Written by Suzanne Krowiak, with additional reporting by Heather Longoria.
The hip is one of the most important joints in the human body— a source of stability and mobility when it’s healthy and functional; pain and stiffness when it’s not. Despite its central role in our ability to move through the world confidently and safely, it remains one of the most misunderstood anatomical structures.
Myths about what is “good” for your hips are so embedded in popular culture that people in gyms, yoga studios, and other fitness settings overuse and misuse their hips for years, causing irreversible damage that leaves them with few treatment options.
How are myths about the best exercises for healthy hips perpetuated? One reason is that the common language and principles around hips don’t always align with current science or comprehensive approaches to joint care. When digging deep with healthcare and fitness pros who work with a variety of populations, there is broad general agreement on three important points:
- Flexibility is not always a reliable benchmark of hip health
- “Hip openers” are often fetishized to the detriment of practitioners, especially in some group fitness and yoga environments
- Hip strength is undervalued
Flexibility Is Not Always A Reliable Benchmark Of Hip Health
If you asked a random group of people on the street or in any fitness setting if they have tight hips, most of them would probably say yes. With all the sitting we do culturally— from work, to cars, to streaming the latest must-watch show on television— a sensation of tightness isn’t uncommon. But that doesn’t always mean we aren’t stretching our hips enough.
Amanda Tripp is a kinesiologist and Yoga Tune Up teacher that sees this confusion a lot in her work. “Just because you feel tight doesn’t mean you need to stretch more,” says Tripp. “In fact, it could mean the opposite. Inflexible hips by yoga standards— for example, not being able to put your ankle behind your head— is not necessarily a bad thing. If you’re an athlete, you might need stability more than you need extreme flexibility so you can generate explosive power for your sport. How much flexibility you need really depends on what you want to be good at.”
Jill Miller, creator of The Roll Model and Yoga Tune Up fitness formats, says the tightness you feel could be your nervous system trying to send you a message. “A lot of what we experience with this term ‘tight hips’ is neural tension,” says Miller. “So the nervous system has decided on a safe range for our hips and will give us feedback . The muscle spindle response will be ‘Okay. That’s enough stretch. That’s enough.’”
Hip Openers Are Fetishized
If you search the #hipopener hashtag on Instagram, you’ll find over 300,000 posts. (By comparison, search #healthyhips and you’ll find 15,000 posts.) Anatomist, yoga teacher, and movement therapist Lauri Nemetz thinks vocabulary in studio culture is really important in helping people take better care of their bodies. “I think we have to avoid the term hip openers,” says Nemetz. “Unless you’re dislocating your hip, you’re in essence always going to be opening part of the hip, and closing another part of it. That dual action is always happening. But for some reason, especially in the yoga and Pilates worlds, we think of lateral rotation (away from the body) as being hip openers, as if that’s somehow more enlightened than if I’m internally rotating (toward the center of the body) my hips. But we need both. There’s a tendency to do extreme poses in yoga because they look good.”
“I think we have to avoid the term hip openers,” says Nemetz. “Unless you’re dislocating your hip, you’re in essence always going to be opening part of the hip, and closing another part of it . . .”
Amanda Tripp agrees. “In the yoga world there is this idea that you need to do hip openers, which means stretching. That’s what people mean when they say ‘hip openers’,” says Tripp. “But you can overemphasize stretching and have too much of a good thing. We need to be equal parts stable and mobile, strong and flexible. Unbridled pursuit of unlimited flexibility can destabilize your joints.”
Hip Strength Is Undervalued
Because of the intense, almost exclusive focus on flexibility in the hips, we may miss one of the best ways to reduce pain and increase mobility in the joint— strength training.
“A lot of times, a tight muscle that’s giving you feedback about its limit of stretch might be very weak,” says Jill Miller. “I’d say 90% of the time when you’re feeling tightness, it’s because the body doesn’t feel safe going into that stretch for fear that it can’t manage the load. So if you try strengthening the hip muscles instead of stretching them, and then go back to try the stretch again, your brain may feel safer going into that range. A joint that doesn’t bear weight is a joint that degenerates.”
Mehmet Gem is a musculoskeletal physiotherapist in the United Kingdom who specializes in hips. His reputation as The Hip Physio brings him into contact with people with a variety of hip complaints, and his sessions often include educating patients about the importance of strength work in a hip treatment plan.
“If someone comes in with hip pain, I want to know how many times they can move from a seated position in a chair to standing up on one leg, and I’ll compare their left side to the right,” says Gem. “How many calf raises can they do on their left leg compared to the right? Then we’ll do bridges. Can you do a hamstring bridge from a chair? What’s the maximum number of repetitions you can do on your left and right? Those subtle tests will give you information you can use to guide the exercises that will improve your hip strength, rather than just doing stretches alone, because there isn’t going to be much benefit from that.”
The good news is that no matter where you land on the spectrum of hip mobility— loosey goosey, stiff and sore, or strong and centered— there are things you can start doing now to feel and move better for many years to come. Not only will practical and accessible exercises help you identify body blind spots and opportunities for improvement in your own hips, you’ll learn why strength training could be the missing ingredient in restoring movement and reducing pain.
At its most basic, the hip is where the top of your thigh bone (femur) meets the pelvis in your hip socket (acetabulum). Tune Up Fitness co-founder Jill Miller, who’s publicly shared her own experience recovering and rehabilitating from a total hip replacement in 2017, takes us on a tour of the anatomical hip— where it is, what it connects to, and all the ways it can move. Understanding how your hips work is the first step in taking better care of them.
Like all other bony structures in the human body, hips differ from person to person. Almost nobody has the “perfect” hips we see in anatomy books. “There are many variables in hip anatomy,” says Gem. “The hip socket and shape will be different, depending on if you have a ‘normal’ hip or dysplastic hip (a congenital condition in which the hip socket doesn’t fully cover the ball at the top of the thigh bone). Different ethnicities are predisposed to different shapes of hip sockets. And that alone— the shape and orientation of the hip socket— will mean that someone has more hip mobility one way than the other. So someone may think their hip is stiff because they’re looking online and see someone else stretching and twisting in hip rotation in ways that they can’t. But they’re comparing themselves to a person in a video who might have a completely different hip shape. The person who’s decided that they’re stiff just may not be meant to do that anatomically.”
One clue that you’re not meant to move your hips in certain ways can be sound. Amanda Tripp says even if you don’t feel pain, you should literally listen to your body when it makes noise. “In one of my very early yoga teacher trainings, before I learned the Yoga Tune Up method, I was taught that if it doesn’t hurt, it’s okay, “ says Tripp. “So, for example, if you’ve got hip snapping, popping, clicking, or grinding, it’s okay as long as you don’t feel pain. When the fact of the matter is that sounds often come from friction. And friction leads to inflammation, which can lead to pain and injury. So we don’t want to ignore sounds coming from the joint space. Just because a certain movement doesn’t hurt today doesn’t mean it won’t eventually be the straw that breaks the camel’s back.”
In addition to the bony structures of the hip, it’s home to a complex set of muscles that work in coordination with each other, and dysfunction in one muscle can have a dramatic impact on the entire joint. Jill Miller takes us on a tour of what she’s termed our “sensory aquarium,” where muscles attach, joints articulate, and sensory receptors communicate with our central nervous system. This intentional exploration of that region of the body with soft therapy balls can help you identify major muscles, including the most popular hip flexor in town, the psoas, and some of its lesser known neighbors, like the sartorius.
Your body has its own story; a structure you were born with, and the one that developed and changed over the course of your lifetime, influenced and shaped by the way you moved it. Jill Miller has been hypermobile since she was a child, a condition which allows her to go to the furthest range of her joints without pain, something she did for decades as she pursued her interests in dance and yoga. “Because of my hypermobility, I was able to compress bone on bone without alarm bells going off in my body,” she says. The consequence of doing that for decades resulted in completely wearing down the cartilage in her left hip, and led to a total hip replacement at the age of 45. After her doctor saw the x-rays showing Miller in end stage osteoarthritis, he did a simple range-of-motion test with her hip. When he saw the extreme swings of her hypermobile hip joint his first words were, “Well, there’s your pre-existing condition.” Her hypermobility, coupled with years of extreme postures and physical movements, necessitated a total hip replacement immediately.
Her own personal experience, combined with years of teaching students with different skeletal structures and ranges of motion, is what led Miller to create Yoga Tune Up. “When I would think of certain traditional yoga poses, I knew it wasn’t really the best path to go down,” she says. “So I stopped teaching poses that I thought would exclude the majority of my classroom a very, very long time ago.”
Samakonasana, or lateral splits, was one of those poses. Here Miller shows us what the pose is, why it can be problematic for some people, and what she suggests doing instead to honor your own biological range.
In addition to reframing how she considered her own yoga practice, Miller made strength work central to her recovery plan after surgery. Here she shares one of her favorite “least favorite” strength exercises— one everyone could benefit from incorporating into a regular practice.
Adding strength work into your hip health routine and focusing on flexibility exercises that honor your own biological range should have a noticeable impact on your stability and mobility. Yet even with that, all that time in chairs for meetings (in-person and Zoom), meals, transportation, and even relaxing activities like watching favorite movies with friends or family, can make you feel stiff and older than you actually are when you get up to move around. To counteract some of the natural tightening of your hips after too many hours in a seated position, try these exercises to release three marquee muscles that contribute to hip stability and mobility— psoas, iliacus and quadratus lumborum.
It’s not just the position of your body that can restrict your psoas and put your hips in an uncomfortable position; the way you breathe is inextricably linked to hip mobility. The psoas and diaphragm work together to bring fluidity to your hip joint.
“You don’t get a psoas without a diaphragm sewn to it, so on a fundamental level, those things are stuck together,” says Miller. “You want to have the ability to have your diaphragm ride up and down the psoas, and you want your psoas to be able to move forward and back, regardless of what your diaphragm is doing. Your diaphragm can really help orient your alignment for postural integrity, and that allows the hips to be at a better location for maximum flexion or maximum extension.”
Michael Mullin, a clinically-based athletic trainer and certified clinician through the Postural Restoration Institute, explains it this way when describing what happens to the hips if the diaphragm is restricted: “The brain is going to try to do whatever it can to make breathing as easy, comfortable, and effortless as possible. You want the respiratory diaphragm to be stacked and balanced over the pelvic diaphragm. On inhalation, both diaphragms descend and then recoil on the exhale. Any change in that position will change the orientation of the pelvis, and the bones will tip, rotate, or torque. The pelvic floor loses its position, and the ribs change their orientation to compensate. The imbalance will manifest where it’s easiest to land— the hip joint.”
Here is a closer look at how the diaphragm and psoas work together, and exercises you can do to free up restrictions for better breath and mobility.
Hip Replacements Are Trending
The number of total hip replacement surgeries is rising dramatically. According to the CDC, the number of inpatient total hip replacements among patients aged 45 and older went from 138,700 in 2000, to 310,800 in 2010. Research published in The Journal of Rheumatology in 2019 predicted total hip replacements would increase by 34% in 2020 (to 498,000), to 75% in 2025 (652,000), and 129% by 2030 (850,000).
It’s impossible to pin the rise in hip surgeries on one specific cause. Orthopedic surgeon Dr. Nicholas A. DiNubile of the University of Pennsylvania coined the term “boomeritis” in 1999 to describe a population of Baby Boomers who overtrained or overstressed their bodies as they got older to the point that they needed medical intervention. More recently, innovations in surgical techniques have made hip replacements more attractive to people who might have avoided the procedure in the past.
The most important thing to know about your hips is that you have more power than you think to keep them healthy, strong, and mobile. By being more intentional about strength training and stretching within your biological range, you may find that you have less pain and more fluidity in short order, which could help you avoid a dramatic surgical intervention down the road.
Equally important is making a commitment to challenging your hips with different activities whenever you can. Variety isn’t just the spice of life; it can be the key to longevity for your bones and connective tissue. “I live for novelty in my practice,” says Amanda Tripp. “No modality can give you everything you need. You should jump, run, walk, swim, stretch, and lift weights. Do all of the things.”
“I want people to spend more time exploring movements,” says Michael Mullin. “I want them getting on the floor and off the floor regularly. I want them rolling, I want them crawling. The best fall prevention I can give someone is to have them get on and off the floor five times, twice a day. Because if your brain doesn’t feel safe getting on and off the floor, guess what? You become more protected with your gait. You become compressed mentally and physically. Your world gets smaller and smaller.”
Jill Miller agrees. “Let’s stop fetishizing certain poses and ranges of motion. Let’s be fascinated by our ability to sense all of the movements of the hip,” she says. “You can’t rely on a person at the head of a class or on a phone screen to be a good mirror of your own skeletal structure. Only we can embody our body; only we can experience our true hip range of motion. And it would be ideal to master it before a surgeon’s scalpel uncovers it for us.”
Ready For More?
Shakira may have been right when she said the hips don’t lie, but do we really know what they’re trying to tell us? If you want to keep exploring exercises that will help you identify the interconnectedness of your bones and fascial tissues and its impact on the way you move, here are two more videos that can help you find body blind spots that could impact your hip health.
First, a foot rollout from Walking Well with Jill Miller and Katy Bowman.
And next, information and a rollout for the hip stabilizing tensor fascia latae (TFL) from Rolling Along The Anatomy Trains with Jill Miller and Tom Myers.
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