When you picture an ACL tear or some other ligament damage in a pro athlete, you don’t usually picture a hip capsule rupture. There are several causes and consequences of hip injuries, just like others. After post-rehab, you should avoid further damage to your hip capsule. A torn hip capsule is painful and bloody, but it is not the end of your athletic career. Here is what else you must know about post-rehab and hip imbalances after rehabbing a torn hip capsule.
We always hear about how vital good hip strength and mobility are to the 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.
However, hip imbalances may cause problems with squats, lunges, pushups, step-ups, running, walking, posture, and other exercises, so getting the most value out of hip exercises is critical, and should go beyond basic assessments such as the Thomas test for hip flexor length, passive internal and external rotation range of motion. A 2-foot squat pattern analysis to see how everything works well together.
Considerations for Hip Testing
There’s a lot of “stuff” that crosses the hip, so picking tests to determine specific muscle length-tension relationships is tricky.
A wide-open test on someone with average body composition and healthy tissues & joints will look completely different on someone carrying an extra 50 pounds and showing early signs of arthritis, likewise with movement tests comparing someone who is pretty fit and vital 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 you can pull the opposite leg.
However, let’s assume for a second that someone has a 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?
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 hit of other issues.
Meanwhile, buddy squats like the Tin Man.
Finding specific muscle sites rather than isolated muscles that need to be worked on is a better thought process when doing an assessment.
If you want a diagnosis, send the person to a physio or a doctor and follow their instructions.
If you want to fix someone, watch how they move, find out deficient areas, and train the deficiencies.
For instance, I consulted yesterday with a guy looking to get in shape for skiing.
An Example of Hip Assessment and Post Rehab
During his physical therapy visit, the therapist noted several injuries (inguinal hernia, a nasty motorcycle wipeout, and a few concussions) without pain or other complications. On single-leg squats to 90 degrees on his left leg, he had significant weakness compared to his right leg. There was a significant amount of movement on his left side as he bent his low back during a single-leg back extension, whereas his right side moved through the hip.
When he stood on his left leg, he wobbled and fell in a single-leg stance hip rotation, but his right leg was solid as a rock. He did, however, respond well to many single-leg exercises and technical feedback to make him react properly. He walked with the posture of John Wayne by the end of the session thanks to my efforts to fire him up and correct his movement patterns.
It does not matter whether the glute medius is restricted, but what does matter is whether the movements are 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 and what they mean, and how to use multiple tests to reach an informed conclusion about what needs to be worked on and specific programs for common injuries seen in the gym settings and private studios.
This makes you a more efficient problem solver concerning injuries than a diagnostician. It puts the emphasis back on training versus simply regurgitating the pink dumbbell tubing exercises everyone else uses. As a bonus, it makes you look crazy bright when you can show immediate improvements in someone’s performance within 20 minutes by finding what they’re weak in, training it, and then re-testing it like a boss.
Thanks again, Dean. Great information. Thank you for sharing.
I am still working through it, but I have picked up a lot of great info; thanks, Dean.
Rick Kaselj, MS