Poor hip control and pelvic stability has been indicated as a possible cause of several running and sports injuries, including runner's knee, iliotibial band syndrome, and ACL tears. In this article, we explain how to test your hip control.
In this article:
Quick test for hip control
Stand in front of a mirror and balance on one leg. Now bend your knee to do a single leg squat. Look at the angle between your hip and where your knee moves. Your knee should stay in line with your second toe and your pelvis should stay level.
If your knee moves in past your big toe or your pelvis drops, it may mean that you have weak hip stabiliser muscles. Doing hip strengthening exercises may decrease your risk of injury.
Hip stability: The glute med is only half the story
Most people these days will tell you that you have to strengthen your Gluteus Medius (Glute Med) muscle to improve your hip stability. We fully agree with that, but the Glute Med is not the only muscle in charge of stabilising the hip and pelvis.
Fetto et al. argues that the Glute Med alone is not able to prevent the pelvis from dropping during walking. The hip has to absorb the biggest force during the mid-stance phase of gait, so you would expect the glute med to be the most active during this phase. EMG studies (where they test muscle activity) have shown that the glute med is actually most active just before mid-stance which indicates that another structure or muscle must also play a role. They also go into details about how much energy it would cost etc. etc. but you can read their full article here if you are interested.
They point out that a person, whose leg is amputated above the knee, always walk with increased hip adduction or a Trendelenburg sign, while a person whose leg is amputated below the knee does not. The difference between the two procedures is that the iliotibial band is cut during the above knee procedure but not the below knee one.
The iliotibial band is thus an important passive stabiliser of the hip and pelvis. No one really ever talks about strengthening the Gluteus Maximus muscle (Glute Max) to improve frontal plane hip and pelvic stability (to stop the thigh moving in and the pelvis dropping). Fetto el al., however, points out that 75% of the Glute Max attaches onto the iliotibial band and they therefore argue that the Glute Max has an important role to play in tensioning the iliotibial band and stabilising the pelvis.
Summary - what exercises to focus on:
You should do hip strengthening exercises that will strengthen the Gluteus Medius as well as the Gluteus Maximus muscles to improve your pelvic and hip stability during running and walking.
Gluteus medius exercise
The Clam exercise is a good place to start. They should be done very slowly to teach yourself to isolate the muscles and control the movement. Once you can manage 3 sets of 15 slow repetitions of this exercise, you should move on to more challenging exercises in standing.
Starting position: Lie on your side with your hips bent to about 60 degrees and your knees at a 90 degree angle.
Movement: Tighten your stomach muscles to help stabilise your trunk during the movement. Keep your feet touching but lift your top knee up and back, so that your legs separate and open like a clam. Hold the position for 3 seconds and then SLOWLY take your leg back down.
Check that: Your pelvis or hips do not roll back as you lift your leg.
Gluteus maximus exercise
A good exercise to start with to activate and strengthen the Glute Max is the bridge with your feet on a chair or step.
Starting position: Lie on your back with your hips and knees bent to 90 degrees and your feet on a chair.
Movement: Tighten up your stomach muscles and lift your bottom off the floor until your trunk and pelvis form a straight line. Squeeze your buttocks and hold the position for 10 seconds. Repeat 10 times.
Check that: You do not put too much pressure on your neck and that you do not over-extend your back by trying to lift your hips too high. It may be an indication that you are forcing the movement too much if your back hurts afterwards.
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
About the Author
Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.
