Close the window    Hip to be Square - The Prehab Workout Hip Injury Prevention and Strengthening Exercises Men's Fitness, April, 2002 Hip injuries have become, well, almost hip. Golfers Greg Norman and Jack Nicklaus have gone under the knife to have their hips repaired or replaced, and it's not uncommon in any sport to see guys benched by a strained hip flexor or extensor. First, the mechanics: The hip is a ball-and-socket joint where the thigh bone's femoral head fits into the acetabulum of the pelvis. A layer of fibrocartilage called the labrum lines the socket and helps keep the joint lubricated. Motion is created by the rotation of the ball in the socket, and the joint is stabilized by the muscles of the hip, thigh, abdomen, lower back, groin and buttocks. Because so many muscles tie into the area, hip problems can radiate throughout the body. "The most common hip injuries are strains of the muscles surrounding the hips," says Daniel Cosgrove, M.D., director of the WellMax Center for Preventative Medicine in La Quinta, Calif. "But fractures and dislocations definitely happen, especially in direct-contact sports such as football." Injuries usually occur as a result of the forceful contraction of a stretched muscle, e.g., when a sprinter bursts off the starting blocks. Hockey, soccer, baseball and gymnastics get their fair share of adductor (inner thigh), flexor (hip front) and groin strains and tears because of the force generated by frequent stops, starts and directional changes. "Almost any sport that requires hip rotation and a forceful transfer of body puts the brunt of this movement on the hips," says Marc J. Phillipon, M.D., director of the Center for Sports Medicine at the University of Pittsburgh and the orthopedic surgeon who repaired Greg Norman's torn labrum. "The rotation of your golf swing, the ability to turn on a dime on the playing field, or the blast of power you need to round the bases at full speed starts in your hips," Phillipon notes. "If the muscles of the area are weak, the hip will take the most of any trauma you suffer on the playing field, regardless of your game." PAINS, STRAINS AND REMEDIES Hip strains range in severity from a mild level I pull, in which muscles are not torn and range of motion isn't compromised, to a severe level III tear that generally requires surgery. Hip pointers, also known as contusions, are usually the result of a fall. Pain, swelling, spasms in the region, and a "crackling" sound or feeling are the symptoms of strains and contusions. Fractures are primarily the result of a fall, a direct blow to the area, or a violent twisting motion. If you sustain a serious injury, your doctor should take X-rays to rule out the possibility of a fracture, which usually involves surgical repair and months of physical therapy. For strains and hip pointers, the immediate aim is to reduce any swelling or internal bleeding. Follow the RICE path: rest, ice, compression and elevation. Massage the affected area with ice for 10- to 15-minute intervals to help decrease swelling, and elevate the area as soon as possible. Rest is critical. Your doctor might put you on crutches and insist that you stay out of the gym or off the field for one or two weeks until you can begin putting weight on the area again. As always, listen to your body and resume your training with gentle range-of-motion exercises only after the area is pain-free. TIPS FOR HEALTHY HIPS Prevention of hip injuries can be as simple as playing your game regularly. Adductor muscle injuries often occur as a result of improper warm-up or conditioning and a general lack of muscular endurance. So stay active, even in the off-season. "The number-one reason most people sustain injury to the hip is due to muscle weakness or inflexibility," says Cosgrove. "Instead of relying on sports to get us fit, we should instead concentrate on getting fit to play sports." To complement your regular gym workout, try yoga or Pilates to improve your flexibility and endurance. "Stretching should already be a part of your daily workout routine," Cosgrove insists. "Don't forget to stretch afterward. The tissue has the most blood flow, highest temperature and greatest elasticity immediately after exercise, so it's an optimal time to get an effective stretch." Always warm up with a light cardio workout such as 10 to 15 minutes on the treadmill or stationary bike; cycling is preferable because it doesn't put extra stress or pressure on the hip joints. Wear the right protective gear if you're involved in any sports in which you might fall or suffer a hit. And keep your weight down and your nutritional standards up, particularly as you age and bone density naturally decreases. The following workout uses several stretches recommended by the American Physical Therapy Association and strengthening exercises that specifically target your flexors, adductors and abductors. Perform all the exercises only as far as they remain comfortably possible. THE EXERCISES 1. THIGH STRETCH Stand behind a chair, resting your hands for support. Keep your head up and back straight. Slowly move your right leg out to the side about 12 inches. Hold for 10 seconds and return to the starting position, controlling the movement with your muscles. Repeat 10 times. Switch legs. [ILLUSTRATION OMITTED] 2. HIP/BUTTOCK STRETCH Lying on your back, straighten your right leg on the floor, bend your left leg, and grasp the left ankle with your right hand. Holding the knee out to the side with your left hand, gently press it toward your shoulder. Hold for 15 to 30 seconds. Repeat five times and switch legs. [ILLUSTRATION OMITTED] 3. PELVIC LIFT This move strengthens your glutes, abs and hamstrings. Lie on your back and bend your knees. Keeping your feet flat on the floor, tighten your abs and glutes and raise your pelvis until it's in line with your knees. Don't let the knees splay. Hold for 15 to 20 seconds. Do three sets of 10. [ILLUSTRATION OMITTED] 4. KNEES TO CHEST This static stretch works your abs and improves hip, back and neck flexibility. Lie on your back, bending your right leg and keeping your left leg straight. Press your chin to your chest, hold the right leg in both hands just behind your knee, and pull your knee toward your chest. Hold for 30 seconds. Do each leg 10 times and then pull both knees to your chest; hold for 30 seconds. [ILLUSTRATION OMITTED] 5. SQUAT Stand holding a barbell across your traps, with your head up and your back in its natural alignment. Slowly lower your body until your thighs are parallel to the floor. Return to the starting position and repeat. [ILLUSTRATION OMITTED] 6. OUTER-LEG RAISES Lying on your left side, rest your head in your left hand, placing your right hand on the floor for balance. Lift your right leg slowly, as far as you comfortably can. Hold at the top and lower it again, controlling the movement: Repeat before your legs touch. Do three sets of 12 to 15 reps and switch sides. [ILLUSTRATION OMITTED] 7. INNER-LEG RAISES Lying on your right side, bend your left leg to place the left heel in front of the right knee. Lift the right leg six to eight inches off the ground; hold for five seconds and lower. Do three sets of 12 to 15 reps and switch sides. For an added challenge, use ankle weights. [ILLUSTRATION OMITTED]