The hip is an incredible, beautiful, and complex joint in the human body. Learn what it does, how it works (and sometimes doesn't) and ways that Pilates helps keep hips happy!
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These are the two teachers that led workshops about the hip:
Joy Karley, MA, NCPT: *http://joykarley.com/*
Samantha Wood, MPT, MBA, NCPT, RYT: *https://www.samanthawoodphysio.com/*
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[00:00:00] Hello and welcome to Pilates Students' Manual a podcast, helping you get the most out of your Pilates classes. I'm Olivia and I'll be your host. Join the conversation and share your thoughts on Instagram at @pilatesstudentsmanual. You can support the podcast by visiting buymeacoffee.com/OliviaPodcasts. Let's learn something new.
Hello, hello everybody. Welcome back to the podcast. Today we're going to be talking all about the hips. The hip is a really important joint in our body, or joints. I guess you do have two of them. [00:01:00] Very likely. And if you do Pilates, you know that you need a lot of strength and a lot of mobility at the hips to perform those exercises to the best of your ability. And you may also so know that those exercises also work to strengthen and increase mobility, flexibility at that hip as well.
So today I'm going to be talking all about the hip, why it's important, a little bit about what the bones are that are involved in the hip, what the muscles are, kind of some proper alignment ideas for the hips, some common dysfunctions, some common injuries that happen at the hips and why Pilates is the most amazing thing ever for all things hips.
A few years ago, I attended the PMA conference in Las Vegas and I took a couple of workshops on the hips. And so a lot of what I'm sharing is [00:02:00] from the workshops that I took while I was there at that Pilates conference. I have included the links to the teachers of those workshops, so if you're interested in learning more about them, they are the experts in this subject area and a lot of what I'm sharing with you is what I learned from them. It was a total of six hours of workshops and this episode is going to be just 20 minutes. So there's a lot more to dive into.
This is good stuff to know as a person who has hips and especially if you've ever had anything go on with your hips, where you were stiff, or you had injuries that were localized to that hip joint. It might be interesting to know a little bit about the hip. And I'm also hoping that by learning a little bit about the muscles, the bony landmarks, and some of those alignment ideas that your understanding of the hip will grow as a result of listening to this episode.
Let's talk about the hips. They are one of the largest joints in your body. They have the second largest range of [00:03:00] movement and they support the greatest load of weight, right? Because they're supporting your entire torso. If you have hip instability or hip weakness that can contribute to injuries at your lumbar spine and also the knee, right? It can go up or down the chain.
It's very important that we keep hip mobility because we need our hips to be mobile and strong for just daily activities, for getting up from seated, for going up and down stairs, for moving around, walking, running, all of those activities require some strength and mobility at your hip.
Pilates is uniquely geared towards keeping your hips mobile and strong. And that's because in Pilates we work in all planes of movement. So just revisiting those briefly, the planes of movement are the sagittal plane, where we do extension and flexion. I remember that as Sagittarius drawing an arrow across the bow string, that extension and flexion action happens in the [00:04:00] sagittal plane. The frontal plane, which is where we do our lateral flexion, our abduction, adduction, where we move to and from the center in that kind of lateral way. And the transverse plane, which is where we do our rotation.
Our hip joint can do all of those things. A lot of times in a lot of forms of exercise and definitely in sports, most of the movement happens in just one plane of action. If you think about running or biking or swimming or- and there's going to be rotation. There's going to be other movements that happen. But a lot of that happens in just one plane and Pilates works in all of them. So super beneficial, regardless of what you do.
The hip is a ball and socket joint. So if you make a fist with one hand and then kind of cup your other hand over your fist, that is what your hip socket looks like in the most general of terms. Your fist is the head of your femur, which is your thighbone. [00:05:00] And then that cupped hand is the hip socket, fancy name for that is the acetabulum and that kind of cups the head of your femur. The same way your fist can rotate around in your cupped hand and can move in lots of directions in your cupped hand, that's pretty much what our thigh bone is able to do relative to that hip socket. Our hips can move in all planes of movement, even if we don't often move them in all the planes of movement.
There are lots of muscle groups that exist around your hip. You've got your hip flexors, which are the muscles that bring your thigh closer to your torso.
So when you lift your leg and your thigh comes closer to you, that is hip flexion. It's a bunch of muscles that do that. Namely your iliopsoas, rectus femoris and your Sartorious, they're all responsible for hip flexion. You've got hip extensors, which do the opposite of your hip flexors, right? They bring your thigh away from you. If you think of reaching your leg behind you, that's [00:06:00] namely glute max and hamstrings.
We have hip abductors, which take your leg laterally wide away from the midline. And those guys include your glute medius, glute minimus, sartorious, your tensor fascia latae, also known as TFL, and your piriformis at some points, depending on like whether your leg is lifted or not. If you're in slight hip flexion, and then taking the leg away from your piriformis can help.
You've got adductors that bring your leg towards the midline. Those inner thigh muscles include you're adductor group, that's adductor magnus, longus, and brevis. Those are three different muscles. One is great, one is long, and one is short, but they all help with adduction, your pectineas and your gracilis.
So we've worked in extension and in flexion, right? There's our sagittal plane. We've worked in ab and adduction, right? There's your [00:07:00] frontal plane, but our hips can also rotate. They can rotate externally and internally.
Your external hip rotators, if you think about turning your feet out, turning your leg out, like second position if you are a dancer, perhaps, some of the muscles have multiple jobs. So glute max helps the external rotation as does glute medius, your piriformis, your superior and inferior gemellae. Gemellae?
This is kind of hilarious because I look at these muscles a lot and I think their names in my head a lot, but I don't always say them out loud. So if I'm mispronouncing them, like, don't take my word as gospel. Your quadratus femoris, obdurator internus and externus, sartorious, biceps femoris. Lots of names and muscles. It's not super duper important that you know the names of the muscles but just like for your edification. Those are the muscles.
And lastly, those internal rotators, your glute medius and minimus, your TFL, piriformis, semimembranosus, [00:08:00] semitendinosus all help to internally rotate the leg and kind of turn you into that pigeon toed stance.
So that's a lot, right? That's pretty complicated. There are a lot of muscles in your hip. It's really honestly surprising that we don't have more hip dysfunction because there's so much going on there, right.
In addition to the muscles, you've got other stuff in your hip socket, including your labrum, which is again, if you go to that fist and your hand kind of cupping the top of your fist, where your hand meets your fist, has this layer called the labrum, and that kind of like holds the bone kind of snugly in that socket. You've got ligaments in there. You've got bursa, which are like little gel packs that help the muscles slide against each other. Because since we heard there are so many muscles in this area in order to help them slide alongside each other so that we can move in all of these fabulous ways, we have these little slidey guys called bursa.
Some things to think about [00:09:00] when we think about proper alignment, and alignment is more complicated than just saying, Oh, this is where everything should be and if it's like this, you won't have any dysfunction in there won't be any pain. It's kind of a guideline because I do know that every body is different and not everybody is going to line up like this.
But when you're working with your Pilates teacher, if they do like a postural assessment for you, they might look at these landmarks in order to maybe make some adjustments to the way you move. Not saying that it solves all problems or that this is a one size fits all approach, but there are certain alignments that cause less pain than other alignments. Sometimes alignments are caused by, you know, weak or tight muscles. And that's something that we can definitely change as we do Pilates.
So I'm just going to give you two ways, looking at the hip, because there are things that you could look at for yourself in the mirror. One of them is looking at your hips from the front [00:10:00] and horizontally across your hips. So up and down your leg, and then also side to side from hip to hip and kind of like looking across. Those are the easiest ones I think for you to kind of see for yourself what your hip alignment is like.
So, what we're looking at here are some bony landmarks. So when you're looking up and down from hip down to the feet, and you're looking at kind of at that front view, the inside bit of your hip protrusion called your ASIS, your anterior superior iliac spine. That's what you feel pressing into the mat. When you're lying on your stomach for an exercise like Swan, you want the inside of that hip point to be directly on top of the center of your knee cap. That should line up with the center of the front of your ankle, and that should line up with the space between your first and second toe. So look straight down your leg. That's what the plumb line should be in the "ideal" body. Right?
Another one you can look at, [00:11:00] if you're looking at yourself in a mirror horizontally, just going across there, you want to make sure that the hip points that both of those hip bones, those ASISes on both sides are level. That the high point of your pelvis on the side is also level going straight across, that your greater trochantor, which is a bony bump on the outside of your thighs, you can kind of feel it when we're lying on our side, doing Pilates, that kind of a bony bump at the side of your thigh bone side of your femur. Those guys want to be even, your knees should be at the same level ,and your legs should be equally turned out.
So those are definitely things that you can look for for yourself. Just looking in a mirror and just notice for yourself is one of my hips higher than my other hip. It's not cause for alarm, if it is no one's body is exactly the perfect "ideal" alignment, but that may give you some clues about stuff [00:12:00] that might be happening in your body, stuff you might be feeling when you do Pilates.
Coming up after the break, I'm going to talk about some common misalignments that happen and I'm also going to talk about some common hip maladies, things that happen to hips that make them sad. And again, as always, Pilates can definitely help. That's coming up next.
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There are so many muscles that cross the hip joint, on the front, on the back, on the side on the inside. There's a lot going on at the hip. Common misalignments of the pelvis can really cause a chain reaction in terms of tightness, weakness, and over-working-ness of muscles that cross that joint. And that can result in your hip not being able to move all of the ways that you want it to move, with limited range of movement, pain, tightness, all of those grumpy things that can happen in our hips.
So our pelvis can tilt two different ways. When we talked about looking at the front view of the pelvis, it can [00:14:00] also- you can also have like one hip higher than the other, but I'm going to talk about this sort of forward and backward tilt, because this is something that we focus on in Pilates a lot.
And that's an anterior tilt and a posterior tilt of a pelvis. I like to think of it as a duck butt and a tuck butt. So duck, with D like dog, is when you're sticking your tailbone behind you and your spine is in extension because your hip points are almost reaching forward towards the ground. And your tailbone is lifting up. It's like the front of the pelvis is tilting more forward. That's why you call it an anterior tilt.
And then the opposite of that is a tuck butt, T like Tom. In a tuck butt your tailbone is scooped underneath you. Your spine is usually rounded. We talked about this a little bit in the back pain episode, these two postural alignments of your pelvis being either too far tucked under and then too far hinged forward. And both of those things are going to create some [00:15:00] sadness.
Thinking about that posterior tilt. If your pelvis is tucked and you are rounded and your back muscles are over stretched because you've increased the space between your pelvis and your rib cage, because you tucked your tailbone underneath you. Right? What that body position over time will cause for your hip is you'll have an overstretched psoas muscle. The psoas is a muscle that's very important for us to walk and it can contribute a lot to low back pain. So when we talk about stuff at the hip causing trouble in lumbar spine land, definitely one of the ways that that can happen.
So because of that orientation of the pelvis, the psoas muscle, iliopsoas, is overstretched. It's stretched longer than it needs to be. Your abdominal muscles are tight because the front of the pelvis is closer to the rib cage than it should be. So your abdominal muscles are kind of scrunched and [00:16:00] tense. They're not strong. You're not like getting a good workout here at all. They're just overworking in this case, they're pulled tight.
Your glutes are often very weak because your glutes aren't being recruited to do so many exercises because of that alignment of the pelvis. And when I say exercises, I may mean exercises in Pilates, but also just like activities in daily life. Your glutes are not as involved. They're kind of turned off. Oftentimes your spine is in that kyphosis, that kind of rounded back. Oftentimes legs are also in external rotation because muscles are compensating for those glutes not working especially. All of that stuff can create sadness in the hip.
And then the flip side of that coin, being in an anterior tilt where you're lengthening your tailbone behind you, hip points are dropping forward. You're likely to have very tight and very weak hip flexors because you've shortened that hip flexor space, the same way we shortened our abs in [00:17:00] that rounded back posture, we've shortened that hip flexor space. Your abdominals are going to be weak because they're overstretched. Your low back muscles are going to be tight because you're shortening that space of the low back. That can create some back pain.
Your glutes are overactive because now with the way your pelvis is tilted, they're having to do more work than they probably should be doing. Your hamstrings are going to be weak because they're being overstretched because your tailbones lifting away from your heels. Oftentimes this results in flared ribs, because you're in that extension throughout your spine.
It's like, none of that is happy. We don't want either of those things. What we want to do is find a balance and that's why neutral spine is so important. It's why we spend a lot of time in exercises working in neutral spine so that we can just bring our body, whether we're in a little bit of a tuck or in a little bit of a duck, but we can bring ourselves back to a place where all of our muscles can work together.
Especially in a joint, like the hip where there's [00:18:00] so much going on, there can be things that happen in the hip that are not structural, but are muscular. So when we're talking about those pelvis tilts those orientations of your pelvis, a lot of times, if we strengthen the muscles that I mentioned were weak, or we stretch, in some cases, areas that are tight, we can get range of movement, we can get strength back into the hip joint because it's a muscular issue.
There can also be structural things that happen at the hip, namely osteoarthritis, hip replacements, piriformis syndrome, and a labral tear. So those are some things that can happen to hips or can happen at the hip socket.
Osteoarthritis is where the cartilage that lines that hip joint wears away, often like natural wear and tear of like having a hip and using it. And it's oftentimes a part of aging that unfortunately, [00:19:00] most people over the age of 60 will have at least one joint that has some osteoarthritis. Often that results in pain and stiffness, but by doing very Pilates-y things, including increasing strength at the center, that abdominal strength can take some pressure off of that hip joint, using that spring resistance, especially to build strength and muscles surrounding the hip joint, increasing flexibility and range of movement. We can do all of that to mitigate the effects of osteoarthritis.
In terms of hip replacements, hip replacements are getting really good, actually. So there are a bunch of things that are like things you shouldn't do when you've had a hip replacement. And definitely let your Pilates teacher know that you have had a hip replacement, whether it was an anterior, posterior, whichever way they came in to do the surgery, but in a hip replacement, coming off of that surgery, there can be a lot of pain. There can be a lot of stiffness. There can be a lot of weakness, and Pilates is a way to get you back your range of movement, and that can [00:20:00] happen after PT or sometimes even instead of PT, again, depending on the surgery, that's not for everyone.
Piriformis syndrome. So your piriformis is an external hip rotator. It's one of the muscles in your butt. And your sciatic nerve goes right either through your piriformis or like right next to your piriformis. And if your piriformis gets tight, swollen or angry, it can press on your sciatic nerve. And that's where sciatica comes from. In some cases that can be a cause of sciatica.
A lot of Pilates exercises and stretches can target that piriformis and get it in a happier place so that it is not putting pressure on your sciatic nerve and that will make you a happier person. If you've ever had sciatica, you will know it's not a fun time.
A labral tear. As I said earlier, your labrum lines, your hip socket, your acetabulum. It can be torn due to overuse, due to trauma. And Pilates is not the only way that you can work with a labral tear, but [00:21:00] because you do work slowly and gently and you can really customize the exercises, you can continue to build strength, build range of movement at that hip socket in a way that doesn't aggravate it. If you do have a labral tear, sometimes surgery is the answer. I mean, hip replacement, that's obviously a surgery. But Pilates can definitely help with all of those hip related things.
I hope you learned something new about your hips today. I hope you get to peek at yourself in the mirror and just notice, in a totally nonjudgmental way, just notice what your hips look like, what they're up to. And as you continue in your Pilates journey, as you continue to work with your body, all of its seasons, you'll be able to build strength and increase flexibility and mobility at that hip joint.
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Thanks for tuning in to this week's episode of Pilates Students' Manual, a podcast helping you get the most out of your Pilates classes. Be sure to check out the podcast Instagram at @pilatesstudentsmanual and subscribe wherever you're listening. Interested in teaching Pilates too? Check out Pilates Teachers' Manual available everywhere you listen to podcasts. I hope to see you next episode. Until next time. [00:23:00]