Preventing Knee And Back Pain By Improving Hip Mobility

The hip complex is indeed a very complex joint –  no pun intended. It is responsible for almost every action we execute everyday. Like the shoulder, it is a a ball and socket joint which is capable of movements in all three planes of motion. In all my years in the fitness industry, I’ve noticed that the knee and hip joints of people seem to be the most vulnerable to injury. Some of you reading this have had your share of these joint pains. Some of these pains and injuies are due to falls, natural disasters and playing sports. However, many are a result of infrequent training of the hip complex and poor exercise selection leading to compensation of the knee and ankle joints.

If you look at the human body, you’ll see that the hip is located at the center of the body. This makes it come into play nearly every time we perform a task or action. Sitting, getting up, climbing stairs, playing sports, running and a plethora of other activities require hip involvement. But many of us have hip mobility issues, and because the body is one big chain of stack of joints, hip immobility can affect the knee and ankle joints. Many joint aches and pains can actually be resolved by strengthening the muscles of the surrounding joints. Even low back pain can be attributed to poor hip mobility. If the gluteus maximus muscle group is weak, it forces the opposing hip flexors to shorten and subsequently pull on the low back in seated positions. If the gluteus muscles, hip external and internal rotators are not trained often enough, it won’t be long before the knees, low back and even ankles are forced to compensate themselves in hip-dominant activities.

MUSCLES-OF-HIP

By strengthening the muscles of the hip, the lumbar spine is better equipped to handle everyday stress of life. Barbell squat, deadlift, single-leg squat, reverse lunges, hip thrust, step-up and certain quadruped exercises are some excellent choices for improving hip mobility and strengthening the muscles. Flexibility in the hip flexors, hamstrings, adductors and hip external rotators is also key to achieving and maintaining a strong and pliable hip joint. Active stretching and myofascial work will help improve flexibility in these muscles while keeping them lose and warm. The foam roller is arguably the most vital fitness accessory because of  its impact in reliving the body of aches, inflammation and tightness. Myofascial work via foam rolling or lacrosse and tennis balls may be advantageous over stretching because of its ability to go deep into muscle tissue.

Whether you’re an all-around gym enthusiast, an athlete or weekend warrior, hip mobility is crucial for long health and prevention of  injury. A training program that addresses strengthening of the hip muscles and improvement of flexibility will successfully achieve this goal.

Stretching Vs. Warming Up

One of the first thing I learned as I made my way from regular folk to fitness enthusiast was the importance of a proper stretch prior to exercising. It was a cardinal rule that was engrained in me early on that I had to adhere to if I wanted to perform better and avoid injury. For a lot of you reading this, I’m sure you can attest to this. For many years, stretching was considered the end-all be-all protocol before and after exercise. Static stretching, the most common type of stretch, was a mainstream phenomena for most of the 80’s and 90’s.

But at the start of the 2000’s, several research studies on stretching started revealing new findings. It turns out the hype about stretching isn’t all it’s made out to be. In fact, scientific studies now conclude that excess static stretching can cause injuries and affect performance in sports and exercise. Earlier this year, a research conducted by The Journal of Strength & Conditioning Research showed that stretching before strength training negatively impacts strength. Another research study conducted by the same publication measured the impact of pre-exercise static stretch on power and muscular explosive performance. The researchers concluded that static stretching prior to strength training should be avoided. This means a person attempting a Deadlift 1RM, bursting off the block for a 100-meter dash, jumping for a tip-off in a basketball game or even a tennis serve will be at a disadvantage if stretching was done prior.

So this must mean stretching is bad for you right?

Not necessarily. I’ve always been of the mind set that stretching is extremely overrated. Now I’m not saying stretching is bad and should be discontinued. I’m simply stating that too much emphasis has been placed on pre and post-exercise stretching rather than dynamically warming up the body and self-myofasical release (arguably the most effective way to loosen tight and stiff muscles). Most people often confuse stretching and warming up but it’s important to note that they are very different. You can warm without stretching but you can’t and shouldn’t stretch to warm up. Stretching has many benefits including increasing range of motion and improving flexibility. However, when it comes to reducing soreness and injury prevention, the British Journal of Sports Medicine found little to no impact from static stretching on delayed-onset muscle soreness (DOMS) in a 2011 research study. The researchers looked at 12 case studies on static stretching in the past 25 years and concluded that “stretching does not produce important reductions in muscle soreness in the days following exercise.”

Dynamic warm-ups and soft tissue work have replaced static stretches in the last 15 years as the protocol for prepping the body before physical activity. Dynamic movements mimic the activity that’s about to be performed and sends blood to those working muscles quicker than static stretching. Soft tissue work (rolling with the foam roller or tennis/lacrosse ball) is another phenomenon that has garnered mainstream attention over the last two decades because of it’s impact on loosening muscles without overstretching the fibers. Because movement is more efficient when muscles and connective tissues are warm and lengthened, dynamic mobility drills and soft tissue work are more effective than static stretching prior to sporting events and exercise. Jumping jacks, hip circles, inchworms, butt kicks, scapular wall slides and high-knee walk are some dynamic mobility drills that positively impact performance. Stretching loosens muscles and the surrounding tendons that connect them to bones. But when this happens prior to exercise, the muscles aren’t able to produce enough power and energy at an efficient rate. The elasticity response from the a static stretch prior to exercise weakens the muscle for up to 30 minutes, which isn’t the right way a person wants to begin an exercise or sport.

Warming up dynamically before a physical activity is the new norm and should have preference over static stretching. It allows for continuous movement, increase body core temperature and promotes blood flow, all of which can help improve performance. Motor control, coordination and balance are variables that are positively impacted from dynamic warm-ups. Static stretching on the other hand limits movement patterns and does very little redirecting of blood to muscle groups.

So here are 5 takeaways:

1. Static stretching improves flexibility while dynamic warm-ups improves mobility.

2. You should only stretch tight and short muscles. Stretching the whole body is a waste of time and can be counterproductive.

3. Post-workout static stretching does NOT reduce soreness.

4. Statically stretching a muscle too far and too long causes pain and injury to muscle fibers.

5. Stretching prior to exercise or sport negatively impacts performance.

Stretching has been and will continue to be one of the most controversial topics in fitness. While several research studies rule against it, there are some that are in favor of it. Although more research is still being conducted, the universal conclusion at this time is that it does very little to improve health, exercise and athletic performance. However if you must stretch, do so only when you feel stiff, after sitting or standing for a long time and upon waking up in the morning.

5 exercises that can help improve posture

For many fitness enthusiasts who train regularly, posture and body mechanics are two vital areas of concern. We often hear people say to others, “Sit up straight”, “Pull your shoulders back” or “Keep your spine tall”. The term ‘slouch’ has never been more apparent in our society the way it is today. Thanks in large part to several case studies that have linked poor posture to imbalances in the kinetic chain, back pain and other degenerative diseases like scoliosis and kyphosis.

Those who know me well will tell you that I’m a strong advocate of postural awareness. Before I take on any new client, I put them through a series of movement pattern screening and postural evaluation exercises. So many different exercises can be used to assess and evaluate posture. In my humble and professional estimation there isn’t a best one, although some fitness professionals could make a case for the Overhead Squat.

There is currently insufficient evidence that supports the notion that exercise can correct posture or lead to deviations. More research is still being conducted at this time. While I don’t believe postural training exists, there are few exercises that can help improve and enhance poor posture. It is important to remember that these exercises shouldn’t be relied entirely upon for postural correction. Active stretching, myofascial work and mind-body awareness should be integrated as well.

So without further ado, here are my top 5 exercises for improving posture:

1. DEADLIFT: I’ve written extensively about the Deadlift in some of my previous blogs. This is arguably the best resistance exercise for improving posture because of it’s functional component. No other exercise mimics the action of picking up an object from the floor. But even more important are the mechanical aspects of it. Setting up for this exercise requires the trunk to be in a diagonal alignment from shoulder to hip which reinforces neutral spine. Flexion of the hips automatically causes activation of the dorsiflexors of the leg forcing the ankle to be mobile. The retraction of the shoulder blades and full extension of this hips  via thrusting at the completion of the movement emphasizes good posture. Retraction and adduction of the scapula will help a person who is internally rotated in the shoulders via external rotation. Likewise, extension of the hips will help a person who has  tight hip flexors and over-lengthened glutes due to prolonged sitting by stretching them at the top of the movement.It is important that you don’t hyperextend the lumbar spine like some people do.

Deadlift1

2. REVERSE LUNGE: The most knee-friendly lunge variation is also a good exercise for those with short and tight hip flexors. When dumbbells are used, the shoulder girdle and upper back region get activated. The hip flexors of the leg that lunges backwards get a deep stretch during execution of this exercise. When I perform this movement, I try to hold the bottom position for 2 seconds to illicit a good dynamic stretch of the hip flexors. When dumbbells are held in each hand, the shoulders ‘pack’ and forced to pull themselves back due the challenge of maintaining good balance. A much farther center of gravity forces the shoulders to externally rotate to prevent tilting forward because of the additional resistance in each hand.

3. SCAPULAR WALL SLIDE: This is an exercise that will garner weird looks from others when you’re doing it. If only those people knew the amazing postural impact it has on the trunk musculature. The good thing about this movement is that it can be included as part of your pre-workout mobility warm-ups or as an exercise in a resistance training program. Stand with your head, upper back and butt against a wall. The heels of your foot should be anywhere from 12 to 18 inches away from the wall. Lift your elbows to shoulder level and press your forearms back against the wall so your elbow and shoulder make a 90-degree angle. Most people won’t be able to get their forearms to press firmly against the wall indicating tight shoulder internal rotators and chronic slouchy posture. With your head, upper back and butt pressed against the wall, fully extend the elbows in a diagonal pattern, hold for a second and return to your starting point. Many will also have a hard time keeping their back flat and will arch quite often early on. The objective here is to continue to keep the forearms close to the wall as much as possible and do your best to keep the back flat. I used this movement to correct extremely tight shoulder internal rotators I battled with for many years. My forearms were 10 inches from the wall when I started this movement!  Though they’re not quite touching yet, they’re about 4 inches from the wall today.

4. DUMBBELL SUITCASE DEADLIFT: This deadlift variation, which was developed through the real life action of picking up a suitcase, is ideal for training the core stabilizers while also strengthening the posterior chain. Though identical to the conventional deadlift, it is different in it’s unique way. Hold a dumbbell of moderate resistance in one hand and stand in front of a mirror in neutral alignment. Your stance should be 3-5 inches less than hip-width apart. Push your hips back and bend the knees as you would do in a regular deadlift. Lower the dumbbell as far as your can without rounding your back or letting your knees cave in. The objective here is trying to remain symmetrical despite the destabilizing forces from the dumbbell attempting to pull you out of alignment. The reason for the mirror is to keep an eye on your symmetry and alignment ensuring you remain neutral all along. Do not allow your trunk to tilt laterally while performing this movement. It is the resistance to tilting that yields the benefits of this exercise. As an added bonus, the core musculature is activated via anti-lateral flexion exercises.

5. WAITER’S WALK: Popularized by the innovative Gray Cook, this exercise is eerily similar to the suitcase deadlift due to the asymmetrical nature of both. The idea behind this exercise came to fruition after witnessing the incredible dexterity and skill waiters display as they constantly hold and walk around with a tray in one hand above their head. To perform this exercise, hold a dumbbell of moderate resistance in an overhead stance. Earlier I talked about ‘packing’ of the shoulder girdle for increased joint rigidity. The same technique applies in the Waiter’s walk. With the dumbbell over your head, ‘pack’ and pull your shoulder back into the scapular without shrugging. Keep your upper arm as parallel as you can next to your ear. As you begin to walk, you’ll feel the weight of the dumbbell trying to pull you out of alignment from all directions. The challenge is to resist these forces and remain symmetrical as much as you can. Do your best to avoid tilting and hiking up the hips. When all the mechanics fall in place, the result is an erect posture in neutral alignment. Begin by walking 20 to 30 yards per arm and work your way up to 40 to 50 yards.

So there you have it. 5 exercises that can help improve your posture. Keep in mind that these are based on my personal experience and years of extensive theoretical studies and research. As always, use good form and work with a moderately challenging resistance. Incorporating active stretches and self-myofascial release will make the process much easier.

The correlation between the hip flexors and back pain

It is estimated that 8 out of 10 people living in this country will at some point experience some sort of back pain. That’s an alarming 80 percent of the country! Poor posture, mechanical imbalances and lack of physical activity are the major prevalent reasons behind this epidemic. Although a recent UN study now ranks Mexico as the most obese country in the world, America is still a close second with a 31.8 percent adult obesity rate. Obesity has been linked to knee, hip and ankle pain, all of which have a direct impact on the lumbar spine.

While back pain can result from a number of factors, perhaps the most common cause of it is weak and tight hip flexors.

The hip flexors are a group of muscles that enable to thigh bone to flex or allow the knee to bend towards the trunk. Activities like stair climbing, squats, lunges and sprinting all require engagement of these muscles. Collectively referred to as iliopsoas, they consist of two major muscles, the psoas major and the iliacus. The psoas major originates form the lumbar spine area and attaches in upper region of the upper thigh hip bone. The psoas is the primary hip flexor. The iliacus originates and attaches in front of the upper thigh hip bone.

Hip Flexors 2

In my experience, almost everyone has some sort of issues with their hip flexors. I’m yet to find a person with super pliable and strong hip flexors. Many of us have tight and weak hip flexors and don’t even know it until it chronically gets bad and starts to affect the low back. Prolonged sitting, not enough emphasis on glute training and excess abdominal crunching are 3 of the major causes for tight hip flexors.

When we stay in a seated position for a very long time, the psoas shortens and pulls on the lower back. Imagine the psoas as an elastic band. When the body is standing in a neutral position, the band is fully stretched in its highest elasticity. But when the body sits, the elasticity of the band gets slack and the length is reduced as a result. When the psoas stays in this slacked position for a long time, it causes the pelvis to tilt anteriorly causing arching of the low back and overstretches and lengthens the glutes.

When the butt gets too slack due to overstretching from prolonged sitting, it automatically gets weak requiring the need for more glute training. Certain abdominal crunches like the prone jackknife where there is repeated hip flexion has also been known to tighten the hip flexors. This is the reason why some us feel a an uncomfortable burning sensation in our upper thigh area while performing these exercises. This ultimately leads to low back pain due to excess stress on the psoas.

The good news is that there are ways to loosen the hip flexors and permanently prevent back pain. Activation mobility drills, self myofascial release work, strength exercises and dynamic stretches are the remedy.

1. WALL MARCHING (PSOAS ACTIVATION): This is a great drill for anyone who sits at a desk for the majority of the day. Stand in front of a wall at arms length with a neutral spine. Place both hands on the wall so you’re in a vertical push-up stance. From there, lift one knee to about hip height or slightly higher. Your pelvis should tilt posteriorly as your upper back rounds slightly. Don’t worry about that. Just make sure it doesn’t round excessively. Hold that position for about 5 seconds and switch to the other knee. Aim to do 8 to 12 repetitions per side.

2. SELF-MYOFASCIAL RELEASE: This is the most uncomfortable of all the hip flexor drills because of it’s direct contact on the fascia. However SMR is the one of the most effective ways of loosening tight muscles and restoring blood flow. A foam roller or small hard ball is needed for this, though using a lacrosse or tennis ball will work much better. Place the foam roller or ball directly under the hip flexor muscles on the floor and roll around it for a couple of minutes. To intensify this, locate a tight spot and stay on it for 20 to 30 seconds. After about a couple of minutes of doing this, you should feel some warmth in your upper thigh region indication increased pliability and restoration of blood flow.

3. STRENGTH EXERCISES: The reverse lunge and hip thrust are two great exercises for fixing tight hip flexors. As mentioned earlier, the glutes weaken and stretch as a result of shortening of the hip flexors. These two exercises serve to activate the glutes while stretching the hip flexors simultaneously. In a reverse lunge, the hip flexors of the back leg is relaxed and stretched while the butt activates. The same theory applies in a hip thrust where the hip flexors get a deep stretch at the top of the thrust while the opposing glute muscle gets contracted.

4. DYNAMIC STRETCHES: Many hip flexor stretches exist for loosening of the psoas and iliacus. Most of them are effective and will certainly help the cause if done correctly and held for a good amount of time. However one of my favorite and perhaps the most common is the half-kneeling stance hip flexor stretch. From a half kneeling stance, drive the butt of the knee on the ground forward until you feel a mild stretch in your hip flexors. It is imperative to drive from the glutes and NOT the lower back. The spine should be neutral all along and arching of the lower back must be prevented. Hold this for about 30 seconds and repeat on your other leg.

These movements and exercises must be performed routinely for results to occur. Make sure you incorporate them in your workout sessions and work and keep the intensity mild. As always listen to your body and consult with a fitness professional if you need any help.