My hip flexion strength and range of motion is terrible!
One of the biggest problems that I have had in relation to my oversized femoral heads (CAM version of femoral acetabular impingement) is a lack of hip flexion AROM and hip flexion strength. I’ve spent a fair amount of time researching the topic since being formally diagnosed last fall and I’ve learned some interesting things that have affected how I’m trying to rehab and improve my hip flexion range of motion, motor control, and strength.
I really believe the control of the pelvis is probably a large part of the problem. Eric Cressey talks about how he had an “a-ha” moment when he heard Ron Hruska say that “A superior acetabulum isn’t much different than an acromion on a scapula.” (http://www.ericcressey.com/hip-pain-in-athletes-the-origin-of-femoroacetabular-impingement). Reading that statement helped me better understand the mechanism for why I may have had this increased bone growth. Poor control of extension while running, cutting, and kicking in soccer when I was younger probably contributed to this increase in bone growth. While there could be a genetic influence (my sister has the same diagnosis, but played tennis and ultimate frisbee), I would guess this control issue was a contributor.
Mike Reinold also discusses the lower body crossed syndrome and how standing in anterior pelvic tilt is essentially standing in hip flexion (http://www.mikereinold.com/2012/05/the-influence-of-anterior-pelvic-tilt-on-hip-flexion-mobility.html). I am 90% sure I do not stand in that much anterior tilt, but any athletic ready position is a position of relative hip flexion and then add in any loss of extension control and the athlete is in significant hip flexion. I demonstrate the “shake and bake” presentation during the Titleist Performance Institute posterior pelvic tilt test about 50% of the time, which clearly tells me my control of extension is not great.
Since I have begun closed chain lower extremity exercises as part of rehab, I have realized that my instinctual form is to anterior pelvic tilt to prevent any lumbar flexion, but this is resulting in almost immediate impingement of my hips. By controlling that with my core (see Functional Stability Training for the Core) and maintaining a neutral spine, I can squat and lunge deeper without any pain.
Lastly, the reactive neuromuscular training ideas that I first heard about in the Selective Functional Movement Assessment course fit in well here as well. I find that if I preset my core with any number of upper body movements – scapular retraction, shoulder extension, diaphragmatic breathing on top of an abdominal brace, or just isometric scapular depression, I can instantly increase my hip flexion ROM. I just need to continue working on these and then wean down to lower levels of support to be able to move through a full open chain AROM without pain.
It is exciting to have more things to work on, so I can continually improve my ability to move at age 32 and beyond.