasons for Restriction:

There can be many reasons for limited hip extension. Finding the source of restriction or reason for limitation will allow for the most efficient and effective treatment of the problem for yourself or one of your patients. Some possible reasons for restriction include:

  • Anterior hip capsule thickening or tightness (Especially after prolonged immobilization)
  • Hip Flexor Contractures
  • Ligamentous restraints
  • Bony or Articular defects (Could be anything from a labral tear to a loose body blocking proper arthrokinematics)
  • Excessive Tone of the...
    • Iliotibial Band/Tensor Fascia Latae
    • Iliacus/Psoas Major
    • Rectus Femoris
      • You must also address the underlying reason for excessive there poor motor control or stability issues?
  • Movement Pattern Avoidance
    • Perhaps hip extension is being avoided subconsciously? Common reasons include...
      • Previous Injury
        • An attempt to avoid previously perceived pain
      • Postural dysfunction causing muscle inhibition
  • Poor ankle mobility can limit hip extension in gait as well

Ways to Improve:

While a few of the aforementioned restrictions may take time and dedication to resolve, the good news is that a majority of people will have restrictions that can respond and resolve quickly. True tissue extensibility issues that are slow responding in nature may take dedication and lots of work. Research is showing that the classic 3x30secs of stretching isn't enough to make real changes. You are going to need to devote 3-5 minutes total of stretching a day, for around 3 months straight to make real tissue length changes. However, unless you have excessive cross-link and excess collagen formation from things like post-surgical immobilization you are probably going to find an ability to make gains quickly.

You may have multiple issues causing a restriction in your ability to extend your hip and you may need to use a combination of techniques that address both rapid responding neuromuscular issues as well as long term techniques that address slow responding issues. Here are some great ways to address both slow and fast responding issues.

Instrument-Assisted Soft Tissue Mobilization or IASTM

IASTM can be performed with a variety of instruments. Examples are traditional gua sha tools, the end of a reflex hammer, The EDGE or EDGEility tools, Graston tools, SASTM tools, etc. I do not have enough experience with the different tools to give a preference to just one yet but logically what ever fits in your hand and is the most comfortable for you and your patients will probably be the best.

Using IASTM to treat common soft tissue restrictions and excessive tone in these common muscle groups will help with increasing hip extension and should result in immediate changes to hip extension ROM. This gain may be transient but can be locked in with certain exercises.
  • Iliopsoas
  • Rectus Femoris
  • Superior Hamstrings/Gluteal fold area

If you don't have any knowledge of IASTM you may need to get some or find a clinician like an athletic trainer, physical therapist or chiropractor that does. However, there is an alternative if you don't know how to use these tools or if you don't wish to pay the dollars to own them. One alternative is to do...

Instrument-Assisted Self Soft Tissue Mobilization or IASSTM (I just made that acronym up)

IASSTM is a cheap, more general application of the aforementioned tools and principles. To increase hip extension you should still focus on the previously highlighted areas of restriction. Common examples of IASSTM would be:

Soft Tissue Release

Another quick and easy way to make gains in hip extension is to reduce excessive tone in the psoas muscle. One specific and pain-free technique is one taught by Dr. Erson Religioso III. Here is his updated psoas release video. 

Hip "Reset" Technique: Repeated End-Range Hip Flexion

Most people who want to work on their tight hip flexors probably spend a lot of time trying to stretch into hip extension. This is not necessarily a bad thing but you might find that your ability to reach the end range of hip flexion will allow you to release any local "lockdown" by the central nervous system. This will quickly reduce hypertonicity or spasm and will allow for greater hip extension. A couple sets of 10-15 reps should show improvement if you would benefit from this technique.  Once again this is the type of technique that would have transient effects that could be maintained by repeating this exercise. This is a relatively new concept for me, check out my last post to get some background on what I mean by a reset.

Mobilization with Movement - Elastic Band 

I couldn't find any good pictures or videos to show the technique that I have in mind. In this technique you or the patient would be in a classic lunge or half kneeling position that is often used to stretch the hip flexors. A strong resistance band would be wrapped around the proximal thigh near the groin and would be either held by a person or affixed to a structure to the front of the person. To perform the the stretch the person would descend into a deep lunge and a slight overstretch would be provided by the resistance band pulling from the posterior to anterior (back to front) direction. This position would be held for a second and then return to the starting position. Repeat for 2-3 sets and 10-15reps per side.

Lunge Position Stretch

This would be a static stretch version of the aforementioned technique. You can hold this position for 3-5 minutes a day easily while doing things like watching TV, checking email or spying on your neighbors.

Bretzal 1.0 

The Bretzal 1.0 is a great anterior chain stretch. If you watch the first part of this video you will see how it even stretches the hip flexors while in a running-like body position. This is a technique that I would recommend for the slow responders or those with other restrictions that may need more attention than just hip extension.

PNF Stretching 

Proprioceptive Neuromuscular Facilitation stretching is a great way to make rapid gains in mobility. There are three major types of PNF stretches: hold-relax, contract-relax and slow-reversal hold-relax. The only disadvantage of PNF stretching like some of the others is that it requires another person (not always) and that you need to know how to do them. I personally like some of the other techniques better because I feel like they empower the patient to make changes themselves but there are some people who respond well when they think you are doing some magic work to "fix" them.

Joint Mobilization

Another quick and effective technique is doing joint mobilizations to the hip joint. Joint mobilizations are effective when there is a presence of inappropriate arthrokinematics. This is a tricky and almost cumbersome technique when it comes to performing joint mobilizations for the hip and definitely requires a trained clinician who knows how to perform them appropriately. However, joint mobilizations can be great for both rapid and slow responding issues because they can work on the joint capsule as well as the tone of surrounding musculature as well.

*Bonus Hip Mobility Exercise*


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