Hip/Lower Abdominal Injuries

Hip Stabilization Exercises

Over the last few years, I’ve written and talked quite a bit about preventing hip injuries in hockey players. Unfortunately, things like adductor and hip flexor strains have become accepted as “part of the game”, and now we’re seeing a surge of femoroacetabular impingement, labral tear, and sports hernia cases. The underlying mechanisms to many of these injuries can be pretty complex, but once you get it, many of these cases can be prevented.

A few months back, I posted a video on how to assess for a pretty common structural “abnormality” that we see in hockey players known as “version”. More specifically, players can have unilateral or bilateral ante- or retro-version. If you missed the video, take a few minutes to watch it below:

In the past, I’ve worked with a lot of players that complain of groin pain that present with associated weakness. It’s important to point out that pain completely changes function, often in unpredictable ways. This is one of the reasons that training or playing through pain can lead to additional problems down the line. Compensations are inevitable. Specific to these cases, often times the cause of the pain and weakness is a misaligned pelvis. As a quick anatomy review, each hemi-pelvis integrates with the spine via the SI joint in the back and with each other via the pubic symphysis in the front.

These three connection points (SI joint on each side and pubic symphysis in the front) form a continuous loop. Because of their integration, one segment become misaligned will necessarily result in a misalignment at another segment. For example, an SI joint being out of whack can lead to a shift in the other SI joint and/or the pubic symphysis. Alignment can be compromised from contact, and/or instability secondary to poor or asymmetrical movement patterns, postures, and strength. Misalignments can refer pain to a number of places throughout the thigh, hips, and lower back, but a common one that we see relates to pubic symphysis irritation. When there is excessive movement across the pubic symphysis, the cartilaginous disc that helps improve the contact area of the two adjoining bones becomes inflamed. This is referred to as osteitis pubis and is one of the most overlooked sources of groin pain. These cases are frequently treated with injections to reduce the inflammation, which is effective in putting a band-aid over the pain, but completely overlooks the cause.

In these cases, asking the athlete to squeeze something between their legs while lying with their knees bent will reproduce the pain radiating from their groin up into their hip AND strength will be poor. Many times, a simple “SI readjustment” from a physical therapist or chiropractor will restore alignment and the pain will be gone and strength restored, instantly. At this point, the athlete has a more neutral alignment, but has demonstrated that they’re prone to slipping back into misalignment (and pain, and weakness). Following readjustment, it’s important to incorporate strengthening exercises that put multi-directional bilateral stress across the hips. These exercises serve to improve the integrity of the hip in a neutral position, which will help ensure that they player doesn’t fall in and out of alignment and progressive degenerate the joint. The exercises in the video below were a few that we’ve used at Endeavor in cooperation with Ned Lenny, a really bright physical therapist in Cherry Hill, NJ. Enjoy.

To your success,

Kevin Neeld

P.S. I’ve added an “ebook only” option to Ultimate Hockey Training, so if you don’t want to shell out for shipping a physical copy, you can now get instant access to the entire package digitally here: Ultimate Hockey Training

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6 Responses to “Hip Stabilization Exercises”

  1. Adam Richmond:

    Hi Kevin,
    Love your work and this stuff on hips has definitely improved my understanding but I think you might want to consider your thoughts on ‘SIJ missalignment.’ It reads as though you are describing a bony ‘missalignment.’ which can be adjusted.

    It has been conclusively proven that SIJ alignment does not change following an adjustment. See http://www.ncbi.nlm.nih.gov/pubmed/9615363

    It is the effect on the soft tissue that changes post manipulation not the bony joint positions. We should therfore consider the role of muscular stability across the SIJ. Hope this helps… I have a PDF of this article and loads more if you want.

    I have more opinions on this but will hold my breath unless you’re interested.

    Yourse in good health

    Adam Richmond

    23.11.2011, 5:45 am
  2. Kevin Neeld:

    Adam-Thanks for the note and the reference. I’m aware that there’s a school of thought that the SI joint doesn’t move and is essentially a locked joint. My understanding is that Vleeming’s research, using better (read: more sensitive) observational methods than were used historically, was able to provide sufficient evidence that it does. I believe Diane Lee’s book “The Pelvic Girdle” also touches on the subject quite a bit. The Postural Restoration Institute also provides more anecdotal evidence of SI joint realignment following certain techniques. It may be a semantic-driven misunderstanding, but I am extremely confident that a more neutral position of the joint can be restored using both manual and non-manual techniques.

    That said, I’d be interested in reading some of the better papers on the topic that you may have and hearing your thoughts as well. I don’t put much stock in abstracts (unfortunately many researchers flat-out lie in these), but reading through the papers and getting a better understanding of your perspective will surely be beneficial for my understanding on the topic.

    All the best,

    Kevin

    23.11.2011, 10:28 am
  3. Lisa:

    Hey Kevin. Thanks for the great post. I too train hockey players that present with similar issues as listed above. Weak adductors are all too common with this sport. Hopefully more trainers will read this post and do some prehabilitation work on their clients.

    23.11.2011, 10:39 am
  4. Rich:

    Hey Kevin,

    I understand the use of the medball between the knees, and the mini-band around the knees to recruit more of the hip stabilizer muscles (glute-med/min, adductors…). But what is the idea behind the foam roller? To create dynamic stability through the hamstrings on top of the glute max/ adductor magnus?
    Do you find it would be easy to ‘cheat’ this and use the quads to raise the hips?

    Rich

    23.11.2011, 11:59 am
  5. Kevin Neeld:

    Rich-That’s exactly the rationale for the foam roller. As with all glute bridge variations, there are ways to cheat to not get the desired effect. In my experience, if the person is set up right (ankles in front of their knees) the roller makes it extremely unlikely that they’ll substitute quad-driven hip extension. That said, why not give it a try before forming an opinion one way or another? Hope you’re well.

    Kevin

    23.11.2011, 12:04 pm
  6. Scott:

    Kevin,

    What is the length of the powerband you use in the video? Keep up the great work! I always look forward to your emails.

    Best,
    Scott

    25.11.2011, 11:15 am

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