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Warming Up the Hips To Prevent Injury

By Greg Cugnet on October 26, 2017

 

My name is Greg Cugnet. I am a physiotherapist working with the UBC Thunderbirds Men’s Hockey Team. Since my time with the team has begun, one thing has become increasingly clear to me: hockey players have tight hips!

Now, considering the physical requirements of the game, and the typical postures held during competition, this hardly comes as a shock to me. Just look at how the players go into a face-off. They are stooped forward, resting their hands on their knees, waiting for the puck to drop. 

When they are skating with the puck everything is in front of them, causing them to lean their upper body forward. When the players get tired, they lean forward to offload their legs and back. And the times that they are not on the ice, they are sitting on the bench. All of these positions keep the hip in a relatively flexed position. 

When I see players in the clinic, a lot of them have an increased curve in their lower back when they are standing upright. The reason for this is that standing requires the hip to come into full extension, and the tightness they have accumulated into hip flexion through gameplay and in daily life (students sit a lot) is now pulling their pelvis into what is called an anteriorly tilted position

The left image shows an anteriorly tilted pelvis as indicated by the blue line. Generally, it will have more of a direct influence on curvature in the lower back, but typically poor pelvic positioning is often accompanied by poor upper spinal postures. 

The image on the right illustrates more optimal posture with a neutral pelvic tilt. The curves of the spine with a neutral pelvis are not as prominent, and place less stress on the joints and discs. 

An anteriorly tilted pelvis can lead to a variety of potential issues. It is a common cause for back pain, hip/groin injuries, and postural misalignment moving up the spine and down the legs. There are a number of muscle attachments above and below the pelvis, and these muscles often play a bit of a tug-of-war against each other as we move. Even when not engaged in strenuous activity, a suboptimal pelvic position makes muscles work harder. I will give an example to illustrate what I mean.

Let’s consider a basic bicep curl with a free weight. You start with your elbow straight, holding the weight in your hand. As you move through the motion, the elbow bends more and more until you are unable to bend it further without using your other arm to pull it in. At the bottom of the movement, we call that the outer range of motion, and the top part of the movement is the inner range of motion. Every muscle is unique in that it has its own “perfect” length where it can produce the most force (tension). 

For the biceps, that length is when the elbow is at roughly 90 degrees. In both the outer and inner ranges of movement, the muscle is going to be weaker. This is what is referred to as the “Length-Tension Relationship” of a muscle. So now let’s bring that back to the pelvis, hip and lower back.

In a neutral pelvic position, because of the attachments of the muscles that act on the pelvis, the length of each muscle is optimal. 

When the pelvis is anteriorly tilted, the lower back and hip flexor muscles are shortened (green circles) and working at inner range of motion, and the lower abdominals and gluteus muscles are lengthened (yellow circles) and working in outer range of motion. 

Neither a shortened tight muscle nor a lengthened weak muscle is efficient. Both are forced to work at different ends of the length-tension relationship, which requires that they work harder than they should. During skating, the player is in an all-out sprint using muscles that are either too tight or too weak to manage the activity. That’s where a lot of injuries occur.

When a player steps on the ice without addressing hip mobility beforehand, he or she is now predisposing the hips, pelvis and lower back to weakness and overworked muscles that can lead to injury. Considering the influence muscle has on injury, the natural approach should be to stretch the muscles, right? Well, not exactly.

For a long time, sport scientists and strength coaches all thought that we should stretch the muscles before we use them if we want to improve range of motion in preparation for gameplay. Through research into the subject, it seems as though a better approach is to address the joints before activity, and stretch the muscles following activity.

Below is a set of movements that a hockey player can perform to loosen the hips for the demands of hockey. These should be done when the player’s body is warmed up. I recommend a light jog or cycle for 5 to 10 minutes beforehand, to get the blood flowing and lubricate the joints prior to moving them into deep ranges of motion. 

These movements are meant for injury prevention! If you have an injury, especially in the back or lower, it is recommended to get a thorough evaluation from a qualified rehabilitation professional beforehand (physical therapist and/or sports medicine doctor). These activities should not induce pain. The motions should all be slow and controlled. Make sure to only work within the range of motion available to you. I usually tell my patients that you can tap in and out of mild discomfort, but sharp, injury-type pain is not what we are aiming for!

1. Start with high knee marches and butt kicks for 20 seconds each. Not only does this get the joints prepared for deeper ranges of motion, but it also picks up the body temperature, which helps the tissues accept lengthening

2. Next, move onto an exercise to increase hip external rotation. Take a step forward, and pull the non-weight-bearing leg up, hold one second, and release leg to the ground. 10 repetitions each side

Tips:

  • Stand tall – don’t arch your back
  • Breathe out as you pull the ankle up
  • Alternate each leg with each step

3) Knee pulls to spiderman with a twist. Start standing tall and pull the knee up as high as you can. Then take a lunge step forward with the same leg and bring your hands to the ground on the inside of your knee. With the outside hand, bring it up to the sky while twisting the upper back. Twist back to neutral, stand up and repeat with the other leg. Take 8 steps with each leg.

Tips: 

  • Keep back straight with each part of the movement
  • Breathe out on the twist
  • If you can’t reach the ground, place your hands on a block or something elevated

4) Hip flexor and quad stretch. As you lean forward, pull the heel towards your butt and squeeze the butt while you do it. Hold 2-3 seconds. Repeat 8 times for each leg

Tips: 

  • Be careful if you have back pain
  • Breathe out as you come forward
  • Place bottom knee on pillow for comfort

5) Hamstring stretch to deep squat. Start with feet wider than shoulder width. Reach down to grab the toes and stretch the hamstrings. Slowly pull body down so that the elbows come to the inside of the knees. Hold each position for 2-3 seconds. Move in and out of each position 8 times each

Tips: 

  • Keep back straight for both positions
  • Pull down into the squat on the breath out – keep your chest up as you come down

 

6) Groin stretch. Start in a wide-legged stance. Drop down to one side slowly, hold 2-3 seconds, move back up to the top position, and then drop to the other side. Repeat 8 times to each side

Tips:

  • Move down on breath out
  • You can rest your elbow on your thigh to relieve tension
  • You can try with two different ankle positions – foot on the ground and toes up 

 

7) Inchworm. Start in standing. Bring your hands to the ground and walk them out in front of you as far as you can comfortably. From there, start to slowly walk your toes back up to your hands. Repeat the process 8 times

Tips: 

  • Make sure you get a good hamstring stretch at the start and end positions – hold 2-3 seconds
  • If you have any shoulder problems, you should not attempt this exercise

8) Leg swings – front to back and side-to-side. Swing your legs like a pendulum. Your aim is to move through as much of the movement as you can using momentum, but just be careful to keep it controlled. Perform 10 times with each leg in each direction.

Tips:

  • Hold onto something to maintain balance
  • Try not to arch and curve your back when doing this. The aim is for movement at the hip

This sequence is good to perform prior to on-ice warm-ups or it can also be included into a daily routine for general hip mobility. Like I said, pain is not what we are going for with this. If you get any kind of sharp pain while doing these movements, stop the activity and consult a rehabilitation specialist.

To find out more about pain prevention and rehabilitation, you can reach Greg Cugnet, (MScPT, Registered Physiotherapist, Allan McGavin Sports Medicine Centre in Vancouver, B.C.) at greg@allanmcgavinphysio.com.

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By Greg Cugnet| October 26, 2017
Categories:  Performance
Keywords:  Conditioning

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