My client is a very petite (5'0") 47 year old, and she enjoys riding horses. Her biggest complaint is pain and tightness in her hips near the end of her ride. She often needs help getting off of the horse. She takes kickboxing classes, and she can not get her leg up very high when doing round house kicks. I recently had her doing reverse crunches with a stability ball, and she said she had mild pain and tightness in her hips when trying to get the ball between her feet. She has no other problems with ADLs. Can you give me some advice to help her get more mobility in her hips?
Thank you for this excellent question. The very first thing I would do is consult with the client’s physician to rule out any osteoporotic conditions, sciatic issues and/ or inter-vertebral disc issues. Given that activities such as horse riding and kickboxing come with a lot of impact (that may not be dispersed through the legs, depending on the riding and kicking style), the hips, SIJs (sacro-iliac joints) and lumbar segments may take a lot of the impact forces and need to be strong enough to deal with them. If the client is experiencing pain and tightness, this may indicate that mechanical stressors cannot be dispersed properly (i.e., bouncing up and down while riding or kicking into ranges of motion and at speeds beyond her control). Second, is this client a novice in horseback riding and kickboxing circles? If so, then we would need to look at her total riding time and kickboxing in one session and periodize her exposure to limit the body stressors while she builds up her tolerances. Third, the client may need to revisit horse riding and kickboxing lessons to ensure that her technique is correct and that she is dealing with the impact forces correctly.
When looking at high impact activities such as horseback riding and kickboxing, we must first consider the position of the body and how the forces are mediated. Since the client is quite small, her limbs must move to extreme end ranges. Think of how much her hips would need to flex and externally rotate for her to ride or how much hip abduction she would need to perform a side high kick. She would need to be strong at these end ranges to be able to comfortably ride and kick. Pain and tightness must also be addressed. Firstly, pain causes muscle inhibition. If the client is horseback riding into pain, provisions must be made to eliminate this - it will not help her in the long run! Secondly, tightness is many times due to weakness. If the client is weak at these extreme end ranges, she must strengthen them.
The following is a list of exercises that will strengthen the client's hips in integration (they are all in the PTN Exercise Library). When considering how the body disperses forces, it is always done with as many segments as possible. The body always chooses to include MORE joints whenever it can, so our hip strengthening/mobilizing exercises must be full bodied. Progressively move the client into a range of motion that she will have when she rides and kicks (remember, the key word is progress!!). If she works on strength in length, she will develop the necessary mobility (flexibility) under neural control. When looking at extensibility, this is ultimately the name of the game. Have fun and continue to learn!