Side-Door Strategies for Improving Hip Mobility

Stay the Course“If I keep doing this stretch, will I get more flexible?” the umpteenth patient asks, as they wrestle with their resistant hips and legs through my latest-and-greatest mobility exercise.

They often ask about a week into their multi-daily wrestling matches, having poured a lot of effort into torquing and elongating muscles and joints that often feel like steel cables. My reflexive response is, “Of course!”

But we have learned that this isn’t always true. Some runners plateau in mobility and these classic, go-to exercises either stop working or never work at all. Sometimes, even, a certain stretch relieves pain without achieving a substantial gain in motion. That’s great, but do we give up? No! I’ve found some side-door strategies for this situation.

Side-Door Solutions for a Front- and Rear-Door Problem

There are two cardinal motions of running:

  • Forward hip flexion; and
  • Rearward hip extension.

This front-and-rear hip motion creates the propulsive force of running. Deficits in either motion can cause speed and endurance limitations as well as injuries. When this happens, we seek help from medical professionals, coaches, other runners, and internet resources to improve hip efficiency.

Most of those strategies involve those two key motions of flexion and extension. Indeed, Part 1 of the Performance Mobility Series addresses this foundational mobility. Stretching hip flexors improves hip extension range of motion. Stretching glutes and hamstrings improves hip flexion.

Beyond that, things get more complicated. But runners and their support teams are increasingly savvy and educated. They begin to find some side-door strategies, techniques that address tissues medial and lateral to our forward and rearward hip muscles. The idea is that these side muscles may be imparting a motion limitation to the forward and rearward movement system.

Hip abductor, adductor, and rotator muscle mobility and strength are recognized needs, so much time is devoted to stretching and strengthening these groups. Various hip-rotator stretches (“miraculous” and less so) are applied, and many strategies are employed to shore up those hip stabilizers! Great improvements may be made this way. But what if you’re still stiff? Don’t give up yet! It’s time to go deeper.

The Rod-Versus-Ball Theory of Motion

In the big picture running stride, the main bone that moves is the femur of the upper thigh. It swings on the pelvis: forward to lift and step in front, rearward to push behind. In this simplistic view, it’s as if the femur is a rod, hinging on a base. But our hip joint isn’t a hinge; it’s a ball-in-socket that moves in 360 degrees of motion via the greater trochanter at the end of the femur (the ball) set into the pelvis (the socket).

The hip is equipped with at least 17 different muscles. Some pull on the rod of the femur, while others exert subtle but powerful forces on the ball-in-socket. These forces include rotating, spinning, sliding, and gliding in a variety of directions.

Because the femur is such a long bone, even a slight motion at the ball, within the joint, can have massive mobility consequences. For example, an angular change of a few degrees of that ball-in-socket can result in six inches of motion at the knee!

So what if one or more of those 17 hip muscles–half of which are very short, thick, and located deep in the pelvis–get stiff and refuse to allow that ball to freely move in the socket? You can easily imagine how small mobility losses at the ball-in-socket can have enormous consequences in the running motion.

Deep rotator, abductor, and/or adductor stiffness may, in fact, be solely responsible for extreme, stubborn, and painful range-of-motion loss in the cardinal running motions. This can be true even if these minor-but-super-stiff muscles are otherwise asymptomatic. The question is, how do we effectively mobilize them to restore full runner mobility? How do we “free the ball?”

Stretching Deep Hip Muscles Presents a Torque Problem

Before we go further, we mention the challenge of stretching those deep hip muscles. Effective stretching is often the result of torque production. Muscles are easiest to stretch if they are long and able to be bent around a corner. For example, the quadriceps are long and can be bent around the knee by pulling the foot back.

Applying force through a long lever arm and at an angle creates torque, where force is multiplied by the length of the lever arm. A long wrench on a stiff bolt makes for easy work. The long muscles of the legs are easier to stretch because they are lengthy and subject to torque.

Conversely, very short muscles connecting two small, adjacent areas of a joint have very little torque. The deep hip rotators, abductors, and adductors are much shorter. A short wrench can’t move a tight bolt.

On top of that, these deep hip muscles are subject to tremendous load and stress. With the forces of normal running, these muscles routinely stiffen. With ultramarathon distances and terrain, stiffness and outright dysfunction are almost a given. They need motion, but are super-difficult to stretch.

Background on Freeing the Hip’s Ball Via Side-Door Soft-Tissue Mobility

The phrase “free the ball” was coined by Gregg Johnson, PT, who revolutionized soft-tissue mobility techniques to restore functional joint motion four decades ago. Freeing the ball involves releasing all soft tissues that connect the ball of the hip to the socket of the pelvis, the deep rotators, abductors, and adductors. Using basic self-massage tools like balls and foam rollers, we will self-treat the lateral hip and pelvis as well as the medial thigh.

Here’s a detailed look at those muscles and how they impact hip mobility:

Pre-Test Your Mobility

Before starting, I recommend mobility pre-testing. This involves assessing mobility of any relevant direction or stretch, but namely those that are especially stubborn, painful, or asymmetrical.

Some possibilities include:

Assemble Your Mobility Tools

Here are the recommended tools:

  • Balls. A range of balls from small (tennis ball or golf ball) to large (softball or massage-specific ball) and from soft (tennis ball) to dense (lacrosse ball or baseball) will allow you to reach muscles large and small as well as those superficial and deep. Massage-specific balls and tools may be ideal, but aren’t necessary.
  • Foam roller. You can use a standard foam roller or one with varying densities and textures.

Free the Hip’s Ball!

Then proceed to mobilization. This video has detailed instructions:

[Author’s Disclaimer: The pelvis and hip may be a painful, sensitive area! Please consult with your doctor before engaging in self-treatment techniques, especially those involving firm tools and body-weight pressure. Avoid work on acutely injured or inflamed tissue. Also, avoid over-massaging, as this can injure soft tissue, joints, and bones.]

Mobilize the Lateral Hip and Pelvis

The muscles of the lateral hip–namely the gluteal group–live in a horseshoe-like area below the pelvic rim and around the greater trochanter.

Using a massage ball, trace a u-shape around the greater trochanter, the lateral bony protuberance on the upper lateral thigh. Stay below the rim of the lateral pelvis (what many consider the hip bone, around where most of us wear our pants).

Apply a variety of pressure and motion, including:

  • Up and down. This runs with the grain of most of the glutes.
  • Side to side. This is cross-grain for the lateral glutes, but with the grain of the deeper hip rotators.
  • Sustained pressure plus hip motion. Lean into the ball, and then apply a small rotational motion at the hip with the whole leg.

Mobilize the Posterior Hip

Find the greater trochanter. Proceed toward the back and inside and feel a drop off. This is the trough of the posterior hip, where the femoral neck and head articulate with the pelvis. The muscles and tendons of the deep rotators, as well as the ligaments of the posterior hip, live here.

Mobilize this area by lying mostly flat on the floor, with a small and firm ball (a lacrosse ball or similar) seated in the trough. You may find your trunk and pelvis rotated about 30 degrees for maximal pressure. Enhance mobilization by sliding your body up and down, and otherwise moving the trunk and pelvis on top of the ball, scouring around the bony trochanter to find any stiff, tender areas. Again, you may apply small rotational motions to the hip while on the ball.

Mobilize the Adductors

The muscles of the medial thigh require a slightly different approach. These longer, denser muscles may respond with ball pressure, but do just as well, if not better, with foam rolling.

Align your body parallel to the foam roller, prone on the floor. The mobilizing thigh is flexed to about 90 degrees. Mobilize primarily by rolling the thigh side to side (from inner groin and pelvis toward the knee and back). Accessory motions may include hip internal rotation and hip flexion and extension.

Prescription

These areas can be dense and stubborn. Start small; mobilize a particular area for a few minutes, then reassess motion. Feel for changes in motion as well as changes in the specific area of restriction. Isolate and address specific areas to effectively “seek and destroy” all relevant restrictions!

Freeing the Hip Ball Has Big-Picture Implications

Targeted soft-tissue mobilization to the medial and lateral hip can first and foremost create substantial improvements in the cardinal running motions. They should also improve all hip motions, including internal and external rotation and abduction and adduction.

Keep in mind these additional considerations too:

  • Impact Beyond the Hip. Consider addressing these hip motions if you have chronic injury and/or sensitivities beyond the hips. Chronic ankle instability, knee pain, foot pain, and low-back pain are all impacted by hip range-of-motion losses. If you’re struggling with any of these issues and have plateaued with a treatment approach local to the site of pain, self-assess hip motion and consider addressing any potential hip- and pelvic-tissue restrictions.
  • Increased Injury Risk. Rapid restoration of hip motion can cause injury! It can overwhelm the hip’s stability and motor control, which may be unaccustomed to moving and stabilizing through an expanded range.

I strongly recommend following hip mobility with a variety of basic hip-strengthening exercises, which may include:

  • Hip extension (bridging);
  • Hip flexion (abdominal work, bike pedals);
  • Hip rotation (clam shells); and
  • Hip abduction and adduction (lateral raises).

Perform even a small number of slow, controlled repetitions to help the brain and neuromuscular system retain and efficiently use this new motion!

Conclusion

If you’re stiff, in pain, and stuck in a rut with your running and mobility routines, a new, side-door approach may be exactly what you need to unlock your full range of motion, decrease old aches and pains, and improve running performance and enjoyment!

Call for Comments

  • Do you use any of these techniques to increase mobility in the deeper, smaller hip tissues? If so, what exercises work well for you?
  • And where specifically do increases in mobility happen? Are you able to increase mobility in running’s main forward and backward motions?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.