Mobilizing the Deep Posterior Hip
A recent discussion on Hockey Strength & Conditioning pertaining to posterior hip "tightness" forms the basis of this post. A question was asked about specific stretches utilized for the deep posterior hip musculature, the deep gluteal musculature and the posterior hip capsule.
Below you will find some of the ACTIVE methods one can utilize to improved range of motion from deep posterior hip restrictions. It is important to note that not all exercises will work for everyone. It will be up to you to figure out which one will work for each specific athlete, client, or patient. Most especially, the two kettlebell videos below are more advanced techniques and usually are reserved for later progressions since they are loaded and require adequate control and stability of the "core".
Below you will find some of the PASSIVE methods a manual therapist can utilize to improved range of motion from deep posterior hip restrictions. It is important to note that not all strategies will work for everyone. It will be up to you to figure out which one will work for each specific athlete, client, or patient.
To give you a brief overview, the posterior hip capsule is innervated by articular branches of the Sciatic nerve (L4-S3). Without question, however, the capsule may also be innervated by articular branches of the Femoral nerve (L2-4) as well. Along with the deep posterior hip musculature (Piriformis and Triceps Coxae - Superior and Inferior Gamelli and Obturator Internus) that lie superficial to the capsule, it should be noted that the tendon of the Gluteus Minimus also sends its tendon through such capsule, not dissimilar to the Rectus Femoris anterolaterally.
Kinesiologically, the posterior hip capsule becomes important for normal hip mechanics. During hip flexion, should restriction of the tissues posteriorly be present, normal glide in this direction cannot occur. As such, Femoral Anterior Glide Syndrome occurs, somewhat similar to what occurs during internal impingement of the shoulder. In the lay person, this often occurs as a result a chronic slouched posture while seated and in athletes this may be demonstrated by the presence of a strong posterior tilt at the bottom of a squat.
Upon physical examination, it is not uncommon to find a firm capsular end feel. The dysfunctional capsular pattern of the hip will first be revealed by a marked restriction of internal rotation.
Techniques that may be utilized to improve hip mobility include, but are not limited to, Muscle Energy Techniques, Mulligan Mobilizations with Movement, Functional Range Release various grade Manipulations, etc. Some of these are demonstrated below. As mentioned above, it is important to note that not all strategies will work for all individuals. It is up to the manual therapist to identify out which one will work for each specific athlete, client, or patient.
In viewing SportsRehabExpert.com founder, Joe Heiler, perform the Mulligan Mobilization with Movement technique above, it should be noted that many other variations of this technique can be performed to mobilize the posterior hip. Specifically, several of the techniques I demonstrated in the first video can be performed with such accessory glides.
Furthermore, watch this...
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