It’s All In The Hips
As a shout out to my late sister, Heather, every time I hear “It’s all in the hips,” I think of that Adam Sandler movie, Little Nicky.
Yeah, it’s not a great film. Until just now I secretly found it hilarious.
Anywho, fire-breathing Adam Sandler aside, you can see that this post will be about the hips!
Having strong, flexible, mobile hips can be the difference between healthy, productive aging and costly, emotionally/physically draining hospital and rehab trips after a fall and a broken hip. Strong, healthy hips can also lead to the ability to remain functionally independent for longer periods of time (1). There are many exercises that can increase mobility in and strengthen the hips; all of these exercises can be modified regardless of the senior’s fitness level and mobility.
First, a little anatomy!
Did you know that the most common location of a “hip fracture” is actually the femoral neck?
This picture illustrates basic hip structure:
The hip is one of the largest joints in the body and is responsible for many everyday functional actions from walking, to rising from a chair to shaking your booty (that last one is “FUN-ctional“). It is a major weight bearing joint that is a ball and socket, meaning one bone ends in a ball (head of the femur) and that ball fits into an area on another bone which acts as the socket (acetabulum in the pelvis). Because of this formation, the hip joint has a wide range of motion (ROM).There are 4 groups of 17 or so muscles that cause movement around the hip joint. The groups are defined by their location around the joint:
- gluteal group – the muscles in your butt move your leg back behind you
- lateral rotator group – muscles that move your legs away from each other
- adductor group – muscles that move your legs towards each other
- iliopsoas group.-hip flexors or the muscles that lift your leg forward
Typically older adults (and those younger adults who have a sedentary lifestyle, a desk job or drive a lot, like me) tend to have very tight hip flexors and a weak gluteal group. I see a lot of tightness and weakness in these areas particularly when a client attempts a squat or a sit-to-stand action. Tight hip flexors and weak gluteals often go hand-in-hand with weakness in the core particularly the Transverse Abdominus which can lead to dreaded low-back pain, lack of balance and eventual falls in frail elderly.
One of my goals is to work the muscles of the hip in such a way that I am targeting all the muscles of the hip as well as creating some muscle confusion by mixing up movements. For example, a sample hip-strength program might include alternating movements in different plains of motion (forward then side –to-side). The following is example of a simple exercise that can be taught to seniors who can walk with some assistance. If my client uses an ambulatory aid, I encourage that they ditch the walker/cane for this, and I spot them.
- a 4-square grid is taped to the floor with masking tape.
- I ask my client to stand in one square with their feet together.
- I instruct the client to make a box by stepping into each square: first to the right (or left), then forward, to the left (or right), then backward.
- This exercise can help increase range of motion (ROM) the hip and can help develop muscular coordination, so it is helpful for balance.
- It can be made more complicated by introducing a band around the legs or by introducing jumping or hopping from grid to grid.
- Many of my clients have said, “Oh, it’s like doing the fox trot.” Add music or I sometimes hold hands with my client and dance with them. (Believe it or not, they seem to do better if I make the exercise like a dance instead of keeping it robotic!)
But what about strength? There are numerous exercises that can strengthen the hips but one of my favorites is the old sit-to-stand. It’s more or less a squat except we use an actual chair to instill the idea of functional movement in the client.
Those people who have a interest or background in fitness tend to better understand and execute a true squat, but the chair is good for those who have a fear of falling or who are deconditioned. Once they are able to execute a sit-to-stand with proper form, I remove the chair. For added challenge, I do the sit-to-stand with the client and they have to keep up with me. Sometimes I see how many we can do in 30 seconds.
Other exercises include standing scissor kicks (hip abduction or movement away from the midline of the body), Psoas (hip flexor) Stretch, and walking! Some exercises for the hips also help build strength in the quadriceps (thighs) which is also important for maintaining functional independence.
Be aware of hip replacements and those recovering from a broken hip. We try to avoid hip extension and squat-like motions for at least 6 weeks after a hip replacement surgery, although walking is encouraged as are therapeutic exercises that can be done laying down (2).
Also, be mindful of bone loss and certain power exercises, total strengthening drills should be preformed for several weeks before attempting jarring movement to prevent injury.