Tips for Healthy Hips | Sports Medicine June 2012

In my practice as an orthopaedic sports medicine specialist, I am often asked by patients what measures they can take to either prevent the onset of hip pain or treat their current pain. People who enjoy running, hiking, cross-country skiing, and skating are often susceptible to hip pain.

The hip is a “ball and socket” joint with many large muscle groups crossing and stabilizing the joint. In the front of the hip, the most important of these muscles are the rectus femoris (one of the quad muscles) and the iliopsoas (the “hip flexor” muscle). In the back of the hip are the gluteal muscle and the short external rotators. On the outside lives the IT band, and on the inside, the adductor muscles (groin muscles).

Hip injuries come in all shapes and sizes, including strains and sprains of all of the listed muscles and their associated tendons; bursitis of a multitude of bursal sacks around the hip; as well as primary joint problems such as osteoarthritis, synovitis, impingement, and labral tears.

As opposed to addressing all of the many possible hip injuries, this article will speak briefly about general tips for maintaining good hip health, whether attempting to prevent or overcome injury.

• Walking aids (for instance, walking sticks, hiking sticks, trekking poles): Force across the hip joint during walking and jogging has been estimated to be between three and six times one’s body weight. This is due to the muscle forces of the abductor muscles, which pull the hip into the joint during these activities. Weight loss is an obvious way to off-load tired hips, but a simpler tool is a walking aid. The use of a single walking stick, cane, or pole, in the opposite hand from the hip with pain, can reduce the force across the hip joint up to 50 percent. Clearly, whether your hips hurt or not, reducing the force on your cartilage during hiking activities makes good sense for the long-term health of your joint.
• Stretching: Unfortunately, in today’s world, we spend much of our time sitting. Because of this trend, the structures in the front of the hip are typically the first to get tight. This includes the hip flexor muscle, the rectus, and the joint capsule itself. If you only have time to stretch one area around the hip, I’d recommend focusing on the hip flexors. Standing with your legs together, first move one leg backwards into a deep lunge. Your front leg should be bent about 90 degrees and be approximately level with your hips. Raise your arms over your head and use your core muscles to reach tall and stabilize yourself. This should stretch the hip flexor of the back leg. Hold for at least 10 seconds and repeat three to four times.
• Strengthening: My experience has been that when weakness occurs around the hip, it occurs first in the muscles in the back and side of the hip (the abductors or gluteal muscles). These muscles can be effectively strengthening with side-lying abduction exercises (lying on your side, lift your leg away from your body). Do three sets of 10 without weights (to begin with).
• Nutrition: Bone health is exceedingly important as we age. Getting enough calcium and vitamin D is critical for maintaining bone mass in our hips. The recommended amount of calcium and vitamin D supplementation is different depending on your age. Most of us will get enough in our diet and with regular sun exposure; however, with long winters here in the north country, some people are vitamin D deficient. Speak with your primary doctor about these issues or go to cdc.gov/nutritionreport for up-to-date information.

Enjoy a summer of adventures and may your hips always be healthy.