Hip pain - particularly of the anterior (front of the hip) variety - is a very common problem in the weight training population.
In her book, Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann discusses Femoral Anterior Glide Syndrome in excellent detail. And, while it may seem like an obscure diagnosis, it's actually a really common inefficiency we see in a weight training population.
In order to understand this syndrome, you have to appreciate the attachment points and functions of the hamstrings and gluteus maximus. With the hamstrings, you'll notice that they attach to the ischial tuberosity of the pelvis (with the exception of the short head of the biceps femoris, which attaches on the femur), and then run down to a point inferior to (below) the knee. In other words, they are a two-joint muscle group. All of the hamstrings aid in knee flexion, and all but the short head of the biceps femoris also aid in hip extension.
Conversely, the glutes attach on the pelvis and the femur; they're a one-joint muscle - and this is why they can so directly impact hip health.
You see, when the hamstrings extend the hip (imagine the hip motion that happens when one comes out of the bottom of a squat), they do so in a "gross" fashion. In other words, the entire leg extends. In the process, there is little control over the movement of the femoral head ("ball" in the "ball-and-socket" hip joint) - and it tends to migrate forward during hip extension, giving you a femoral anterior glide syndrome. In the process, it can irritate the anterior joint capsule, and this irritation can give a sensation of tightness in the front of the hip.
Fortunately, the glutes can help prevent the problem. Thanks to their point of attachment on the superior aspect of the femur (closer to the hip), they have more direct control over the femur as it extends on the hip. As a result, they can posteriorly pull the femoral head during hip extension. So, in an ideal world, you get effective co-contraction of the hamstrings and glutes as one extends the hip; they are a system of checks and balances on one another. If you use the hamstrings too much in hip extension, you're just waiting to develop not only femoral anterior glide syndrome, but also hamstrings and adductor magnus (groin) strains and extension-based back pain.
As an aside, this hamstrings/glutes relationship is somewhat analogous to what you see at the shoulder with the subscapularis posteriorly pulling the humeral head as the infraspinatus and teres minor allow it to drift forward. That's another newsletter altogether, though!
Once the femoral anterior glide issue is in place, the first course of action is to stop aggressively stretching the hip flexors. While the issue gives a sensation of hip flexor "tightness," in reality, stretching the area only exacerbates the anterior hip pain. A better bet is to just ditch the stretching for a few days, and instead incorporate extra glute activation work. Eventually, though, one can reintegrate both static and dynamic hip flexor stretches.
Just as importantly, it's important to identify the causes. We'll see this issue in runners who have no glute function, but more commonly, I'll see it in a weight training population that doesn't understand how to complete hip extension. Here's what a hamstrings-dominant hip extension pattern would look like with squatting.
The final portion of hip extension is when the glutes are most active, so it's important to "pop the hips through" at lockout of deadlifts, squats, pull-throughs, and other exercises like these. In the same squat example, it's really just as simple as standing tall:
Of course, this is just the tip of the iceberg when it comes to hip issues in athletes, but it's definitely something we see quite a bit. If you'd like to learn more, I'd highly recommend you check out our Functional Stability Training series, particularly the Lower Body and Optimizing Movement editions. They're on sale for 25% off through tonight (Cyber Monday) at midnight.
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This might be surprising to some, as one would think that any sort of physical activity would benefit untrained elderly individuals. However, I wasn't surprised at the results at all, given all the research I'd done to prepare for The Truth About Unstable Surface Training. And, I wasn't surprised at all when I realized that this had significant parallels to how we train balancing proficiency in athletes.
It's important to understand first and foremost that balance and proprioception (and, therefore, stability at a certain point in time) are skill-specific. In particular, one must appreciate that static balance - which is typical of Tai Chi - is markedly difference from dynamic balance, which we encounter all the time in everyday life and in the world of athletics.
For proof, one mustn't look any further than when Drowatzky and Zuccato (1966) found little carryover from static to dynamic balance (1). Tsigilis et al. confirmed this finding 35 years later (2). And, it's one reason why I feel so strongly that we have to qualify our unstable surface training (UST) recommendations. UST necessitates a significant amount of static balance that may not transfer to sporting movements, which typically are more dependent on dynamic balancing proficiency.
From my e-book on the subject, "Previous research has demonstrated that scores on static balance tests are not useful information when attempting to predict inversion ankle injuries in soccer players (3). This lack of correlation implies that methods to improve static balance may not be effective training approaches to prevent injuries in dynamic sporting contexts - especially when dealing with athletes with no recent history of lower extremity injury."
Now, we know that we can't train complete specificity 100% of the time. Otherwise, in the elderly, we'd be trying to simulate every kind of fall that is possible. And, in a football player, for instance, we'd be trying to simulate every kind of tackle a running back could possibly encounter. So, what do we do? Once again, we look to the research!
In a study by Bruhn et al., a high-intensity strength training group actually outperformed the unstable surface training (static balance training) group on measures of static balance (4). In other words, one group trained static balance, and the other didn't - and the one who didn't train static balance directly actually improved the most overall. Maybe muscle cross-sectional area played into it? Maybe it occurred because of increased stabilization via enhanced intra- and intermuscular coordination that would allow for more rapid and effective force production (strength and rate of force development)? Maybe true specificity isn't as important as we thought?
1. DROWATZKY, J.N., AND F.C. ZUCCATO. Interrelationships between selected measures of static and dynamic balance. Res. Q. 38:(3) 509-510. 1966.
2. TSIGILIS, N., E. ZACHOPOULOU, T. MAVRIDIS. Evaluation of the specificity of selected dynamic balance tests. Percept Mot Skills. 92(3 Pt 1):827-33. 2001.
3. KONRADSEN, L. Factors Contributing to Chronic Ankle Instability: Kinesthesia and Joint Position Sense. J Athl Train. 37(4):381-385. 2002.
4. BRUHN, S., N. KULLMANN, AND A. GOLLHOFER. The effects of a sensorimotor training and a strength training on postural stabilisation, maximum isometric contraction and jump performance. Int J Sports Med. 25(1):56-60. 2004.
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