Hip flexibility is important for achieving a full depth squat, particularly the ability to flex (bring the knee to the chest), and externally rotate (turn the foot outwards). Hip mobility can be limited due to a sedentary lifestyle and prolonged sitting. In the athletic population, limitations can also occur when compensating for weakness or imbalances on the same or opposite leg.
How to Screen Hip Mobility
When screening hip mobility, it is important to assess for both range, and possible underlying strength deficits that may be related to the limitation.
Hip Range of Motion
a. FABER
Firstly, to assess the ability of the hip to turn outwards, complete a FABER test. Lie on your back, bring one foot up to rest on the opposite knee, and relax the leg and allow the hip to turn outwards. Measure the distance from the outside of the knee towards the bed.
Compare sides.
This test is positive if there is a difference between sides (~3+cm) or if the knee is unable to lower towards the bed.
b. Knee to Chest
To assess hip flexion range of motion, complete a knee to chest stretch. This test is positive if there is a difference in range between sides, pain is felt at the front of the hip, or if your thigh is unable to touch your chest without the lower back rounding.
c. Hip Internal Rotation
Finally, lie on your back with your hips and your knees at 90 degrees. Turn your feet out to the side and compare hip internal rotation between sides. The test is positive if there’s pain, an observable difference between sides, or an inability to turn the foot out.
Hip Strength
In addition to hip range of motion deficits, there may be underlying weaknesses in the muscles that control the hip. Thus, it is important to assess strength of the inner thigh and glut muscles as well.
a. Copenhagen
You can complete a Copenhagen assessment to assess strength of the inner thigh (adductors) and core muscles. As shown in the video down below, start on your knees and see how long you are able to hold each side for. If you’re able to achieve 30s then move on to assess a Copenhagen on your toes. This test is positive if there is a difference in the duration you are able to hold for between sides (5s+).
b. Single Leg Squat
Next, it is also important to assess the strength for the deep gluteal muscles (gluteus medius and minimus). At home, there isn’t a way to isolate these muscles for assessment, however a single leg squat is a functional test of the control of these muscles. Complete eight single leg squats per side and compare between sides. This test is positive if there are differences between sides such a) depth b) stability c) number of reps able to be completed d) pain. Differences here may be due to multiple factors so it is important to see a physio for a full assessment, however they may be due to weakness in the gluts or lower limb stability/control.
How to Fix Hip Mobility
To improve hip mobility, it is important for the exercises to address both the limitations in range, and the underlying strength deficits that may be causing it. Here are some possible exercises to improve hip mobility, based upon what the previous assessment showed.
Exercises to Improve Range
Everyone with a restriction should do these exercises to improve range, while the following strength exercises depend on the findings of the previous assessment.
KB goblet squat with hip rotation: As shown in the below video, sit at the bottom of a squat whilst holding a kettlebell (about 8-16kg), and rock side to side. Particularly, focus on rotating at the hip and driving the knees out, on the side/s of the restriction/s.
Hip stretches: Stretches to improve hip flexion/external rotation range should also be implemented such as a pigeon stretch or a seated/lying glut stretch. Hold each stretch for 2 minutes.
Hip aeroplanes: This is working on actively lengthening the muscles in the hip that can be causing the restriction. Stand on one leg, unlock the knee, then send the hips back like doing a single leg deadlift. In this position, open your hips upwards as far as you can go, and then bring your hips down in the opposite direction. All this should be done as slowly and controlled as possible. Have a wall next to you for safety, however avoid using it.
Banded hip internal rotation: Sit on a chair and have a light/easy resistance band
Exercises to Improve Strength/Neuromuscular Control
Copenhagens: If the Copenhagen assessment as above is positive, then incorporate these into your training program to address the strength imbalance. Do three sets of 10-30s (depending on how long you can hold it for), three times per week.
If the single-leg squat test is positive, incorporate some glut strengthening work into your program. For example, a captain morgan exercise, as shown below, for 3x10-20s (depending on how long you can hold for), four times per week.
Reassess
After completing the above exercises for one week, reassess as above to see if there has been any improvement. Continue to complete these exercises until the test is not positive, or until progress has plateaued.
The information above is provided as general information only, and is not intended to be specific advice about your condition and body. For specific advice about your condition, we do recommend that you see your physiotherapist for a full assessment and management.
This blog was written by our physiotherapist, Emma Garrett.