Dealing with Hip Pain: Part 2

In Dealing with Hip Pain: Part 1, we talked about banded distractions and mobilization strategies using a True Stretch. Today, we’ll be going over Controlled Articular Rotations (CARs) in various positions – so that you can regress/progress the exercise to suit your patient’s ability and comfort level. At the end of this post, I’ll show you how I utilize CARs with my patients.

Standing hip CARs

Key points:

1. Preparation: Isometrically engage the whole body – think “bracing the gut for a punch”
2. Start: Pull moving leg into hip flexion, followed by hip abduction, hip internal rotation and hip extension. Lower leg back to start position.
3. Finish: Reverse the motion by performing hip extension and external rotation, followed by hip adduction into flexion. Lower leg back to start position.

Quadruped hip CARs

Key points:

1. Quadruped position: Knees under hips, hands under shoulders
2. Start: Pull moving leg into hip flexion, followed by hip abduction, hip internal rotation and hip extension. Lower leg back to start position.
3. Finish: Reverse the motion by performing hip extension and external rotation, followed by hip adduction into flexion. Lower leg back to start position.
4. Compensations:

a) Spinal movement

b) Torso rotation

c) Elbow bending

Prone hip CARs and Compensations

Key points:

1. Prone position: Lay face down on the floor
2. Start:  Slide leg out to the side into hip flexion and abduction. Internally rotate the hip and then extend the hip. Lower leg back to start position.
3. Compensations:

a) Spinal movement

b) Torso rotation

c) Pelvis & elbow lifting off the floor

Case Study: A Crossfit Athlete with Hip Pain due to Capsular Restriction

The movement above was performed at the end of my client’s session, after working to gain more capsular mobility over the past few weeks.

For this exercise, we focused on keeping his body in a neutral position; avoiding any closing angle pinch. He performed an isometric contraction of the entire body, and also the lateral glut complex when taken into the end range.

Notice the compensation (0:03 in the video) during horizontal abduction of the hip, where he tries to compensate by internally rotating the hip. This is evidenced by his foot moving out faster than his knee. I chose to find the threshold of the movement, and then worked to engage the lateral glut muscles with a band in order to find the space in his brain to retrain the neurological component while strengthening said tissue region. I chose to use a dowel over a fixed object because it is less stable. Pushing hard into it to isometrically engage the entire system to try and independently move one part

This version of a Controlled Articular Rotation (CAR) is part of the system known as Functional Range Conditioning (FRC) and is a brilliant way to engage the nervous system to get long muscles working long and more importantly, short muscles working short. Mobility work is INTENSE!

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