Understanding the Hip Hinge: The Basics

The hip hinge is an important movement pattern for everyday life and athletics.  This movement is similar to “bowing” or bending at the hips while maintaining a flat spine.  The movement occurs at the hips which loads the gluteus maximus and hamstring muscles.  The hip hinge is characteristic of picking up a bag of groceries from floor or performing a maximal dead lift with a barbell.  Mastering the hip hinge takes advantage of the large gluteal and hamstring muscles while minimizing compressive loads through the low back.

Muscle Activity during the Hip Hinge

The hip hinge movement is controlled by eccentric actions of the hamstrings and gluteus maximus muscles.  These muscles are actively lengthening to control the “bowing” movement of the hip hinge.   Research has shown slightly greater activation of the medial, or inner, hamstring muscles during the hinge in comparison to the lateral hamstrings.  Also, in comparison to the squat, the hip hinge requires greater hamstring than quadriceps muscle activation.

The hip hinge also requires activation of the core musculature to maintain a neutral spine position.  The rectus abdominis and oblique abdominal muscles are activated at relatively low levels compared to the low back musculature.  The erectors spinae is the primary muscle required to maintain a neutral lumbar spine during the hip hinge.  The demands placed on the hamstrings, gluteus maximus, and erector spinae makes the hip hinge a great movement pattern to train the posterior chain.  The posterior chain is important for athletic success and to counteract the postural changes which occur as a result or aging or a sedentary lifestyle.

Adding Load to the Hip Hinge

Once the hip hinge pattern has been mastered, a kettlebell or dumbbell can be used to add load and build strength.  Begin by placing a light kettlebell or dumbbell on its end on the floor.  Stand over top or slightly in front of the kettlebell.  Place your feet slightly wider than hip-width with your knees slightly bent.  Keep your chest up, shoulders back, and abdominals tight.  Without bending your knees any further, push your hips back and lower your chest toward the floor.  Reach for the kettlebell, keeping your back straight and bending your knees only slightly.   The movement occurs at the hips, not the knees.   Once you can grab the kettlebell, pick it up and reverse directions by pushing your hips forward and squeezing your glutes.  Return the kettlebbell to the floor by hinging at the hips.

Closing Thoughts

The hip hinge can be a challenging movement pattern to master.  Many are prone to flexing or rounding the low back instead of moving through the hips.  This commonly occurs in everyday life when bending to the floor to pick up light or heavy objects.  A low back-driven pattern will increase demands on the lumbar spine structures instead of the much larger and stronger lower body muscles of the posterior chain.  This article highlights some of the basics to performing the hinge.  In future articles, we will outline exercises to improve the hip hinge movement pattern.

References 

  1. Andersen V, Fimland M, Gunnarskog A, et al. Core muscle activation in one-armed and two-armed kettlebell swing. J Strength Cond Res. 2015;30(5):1196-1204.
  2. Del Monte M, Opar DA, Timmins RG, Ross J, Keough JW, Lorenzen C. Hamstring myoelectrical activity during three different kettlebell swing exercises. J Strength Cond Res. 2018;Ahead Prin:1-17. doi:10.1519/JSC.0000000000002254.

Total Hip Arthroplasty (Replacement)

Total hip replacement is a surgical procedure that is most likely performed on people who have severe osteoarthritis of the hip. Other possible reasons for a hip replacement include, rheumatoid arthritis, osteonecrosis, fracture, and bone tumor. Since 2003, the number of hip replacement surgeries performed has increased by 33% in the United States. The most common age groups receiving hip replacements are people over 70 years of age.

Hip Replacement: Anterior vs. Posterior Approach?

There are 2 main surgical options for a total hip replacement; a posterior approach and an anterior approach. The type of surgical approach is typically determined based on physician preference. The anterior approach is a fairly new procedure which requires the surgeon to cut less muscle which some believe results in a faster recovery time. The posterolateral approach has been done for a longer period of time. One of the biggest risks following total hip replacement is dislocation. This complication has been noted to occur with 1% of surgeries with anterior approach and 1.3% with posterolateral approach.

The Role of Physical Therapy

The typical course of treatment after total hip replacement could involve a short stay in the hospital and in some cases a short stay at an inpatient rehab facility. Upon returning home, a large percentage of patients undergo a period of outpatient physical therapy, which usually lasts 1-2 months. Outpatient Physical Therapy consists of a combination of manual physical therapy, supervised exercise to improve range of motion, strength training of the muscles around the hip, and functional exercises that are geared towards returning the individual to prior functional activities.  At least one study shows that physical therapy had a positive effect on patients after a total hip replacement with faster recovery times and an increase in walking ability. Another study also found that physical therapy allows for an overall increase in functional status for patients who have received a total hip replacement.

Closing Thoughts

Physical therapy following hip replacement surgery requires a team approach between the patient, surgeon, and physical therapist.  If you are considering undergoing a hip replacement, or have recently undergone this procedure, please call one of our physical therapists to learn more about your recovery and return to function.

-Dr. Tom Michaels, PT, DPT, OCS, CSCS

References

  1. Freburger J. An analysis of the relationship between the utilization of physical therapy services and outcomes of care for patients after total hip arthroplasty. Journal of Physical Therapy. 2000;80(5):448-458.
  2. Kishida Y et al. Full weight-bearing after cementless total hip arthroplasty. International Orthopaedics. 2001;25:25-28.
  3. Jolles B, Bogoch E. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Systematic Review. 2006:3.