I recently saw an article popping up on social media titled “Why the Australian Ballet dancers quit stretching” (found here). It got me thinking about some of the patients I’ve had in the past with hip pain that insist that their hips are “tight,” even though they have well above what would be considered normal range of motion. Depending on the case,
I have sometimes indulged their desire to learn all the stretching techniques and angles I could come up with, and then watched them get their legs into positions that don’t seem like they should even be possible. More recently, however, I have reassured them that while they can certainly perform some dynamic stretching before activity to “loosen up” if they feel they need it, much more time should be focused on strengthening than stretching the muscles surrounding and controlling their hips. Hip pain being the complicated issue that it is, these two tactics have both been successful at times, as well as failed miserably, in my treatments in the past. But what does the research say?
A systematic review and meta-analysis (found here) examined the difference between treatments for hip pain that included active core strengthening under supervised care versus those that consisted of passive, unsupervised care, and had no core strengthening component. The authors of the review concluded that “supervised PT programs focusing on active strengthening and core strengthening were found to result in statistically significant improvements in functional outcomes compared with unsupervised, passive, and non-core focused programs.”
This shouldn’t come as a surprise to many of us who work with patients who report feeling “tight” or “stiff” in areas where we know from observation that they in fact have some underlying weakness. The public perception remains, however, even when dealing with high level performers, that the need to stretch and get more flexible is the ticket to better function.
When it comes to healthy hips, whether my patient is a professional ballet dancer, or a weekend soccer field warrior, the name of the game is strength and proper motor control within functional ranges. Patient education is a key component here for me, as well as encouragement that appropriate strength and control is the way to get them on the road to improved performance and decreased dysfunction. Increased strength, control, and ability to move through a full available range of motion in my patients’ abdominals, hip flexors, glutes, quads, and hamstrings will more often than not decrease the limitations they are experiencing and help them to improve their performance.