One of the most frustrating and overused medical opinions is that of “weak hips.” At Mobility-Doc we are fortunate to work with some fantastic national-level athletes. Almost invariably if an athlete walks into a medical office with knee pain, no matter how gifted the athlete is, he or she will be told that they have “weak hips,” and that the solution is to “strengthen [their] core.” I’m not convinced that most medical professionals can identify what actually constitutes one’s core. I’m certainly positive that it can’t be strengthened by any of the exercises located on the black and white hand outs that will be passed onto the patient at the end of their visit. So let’s talk about how to address “weakness.”
Reciprocal inhibition is a term that helps to explain that rant that just happened. It speaks to the concept that a “tight” muscle can cause another muscle to be “weak.” Muscular strength at the hips happens to be one of my favorite ways to explain all of this. I like to imagine a band when I’m trying to rationalize this treatment protocol. Have you ever been early to a concert and heard each part of the band get tuned? Each section holds a note until that note is clear and perfect. Then slowly the band will start to put the sections together. If the one section is too loud it will throw of the timing for everyone else. Some background sections might even compensate by getting louder. You need to turn down the section that went rogue and then retune the band. If you don't retune the band you will run the risk of falling back into the same state of dissonance and disorganization that you just left.
Your gluteus medius and minimus are responsible for abducting your hip, or bringing your leg out to the side. Your piriformis and TFL are actually also less forceful abductors and can assist your gluteal muscles. Your adductors, meaning your “groin muscles,” do the exact opposite of your abductors. It’s not uncommon for people with tight adductors to test weak in hip abduction. That's because your overly active adductor group is overpowering your abductors and making them appear weak. Your adductors are analogous to that band section that is too loud. As a result the abductors try to compensate by becoming “louder,” or more active to the point of fatigue, hence the weak presentation.
Furthermore, your piriformis and TFL are going to have to work extra hard now to pick up the slack. Not only will they be working to try to abduct the hip, but they’ll continue to do their typical job of externally rotating the hip. You know, when “pigeon” stretch feels really tight on that side? That’s you’re overly active then resultantly tight piriformis (among other muscles). This is going to result in weak hip abduction, a weak single leg stance, a tight iliotibial band, a painful piriformis muscle, and knee pain. As you can see, there is a whole cascade of consequential issues.
If you came into our offices we would detect the muscular imbalance through functional muscle testing. We would then perform some soft tissue treatment to your adductors and your iliotibial band, perform some activation exercises for your gluteal muscles, and suddenly you would test incredibly strong in hip abduction, realizing that your hip abductors weren’t the primary source of the issue to begin with.
What you could do to correct this imbalance is: 1. foam roll the inside and outside of your thigh to inhibit the overactive muscles; 2. stretch your groin muscles in order to lengthen them back to a normal resting state; 3. perform an isolated movement activation exercise like some side-lying leg raises to reactivate your gluteal muscles; 4. perform a functional activation exercise like a single leg RDL. Isolated activation exercises that are done in step 3 aren't overly complicated, but they have to be chosen purposefully and done correctly. Think: straight leg raise, shoulder flexion, ankle dorsiflexion, etc. This is just to “prime” the area, in a sense. Also, perform the movements slowly, especially during the eccentric phase of the movement, and with light weight, and high reps.
However, it isn’t enough to just do side-lying leg raises, because functionally, you don’t use your abductors in that means. Stay tuned for the final piece in corrective exercise, integration techniques or functional activation exercises. You’ve foam-rolled, mobilized, and stretched in order to restore normal range of motion at a joint. You've activated your inhibited muscles so that they start picking up the slack when moving. Now you're ready to put it all together with more complicated movements.
Post from the Mobility Doc!
John Giacalone holds his doctorate in chiropractic. He is certified as a level 2 USAW coach and has competed as a weightlifter. John has competed at 85kg, and more recently 77kg, where he qualified for the American Open in 2015. John's best snatch is currently 121kg, and clean and jerk at 1451g. John's additional certifications include CSCS, USATF1, FMS, SFMA, CFL1, CF Mobility, CF Weightlifting, and NASM CES.