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    • Jul 11, 2022
    • 4 min read

The Hip Explained

In today’s society, it is common to sit for most of our day. Most people go from sitting at work to sitting in a vehicle while commuting, and then go home to sit during hobbies (e.g., playing video games). This sedentary behavior is associated with increased hip pain.[1] Even further, sitting can change how our joints move – prolonged sitting is found to reduce our ability to move our hip into extension (i.e., moving your leg behind you), an important hip function for normal activities such as walking or climbing stairs.[2] Long-term issues, such as arthritis, can occur if we don’t counteract these subtle joint changes that are a result of sedentary behavior.[3] Our understanding of arthritis has evolved over the years - exercise and movement does not cause arthritis, but rather it can be caused by poor movement patterns, obesity, poor nutrition, and injury.[3] Weaker glutes often perpetuate poor movement patterns, and when coupled with obesity can result in even greater risk of developing arthritis.[4] In short, normal physical activity is found to help reduce the risk of arthritis, while obesity, injuries, and poor movement patterns tend to increase disablement due to arthritis.[5]


Basic Anatomy

As a result of the hip being extremely mobile, it requires a lot of stability to control its movements and prevent injury. The hip is a “ball and socket” joint (think about a hand palming a basketball) which allows for significant range of motion. A structural reason as to why the hip has significant mobility is that the head of your femur (the “ball” at the top of your thigh bone; the “basketball”) is considerably larger than the hip socket on the pelvis (acetabulum). The structural layout of this allows for greater motion but sacrifices natural stability. The hip creates stability primarily through multiple different non-bony structures: Labrum, ligaments, and muscles. The labrum (a disc of cartilage around the edge of the socket) helps to increase surface area so that our hip stays in place during extremes of movement. Furthermore, ligaments that surround the head of your femur promote stability in the hip by passively supporting and limiting excessive hip motions while also creating a “vacuum” seal, limiting fluid movement in or out of the joint space (this fluid helps provide nutrition to the joint).[6] Numerous muscles around the hip also help stabilize the joint during normal activity.

Some examples you may have heard of are the quadriceps, adductors, TFL (Tensor Fascia Lata), gluteus medius, gluteus maximus, piriformis, and hamstrings.[7] All of these muscles help stabilize the joint to allow us the ability to walk, run, jump, hike, sit, and everything in between, but one of the most important muscles for keeping the hip healthy and stable is the gluteus medius. The gluteus medius muscle helps to keep our pelvis level while walking or doing single-leg activity.[8] As mentioned in the previous paragraph, hip weakness may lead to increased risk for hip arthritis, which is why it is important to strengthen the muscles around our hip because they allow the hip to stabilize and control the hip during its motion in all directions.


What To Do?

To prevent mild or severe issues with the hip, stabilization training can be very useful, particularly those that target the activation and training of the quadriceps and the glutes.[9] These muscles are critical for producing stability for the low back and our legs. Running is often great for the hips, but typically lacks specific training needed to train the hip holistically. For instance, running does require the use of the gluteus maximus and gluteus medius, and does increase strength in the gluteus maximus, but it typically doesn’t provide adequate training to the gluteus medius if weakness exists (mentioned above).[10] However, increasing the incline while walking/running on a treadmill may increase glute medius activity.[11]


At your workstation, consider incorporating a standing leg abduction exercise. In addition, when sitting try pushing your legs outwards with a resistance band, or belt, around your knees.












These exercises help target the gluteus medius to improve strengthening and stability for the hip. If you feel you need more mobility (such as tight hip flexors), check out our Perspective.


Stretch, Strengthen, and Soothe

The Hip Trifecta exercises can help the hip stay healthy and injury-free. Band Squats help improve glute activation and increase range of motion. Leg Hugs help stretch out hip rotators that can often limit range of motion. Hip massage helps reduce built up tension in the muscles around the hip.


References

  1. Harding N, Noorbhai H. Physical activity levels, lifestyle behaviour and musculoskeletal health profiles among seated video gamers during COVID-19. BMJ Open Sport Exerc Med. 2021;7(3):e001194. doi:10.1136/bmjsem-2021-001194

  2. Boukabache A, Preece SJ, Brookes N. Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study. Musculoskelet Sci Pract. 2021;51:102282. doi:10.1016/j.msksp.2020.102282

  3. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2021;325(6):568. doi:10.1001/jama.2020.22171

  4. Fenato RR, Araujo ACF, Guimarães ATB. Comparison of gluteus medius strength between individuals with obesity and normal-weight individuals: a cross-sectional study. BMC Musculoskelet Disord. 2021;22(1):584. doi:10.1186/s12891-021-04470-8

  5. Wright AA, Cook C, Abbott JH. Variables associated with the progression of hip osteoarthritis: A systematic review. Arthritis Rheum. 2009;61(7):925-936. doi:10.1002/art.24641

  6. Retchford TH, Crossley KM, Grimaldi A, Kemp JL, Cowan SM. Can local muscles augment stability in the hip? A narrative literature review. J Musculoskelet Neuronal Interact. 2013;13(1):1-12.

  7. Gearhart D. Hip Pain: muscle versus joint. Published April 18, 2018. https://buckssportschiropractic.com/2018/04/18/hip-pain-muscle-versus-joint/

  8. Lee SK, Lee SY, Jung JM. Muscle Activity of the Gluteus Medius at Different Gait Speeds. J Phys Ther Sci. 2014;26(12):1915-1917. doi:10.1589/jpts.26.1915

  9. Gay C, Chabaud A, Guilley E, Coudeyre E. Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Ann Phys Rehabil Med. 2016;59(3):174-183. doi:10.1016/j.rehab.2016.02.005

  10. Lieberman DE, Raichlen DA, Pontzer H, Bramble DM, Cutright-Smith E. The human gluteus maximus and its role in running. J Exp Biol. 2006;209(11):2143-2155. doi:10.1242/jeb.02255

  11. Jeong DE, Lee SK, Kim K. Comparison of the Activity of the Gluteus Medius According to the Angles of Inclination of a Treadmill with Vertical Load. J Phys Ther Sci. 2014;26(2):251-253. doi:10.1589/jpts.26.251

Healthy Is Wellness, LLC (“Healthy Is Wellness”) is not a health care provider, and does not provide professional medical advice, diagnosis, and/or treatment. THE INFORMATION PROVIDED BY HEALTHY IS WELLNESS IS FOR INFORMATIONAL PURPOSES ONLY.

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