The block construction of Etherna allows for very easy content creation. Some things just cannot be made easier.

Unravel Those Hip Flexors

Hip Flexor Tightness

What are the Hip Flexors?

As the summer starts to close many people will be noticing the after effects of increased running mileage. I hear a lot of people mention tight, aching, or painful sensations over the front of the hips which may also be accompanied by a painful lower back. This is partially down to a tightness of the hip flexors which is a collective name for a group of muscles known as the rectus femoris, psoas, and illiacus.

The hip flexors primary function is to flex the hip, this basically means that they lift the thigh forwards and up towards the torso. If you think about the cyclic pattern of running we are repeatedly lifting the thigh in our swing phase. Not only this but the majority of jobs and lifestyles nowadays involve a lot of sitting; at a desk, in the car, or in meetings. The seated position puts the hip flexors in a shortened state. If we hold this position for prolonged periods these muscles will become very tight.

Psoas Muscle

Psoas Muscle

Rectus Femoris Muscle

Rectus Femoris Muscle

Iliacus Muscle

Iliacus Muscle

What does this mean for my body?

If the hip flexors are tight when the thigh is pulled backwards during walking, running, or standing it will stretch these tight muscles and cause some discomfort. The other issue is that the prolonged sitting position and the tightening of the hip flexors causes their counterparts (the gluteals or buttocks) to become lengthened and weaker. This results in a stronger pull on the pelvis in the forward or anterior direction which causes our pelvis to tilt forwards. This has a knock on effect on the lower back causing it to arch inwards hence the common lower back aches and pains.

What can I do?

The fix seems very straight forward, if the hip flexors are tight and short we need to lengthen and loosen them. As well as this to create muscular balance we need to retrain and strengthen the gluteals. By restoring balance in these muscles the postural imbalances will be rectified and hopefully relieve any aches and pains as well as regain a normal range of movement.

Exercise Ideas:

Perform the following 1-2 times per day (or every other day depending on time) or it can be added to your warm ups for any activity you currently do.

1. Hip Flexor Kneeling Stretch

Kneel on one knee, so your leg trails behind you, lunge the other foot out in front of you. keep your torso upright and thrust the pelvis forwards until you feel a stretch up your thigh and over the hip. Hold this position for 30secs and repeat 2 times on each leg. Once you can balance effectively introduce raising the arms straight up over the head, remaining upright through the torso. (See Image 1)

Image 1. Hip Flexor Stretch

Image 1. Hip Flexor Stretch

2. Pigeon Pose

Place one leg and knee flat on the floor in front of you, then trail the other leg flat behind you. Use your arms to control your weight and lower your weight down so your hips drop towards the floor. you will feel this stretch around the buttock and hip area. Hold this for 30 secs and do 2 sets each side. (See Image 2)

Image 2. Pigeon Pose

Image 2. Pigeon Pose

3. Fire Hydrants

This gets its name from the pattern of movement mimicking that of a dog and fire hydrant. Kneel on all fours so your hands are under the shoulders and the knees under the hips. Then keeping your back flat and straight raise one knee off the floor and take the leg out to the side, as though cocking the leg (hence the name). return the leg back in and repeat. Do 2 sets of 15 each leg. (See Image 3)

Image 2. Fire Hydrants

Image 3. Fire Hydrants

4. Gluteal Bridges

Lie on your back and bend your knees so you feet become flat on the floor. Then, keeping your shoulders and upper back flat on the floor, raise your hips up off the ground as high as you can, squeezing the buttocks. Once at the top hold it for 1-2 seconds then slowly return to the floor and repeat. Do 2 sets of 15. Once you can do this with great control you can try the same movement but using one leg only (make sure you work both legs thought). See Images 4 & 5.

Image 3. Double Glute Bridge

Image 4. Double Glute Bridge

 

Image 4. Single Leg Glute Bridge

Image 5. Single Leg Glute Bridge

 

Fix Your Weakest Links!

Working As A Unit – The Body’s Subsystems

When we experience pain, injury or stiffness we instinctively focus on that particular area or body part. The way we treat ourselves or manage this complaint then takes the same specific focus, targeting the painful or restricted area. This may help reduce any of the local trauma and be temporarily relieving. However, in order to fix any underlying dysfunctions that may be contributing to any pain, or stiffness we sometimes need to approach the body a series of “chains” or systems. These systems work together to allow efficient movement, and aren’t just independent muscles.

The Body’s Subsystems…

Five of the main subsystem identified in the health and fitness world are the Anterior Oblique Subsystem (AOS), Posterior Oblique Subsystem (POS), Lateral Subsystem (LS), Deep Longitudinal Subsystem (DLS), and the Intrinsic Stabilisation Subsystem (ISS). Each system offers a different function but they all need to be working effectively together to ensure the body is stable and moving properly. This then helps prevent injury or dysfunction.

Should any of the subsystems be not be functioning optimally it will have a debilitating effect on movement efficiency, joint function, and cause potential alterations in posture. If we can understand the function of these subsystems, and how they can affect our posture and movements then we may be able to rectify any dysfunctions, improve our posture, and maintain pain free function. This blog post will therefore discuss each of the five subsystems and provide an overview to help recognise common dysfunctions so we can address these systems in our daily training.

Anterior Oblique Subsystem…

The AOS consists of the External Obliques, Abdominal Fascia, and opposite side Adductors (National Association of Sports Medicine). Additional muscles have been considered part of this subsystem such as the Internal Obliques, and Rectus Abdominis (Brookbush Institute).

This subsystem stabilises the anterior or front chain and trunk during functional movements such as walking. It also helps transfer force between the lower and body, specifically integrating pushing and twisting movements. This system helps reduce any excessive or forceful rotation or extension through the trunk, anterior pelvic tilt or sacroiliac joint (SIJ) motion within the Lumbo-Pelvic Hip Complex (LPHC). The muscles of this subsystem achieve its function by actively lengthening or eccentrically contracting.

Common Dysfunctions…

This system can commonly be either overactive or underactive, which can contribute and present as a dysfunction in certain areas of the body.

…Overactivity of AOS…

The AOS can be overactive and can cause a dysfunction in the upper body. This may present as certain adaptations during an overhead squat assessment. Specific things to look for are and excessive forward lean of the torso, scapula winging, excessive internal rotation of the shoulder, increased curve of the upper back (thoracic kyphosis). It is common for an over-active AOS to be paired with and underactive POS which will be discussed later.

If these adaptations arise and you think your obliques, and adductors being overworked then you can approach this by reducing any core flexion exercises in your program i.e. crunches, and release shortened, tight structures associated with the dysfunction such as the pecs, and obviously adductors and obliques. You will also want to increase the activity of the POS which will be discussed later.

…Underactivity of AOS…

An underactive AOS can contribute to a dysfunction in the LPHC. This dysfunction will display an anterior pelvic tilt, and an excessive curve in the lumbar spine (lumbar lordosis) as a result of excessive extension coupled with no resistance or stabilisation from the AOS. This again is often paired with an underactive POS.
You can approach this underactivity of the AOS and pelvic tilt etc. by loosening the tight structures, usually the hip flexors and the erector spinae muscles in the lower back. You should also then activate the AOS by including the following into your program.

1. Cable Chop Patterns – to activate the AOS, squeeze glutes, legs stabilise and AOS resists the extension and rotation of the cables as you chop from high to low.

2. Ball Catch-Twist-Throw – sit on a yoga ball, have a partner throw you a medicine ball, catch the ball whilst maintaining stable, twist to one side then twist back throwing the ball back. Repeat on the other side.

3. Standing Cable Chest Press – this increases the workload for the anterior trunk and legs. Stand with cables behind so you have to resist their pull. Then perform your chest press keeping the trunk stable.

4. Step Up to Press – Step up, raise trailing leg knee to 90° (forcing single leg balance and stability), then press the arms without the trunk folding and becoming unstable.
• Progression 1: drop to one band resisting the rotation pull of the band. Hold band in opposite hand to lead step up leg. Look for a good reach and avoid leaning back and turning out with the band.
• Progression 2: start side on, lead leg nearest step. This starts you in a turned out position forcing AOS to activate to turn the body into the step up, press and stabilise.

Posterior Oblique Subsystem…

The POS consists of the Gluteus Maximus, the opposite Latissimus Dorsi, and the Thoraco-Lumbar Fascia. The Gluteus Medius has also been considered as part of the POS by Brookbush Institutes.

The role of the POS is to stabilise the posterior “chain” (Lumbar Spine and SIJ). It transfers forces between the lower and upper body, and in particular combines pulling and turning out movements as well as decelerating whole body turning in or face down (pronation). It also helps control spine flexion and rotation, and hip flexion, adduction and internal rotation.

This subsystem runs from the Glute Max diagonally across the SIJ into lumbar fascia and into the opposite Latissimus Dorsi. The POS plays a big part in asymmetric movements such as walking with one side decelerating and one side accelerating thus requiring high levels of stabilisation.

Common Dysfunctions…

…Underactivity of POS…

The POS is almost always underactive and often in combination with either an overactive or underactive AOS. This can then contribute to dysfunctions in the upper body or the LPHC as mentioned.
To approach an underactive POS we obviously need to activate the muscles of this subsystem (Glutes and Lat Dorsi). This can be done using the following examples.

1. Glute Bridge Progressions – focusing on a good squeeze of the glutes.

2. Cable Squat to Row – squat holding cable out in front, under tension, as you stand tall, stabilise the trunk and row the bands in. Resist the pull of the band and avoid forward lean or sway.
• Progression 1: progress to single arm row, maintaining stable trunk position minimalizing twist of the trunk.

3. Step Up to Row – This is similar to the AOS step up to press, but the press is substituted with a cable row. But again focus on keeping trunk stable.
• Progression 1: progress to single arm row, maintaining stable trunk position minimalizing twist of the trunk.

Deep Longitudinal Subsystem…

The structures of the DLS are the Sacrotuberous Ligament in the hip, the Biceps Femoris (one of the hamstrings), Tibialis Anterior, and Peroneals. Other muscles have been suggested as part of this subsystem such as the Erector Spinae, and Piriformis (Brookbush Institute).

The job of this subsystem is to stabilise the Lumbosacral Joint Complex as well as the Medial Arch of the foot. It also controls the lower leg and foot during walking. It helps decelerate the lower leg during the swing phase of walking. It also controls foot position when striking the floor during walking by controlling lifting of the toes (dorsiflexion) and controlling the tilt of the ankle (inversion-eversion).

It also helps with proprioceptive communication (sensory feedback) of forces between the foot, knee and hip complex during high intensity activities. Therefore it helps ensure good positioning, balance and alignment of the lower body joints thus preventing injury. However, if this system isn’t functioning optimally this may not be the case.

Common Dysfunction…

This system is almost always overactive meaning Biceps Femoris and Erector Spinae to become dominant. Individuals may then present with low back pain, hip pain and an alteration in functional movements such as squatting, running or jumping etc. This alteration is linked to an excessive pronation (rolling flat) of the foot during activities. The ability to dorsiflex (raise the foot) is also inefficient and places excessive force on the structures of the foot. You may also notice an inward buckling of the knees, thus putting the ankle, knee and hip out of alignment during movement.

As with all the other subsystem we approach this by releasing the tight structures of the overactive DLS such as the biceps femoris, erectors spinae, peroneals, and often the piriformis. This can be done by seeking manual therapy, foam rolling techniques or active stretching work. Isolated hamstring exercises should be avoided as this will further activate the already overactive structures.

POS activation exercises as described above should be added to help support this subsystem and reduce the responsibility place on the DLS. To activate the POS you should basically include any leg work (squats, step ups, lunges) with pulling movements (row).

Lateral Subsystem…

This LS consists of the Gluteus Medius, Adductors, and opposite Quadratus Lumborum. Other muscles are considered to be involved such as the Gluteus Minimus, and Tensor Fascia Latae (Brookbush Institue).

The role of the LS is to stabilise the LPHC in side to side movements, it also transferring forces between the lower and upper body. It plays a significant part in single-leg movements, ensuring optimal alignment of the hip, pelvis, SIJ, and lumbar spine during both double and single leg stance.

Common Dysfunctions…

This can be underactive on one side but the opposite side will compensate and become overactive. This can cause dysfunction in the SIJ, and lower leg function. You will notice a drop of the pelvis to the side of under-activity when standing on one leg. The standing thigh will also adduct, as well as some side flexion of the trunk. This will affect the alignment of the leg during single stance exercises and cause unnecessary forces will be placed on the structures of these joints.

Like the majority of dysfunctions in the other subsystems an underactivity of this system often pairs with an underactive POS and overactive DLS.

As discussed before tightness of the overactive muscles should be released. The common shortened muscles are the quadratus lumborum, and adductors. However muscles such as the gluteus medius can be underactive, and therefore the approach should be release the QL and adductors but activate the gluteus medius.

You can then include POS exercise as described earlier as well as single leg exercises with shoulder exercises such as:

1. Step up to single leg stabilisation then curl and press (keeping hips level and core engaged, avoiding side bend).

Also include glute medius activation:
2. Clams

3. Side Plank – but avoid dynamic side bending exercises.

Intrinsic Stabilisation Subsystem…

The ISS consists of the Tranversus Abdominis, Multifidus, Pelvic Floor, Diaphragm, and the Thoracolumbar Fascia. The Brookbush Institute considers the Internal Obliques as part of this system too.

Its role is to increase abdominal pressure, increase the stiffness of the spinal segments and SIJ, and stabilise the LPHC. The pressure created by pushes back on the vertebrae reducing any forward moevement that may be caused by excessive spine extension or over-activity of the QL, Latissimus Dorsi or Erector Spinae.

The Multifidi provide feedback to the central nervous system allowing continuous alteration of movement and postural, this helps with spinal alignment and stability during activity.

Common Dysfunctions…

Like the POS this subsystem is almost always underactive which leaves us prone to disc herniation (slipped disc), sprains and strains of the spine, as well as LPHC and SIJ dysfunction. It will also affect posture, and stability of the trunk, spine and core during activity. Its ability to withstand sudden position or postural changes, or impacts to the body, this leaves us at risk of injury.

To approach this system the muscles need activating. They are only small muscle groups so there isn’t a huge amount of movement but the following exercises can be introduced to any warm up before training.

1. Draw belly button to the floor in lying position, this can be done by “squeezing the anus” (transversus abdominis activation)

2. Kneeling “superman” exercises – ensure the transversus abdominis is activated throughout.

3. Explosive Moutain Climbers – do these explosively keeping trunk straight and stiff.

Overview of Subsystems and Dysfunctions…

Below is a table of which systems are usually underactive or overactive in certain dysfunctions. Along with the discussion above this may help you approach how to deal with any issues you have and what to include and take out of your training.

SubsytemISSPOSLSAOSDLS
Upper Body DysfunctionUnderactiveUnderactiveOveractiveOveractive
LPHC DysfunctionUnderactiveUnderactiveUnderactiveOveractive
SIJ DysfunctionUnderactiveUnderactiveUnderactive on affected side
Overactive on opposite side
Underactive on affected side
Overactive on opposite side
Overactive
Lower Leg DysfunctionUnderactiveUnderactiveOveractive

Reading Suggestion…
http://brentbrookbush.com/category/core-subsystems/

It’s All In The Hips!

Trapped in Squat Pain? Release Yourself!!

The squat involves a whole complex of joints and problems can occur at any and sometimes all of these joints. For this article I will look at pain within the hip joint complex during squatting. This is something I have experienced and had a lot people ask me about.

There are an infinite number of things that could cause pain in the hip and without delving deep into everything I want to focus on an impingement like, nipping pain that often occurs during deep flexion of the hip such as in the bottom of the squat. This deep flexion of the hip occurs during everyday activities too however such as stair climbing or sitting into a chair. Therefore it could be very debilitative for some if this pain is persistent and not addressed.

I have read around this subject and also analysed my own and others squat. Many of the people who experience this have some or all of the following symptoms.

Common Symptoms. . .
• Pain that occurs in the front of the thigh and hip, feels like a nipping or catching
• Pain in the front or outside of the knee
• A feeling of tightness and congestion in this front thigh/hip area
• Pain in the lower back

On analysing the squat I then found some common dysfunctions or compromises evident on both my own and others squat technique. Things I found were as follows:

Signs of Dysfunction and Compromise. . .
• Knees may bow or collapse in with an inability to keep them pulled out
• There is an excessive forward lean of the upper body
• Arching and overextension of the lower back
• Shift of weight on to one leg
• Shift of weight onto the toes

What Could Be Happening? . . .
There is no one factor that will be responsible for a dysfunction, or pain. You should not rule out any pathology or condition so if the problem doesn’t subside with an attempt to self-treat then visit a medical professional. I have found both in myself, and others that there are some common factors present in individuals with squatting pain or activity related pain in the LPH complex. These factors are:

• Joint Dysfunctions
• Shortened, Overactive Muscles
• Lengthened, Underactive Muscles

Joint Dysfunctions. . .
Dysfunctions can occur at any point in the “chain” during the squat. However, for this article we will focus on the hip and pelvic area. If this joint is altered in terms of positioning this will have a knock on effect on the movement occurring at these joints and thus overall movement compensation. Another effect of an alteration in joint position is the ‘nagging’ or impingement like pain in the hip. Areas I have found to be dysfunctional in those (and myself) with this hip discomfort are as follows:

• Head of the Femur (Thigh Bone) sits more forward in its socket
Shirley Sahrmann proposed some familiar muscle imbalances to be contributors to this anterior translation. One of these is a tightness in the posterior capsule in combination with weak gutes prevents the femoral head from gliding backwards when the hip flexes, therefore the femur is forced forward. Along with this there is a proposal that one of the hip flexors (psoas major) is actually weak and unable to stabilise the hip into its socket. This allows this forward translation and creates the ‘nipping’ during a squat as the head of the femur can’t glide backwards as we flex the hip, instead it remains forward catching the soft tissues in the front of the hip.

• Anterior rotation of the sacroiliac joint (SIJ). . .
This is a very common alteration in the athletic and active population. A lot of people tend to be front dominant in their activities and therefore these front muscles become overworked and tight. A lot of people mention tight hip flexors when it comes to forward tilting of the SIJ and the pelvis. However, Sahrmann mentioned that the psoas may be actually be weak if the head of the femur is translating forwards. The psoas is a hip flexor but I believe the rectus femoris (one of the quadriceps, and hip flexors) is hugely responsible for anterior pelvic tilt. This muscle attaches to the inferior spine of the ilium and therefore if it is tight it will pull this and thus the pelvis forward. The psoas could still be weak and actually part of the reason the rectus femoris is tight as it may be working overtime to make up for the psoas weakness. If the glutes are also weak, as mentioned above, they will be unable to rectify any anterior tilt of the pelvis.

If the femoral head translates forwards as well as an anterior tilt of the SIJ and pelvis. This will close the space within the hip joint itself and therefore increase the likelihood of impingement and discomfort when moving through ranges of motion at the hip. During a squat you already close the angle between femur and pelvis so if there is an excessive amount of forward tilt even before we start squatting this will cause obvious problems.

Shortened, Overactive Tissues. . .
There are many muscles that could be involved in problems at the hip but for the purpose of this article I will discuss the major muscles I have found to be major contributors to hip pain during squatting.

• Rectus Femoris (part of the Quadriceps)
• Adductors (or groin muscles)
• TFL (outside of the hip, causing tightness in the Iliotibial band or ITB)
• Erector Spinae (lower back muscles)
• Piriformis (deep muscle in the buttock region)
• Hip Capsule

So when experiencing some form of hip pain assess these areas, if shortened they may feel tender to touch. One step to attempting to rectify your hip position and ultimately your pain would be to release these tight tissues. There are many ways to approach this, stretching, foam rolling and self-release, or deep tissue massage. These will be covered in the treatment section of this article.

Lengthened, Underactive Tissue. . .
• Gluteus Maximus (big glute muscle)
• Gluteus Medius (smaller glute muscle)
• Rectus Abdominis (“Abs” or “6-pack”)
• Transversus Abdominis (internal core muscle)
• External Obliques (muscles around the side of the core)

If these muscles are weak they are unable to aid the stability and proper control, and movement of the hip and therefore these compensatory patterns of movement and altered joint positioning occur. To attend to this issue, we do what we would normally do with a weak muscle, we train it to strengthen it and activate it. How we do this will be covered in the treatment section of this article.

Just for a second we will go back to the common dysfunctions and look at these in relation to the above contributing factors.

• Knees may bow or collapse in with an inability to keep them pulled out
This could be attributed to the tight adductors pulling the knee and thigh inwards, as well as having the weak glutes being unable to externally rotate the hip and pull the knee outwards. Therefore if you experience this bowing in of the knees then maybe try stretching and releasing the adductors and also strengthening the glute muscles in particular the glute maximus and medius.

• There is an excessive forward lean of the upper body
This could be due to the tight rectus femoris pulling the body forward from the pelvis with a weakness of the core and glutes being unable to stabilise and pull the trunk respectively during the movement. It may also be the hip capsule tightness restricts the hip movement and therefore the upper body needs to lean excessively to achieve squat range of movement. Therefore if you notice a forward lean then try strengthening the whole core (abs and deep core) as well as loosening the hip capsule, and rectus femoris.

• Arching and overextension of the lower back
This one will more than likely be due to the tightness of the erector spinae muscles pulling the lower back into the arched position. But also the weakness and inability of the rectus abdominis to pull the spine forward, and the glute inability to pull the pelvis backwards and thus the lower back out of an excessive arch. Therefore when feeling this arch occur work on loosening those lower spinal muscles, and strengthen the glutes and rectus abdominis (abs).

• Shift of weight on to one leg
Now this could occur due to a simple imbalance of strength from one leg to another, a leg length discrepancy or previous injury. However, looking at the structures that are usually tight it could also be the tightness of the TFL because if the foot is fixed the hip cant abduct so contraction of this tight muscle will tilt the upper body from the hip causing some sideways lean and potential for a shift of weight to one foot. A weakness of the obliques will also mean that the core cannot stabilise itself in this sideways plane as well as it should. Therefore this tightness and weakness could be addressed if this occurs.

• Shift of weight onto the toes
This is usually due to ankle mobility restrictions due to tight calves and not directly related to the hip, however it could have a knock on effect because if this starts to occur it will cause compensations further up the chain. Therefore if this is noticed then it needs addressing.

Treating Yourself. . .

Addressing Joint Dysfunctions. . .
When it comes to adjusting this alteration in joint position and mechanics we need to physically manipulate this joint. This is usually done manually by a therapist however, there are many ways in which you can apply similar mobilisations yourself using resistance bands.

1. Addressing Anterior Translation of the Femoral Head
The issue is that the head of the femur is stuck in a forward position and doesn’t glide as it should in the socket which causes the discomfort we feel during movements of the hip. Good ways of addressing this situation are as follows:

• Kneeling Banded Mobilisation – attach a band at kneeling hip height behind you. Place your affected leg through the band and place it high up into the groin region so it covers the hip joint. Kneel on all fours. You should adjust you distance from the band to alter the tension, you want to feel the band pulling the hip joint back. Once you have a good tension you can rock back and forth sitting onto your heels and back. You can also rotate you hip in and out from this position by twisting your leg so you lower leg moves side to side. The direction of pull can be altered in order to pull the head in different directions and mobilise the hip in various directions. You can perform 30 or so reps with band at one angle and then change angle and do another 30. Do a couple of sets at each angle of pull and also the rotations.

• Standing Split Squat Banded Mobilisation – stand through a band attached behind you at hip height wrap around the affected leg. Then perform a split squat, leading with your good leg. Adjust your position to alter the tension on the band, tension should be enough to pull the hip joint back as you dip into the split squat. Do 15-20 for 3 sets.

• Banded Step Ups – attach the band behind you again and place your leg through it wrap up into the groin around the head of the femur. You then want to step up with the banded leg and perform your step up. Choose the tension wisely as you don’t want it pulling you off the step/bench, but you want enough to pull back on the hip joint. Ensure you get full extension on the step up and if you want to engage the core too try not to touch down with the trailing leg and raise it up so thigh is parallel to the floor before stepping back down. Do 10-15 step ups.

• Lying Wall Squat With Rotation – Lie on your back with your feet flat against the wall and hips and knees bent as though in the bottom squat position. From here you can allow your knees to fall out stretching the inside of the hip and the adductors (groin). Extra pressure can be applied by the hands for more stretch on this. You can also then cross one foot over the other knee, as though cross the leg. Once crossed you can press down on the crossed-leg knee pushing it towards the wall. This can be pressed and held or can be oscillated in and out stretching the capsule.

To make the banded exercises effective you should have enough tension so you can feel the band pulling the head of the femur feeling it glide slightly as you move.

2. Addressing Anterior Pelvic Tilt
This is a common problem and is a fairly simple fix if you put in the time and work. It comes down to primarily two things. Tight anterior (front) musculature pulling the top of the pelvis forwards, and under-active posterior (back) musculature not pulling the top of the pelvis backwards. This imbalance then has the overall forward tilt of the pelvis. This in turn then alters the position of the hip joint as discussed above. So based on this the way to approach this is simple. Lengthen the tight tissues, and activate the under-active tissues.

• Foot Up Hip Flexor Stretch – This is similar to the Bulgarian Split Squat. Place the laces of your shoe on a bench and lunge the opposite foot forward. Then drop your hips towards the floor, keeping the foot in contact with the bench. You are wanting to feel a stretch right up the quad and into the hip flexor, this can be further stretched by raising the arms straight above the head and keeping the torso upright as you drop down. You eventually are aiming to be able to get the trailing knee to the ground, getting the raised foot against the buttocks, whilst keeping the torso upright so knee, hips and shoulders are all inline. This should be held for 30secs once a stretch is found or can be gently oscillated in and out of stretch 20-30 times.

• Lying Quad Stretch – lie face down with legs straight out. Then grasp one foot behind you by bending the knee, pull the foot into your buttocks. Aim to keep the pelvis, hips and core flat on the ground. If you struggle to grab your foot without raising the hips or arching the back you can use a band or towel and use this to pull your foot close to your buttocks without compromising position of the hips etc. Hold this stretch for 30 secs and repeat 3 times.

• Single Alternate Leg Wall Push – lie on your back next to a door frame. Bring the foot closest to the door frame up so it is flat against the frame, you want to have the knee as bent as you almost like this side is a deep squat position. Have the other leg out straight. Then you want to push hard down on the frame with the foot flat so the glutes are firing. Hold this for 20 secs or so, relax then repeat 5-10 times. Then you can swap sides so other foot is pushing down. This causes the glutes to maximally fire aiming to pull the pelvis back and into a better position, rectifying any anterior tilt.

• Single Leg Bridges – lie on your back with the feet flat and knees bent. Then raise one foot off the floor completely straightening and outstretching the leg. Then push through the flat foot, firing the glutes, and raise the hips off the floor until your knee, hip and shoulder is flat and in a diagonal line. Hold at the top for a second or two, keeping the core engaged, then lower under control then repeat. Do 3 sets of 15-20 reps.

You should also learn to adjust your own posture to help rectify any stuck hips or tilted pelvis.

• Stand up tall
• Squeeze and contract the glutes hard
• Flex the abs and engage the core and transversus abdominis so you stomach is pulled in and ribs pulled towards the pelvis slightly.
• Once all contracted you can ease off slightly as walking around in a fully flexed state is not comfortable, so ease off to about 50%.

3. Other Areas to Strengthen. . .
The following areas will help maintain good hip and pelvis as well as help stabilise the complex of joints and tissues.

• Superman – kneel on all fours and level your spine so it is flat, then attempt to pull your navel towards your spine without moving your spine or over-contracting your abdominals. To do this you should pretend you are trying to cut off your flow of urine mid-flow or clenching your rear passage. This is the best way to cue the Transversu Abdominis (deep core muscle) to activate. Once you can master contracting this muscle and keep core flat, then raise one arm straight out in front of you. As you do this raise the opposite leg straight out behind you, then lower them both and repeat with the other arm and leg. If you feel any movement in your spine or abs, or you feel your Transversus Abdominis turn off then stop reset and start again. Do 15-20 reps each side for 2-3 sets.

• Half Plank Progressing to Full Planks – the plank is often done wrong to reduce the difficulty of the exercise. The shoulders, hips and knees should be all in line with no sag of the stomach or arch in the lower back. If you struggle to do this without lower back arch, or a sag in the hips or stomach start with a half plank with the knees on the floor. Hold the plank for 30-40 secs for 3 sets.

• Straight Leg Reverse Crunch – Lie on your back and grasp some stable object behind your so your shoulders and arms are fixed still. Then squeeze your abs pulling your legs towards your chest, keep legs as straight as possible to avoid excessive firing of the hip flexors, you are only aiming to lift the hips off the floor so don’t need to fully bring legs into the chest. Also avoid any excessive folding of the pelvis. Perform 3 sets of 15-20 reps.

• Glute Medius Clams – lie on your side and bend the knees to 45° with one foot on top of the other. Then open the knees apart as far as you can without twisting your body or separating the feet. There may not be a huge movement you are looking to feel the outside of the glutes activating here. Do 20-30 reps on each side.

• Active Oblique Activation – lie on one side keeping the bottom leg straight and in line with the shoulders and neck. Bend the top leg to 90° out in front of you. Grasp the underside of your this thigh with your bottom hand. Place your top hand on the back of your head, with the elbow pointing to the ceiling. Then try touch your top elbow to the floor by rotating the core inwards, hold briefly at this point then rotate the core outwards, opening the body out and try get your back and arm flat on the floor, keeping you hand on your head. Again hold at this end point. Perform this for 15 or so reps. Check this link for a demo. https://www.youtube.com/watch?v=vxocwecYjqE

4. Foam Rolling and Self-Release
I could write a whole article on this area alone with the vast range of exercises available. However, I thought I would share a little gem of simplicity that can be used when trying foam rolling or self-release exercises. If you find an area that is tight or shortened you can pick up your foam roller, barbell or hockey ball etc. (something solid to apply pressure to the muscle tissue) and do the generic sit on it and roll. This may give you some relief but there is so much more you can do.

• Contract-relax – place the body area on the roller, hunt around until you find a sore, painful, tight spot. Once you find this spot hold as much weight over it as you can, holding it still on the roller. Then contract the muscle, in a static contraction and hold it for 5-10 secs, when you relax try put more weight onto the area via the roller. Do this until you notice an improvement in pain.

• “Lock and Load” – this is a concept I decided to term lock and load. If you find a muscle that is short or tight, you can place a “lock” on the muscle near the tight area. This can be done by placing the roller or cricket ball etc. across the muscle belly or near the tendon (depending where the tightness is felt in the muscle). Once the lock is in place you can “load” and move the muscle into stretch through full range as far as you can. As you do this keep pressure on the muscle locking it in. then you can release the lock and return to start. You can then repeat on same area until improvement occurs or find another tight area.

There isn’t any really right or wrong way to do this. Simply find an area that is tight and go at it using these methods as well as your generic sitting and rolling on a foam roller. For example if my quad feels tight just above the knee I will lie face down and place this thigh on a roller. The roller will sit at the end of the muscle at the top of the knee near where it starts to meet the tendon. Once there I will lock it in putting my weight through it. I will then move my heel towards my buttocks so my quad stretches. This pulls the fibres from the “lock” stretching the tight area.

Take Home Message. . .
If you are suffering with a nagging hip pain during your squats, or even just a noticeable anterior pelvic tilt (which could lead to hip pain) try addressing the above issues using the exercises above.

Basically all you need to consider is to lengthen and stretch the shortened tissues (listed above), and strengthen the weaker, lengthened tissues (listed above). By addressing these common characteristics you may help alter any alteration in joint and pelvis position, as well as create more space for the hip joint to glide during your squats.

You should always gain medical advice for any long lasting hip complaint that is not relieved with exercise or with time. The above is not an alternative for seeking advice from a medical professional it is merely what I have found to be successful for myself and some of my clients.