Are You Ready To Run? Part VI

Question: How do you know your hips are normal and healthy? Today, we’ve got a test for you to find out.

We’re almost halfway through our “Ready to Run” primer. Click on the links below if you missed one of the previous posts in the series.

The Standards

#1-Neutral Feet

#2-Flat Shoes

#3-A Supple Thoracic Spine

#4-An Efficient Squatting Technique

Standard #4 was the first test to assess how functional your hips are. We’re about to take a closer look at your hips with our next standard:

#5 Hip Flexion

If you’re new to running, or in the midst of trying to reform your running technique, paying attention to the strength and flexibility available in your hips is mission critical. Your hips hold a host of power for your lower body. Being able to fully access that power is dependent on having strength through a full range of motion in your hips.

Our hip flexion standard is a straight-ahead test: can you stand on your left leg, pull your right knee up above the crease of your hip, let your arms relax by your side, and hold that position for 30 seconds and then do the same standing on your left leg?

Here’s how to do it:

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Start in standing and go through the Bracing sequence to organize your spine, hips, and legs before you get started.

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Grab your right leg with your hands and pull your knee up above the crease of your hip.

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Let your arms relax by your side and keep your right leg in the same position for 30 seconds. If your leg starts to drop before 30 seconds is up, you don’t pass the test. Repeat this test while standing on your right leg.

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If you can’t keep your left leg straight or your knee drops below the crease of your hip, you’ve got some work to do to meet this standard.

MAKING THE INVISIBLE VISIBLE

The hip flexion test makes it clear what type of use you regularly engage in with your hips. If you sit for work all day with your knees and thighs resting comfortably level with the crease of your hips (this is about 90 degrees of hip flexion), your body adapts to this range of hip flexion as your “normal” end range. There are several problems with this.

First, most furniture designed for sitting these days requires about 110 degrees of hip flexion. Without this hip range of motion, your pelvis will rock backwards and your low back will flatten out to allow your thighs to rest comfortably in the seat.

That slouched, flat low back position uniquely adds direct vertical load through the discs of your lumbar spine. If you’ve ever had a disc herniation or bulge, you know what I’m talking about here. If you’ve not yet had the pleasure of a disc injury, please know that I would rather you not have to be pushed into the hospital ER in a wheelchair, dear one.

Second, while you’re crushing your discs sitting in that chair as you read this, also remember that the no man’s land of 90 degrees of hip flexion for 8 to 16 hours a day (it’s not just the sitting at work, it’s all the sitting you do commuting and in your home that counts, too) creates a big ball of stiffness in your the front of your hips, what is commonly referred to as the “hip flexors”. Those big muscles cross the front of the hip and attach deep in your abdominal wall on the front of your lumbar spine. Tight hip flexors passively drag your spine and pelvis forward into what some folks call “sway back” position. This over-extended position of the low back closes down the tunnels the nerves in your back exit out of, which leads to nasty injuries like spinal stenosis and nerve root impingement. As your back and hips get stiff, and your nervous system tissues get over-taxed, the power output in your lower body tanks.

Third, if you struggled with keeping your balance for 30-seconds on either leg, you’ve got a proprioceptive issue. Proprioception refers to your nervous system’s efficiency at sensing changes in body position and the ability to maintain position under dynamic movements-like running. If you can’t pass this 30 second test, it’s unlikely you’re going to be able to maintain your posture and form while running a 5k or longer.

SOLUTIONS

How do you avoid or deal with the inevitable compromise of your hip function if you’re forced to sit for work? The simplest fix is taking frequent breaks, every 20 to 30 minutes, even for just 1 minute, to walk around, go through the bracing sequence, or pump out a few Air Squats or push-ups before sitting back down. Don’t try to fix your slumping in your seat, you’ll never find neutral again without standing up, so just get up and reset.

A standing desk is a great alternative to a standard desk. Cost is a frequent objection to converting to a standing desk, but we’ve found a great low-cost option in the Oristand that will allow you to try out a standing work station without breaking the bank. Get a cheap bar stool or high top table chair and you’ve got a seat that keeps you out of that dreaded 90 degrees of hip flexion in sitting.

Aim to sit (in a conventional seat) for 8 hours or less for a week. You can sit any way you like on the floor at home (which doubles as a great opportunity to work on improving your hip mobility), and try to stand more when it’s an option. The goal shouldn’t be to never sit, rather, we want you to develop a higher consciousness about what shapes you put your body in for most of your day.

In terms of physically restoring normal hip flexion we need to address two components: joint range of motion and motor control.

You should be able to bring your knee above the crease of your hip without rounding your lower back. This is normal hip flexion range of motion (usually between 120 and 130 degrees). We recently posted this video on our YouTube channel to help you address any hip flexion restrictions you may have.

The other piece of passing this test is building strength in your hip flexors to allow you to pull and hold your thigh in that end-range hip flexion position. I have heard numerous patients and clients alike bemoan their chronically tight hip flexors. Sitting less is part of the remedy to this situation. The other half of that is actually building strength through the front of your hip. As I mentioned earlier, your body adapts to what you do most frequently. If you are most often in that mid-range hip flexed position your hip flexors will get adaptively tight. A muscle that can’t move throughout its normal range of motion is a weak muscle. Tightness in the muscle hides this weakness to a certain extent. But this is also why just stretching your hip flexors will never solve the problem. If you don’t teach (train) your body to use your hip flexors through their entire range of motion after you’ve restored that normal range, your body will continue to pare off that range you are not strong in. We’ll be posting a few ideas on our YouTube channel for you on strengthening the anterior (front side) hip musculature in the next week.

The normal function (strength and range of motion) we expect to see in the physical therapy clinic is congruous with the performance capabilities your expect out of your hips as a runner. We’re not asking you to be super-human to meet this standard. We’ll be more than happy if you’re just normal. It takes regular attention to maintain normal function but it is within your reach. You don’t have to be super-human, just consistent.

Merry Christmas, everyone!


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