Thursday, February 17, 2011

HIP HINGE! Your Body Wants You To

The hip hinge is a fundamental movement pattern. You need it to get out of a chair, squat, pick things up, deadlift, do an Olympic lift and generally spare your spine while moving.

See the video below of how to do a hip hinge.

However, it's surprising how many people can't hip hinge. I've noticed it with a whole host of different populations. When I get a client who has back pain, one of the first things I do is observe them get in and out of a chair. A high proportion of these clients tend to get out of the chair by lifting their hips up high and then unrolling or flexing/ bending  through the lumbar spine. Some can't even get out of the chair without using their hands to push themselves up. A few simple cues and adjustments and then suddenly they can get out of the chair with a neutral spine and without using their hands. Mostly I tell them to bring their feet wider, push their knees out, hinge from the hips, keep the chest up and drive into the floor with their feet - and bingo they get out of the chair with a neutral spine and using their hips.

Chair Squat - start position

Chair Squat - mid point
Why can't people hip hinge then?

If the hip hinge is a fundamental movement pattern, and everyone should be able to do it and use it on a daily basis, why can't people do it. Why do they bend/ flex in the lumbar spine? Why does the thoracic spine round too much?

The body will take the path of least resistance, the least stiff part will move and compensate for the stiff part. In the words of Charlie Weingroff (2010):

"The movement goal is achieved but there is no integrity to the movement."
Which means I asked them to get out of the chair and they got out of the chair, the goal was achieved. The hips and thoracic spine may be stiff so they used the lower back to get out of the chair, they achieved the ultimate aim. Or in the context of weightlifting, one person deadlifts the weight using the hips, while another person uses their lower back - they both got the weight up, and if you're in a competition you can justify it to yourself, but don't train like this, you're going to end up in a world of hurt.

Your body responds and adapts to what you practice most. If you adopt a certain posture 8 hours a day, what does your body do, it adapts to it.

"Prolonged sitting has been cited as a factor in the development of back pain. Cyclists who spend 3 hours riding their bicycles in a position of lumbar flexion have a reduced lumbar curve when compared with control subjects who do not ride bicycles." (Sahrmann,2002:13)
which means

"repeated motions of daily activities, as well as those activities of fitness and sports, may also induce undesirable changes in the movement components." (Sahrmann, 2002:13)

So in most cases the lumbar spine is moving too much. In this context the joint by joint theory espoused by Mike Boyle and Gray Cook makes sense. If the body is a series of joints stacked on top of each other, with some tending to be more mobile and some more stable, a loss of mobility in a joint may affect the ones above or below. So in the case of the hip hinge, if I lose mobility in the hips the lower back will compensate, if I lose mobility in the thoracic spine, the lower back will compensate; the lower back should be stable. In lower back pain rehab we always ended up spending as much time on trying to restore peoples hip mobility and strength and their thoracic spine mobility, as well as lumbar spine stability. When I first read Mike Boyle's joint by joint article in made perfect sense because I was seeing it on a daily basis with people.

And remember, stable doesn't mean static and still

"stability is the ability to control movement in the presence of potential change." (Weingroff, 2010)

So why can't I bend my lumbar spine, it's meant to bend isn't it?

Somewhere in Canada there's a guy called Stuart McGill and if he's not on his yacht or kayaking or cross country skiing or grooming his moustache then he's in his spinal lab at the University of Waterloo. He breaks spines so you don't have to.

It seems the number one mechanism for herniating a disc is fully flexing the spine.

"In fact, herniation of the disc seems almost impossible without full flexion." (McGill, 2002:56)
 And the number of flexion is important, the spine doesn't have to be loaded up, the repeated flexing of the spine with minimal load can cause disc herniation. I like Mike Boyle's analogy of a credit card, if you keep bending it back and forward eventually it will snap, not because you were applying much force but the repetition caused a weakness in the plastic until it snapped.

Imagine this shiny new gym membership card is your spine, eventually it's going to snap
"repeated spine flexion - even in the absence of moderate load - will lead to discogenic troubles." (McGill, 2002:127)
The way to avoid this is to flex at the hips while keep the back in neutral and the abdominals braced for the task at hand. This is the hip hinge. Interestingly,  one group of people who lift some of the heaviest weights are Olympic lifters, they lock their spine into neutral and rotate around the hips (McGill, 2002). Their incidence of back pain is lower than the general population. If you look at the video clip below of the snatch grip romanian deadlift, you can see the spine in neutral and the hips doing the work. The position of the bar below the knee is essentially the same as the start of the second pull in the Olympic lifts. (note: if you ever film yourself doing a lift, then it gives an insight into your technique and will immediately make you lift with better technique).

Hang on, shouldn't I be able to touch my toes?

Toe touch: an assessment not an exercise
Being able to touch your toes is still seen as a measure of flexibility. It appears in Gray Cooks Selective Functional Movement Assessment  as one of the tests you employ if someone is in pain, it's the multi segmental flexion assessment (Cook, 2010).

I think Charlie Weingroffs Core Pendulum theory is a good explanation of this. Charlie explains this in his excellent DVD set Training=Rehab Rehab=Training (go and order it now, it'll change your life for sure! And I don't get any money for saying this). We need to exhibit for flexion and full extension for our spines to know where the middle is, joint centration. If you have a loss of flexion then your neutral spine will be off because your body doesn't know where the middle is, same as if you have a loss of extension. The lumbar spine is meant to flex and extend but going to the end range on a regular basis is not a good idea, its proven to eventually cause disc problems. Remember an assessment is not an exercise you should be doing on a daily basis.

Core Pendulum: If neutral is in the middle(3), then your body only knows its the middle because it can get to the end ranges (1 & 5), if it can't, adopting neutral spontaneously is going to be difficult.

As an example, I never practice touching my toes and I hardly ever stretch my hamstrings passively and my flexibility in this area isn't the greatest and yet I can touch my toes. This is purely from doing hip hinges, kettlebells swings, deadlifts and so on.

Save your spinal flexion for when you need it, on those occasion's when its impossible not to flex, the rest of the time adopt spine sparing strategies such as the hip hinge, squat using the hips or a golfers lift for picking things up.

Golfers Lift: reduce load on lumbar spine when picking up light things
A quick note on the golfers lift: The leg cantilevering behind acts a counter weight, effectively hinging one hip and helps reduce the load on the spine. To train this movement I like to put a kettlebell in the hand opposite to the one on the floor.  For back pain clients who can't balance, it's acceptable to support one hand on a wall or chair or table when picking things up.

Hip hinge common mistakes

In the first video clip below you can see Nick is bending his knees too much and flexing in the thoracic spine. Knees should be about 20 degrees  (if  you happen to carry a protractor or goniometer around with you) this allows the glutes to be engaged more effectively. You should feel a stretch in the hamstrings on every repetition. Cue to keep the chest up but the head neutral.

In the second clip below, you can see the hips hardly move back at all. In fact, Nick had a hard time trying to demonstrate this because he's is so used to hip hinging, his hips are still moving, you'll see some people with no hip movement and all spinal flexion. You can try to get them to push their hips back by standing near a wall and trying to push their glutes (bum) back to the wall and touch, may be a foot length away from the wall at first. The broomstick on the back can also help people feel when the back starts to bend.

Another thing that can happen mainly with women is the lower back has too much curve in it, too much extension. No video of this because neither me or Nick can get that much extension in our backs! Remember neutral is not over extended, it's in the middle of the pendulum swinging.

You can start to weight the movement using a kettlebell once the hip hinge has been grooved in, and some people will naturally start to brace more when they have a weight in their hands, and it helps to get that stretch feeling in the hamstrings, loaded up and ready to contract.

And finally the squat

For most people using a squat that has some kind of hip drive component to it is the way forward. If you're an olympic lifter you are going to drop almost straight down and most probably be in a front squat position. For everyone else, especially the general population, sitting back more is going to be more beneficial.

I've used the bench squat technique (see video below) successfully with back pain clients as well as clients referred to me on GP referral (exercise referral scheme) with knee replacements and hip replacements. It is essentially an unweighted box squat. The client learns to break at the hips first and sit back, keeping a near vertical shin also helps those who have knee pain. The hip hinge is a vital component of this.

When a person can't sit all the way down onto a bench or chair I use a step on risers, and gradually as they get better reduce the number of risers down. Don't think about loading up a squat until someone can do it bodyweight with neutral spine.

In the video below are some common squat mistakes.

On the first repetition - trying to do all the movement at the knees, no hip hinge. A lot of people do this when you ask them to squat. I think it might actually be a misunderstanding, you say squat and they think the knee must bend, they have an image in their head of what a squat is. Sometimes you can correct this immediately with the right cue to use the hips. Thus demonstrating it's not always a muscle or joint issue.

On the second repetition - rounding the thoracic spine and over extending the cervical spine by looking up.

On the third repetition - knees caving in.

To paraphrase Gray Cook (2010) I wouldn't get too caught up trying to analyse why all this is happening, is it because the hips are tight or not working, or the lower back not stable, or thoracic spine being immobile or the ankles being stiff? Possibly all of these, but work on fixing the movement pattern. Sometimes its just because the person just never moves that way, the software isn't in their brain, practice the movement and the nervous remembers it and saves the software for the new improved movement pattern.

And maybe they never challenged themselves before, if you sit in a chair all day you don't need to be very mobile or stable. You only need stability in the presence of mobility (Weingroff, 2010)

In conclusion

You need the hip hinge. You need it to spare your spine and keep your lower back neutral when picking things up at home or in the gym. You need your hips working for you, not against you. Your body remembers what you do most.

Tina Fey: No, don't pick that typewriter up with a flexed spine, hip hinge dammit! Okay, I forgive because you created 30 Rock and you're hot. But if you're ever in England and you have back pain give me a call and I'll see what I can do.


Cook G (2010) Movement
McGill (2002) Low Back Disorders
Sahrmann (2002) Diagnosis & Treatment of Movement Impairment Syndromes
Weingroff (2010) Training=rehab rehab=training DVD

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