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Hip opening mobility sequence

July 24, 2012

In this video Dr. Spina demonstrates a hip opening mobility sequence.  The word mobility is highlighted due to the fact that in most cases, therapists and trainers incorrectly use the term to substitute ‘flexibility’ which is INCORRECT.  Flexibility is the ability to passively achieve a range of motion across an articulation.  Mobility = flexibility + STRENGTH  ….and is thus the ability to actively achieve a range of motion across an articulation.  The former, flexibility, provides little to know advantage during movement (ADLs or athletic)…whereas the latter has a direct impact on performance.

During this FRC hip mobility sequence, the movements are rotational in nature due to the fact that it is rotational movements/stretches/mobility exercises which best target the capsule itself as they do not increase tension in either the one or two joint muscles affecting a particular articulation (with the exception of the ‘Bear sit’ position seen in the video which is really a position working on RAILs (Regressive Angular Isometric Loading) training for the abductors of the hip).

F.R. ® Lower Limb certified practitioners may recognize the 90/90 (Question mark position) – utilizing PAILs/RAILs sets in these positions is a very effective way of increasing hip ROM.  Of course with these we are also targeting the Gluteus minims of which the epimysial layer is continuous with the capsule itself.


3 Comments leave one →
  1. July 24, 2012 3:36 pm

    Do you have any insight regarding a patient with abnormal femur version… specifically – femoral retroversion (15 degrees outside of normal range) and introducing this type of mobility training. I am wondering if you introduced the kind of internal rotation demand that is present in the 90/90 pose if there is risk. It would be going against the boney anatomy – though I am sure the muscles themselves and capsule could benefit… not sure of the implications. Thanks for any guidance…

    • July 24, 2012 6:55 pm

      Hi Robyn, thanks for the question

      When discussing articular limitations caused by aberrant bone formation, what is important is to assess what is restricting a particular ROM. Is it bone or soft tissue. Just because a bone/articulation is misshapen, it does not predetermine that the end range of said joint is because of a bony block. What you can do safely is ensure that the patient has control of the ROM that is under the control/restriction of soft tissue…thus you are ensuring that you are getting the most out of the joint within the bony confines. Does that make sense?? In other words, if after your assessment a reduced ROM is believed to be caused by soft tissue, then by all means prescribe mobility training in the direction of the restriction. If the restriction of ROM is bony in nature, then to force more motion will only lead to bone impaction and pain.

      Having said that, articular mechanics are such that if there is a bony impaction on one side, improving mobility on the contralateral side will reduce the decree of impaction.

  2. July 25, 2012 2:50 pm

    Thanks so much for your thoughtful response Dr. Spina. I was not so much referring to “misshapen” bone – as in Femoral Acetabula Impingement…. but instead wondered anatomical position of the femur. So for example if the femur is measured on 3D CT scanning as having -1 degrees of anteversion (and normal is 15-20 degrees) the patient will naturally have much less internal rotation than would be expected due to the boney anatomy she was born with. She will also have much more external rotation naturally. I know some experts (i.e.: Shirley Sahrman of Washington University St. Louis MO USA) will say never to encourage extra internal rotation on a person like this as there is great risk to tear the labrum.

    Your statement here:” If the restriction of ROM is bony in nature, then to force more motion will only lead to bone impaction and pain.” may indeed be addressing this issue – as I think you are saying if it’s truly the boney anatomy and not the soft tissue… then don’t push it – right?

    I do worry though that if the person like this gets such limited rotation in functional activity if the soft tissues will suffer (tight abductors – weak adductors etc.) I suppose soft tissue work like myofascial release manually might be the only possible option, short of having a femoral osteoltomy – which some surgeons will propose ….

    Very much appreciate your thoughts… your blog is extremely rich in terrific information and education ~ Best to you, R

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