Junk in the trunk - Posterior Hip (Pt. 2)
The posterior hip usually refers to the tush, the bum, or in technical terms, the fanny. In sport, you can always tell when your competition is going to have some major explosive power just by checking out their rear end and when it comes to back pain or leg pain it’s important to assess this region.
This article will provide an anatomy lesson covering bones, joints and muscles of the hip, as well as some tips for improving performance and reducing pain. If you missed the previous blog about the anterior hip (hips don’t lie - pt. 1) you can check that out here.
The hippest bones in the body
The posterior hip consists of the rear-facing portions of the pelvis bones (ilium), the sacrum, the tailbone (coccyx) and the leg bones (femur). When we move the posterior hip, we also usually move the low back as well. When healthy, these bones are very strong and have the highest bone-density in the body because they are responsible for carrying the entire weight of our upper body when we walk, run, and jump.
There are a large range of bony changes that we see in normal, healthy hips. These differences can occasionally impact certain capabilities such as squatting depth and stance as well as total range of motion in the hip joint.
Posterior Hip Joints
The posterior hip consists of two major joints:
the sacro-iliac (SI) joint
the iliofemoral joint
The SI joints are located at either side of the sacrum and attach to the ilium. These two joints are supported by strong bands of cartilage that keeps them very stable. New research has told us that the SI joints hardly move at all and actually may fuse as we get older.
It is possible that the ligaments and muscles surrounding the SI joint can become irritated and contribute to pain we feel through the posterior hip. In my mobile Kanata chiro practice, patients frequently describe this pain as sharp and worse with raising one leg or twisting through the hips.
Typically we don’t have to worry about training to strengthen or stabilize the SI joint because it is already working hard during our day-to-day life and will be strengthened in every movement from walking to jumping.
When patients describe SI joint pain and associated lower back pain we focus on modifying aggravating activities to reduce “poking-the-bear”, applying targeted chiropractic treatments for mobility and symptom relief, and introducing healthy movement to increase function so patients can get back to their favourite activities quickly.
The second joint of the hip is the iliofemoral joint. it is a ball and socket joint and is the connection between the leg and the pelvis. Ball and socket joints are very mobile and provide us the freedom to move our joints through a large range of motion.
We occasionally discover anomalies in the hip joint that cause the bones themselves to limit the range of motion of the hip such as in femoral-acetabular impingement syndrome. These anomalies can cause pain which may feel like a pinch with hip flexion and internal rotation or at end ranges of hip motion. When having hip pain, it is important that your chiropractor or physiotherapist performs a thorough assessment to help you determine your natural hip capacity for movement.
Posterior Hip Musculature
The main movers of the hip are the gluteus muscles, piriformis, hamstrings and adductors. We also have several smaller muscles that help us rotate the leg from side to side but we don’t usually train these specifically.
The gluteus maximus is the largest of the glute muscles and rotates and extends the hip. This muscle creates huge amounts of power when we run, jump, and lift.
The gluteus medius and minimus are the smaller of the three glute muscles. They work together to help stabilize the hip while we walk and run.
The piriformis travels from the edge of the sacrum to the femur and helps us rotate the leg. Depending on the person, the sciatic nerve may travel above, below or through the piriformis, so if we have an issue with the piriformis it may impact the sciatic nerve in some people.
The sciatic nerve is the major nerve for the thigh and calf. When it’s irritated or compressed we often experience pain or weird sensations throughout the leg. As a chiropractor, it is part of my assessment to determine if leg pain is a result of the piriformis or if something else is impacting the nerve.
The hamstrings and adductors are not always considered posterior hip muscles but both of them help us extend the hip and rotate the leg so we’ve included them here. When you’re walking, running, playing sports or lifting, you’ll want to make sure that these muscles are capable of keeping up with your demands to avoid hamstring and groin injuries.
Training the posterior hip
There are hundreds of exercise variations that will help you build up strength and endurance in the posterior hip. The major movement patterns to focus on when training this area include squats, lunges, and hinges. Walking and running are also great exercises for the posterior hip and often are beneficial for back health.
The most important thing to remember when training the posterior hip is to increase your exercises slowly. Most injuries I see occur when highly-motivated trainees rapidly increase weights, frequency or mileage without taking the time necessary to build up their capacity for these movements.
The key to progress over time is to “slow-cook” your fitness improvements. Gradually increasing the challenge week after week will allow you to confidently crush your fitness goals while avoiding injuries that can create set-backs and frustrations. And remember, there are no such thing as good or bad exercises - we just need to find the ones that match you and your goals.
If you’ve been struggling with your performance or with pain, it may be helpful to speak to a professional to get you started moving in the right direction. I often meet patients who have had nagging pains for weeks that are interfering with their ability to workout, sit at their desk, and play with the kids. Within a few sessions of treatment we can frequently reduce the sensitivity and provide tools and training ideas that help alleviate the pain and discomfort at home and work.
