Post-Rehab and Hip Imbalances

Back with another post-rehab post for you.

After the feedback from the post-rehab article that Dean Somerset wrote,  I asked Dean if he has some great tips when it comes to post-rehab and hip imbalances.

This is what he had to say on the topic.

Take it away, Dean.

Hip Imbalances

We always hear about how important good hip strength and mobility is in relation to knee, low back, and even shoulder health and performance.

It’s pretty much the greatest thing since sliced bread, however if you’ve had a chance to read “Wheat Belly,” you’ll probably think any relation to bread should be avoided at all costs.

Be that as it may, hip imbalances can cause issues with squats, lunges, pushups, step-ups, running, walking, posture, and pretty much everything you can do in a gym or in a recreational setting, so figuring out how to get the most bang for your buck when it comes to the hips is pretty important, and should go far beyond the basic tests such as the Thomas test for hip flexor length, passive internal and external rotation for range of motion, and a 2-foot squat pattern analysis to see how everything plays nice together.

Considerations for Hip Testing

There’s a lot of “stuff” that crosses the hip, so picking tests to use to determine specific muscle length-tension relationships is kind of tricky.

A wide-open test on someone with a normal body composition and healthy tissues & joints is going to look completely different on someone carrying an extra 50 pounds and showing early signs of arthritis, likewise with movement tests comparing someone who is fairly fit and strong to someone who is pretty weak and de-conditioned. The same tests won’t work on different people all that well.

A Test for the Hip

Let’s look at the hip flexor test known as the Thomas test.

Here’s a quick little video showing an example of one done correctly.

Things to Think About When Performing the Thomas Test

Having the leg extend over the bench while the other one is pulled to the chest can be a good indicator of how tight the iliopsoas is by how low the leg hangs and how high to the chest your can pull the opposite leg.

However, let’s assume for a second that someone has a really tight posterior hip complex, and when they pull their knee to their chest they go through a posterior pelvic tilt.

Would that affect their Thomas test?

Absolutely!

Maybe they’re also restricted through their SI joint, they have a tight IT band, excessive kyphosis, tight rectus abdominus, flux capacitors out of whack, whatever. As a result, a test for a tight hip flexor can get muddied in a whack of other issues.

Meanwhile, buddy squats like the Tin Man.

When you do an assessment, a better thought process than trying to find isolated muscles that need to be worked on is to find specific sites of the body that need to be worked on.

If you want a diagnosis, send the person to a physio or a doctor, and then follow their instructions.

If you want to fix someone, watch how they move, find out areas that are deficient, and train the deficiencies.

For instance, I had a consult yesterday with a guy looking to get in shape for skiing.

An Example of Hip Assessment and Post Rehab

He’s had some injuries (inguinal hernia, bad wipeout on his motor bike, a few concussions), but wasn’t feeling in pain or having any kinds of problems. When I got him moving, he had some significant weakness during single leg squats to a knee angle of 90 degrees on his left compared to right.

During a single leg back extension, his left side created movement by hinging at the low back versus the hip, whereas his right one was through the hip.

In a single leg stance hip rotation, he wobbled and fell while standing on his left leg, but was rock solid on his right. As a result, I started training the hell out of his glutes with a lot of single leg exercises, really specific technical feedback to get him fired up properly, and made him walk like John Wayne by the end of the session.

From a training perspective, I could care less about whether his glute medius is restricted or not, but I want to make sure his movement patterns are absolutely perfect.

This is what Post-Rehab training is all about: finding the deficiencies and making them better.

In Post-Rehab Essentials, I go through assessments like the ones mentioned, as well as what they mean and how to use multiple tests to come to an informed conclusion about what needs to be worked on, as well as specific programs for common injuries seen in gym settings and private studios.

This makes you more of an efficient problem solver with respect to injuries than a diagnostician, and it puts the emphasis back on training versus simply regurgitating the pink dumbbell tubing exercises everyone else uses.

As an added bonus, it makes you look crazy smart when you can show immediate improvements in someone’s performance within a 20 minute period by finding what they’re weak in, training it, and then re-testing it like a boss.

Dean Somerset

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Thanks again, Dean.  Great information.  Thank you for sharing.

To check out Dean’s Post Rehab-Essentials course, click here.

I am still working through it but I have pick up a lot of great info, thanks Dean.

Rick Kaselj, MS

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