Hip Mobility: Evaluation Methods, Key Components, and Improvement Strategies

How do you evaluate hip mobility?

Evaluating hip mobility involves a systematic assessment of the hip joint's full range of motion across multiple planes, utilizing both isolated joint tests and functional movement screens to identify specific limitations and compensatory patterns.

Why Evaluate Hip Mobility?

The hip joint, a crucial ball-and-socket joint, is designed for extensive multi-planar movement, enabling activities from walking and running to squatting and jumping. Optimal hip mobility is foundational for athletic performance, injury prevention, and pain-free daily function. Limitations in hip range of motion (ROM) can lead to compensatory movements in the lumbar spine, knees, and ankles, increasing the risk of pain and injury in these adjacent areas. By evaluating hip mobility, we can identify specific restrictions—whether muscular tightness, capsular stiffness, or bony impingement—and target interventions effectively.

Key Components of Hip Mobility

To comprehensively evaluate hip mobility, it's essential to assess the six primary movements of the hip joint:

• Hip Flexion: Bringing the thigh towards the torso (e.g., lifting the knee).
• Hip Extension: Moving the thigh backward, away from the torso (e.g., the push-off phase of walking).
• Hip Abduction: Moving the leg away from the midline of the body (e.g., stepping sideways).
• Hip Adduction: Moving the leg towards or across the midline of the body (e.g., crossing legs).
• Hip Internal Rotation: Rotating the thigh inward, bringing the foot away from the body's midline (e.g., pigeon-toed stance).
• Hip External Rotation: Rotating the thigh outward, bringing the foot towards the body's midline (e.g., duck-footed stance).

Principles of Effective Hip Mobility Assessment

When conducting assessments, adhere to these principles for accurate and actionable results:

• Bilateral Comparison: Always assess both hips. Asymmetries can be highly informative regarding unilateral issues or dominant movement patterns.
• Active vs. Passive Range of Motion: Assess both what the individual can achieve on their own (active ROM) and what range can be achieved with external assistance (passive ROM). Discrepancies can indicate muscle weakness or motor control issues rather than just stiffness.
• Identify Compensatory Movements: Observe closely for any movement in other joints (e.g., lumbar spine arching or rounding, knee collapse) that might be "faking" hip mobility.
• Client Feedback: Ask about any pain, pinching, or stretching sensations during the tests, noting where and when they occur.
• Consistency: Use consistent positioning and measurement techniques for reliable re-testing and progress tracking.

Practical Tests for Hip Mobility Evaluation

Here are several effective tests to evaluate hip mobility, ranging from isolated joint assessments to functional screens:

1. Thomas Test

• Purpose: Primarily assesses hip flexor length (iliopsoas, rectus femoris, TFL) and hip extension mobility.
• Procedure:
  • The individual lies supine (on their back) at the very edge of a table or bench, allowing their legs to hang freely.
  • They bring one knee towards their chest, hugging it tightly with both hands, ensuring their lower back flattens against the table.
  • Observe the opposite (test) leg.
• Interpretation:
  • Normal: The back of the test thigh remains flat on the table, and the knee of the test leg can flex to 80-90 degrees.
  • Tight Iliopsoas: The test thigh lifts off the table.
  • Tight Rectus Femoris: The test thigh remains on the table, but the knee extends (straightens) more than 80-90 degrees.
  • Tight TFL (Tensor Fasciae Latae): The test thigh abducts (moves outward) as it lifts off the table.

2. 90/90 Hip Internal and External Rotation Test

• Purpose: Assesses isolated hip internal and external rotation range of motion.
• Procedure:
  • The individual sits upright on the floor with both hips and knees bent to 90 degrees. Their feet should be pointing straight ahead, about hip-width apart.
  • External Rotation: Keeping the knee grounded, the individual rotates one lower leg outward, away from the midline, allowing the foot to come inward towards the body. Measure the angle between the lower leg and the floor.
  • Internal Rotation: Keeping the knee grounded, the individual rotates the same lower leg inward, towards the midline, allowing the foot to come outward away from the body. Measure the angle.
• Interpretation:
  • Normal: Typically, external rotation should allow the lower leg to move to approximately 45 degrees or more from vertical, and internal rotation to 30-45 degrees. Significant asymmetries or restrictions indicate rotational limitations.

3. Deep Squat Assessment

• Purpose: A functional assessment that reveals combined hip flexion, abduction, and external rotation mobility, as well as ankle dorsiflexion and thoracic spine mobility.
• Procedure:
  • The individual stands with feet shoulder-width apart, toes pointing slightly out.
  • Instruct them to squat as deep as possible while keeping their heels on the ground and chest upright.
  • Observe from the front, side, and back.
• Interpretation:
  • Heels Lift: May indicate limited ankle dorsiflexion, but can also be a compensation for limited hip flexion.
  • Knee Valgus (collapse inward): Can point to hip adductor tightness, hip abductor weakness, or poor motor control.
  • Excessive Forward Trunk Lean: Often a compensation for limited hip flexion (or ankle dorsiflexion) to maintain balance.
  • Inability to reach parallel or below: Signifies general hip flexion limitation.
  • Butt Wink (lumbar spine rounding): Indicates hip flexion limitation, forcing the lumbar spine to compensate.

4. FABER (Flexion, Abduction, External Rotation) Test

• Purpose: Assesses combined hip flexion, abduction, and external rotation, often used to screen for hip joint pathology but also useful for general mobility.
• Procedure:
  • The individual lies supine.
  • They place the ankle of one leg on the opposite knee, forming a "figure-4" position.
  • Gently allow the bent knee to drop out to the side towards the table.
  • Compare the distance of the knee from the table bilaterally.
• Interpretation:
  • Normal: The bent knee should drop close to parallel with the opposite leg or even touch the table.
  • Restricted/Elevated Knee: Indicates tightness in hip external rotators, adductors, or hip capsule stiffness.
  • Pain: While this article focuses on mobility, note any pain, as it could suggest hip impingement or sacroiliac joint dysfunction.

Interpreting Your Findings

After conducting these assessments, synthesize your observations:

• Identify Specific Limitations: Is it flexion, extension, or rotation that is most restricted? Is it unilateral or bilateral?
• Connect to Functional Movement: How do these limitations manifest in activities like walking, squatting, or lunging? For example, limited hip extension might lead to over-arching the lower back during running.
• Consider Compensation: What other body parts are compensating for the hip's lack of mobility? This helps understand potential sources of pain or dysfunction elsewhere.
• Contextualize: Consider the individual's activity level, history of injuries, and daily habits (e.g., prolonged sitting) when interpreting results.

Next Steps: Improving Hip Mobility

Once specific limitations are identified, a targeted approach can be implemented. This typically involves:

• Stretching: Static, dynamic, and PNF stretching to lengthen tight muscles (e.g., hip flexors, adductors, piriformis).
• Soft Tissue Release: Foam rolling, massage, or manual therapy to address muscle adhesions and trigger points.
• Mobility Drills: Controlled articular rotations (CARs) and other dynamic exercises to improve active range of motion and joint lubrication.
• Strengthening: Addressing weaknesses in antagonist muscles (e.g., glutes for hip extension and external rotation) to support new ranges of motion.

Conclusion

Evaluating hip mobility is a critical step in understanding movement limitations, preventing injuries, and enhancing physical performance. By systematically assessing the hip's multi-planar range of motion through specific tests and functional screens, fitness professionals and enthusiasts can gain valuable insights into joint health and movement patterns. This data then informs a targeted strategy to restore or optimize hip mobility, fostering a more resilient and efficient body. Always consider consulting with a qualified healthcare professional or certified fitness expert for a comprehensive assessment and personalized intervention plan.