If you suffer from hip pain, Pilates is an excellent way to remedy discomfort. The pain is often caused by issues with nearby muscles, ligaments or tendons, although hip pain can also be referred from the lower back. While it may be tempting to keep the area immobile, regularly practicing Pilates can decrease pain significantly. This is because the joint itself benefits from gentle yet deliberate movement.
The hip joint is both extremely strong and amazingly flexible, it needs to be, as it has to bear weight and allow for a wide range of movement. It is located where the head of the femur, or thighbone, fits into a rounded socket of the pelvis. It’s known as a ball-and-socket joint. This is because the top of the thigh bone is shaped like a ball and the ‘ball’ sits inside a hollow socket in your pelvis.
The hip joint is held together by a covering of muscles which are secured to the bones by strong cords called tendons. These muscles and tendons form a capsule around the joint and support its movements. They help move the joint, supporting your leg and upper body movement. The main muscles that support the hip joint are the hip flexors of which the primary ones are the rectus femoris, iliacus, psoas, iliocapsularis, and sartorius muscles. In addition weak, buttock muscles can contribute to lots of different painful hip and leg conditions.
Inside the capsule is the synovium, which lubricates the joint with synovial fluid and keeps the cartilage healthy. The cartilage sits between the bones of your hip joint to stop them rubbing together and reduces any impact when you walk or move your hip.
This ball-and-socket construction and the relevant muscles allows for three distinct types of movement:
- Hip flexion and extension – moving the leg forwards and backwards.
- Hip abduction and adduction – moving the leg out to the side (abduction) and inward toward the other leg (adduction).
- Rotation – internal rotation (pointing toes in) or external rotation (turning the toes out) and then moving the straightened leg in the direction of the toes.
The hip joint can withstand repeated motion and a fair amount of wear and tear but despite its durability, the hip joint isn’t indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. Bones in the hip can break during a fall or other injury and any of these conditions can lead to hip pain.
If your hips are painful it may be caused by one of the following:
- Arthritis. Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that cushions your hip bones. As the arthritis progresses the pain gets worse. Because of the pain many people start to avoid exercise, this leads to stiffness and a reduced range of movement in the hip and increased pain. The good news is that gentle exercise and stretching can make a radical difference and actually prevent the need for surgery.
- Muscle strain or tightness. There are a variety of factors that can cause this, from shortened hip-flexors, due to prolonged sitting, to excessive compression and muscular tension from imbalanced walking or standing patterns. For example if you have previously injured your left knee your body may well have learnt to stand in a certain way to protect the knee. Unfortunately after your knee has healed this way of standing has become the “norm” and your body continues to avoid putting pressure on the knee by placing additional pressure on other muscles and joints. The good news is that we can help our hips move more freely and release tension with a few simple exercises whilst regular body awareness exercises will help you re-educate your body to become better aligned so that your joints and muscles can start to work properly.
Exercises and stretches for hip pain
If you suffer from chronic pain it is important to check with your doctor that it is OK for you to do exercise before commencing any exercise programme. Assuming he has said that it is safe for you to proceed, the following exercises can help stretch and strengthen your hip muscles. Depending on your current mobility, you may be unable to do some of these stretches and exercises at the beginning. That’s fine, focus on those that you can do and you will find that the other exercises will become easier over time.
Knee Fold & Stretch
Lie on your back, with both knees bent and your feet flat, about a hip width apart. Engage your core and raise your left knee so that the lower leg is parallel to the floor. Now place both hands on the left knee and bring it towards your chest. Hold the stretch for 20 seconds.
Then let go of the knee and gently lower the leg back toward the floor. Repeat with other leg.
The Frog – External hip rotation
Sit on the floor with both legs stretched out in front of you. Bend your legs at the knees and press the soles of the feet together. Place a hand on top of each knee and gently push them both down towards the floor. Apply just enough pressure to the knees until you feel a stretch, but do not push them any further than is comfortable.
Hold the stretch for 10 seconds and then relax.
Repeat the stretch 5 to10 times.
Bent Knee Opening
Lie with your knees bent and a hip width apart with your feet flat on the floor. Engage your core and then gently allow one knee to move out to the side and towards the floor. As you exhale slowly return the knee to the starting position. Then repeat on the other side. Start with a small range of movement here. The aim is not to bring the knee as close to the floor as possible. The aim is a relaxed and smooth movement in the hip socket. Try to keep your pelvis still as you move one knee out. A slight weight shift is natural, but you are looking for a free and easy movement at the hip, so the pelvis should be able to stay relatively settled. You can also vary this by moving both legs out to either side simultaneously, which will be a more balanced and therefore an easier movement.
Perform 8 repetitions on each side.
Lie on your back, bring your knees up and hug your bent legs to your chest (as is comfortable). Place your hands on top of your knees and allow your legs to slowly move away from your chest until your arms are extended and your knees are roughly above your hips. You are aiming for your thigh bone to stand relatively upright in your hip sockets. Allow your feet and lower leg to just dangle heavily, in order to relax your quads and hip flexors at the front of your thigh. Start moving your knees with your arms, drawing small circles into the air. Try to allow your arms to do the work here and your hip muscles to remain as passive as possible. This can be tricky. The more relaxed you are, the easier it will be for your hips to let go. The more passive the muscles around the hip become, the better. In order to achieve this, think less about the knees circling on the ceiling and more about the sensation of your hip bone circling.
Perform 10 circles in each direction.
Oblique Strengthener – Double hip rotation
Lie flat on the back with your knees bent and the feet are flat on the floor. Your legs should be together an in parallel. Gently rotate the knees to the left, lowering them toward the floor. Rotate the head to face the right while keeping the shoulders against the floor.
Hold this position for 20–30 seconds.
Slowly return both the head and knees to the starting position.
Repeat on the opposite side.
Hip and lower back stretch (Supine Rest Position)
Lying flat on the back, bend the knees and bring them toward the body until the feet are flat on the floor. Bring your knees up into a double knee fold and then using your hands, pull both knees in toward the chest. Breathe deeply, pulling the knees closer to the shoulders with each exhalation.
Go as far as is comfortable, then hold the position for 20–30 seconds. Breathe normally.
Standing Hip flexion
Stand upright. Extend one arm out to the side and hold on to a sturdy surface, such as a wall, table, or chair, for support. Slowly raise the right knee to the level of the hip or as far as is comfortable while keeping the left leg straight. Only hold this position for a second before placing the left foot back on the floor.
Repeat with the left knee.
Standing Hip extension
Stand upright with the legs straight and the feet shoulder-width apart. Extend both arms out in front of you and hold on to a chair, table, or wall for support. Keeping the right leg straight, take the left leg backwards without bending the knee. Lift the leg as far as possible without causing discomfort, then clench the buttock tightly and hold the position for 5 seconds.
Repeat this stretch 5–10 times on each leg. To increase the resistance, try attaching small weights to the legs.
Standing Hip abduction
Stand upright. Extend the left arm out to the side and hold on to something solid, such as a chair, table, or wall. Starting with the feet together, lift the right leg out to the right side. Keep the left leg straight and avoid rotating the hips.
Hold the position for 5 seconds and then slowly return the leg to the starting position.
Do this exercise 5–10 times on one leg, then repeat it on the other side.
Stand upright with the feet in parallel a hip width apart. If necessary, hold on to a chair, table, or wall for support. Keeping the back straight but allowing the torso to come forward, gently lower the body by bending the knees until they are above the toes. The feet should remain flat on the ground. Hold this position for a few seconds, then slowly straighten the legs to return to the starting position.
Repeat 5 to 10 times.
Lie on your back with your knees bent and your feet flat on the floor. Ensure that your knees are pointing to the sky and not dropping sideways. Engage your core and then using your glute muscles push your pelvis upwards until your body forms a straight line from your shoulders to your knees. Your spine stays in neutral alignment so the natural arch remains. Now lower your pelvis half way, before pushing upwards again. Keep your inner thighs engaged – it may help you to place a ball just above your knees.
Repeat 5 to 10 times before gently lowering your spine back to the mat.
Lie on your back with your knees bent and feet flat on the floor, a hip width apart. Place your right ankle just above your left knee and with the fingers of your right hand push your knee away from you.
Hold for a count of 20 and then repeat on the other side.
Figure Four Stretch
Lay on your back with your legs bent and feet flat on the ground. Place your right ankle on your left knee, loop your hands around the back of your left leg, and draw it toward your chest. Feel the stretch in your glute and hip.
Lie on your side. Rest your head on your arm or hand. Your legs should be together, one on top of the other. Bend your hips to approximately 45 degrees and bend your knees at 90 degrees. Make sure one hips, knees and ankles are stacked. Raise the top knee upwards while keeping your feet in contact with one another. Then bring the knee back to the starting position. Repeat 10 times with each leg. • Focus on not allowing the alignment of the body to be disrupted with leg movement and try to ensure you don’t rock backwards.
Start on your hands and knees , with your arms under shoulders and your knees under your hips, the knees hip-distance apart. The pelvis and spine should be in neutral alignment. Breathing out pull your pubic bone up towards your belly button, and take your belly button towards your spine. Pressing down on your hands roll your head forwards. Breathing in, start to unravel the spine, sending your tailbone away from you as you lengthen the upper spine and raise the head. Repeat 10 times.
For those of you who prefer to watch and listen to “how to do” exercises, there is a class on exercises for painful hips here.