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Every client's body is different. They vary in terms of height, weight, muscle structure, bone structure, and more. As a trainer or coach, it's your job to develop a fitness program that works with (and for) their specific musculoskeletal makeup. One consideration is if they have a high hip, also known as a lateral pelvic tilt.
If someone has a lateral pelvic tilt, it means that one hip sits higher than the other. The hip that sits higher is referred to as a hip hike. The hip that sits lower is a hip drop.
Lateral pelvic tilt is one of three types of pelvic tilt. The other two are anterior pelvic tilt and posterior pelvic tilt. With anterior pelvic tilt, the top of the pelvis tilts forward. This is perhaps most apparent in women who are pregnant. But it can occur in others as well. In posterior pelvic tilt, the top of the pelvis tilts backward.
Lateral pelvic tilt is sometimes caused by structural differences. One example is scoliosis. Scoliosis is often referred to as a "sideways curvature of the spine." This curvature results in one hip sitting higher than the other.
Another structural issue that can impact hip alignment is leg length discrepancy. Leg length discrepancy means that the right leg is longer than the left leg or vice versa. If leg length differs, the hip may not sit evenly.
In addition to scoliosis and leg length discrepancy, lateral pelvic tilt can have functional causes. Tight hip flexors can change hip muscle function, for instance. Hip flexor muscles are located in the hip, lower back, leg, and groin. If the gluteus muscles on one side of the body are weaker than the other, it can also cause the pelvis to tilt.
All types of pelvic tilt can throw the body out of alignment. This impacts the structure and function of the hip joint. If the function is impacted a lot, it can hinder hip mobility. It may even result in hip pain.
Greater trochanteric pain syndrome is a condition causing pain in the hip, thigh, and glutes. A 2017 review explains that lateral pelvic tilt can contribute to this hip syndrome. This is primarily due to the pelvic tilt weakening the hip abductor muscle. Research further indicates that greater hip asymmetry is associated with low back pain as well.
In some cases, pelvic tilt is noticeable visually. You can look at a client's body from the backside and easily see that one hip sits higher than the other. (A side view may reveal when the pelvis tilts forward or back.) If the client complains of hip flexor pain, this may also be a sign of uneven hips.
Since tight hips are often associated with sitting for long periods of time, it might also help to ask about your client's sitting habits. Studies have also found that people with lateral pelvic tilt switch sitting positions more often. Therefore, asking about how often they move around while sitting may help identify less visible cases of pelvic tilt.
Two basic gym-based programs can help correct high hip. They are stretches and strength training exercises.
Incorporating a hip flexor stretch or two is beneficial for clients with hip asymmetry caused by tight hip flexors. Stretches that target the hip muscles include:
Kneeling hip flexor stretch. Have the client kneel on one knee, extending the other leg behind them. Next, ask them to push their hips forward until they feel stretching in the back leg.
Standing lunge stretch. This movement is essentially the same as the kneeling stretch, except the client is standing. Just make sure they don't lean so far forward that their knee extends past their toes.
Butterfly stretch. The butterfly stretch involves sitting on the floor, placing the bottom of the feet together, and bringing them into the groin area. The elbows are placed on the knees, gently pushing them down. If the client experiences groin pain, they are pushing too hard.
Reclined stretch. Another option is to have the client lie on their back with their knees bent. Rest the ankle of the right leg just above the left knee. Then grab the left shin and pull that leg in. This move is a good hamstring stretch that also loosens the hips.
Knee to chest stretch. While still lying on their back, ask the client to straighten their legs. Then have them pull one knee into their chest. The other leg should remain straight. It's also important that their lower back stays against the floor versus arching. Hold this position to give time for the muscles in the leg and hip area to relax. Repeat on the other side.
Hip flexor foam rolling. Another way to stretch tight hips is with a foam roller. Have the client place the roller under their tight muscle and roll gently back and forth.
Adding strength training exercises can help bolster the muscles that support the hip area. It may also help clients with high hip due to weakened gluteus muscles. Exercises that strengthen the hip area are:
Glute bridge. Ask the client to lie on their backs with their knees bent. Tell them to raise their hips toward the ceiling, contracting their glutes and stomach muscles along the way.
Fire hydrant. Have the client get on all fours, lifting one leg up to the side until at a 90-degree angle. The foot on the lifted leg should be flexed during the entire exercise.
Mountain climbers. This exercise strengthens many of the muscles in the hip. It involves being in a push-up position, then bringing one knee closer to the elbow as if climbing a steep mountain. That knee is then returned to its starting position, followed by the same motion on the other side. This pattern is repeated several times.
Side planks. The plank is good for developing full-body strength. When it is performed on the side, it helps target the hip area even more. Start with short holding times. As the client gets stronger, these times can increase.
Hip circles. This hip strengthening exercise is performed standing up. Have the client place their hands on their hips. Lift one foot off the floor and move it in circles. Then have them switch directions and circle their leg the other way. Do this move on both sides. If the client struggles with balance, holding a chair back or wall can help.
Resistance band side steps. While still standing, have the client crouch into a semi-squat. Place a resistance band around their ankles. Then ask them to take a few steps to one side before stopping and taking a few steps back to their starting spot.
If stretches and strength training aren't helping, your client may need further intervention. Refer them to their doctor to rule out other issues, such as hip dysplasia, hip impingement, and hip arthritis. These conditions may require physical therapy to help ease the pain.
In severe cases, surgery may be required. Hip replacement surgery, for instance, involves removing the client's hip joint and replacing it with an artificial joint instead. A total hip replacement may be recommended if the client's pain is a result of arthritis. Nowadays, hip replacement isn't as major a surgery as it used to be. According to Johns Hopkins, some patients leave this surgery with only 1-2 small incisions.
Want to learn more? ISSA's Corrective Exercise Specialist Certification course teaches how to help clients with muscle pain and/or movement dysfunction. It also covers corrective exercises that can release common joint restrictions.
"Scoliosis - Symptoms And Causes". 2021. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/scoliosis/symptoms-causes/syc-20350716.
Speers, Christopher JB, and Gurjit S Bhogal. 2017. "Greater Trochanteric Pain Syndrome: A Review Of Diagnosis And Management In General Practice". British Journal Of General Practice 67 (663): 479-480. doi:10.3399/bjgp17x693041.
Al-Eisa, Einas, David Egan, Kevin Deluzio, and Richard Wassersug. 2006. "Effects Of Pelvic Skeletal Asymmetry On Trunk Movement". Spine 31 (3): E71-E79. doi:10.1097/01.brs.0000197665.93559.04.
Al-Eisa, Einas, David Egan, and Anne Fenety. 2004. "Association Between Lateral Pelvic Tilt And Asymmetry In Sitting Pressure Distribution". Journal Of Manual & Manipulative Therapy 12 (3): 133-142. doi:10.1179/106698104790825239.
"Hip Replacement Surgery". 2021. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hip-replacement-surgery.
The ISSA's Corrective Exercise Course will help you learn how to identify and correct the most common movement dysfunctions that you are likely to see in a wide range of clients.
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