Article By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
As this long relentless winter comes to an apparent end, it is time to think about how we will be spending our spring and summer. If the lingering winter has you longing for the golf course or getting off the treadmill for an outdoor run then you should be using the additional indoor time to strengthen your hips. The hips are an integral structure to successful participation in any weight bearing activity such as golf and running. The stronger your hips are the more balanced you will be when hitting a golf ball. Running takes place on one foot at any given moment, therefore the hip muscles must be strong enough to support your body weight while standing on one foot.
The main area of hip weakness affecting a large portion of the population is what is known as the “rotator cuff of the hip”. The term rotator cuff is commonly associated with the shoulder but there is also a group of muscles in the hip that form a “rotator cuff”. These muscles move the hip to the side and turn the hip outwardly (toe out). Just as the rotator cuff of the shoulder is commonly torn we are now seeing an increase in the tears of the hip rotator cuff. The muscles involved are the gluteus medius, piriformis, superior gemellus, obturator internus, inferior gemellus, quadratus femoris, and obturator externus. These muscles are located deep in the buttock and attach to the bony protuberance called the greater trochanter on the side of the hip.
There are several ways to “self test” the strength of these muscles. If you walk for 30 minutes and must stop and rest during the 30 minute walk there is most likely a weakness in these and other muscle groups of the legs. Chronic use of a handrail to walk up and down the stairs is also an indicator of progressive weakness of the hips. There are studies that show patients who experience chronic back pain are likely to have weakness of the hip rotator cuff. The last simple test requires you to lay on your side with your back up against a wall or couch while keeping your legs straight. Raise and lower the top leg 25 times. After the 25th rep do not allow the top leg to touch the bottom leg. Keep the top leg suspended in the air and hold it for an additional 30 seconds. If you cannot complete this test you have significant weakness in the rotator cuff of the hip.
There are many ways to strengthen the hip rotator cuff. There are complicated and very time-consuming methods. There are also simple methods. The method you choose should match your activity goals. The length of this article will prohibit explaining the complicated methods. There are three simple exercises that can be done without any equipment and will begin the process of strengthening the rotator cuff of the hip. Bridging is the most basic exercise. Lie on your back with your hips and knees bent and your feet flat on the floor. Press down through your feet squeezing your buttock muscles together to slowly raise your hips off of the floor until your hips are in line with your knees. Keep your feet and shoulders on the floor at all times. The goal of the bridging exercise should be 30-50 repetitions twice a day. The clamshell exercise is a simple way to isolate the rotator cuff. Lie on your side against a wall or couch with your head, back, and bottom of your feet all in contact with wall. Keep the feet on top of one another, then lift top knee off of the bottom knee approximately 4 inches. Lower the top knee back to the bottom knee slowly and repeat the movement. The goal for the clamshell exercise should be 25-30 repetitions twice a day. The last exercise is a weight bearing exercise. It involves walking sideways. Stand with good posture and keeping your knees straight. Begin by taking a step to the side approximately hip distance apart. Be sure to keep your feet straight with the toes pointing straight ahead. (Avoid allowing the toes to turn out.) Then allow the trail leg to come closer to the lead leg. Find an area of the house that is 15-20 feet long and walk side to side to one end and then return to the returning point. Side to side walking forces you to stand on one foot at any given moment, engaging the rotator cuff muscles of the hip. The goal for side walking should be 3-400 feet of side to side walking on a daily basis. Follow these simple steps and you may find that your golf game and/or your next 5k-roadrace improve significantly.