Hip, groin and pelvis injuries: prevention and treatment

Conditioning techniques to treat and prevent upper leg injuries

PHASE 1 (Muscle Balance)

Hip Labrum tear, Hip Bursitis

ExercisesThe aim of phase 1 is to restore normal muscle length, range of motion and introduce postural awareness. The stretches outlined below are an indication of muscle stretches that are advised but do not have to be followed to the letter. Therefore if you have a preferred quad or hip flexor stretch for example, go ahead and use it. The stretches below are aimed to give a new perspective and new ideas on the sometimes stale stretches that we have been performing over the years.

Hip flexor floor stretch

Lying supine, with knees bent, both feet flat on the floor, the lower back is flat. Bring one leg up towards chest and hold it, while keeping lower back to the floor. The other leg is extended straight out and the gluteals on that side are contracted, while the back of the leg is pushed into the floor. This position is held for 8-10 seconds and repeated 6 times before swapping legs.

Abductor stretch

Standing with leg to be stretched crossed in behind. Laterally flex away from the stretching leg until a stretch is felt. This position is held for 20-30 seconds, repeating 2-3 times and swapping legs if necessary.

Standing Adductor Stretch

Standing with one leg straight and the opposite leg bent with legs apart and feet facing forward. Move sideways towards the bent leg until a stretch is felt in the inner thigh of the straight leg. The stretch is held for 20-30seconds and repeated 2-3 times before swapping legs.

Piriformis Stretch

Lying supine with the left leg straight and the right knee flexed. The right leg is crossed over the left with the left foot is positioned on the lateral aspect of the left thigh, just above the knee.
Gently pull the right knee towards the left hip until a stretch is felt deep in the right gluteals. This position is held for 20-30 seconds before repeating 2-3 times on each side.

ITB Stretch

Lying on your side with lower hip and knee bent, and the pelvis slightly rotated forwards. The top leg is straight and positioned forwards, with the knee turned up slightly.
The top leg is then abducted and then extended, so it is positioned slightly behind the body. The leg is then dropped towards the floor and allowed to hang for 15-20 seconds. The pelvis should not move and the lower back should not be allowed to arch during the movement.

PHASE 2 (Static dynamic and reactive stabilization)

1. Side lying hip abduction

Client is side lying, with lower leg bent and top leg straight. The top leg is lifted upwards, towards the ceiling. The pelvis remains in neutral and the lower back does not arch or flatten. Complete 10 repetitions.

2. Side lying hip adduction

Lying on your side, with the leg to be exercised lowermost. The hip and knee are straightened and the pelvis is held in neutral alignment. Top leg is rotated and knee bent.  Contract abdominals and lift lower leg up towards the top leg.

3. Balancing on swiss ball alternative

4. Wall slide with Swiss ball

Stand with the swiss ball in the lower back against a wall. Feet are positioned shoulder width apart, with knees over the second toe. Contract abdominals by pulling navel upwards and inwards and lower hips. Neutral spine alignment is maintained. Complete 3x 10 repetitions.

PHASE 3 (Functional Strength)

5. Standing hip flexion/glut contraction

Stand with feet close together and begin by shifting weight to the stance leg and tighten gluteal muscles on this side. Contract abdominals and flex opposite hip. Hold this position for 8 seconds maintaining gluteal and abdominal contraction.

6. Hip extension with Swiss ball

Lie supine with legs straight and heels resting on swiss ball, hip width apart. Contract abdominals and perform hip extension by lifting the hips up until a straight line is formed from the knees to the shoulders. Movement should be initiated by contracting gluteal muscles. Return to the start position and do 8-10 repetitions.

7. Supine hip extension

Start by sitting on the swiss ball then rolls down, while comfortably placing the head, neck and shoulder blades on the ball. Hips lifted so that they are in line and hands placed across the chest. Contract abdominals. Perform hip flexion by lowering hips then perform hip extension to move back to the start position. Movement should be performed slowly and hips and shoulders should be level.


7b. Holding end position for up to 8 seconds.

8. Lunges

9. Cable adductions

10. Cable abductions

11. Cable hip flexion

12. Cable hip extensions

PHASE 4 (Functional Power and Agility)

13. Reverse curl with Swiss ballLie supine with back flat on the floor, head on the ground and hands 3 or 4 inches away from hips. Grip ball with lower leg and try to lift the ball quickly and lower it down slowly. Try not to let the ball rest on the floor. 10 repetitions

14. Squat push with medicine ball

Begin movement by squatting down to a point where your thighs are parallel to the floor. The abdominals are braced. Accelerate weight upwards and end position is where arms are extended over head and body is in optimal postural alignment.

15. Multi Planar hops – Sagittal

Prerequisites – you must be able to perform a two legged static box jump and a single leg balance with good posture, exhibit good core strength and have progressed through the previous phases with out any problem

Contract abdominals and stand on one leg in preparation for the movement. Flex hip and knee slightly, then do an explosive jump forward to land on the opposite leg. Stabilise landing for 3-4 seconds before performing another explosive jump. Perform movement 6-8 times before swapping legs. Use this format for side hops (frontal plane) and turning hops (transverse plane) ideally performing a 90 degree turn.

15b. Multi Planar hops – Frontal

15c. Multi Planar hops – Transverse

16a. Box jumps – two legged jump two legged land

Brace abdominals, flex hips and knees slightly before starting the jump. The landing should be flat footed and once you have landed you should stand up right in good postural alignment looking straight ahead.

16b. Box jumps – two legged jump one legged land

16b. Box jumps – one legged jump two legged land

16b. Box jumps – one legged jump one legged land

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