Hip Mobility: How to Test for Poor Mobility, Identify Restrictions, and Improve Movement

How Do You Test for Poor Hip Mobility?

Assessing hip mobility involves a combination of observational analysis and specific physical tests designed to evaluate range of motion, identify muscular imbalances, and uncover functional limitations across various planes of movement.

Understanding Hip Mobility: The Foundation of Movement

The hip joint, a ball-and-socket articulation, is designed for extensive movement in multiple planes: flexion, extension, abduction, adduction, internal rotation, and external rotation. Optimal hip mobility is not just about flexibility; it encompasses the ability to move through a full, pain-free range of motion with adequate strength and control. Restricted hip mobility can stem from various factors, including:

• Muscular Tightness: Shortened hip flexors (iliopsoas, rectus femoris), adductors, or hamstrings.
• Joint Capsule Restrictions: Thickening or stiffness of the connective tissue surrounding the joint.
• Osteoarthritic Changes: Degenerative changes within the joint itself.
• Nerve Entrapment: Conditions affecting nerves that pass through or near the hip.
• Lifestyle Factors: Prolonged sitting, lack of physical activity, or repetitive movement patterns.

Poor hip mobility can manifest as pain in the lower back, knees, or hips, and significantly impact athletic performance, daily activities, and overall quality of life. It often leads to compensatory movements in other joints, increasing the risk of injury.

Signs and Symptoms Indicating Potential Hip Mobility Issues

Before diving into specific tests, recognizing common signs and symptoms can provide initial clues:

• Difficulty with Deep Squats: Inability to reach parallel or below without rounding the lower back ("butt wink").
• Limited Range of Motion: Struggling with movements like crossing legs, sitting cross-legged, or bringing knees to the chest.
• Pain or Stiffness: Especially after prolonged sitting or in the morning.
• Compensatory Movements: Excessive arching of the lower back during leg lifts, or outward rotation of the feet during squats.
• Uneven Gait: Noticeable differences in stride length or pelvic rotation during walking.
• Knee Pain: Often a secondary symptom, as the knees may bear increased load due to restricted hip movement.

Key Principles for Effective Hip Mobility Assessment

When performing any assessment, adhere to these principles for accurate and reliable results:

• Bilateral Comparison: Always test both sides, even if symptoms are unilateral. Asymmetries are crucial indicators.
• Active vs. Passive Range of Motion (ROM):
  • Active ROM: The range a person can achieve using their own muscle power. Indicates muscle strength and coordination.
  • Passive ROM: The range achieved when an external force (e.g., examiner, gravity) moves the limb. Indicates joint capsule and muscle length.
• Contextual Assessment: Observe mobility in different positions (supine, prone, seated, standing) as gravity and muscle activation change.
• Pain-Free Movement: Do not force movements into painful ranges. Pain is a signal to stop.

Practical Tests to Assess Hip Mobility

These tests provide insights into different aspects of hip function.

Thomas Test (Hip Flexor Length)

• Purpose: To assess the length of the hip flexors, specifically the iliopsoas and rectus femoris.
• How to Perform:
  1. Lie supine on the edge of a table or bench, with your knees bent and feet flat on the floor.
  2. Bring one knee towards your chest, holding it firmly with both hands, ensuring your lower back flattens against the table.
  3. Allow the other leg to relax and hang freely off the edge of the table.
• Interpretation of Restriction:
  • Iliopsoas Tightness: If the test leg (the one hanging) cannot achieve at least 10 degrees of hip extension (i.e., the thigh lifts off the table), the iliopsoas is likely tight.
  • Rectus Femoris Tightness: If the thigh can rest on the table (good iliopsoas length) but the knee cannot flex to 80-90 degrees (i.e., the lower leg extends forward), the rectus femoris is likely tight.

90/90 Hip Internal and External Rotation Test

• Purpose: To assess the internal and external rotation capabilities of the hip joint, indicating potential tightness in the deep rotators or capsule.
• How to Perform:
  1. Sit on the floor with your knees bent at 90 degrees, feet flat.
  2. Lean back slightly on your hands for support.
  3. Drop both knees to one side, aiming for a 90-degree angle at both the hip and knee of each leg, forming a "pinwheel" position.
  4. Observe the range of motion for both the leading (externally rotated) and trailing (internally rotated) hip.
• Interpretation of Restriction:
  • Limited Internal Rotation: Difficulty getting the trailing knee close to the floor without the hip lifting indicates tight external rotators or capsular restriction.
  • Limited External Rotation: Difficulty getting the leading knee close to the floor without the hip lifting indicates tight internal rotators or capsular restriction.
  • Normal Range: Typically, individuals should be able to achieve roughly 45 degrees of internal rotation and 45 degrees of external rotation in this position, though individual variation exists.

FABER Test (Flexion, Abduction, External Rotation) / Patrick's Test

• Purpose: To assess for hip joint pathology (e.g., osteoarthritis, impingement), sacroiliac joint dysfunction, or adductor/capsular tightness.
• How to Perform:
  1. Lie supine on a flat surface.
  2. Flex one hip, abduct it, and externally rotate it so the ankle of that leg rests on the opposite knee (forming a "figure-4" shape).
  3. Gently allow the knee of the bent leg to drop towards the table.
  4. Observe the distance of the knee from the table and note any pain.
• Interpretation of Restriction:
  • Limited Drop & Pain in Groin/Hip: Suggests hip joint pathology (e.g., impingement, arthritis) or tight adductors/hip capsule.
  • Pain in Sacroiliac Joint: May indicate SI joint dysfunction.
  • Asymmetry: A significant difference in the distance of the knee from the table between sides suggests a mobility restriction.

Deep Squat Assessment (Functional Mobility)

• Purpose: To evaluate overall functional hip, knee, and ankle mobility, as well as core stability, under load.
• How to Perform:
  1. Stand with feet shoulder-width apart, toes slightly pointed out.
  2. Slowly lower into a deep squat, aiming to get your hips below your knees, keeping your heels on the ground.
  3. Observe from the front, side, and rear.
• Interpretation of Restriction:
  • "Butt Wink": Rounding of the lower back at the bottom of the squat indicates limited hip flexion mobility (often tight hamstrings or hip flexors) or poor pelvic control.
  • Inability to Reach Depth: Without heels lifting or excessive forward lean, suggests ankle dorsiflexion, hip flexion, or thoracic mobility limitations.
  • Knees Caving In (Valgus Collapse): May indicate weak hip abductors/external rotators, or limited ankle mobility.
  • Excessive Forward Lean: Can point to poor ankle dorsiflexion, weak glutes, or tight hip flexors/adductors.

Gait Analysis (Dynamic Mobility)

• Purpose: To observe how hip mobility, stability, and control influence movement during walking or running.
• How to Perform:
  1. Observe an individual walking or running from multiple angles (front, side, back).
  2. Focus on the pelvis and hip movement.
• Interpretation of Restriction:
  • Limited Hip Extension at Push-Off: A reduced stride length or early toe-off can indicate tight hip flexors.
  • Excessive Trunk Rotation or Lateral Pelvic Drop: May suggest poor hip stability (weak glute medius) or compensatory movements due to limited hip rotation.
  • External Toe-Out: Often a compensation for limited hip internal rotation.

Interpreting Results and Next Steps

Once you've conducted these assessments, look for patterns:

• Consistent Asymmetries: Significant differences between the left and right sides.
• Limited ROM in Multiple Tests: Suggests a more global hip mobility issue.
• Pain During Specific Movements: Pinpoints areas requiring attention.
• Compensatory Patterns: How the body "cheats" to achieve movement.

If you identify significant restrictions, pain, or functional limitations, it's crucial to:

• Consult a Professional: A physical therapist, chiropractor, or sports medicine physician can provide a definitive diagnosis, rule out underlying pathologies, and develop a personalized intervention plan.
• Implement Targeted Mobility Drills: Incorporate stretches and mobility exercises specific to the identified restrictions (e.g., hip flexor stretches, adductor mobilizations, rotational drills).
• Integrate Strengthening Exercises: Address any accompanying weakness in the surrounding musculature (e.g., glute activation, core stability).

By systematically testing and understanding your hip mobility, you can proactively address limitations, improve movement quality, reduce injury risk, and enhance overall physical performance.