HIP

Squats and Hip Dysfunction

 

 

Movement disorders and motor programming are all the rage in the physical therapy and fitness worlds these days, and that’s a great thing. We’re stepping back and opening our eyes to the entire body as a system, trying to understand the positions and habits that lead to problems, rather than simply treating the joint as a joint and the muscle as a muscle.
 
The hip is one of the most powerful joints in your body and as such, plays a major role in many athletic movements. Dysfunctions of the hip musculature can hinder your athletic performance and lead to multiple types of injuries. The squat is one of the most basic movement patterns of the hip and yet it is often something people struggle to perform with perfect technique. We’re going to take a look at the two most common dysfunctions at the hip, how they affect your squat, and what you can do to fix them.

Common Dysfunction #1: Posterior Weakness or Weak Glutes

Of the various issues involved in poor squat technique, poor glute control and strength are easily the largest factors.  Movement dysfunction is a game of compensation. When you place a movement demand on your body, it’s going to try it’s hardest to perform it. If it can’t do so using the correct muscles, then it’s going to start firing all sorts of funky stuff in a mad dash to satisfy your demands.
The gluteus maximus is a primary mover of hip extension. Weak glutes mean weak extension. If this is you, then during the eccentric (lowering) phase of the squat there’s a good chance you’re going to start tipping forward. People talk a lot about core tightness and abdominal bracing as it relates to the forward lean and that’s absolutely valid - but also secondary.  The first step to maintaining an upright torso is proper eccentric glute control. If you don’t have the glute strength to maintain and drive hip extension, then your lower back will kick in to compensate and guess what?  It’s not really suited for the task. 
 
Another issue with poor gluteal control is the compensations it causes in the anterior hip musculature. When we tip forward during a squat a couple of “not so good” things happen involving our hip flexors. First, they will frequently begin to fire in order to help us balance because our glutes aren’t doing the job. Second, and weirdly enough, they will also activate in an attempt to pull us into deeper flexion. In other words, they’re trying to help us squat lower than our gluteal control should allow. The result of this compensation is an over-activation of the anterior hip musculature.

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Common Dysfunction #2: Anterior Tightness or Tight Flexors

The primary movers in hip flexion are the rectus femoris (one of your quadriceps), sartorius, and the iliopsoas (the deepest and strongest of the hip flexors). There are a few smaller muscles that also play a role, but typically when you have tight or inflamed hip flexors it’s due to a dysfunction of one or more of those muscles listed above.
 
In a general, most hip flexor tightness isn’t the result of activity, but rather a consequence of the passive positions we maintain throughout the day, like sitting. While the squat can actually be a profoundly therapeutic exercise in terms of restoring proper gluteal activation and helping mobilize the front of the hips, when done incorrectly it will do the exact opposite: reinforce the negative positions and unwanted compensation patterns.
 
When your flexors are tight you will have a tendency to lean forward while squatting. A forward lean will shift your center of gravity forward and increase activation of your quadriceps while decreasing activation of your glutes.  Also, once you’re in the bottom position and your hip flexors have turned on, your body is going to want to use your quads to extend your knees, and guess what? Two of the three main hip flexors are attached to your quadriceps, which are now firing.  As a result, when you stand up your hip flexors are going to stay shortened, contributing to an anterior pelvic tilt (forward roll of your hips) and make it really difficult to adequately activate the posterior hip muscles.
 
Another issue with tight hip flexors is that they are usually an indication of missing hip flexion or a lack in hip mobility.  Like I mentioned earlier, your hip flexors will frequently turn on as a way of pulling you down into deeper hip flexion. But they really shouldn’t have to.  In an ideal world, you should have enough passive flexion to achieve the proper depth without the help of your hip flexors.
 
Ok, so we may have figured out the problem, now let’s fix them!

Fixing the Problem
Often when diagnosing a movement disorder, you are dealing with a bit of a “chicken-or-the-egg” dilemma. Was it anterior tightness that caused posterior weakness or the other way around? As with most things, it’s probably a bit of both. What degree of each, though, is unique to each individual?  It’s possible that you started squatting and due to your forty-hour-a-week desk job you already had profound issues with all of the aforementioned problems. It’s just as possible, though, that initially when you started squatting your mechanics were pretty good but you increased the weights too quickly and this got you in the habit of using negative compensatory motions. Regardless, the most important thing is identifying the existence of the improper movement patterns and subsequently addressing them.
 
Hip Flexion and Hip Mobility Fixes

Quadruped Rocking With Active Shoulder Flexion:
 
1.    Get on all fours.
2.    Push with your arms and drive your hips backwards until your hips are sitting on your heels (or as close as you can get, anyway).
3.    Make sure the motion is coming from your shoulders rather than your hips.
 

This exercise is like a trick to get your body to move into a position of deep flexion without activating your hip flexors. If you get on all fours and simply start shifting backwards, then it’s pretty likely you’re going to engage your flexors to do so. By focusing on pushing with your shoulders, you’re using different muscles to produce the movement and that should allow you to achieve the position without activating your hip flexors. 
 

 

 

Thomas Stretch:
This exercise is the same thing as the Thomas Test I described earlier, but this time rather than simply observing the position of the thigh, have someone gently press your thigh downwards until you feel a stretch through your quad and the front of your hip. Hold this stretch for thirty seconds to a minute.  Repeat 3-4 times. 
 
Personally, I am not a huge fan of a lot of the other hip flexor stretches because most of them involve you being upright.  As long as you’re upright, and more than likely having trouble balancing, then you’re hip flexors are probably going to fire. In other words, if you already have this dysfunction then your hip flexors are already prone to being over active. Stretching them in an upright position will turn them on to a degree, but what you’re attempting to accomplish is getting them to shut off.  See the dilemma here?
 

 

 

 

 

 

 

 

Paleolithic Chair:
 
I think the most effective stretch or mobilization for overall hip mobility is the Paleolithic Chair. Get down as low as you can while keeping your heels on the ground and hang out there. If you have to grab onto something to maintain balance at first, that’s fine - just focus on getting low and keeping your heels on the floor. Try to do this for three to five minutes at a time initially. Ideally, you will build up to a total of about ten minutes a day.
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posterior Strength and Gluteal Activation Drills
The best way to get your glutes firing during a squat is to do some basic warm-up drills that will reinforce glute activation. Here is an example of a glute warm-up routine:

[caption id="" align="alignnone" width="460.0"]1.    Glute Bridge - 10x (both legs) 1.    Glute Bridge - 10x (both legs)[/caption]

[caption id="" align="alignnone" width="460.0"]2.    Single Leg Glute Bridge - 10x each leg 2.    Single Leg Glute Bridge - 10x each leg[/caption]

 

 

[caption id="" align="alignnone" width="460.0"]3.    Fire Hydrants - 10x each leg 3.    Fire Hydrants - 10x each leg[/caption]

[caption id="" align="alignnone" width="460.0"]4.    Quadruped bent-knee hip extension - 10x each leg 4.    Quadruped bent-knee hip extension - 10x each leg[/caption]

 

 

 

You can perform all of these fixes as a five to ten minute mobility and warm-up session before you squat, which should significantly improve your squat positioning. But really, the simplest fix for weak eccentric glute control is also one of the most straightforward: lighten your weights and focus on your form, with specific attention to keeping your torso upright. Mindfulness of your movements and strict adherence to proper patterns is the best medicine for your ailments.  Good luck, and get squatting!

 

References:

www.movementasmedicine.com

www.athletesequation.com

www.tonygentilcore.com

www.breakingmuscle.com

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