Hip Extension

Melissa Liu

Description of Motion

Hip extension occurs when the femoral head (convex) rolls posteriorly and glides anteriorly in the acetabulum (concave) moving the femur backward and upward in the sagittal plane. Normal hip extension range of motion is 20-30 degrees.¹

Muscles involved in hip extension include:²

Primary:

• Gluteus maximus - Inferior Gluteal N. L5-S2
• Biceps femoris (long head) – Tibial N. L5-S2
• Semitendinosus – Tibial N. L5-S2
• Semimembranosus – Tibial N. L5-S2

Secondary:

• Adductor magnus (hamstring portion) – Tibial N. L4
• Gluteus medius – Superior Gluteal N. L4-S1

Mobilizing - Increasing Range of Motion³

1) Chair Stretch - Hamstrings

• Start seated at the edge of a chair with both feet touching the floor.
• Extend one leg out in front with the heel on the floor. Keep the knee and toe pointing up.
• Place hands on the hips and gently tilt pelvis forward until a stretch is felt in the back of the leg.
• To increase the stretch, elevate the foot on a stool or chair.
• Hold the stretch for 30-60 seconds, repeat 3 times and switch legs.
• Perform the stretch 3 times a day to improve hamstring flexibility.

2) Doorway Stretch - Hamstrings

• Start supine with one leg through a doorway and the leg to be stretched propped up against the wall.
• Keep pelvis neutral, both legs straight with the knees and toes pointing up.
• A gentle stretch should be felt in the back of the leg.
• To increase the stretch, move the buttocks closer to the wall, keeping the knee extended with the toes pointing up. Or, lift the leg away from the wall.
• Hold the stretch for 30-60 seconds, repeat 3 times on each leg.
• Perform the stretch 3 times a day to improve hamstring flexibility.

3) Figure Four Stretch - Gluteus Maximus

• Patient starts supine with both knees bent and feet on the floor.
• Cross the ankle of one leg on top of the opposite thigh. Keep the knee of the top leg pointing sideways.
• Grasp the back of the thigh of bottom leg with both hands.
• Pull the bottom leg closer to the body.
• A gentle stretch should be felt in the back of the hip and buttock of the top leg.
• Hold the stretch for 30-60 seconds, repeat 3 times on each leg.
• Perform the exercise 3 times a day improve flexibility in the gluteus maximus.

Indications for Stretching

• Poor posture that results in a decrease in the normal lordosis of the lumbar spine. Examples include: posterior pelvic tilt, flat back and sway back.
• Sitting for prolonged periods of time puts the hamstrings in a shortened position.
• Low back pain because of poor core strength that require the hamstrings to take on the role of stabilizing the trunk.
• Tight Iliotibial Band with lateral knee pain due to decreased mobility of the gluteus maximus.

Strengthening

1) Standing Hip Extension

• Stand holding on to a chair for support, engage the abdominals.
• Extend one leg backward, keeping the knee straight.
• Do not arch the back.
• Hold for 2-3 seconds, feel the buttocks engage.
• Return back to the starting position. Perform 3 sets of 10 reps, switch other side.
• To progress this exercise, add a resistance band around the ankle.

2) Prone Hip Extension

• Start prone with legs straight.
• Raise the thigh off the floor, keeping the leg straight.
• Hold for 2-3 seconds while squeezing the buttocks.
• Lower the leg and repeat other side.
• Perform 10 times, 3 times a day to strengthen the glutes and hamstrings.
• To progress this exercise, gradually increase the repetitions or add an ankle weight.

3) Bridge Exercise

• Start supine with both knees bent, feet on the floor and arms by the side of the body.
• Press feet into the floor and engage the abdominal muscles while rasing the hips up towards the ceiling.
• Hold for 5-10 seconds while squeezing the buttocks.
• Gently lower back to the floor.
• Repeat 10 times, 3 times a day to strengthen the glutes and hamstrings.
• To progress this exercise, perform with one leg off the ground.

Potential Clinical Syndromes or Etiologies

The following clinical syndromes can benefit from stretching and strengthening the hip extensors.

• Low back pain due to postural deficiences such as an anterior pelvic tilt – due to tight hip flexors and weak hip extensors. Or, a posterior pelvic tilt – due to tight hip extensors and weak hip flexors.

• Gait Deviations - A posterior lurch of the trunk occurs during initial contact due to weak hip extensor function

https://www.youtube.com/watch?v=bTQ5ID7Tpa4

• Osteoarthritis of the hip

http://www.arthritisselfmanagement.com/health/exercise-and-physical-therapy/exercises-for-hip-oa/?page=all

• Hip Arthroplasty

http://orthoinfo.aaos.org/topic.cfm?topic=a00377
http://orthoinfo.aaos.org/topic.cfm?topic=a00303

Additional Web Based Resources

http://www.spine-health.com/wellness/exercise/hamstring-stretching-exercises-sciatica-pain-relief
http://www.physioadvisor.com.au/8118650/hip-strengthening-exercises-hip-rehabilitation-e.htm
http://www.wheelessonline.com/ortho/hip_joint_index

References

Footnotes

1. Reese NB, Bandy WD. Joint Range of Motion and Muscle Length Testing. Elsevier Health Sciences; 2009:306

2. Gilroy AM, MacPherson BR, Ross LM. Atlas of Anatomy. 2012:398-403

3. Reviews CT. e-Study Guide for: Therapeutic Exercise : Foundations and Techniques by Carolyn Kisner, ISBN 9780803615847. Cram101 Textbook Reviews; 2012:673-696