Hip mobility is disproportionately important for functional movement because the hip is the primary joint of locomotion, load transfer between the upper and lower body, and power generation. Hip mobility restrictions produce compensatory changes throughout the kinetic chain: the lumbar spine hyperextends to compensate for reduced hip extension, the knee valgus collapses to compensate for reduced hip external rotation, and the thoracic spine stiffens as the pelvis tilts anteriorly.
The Most Common Restrictions and Their Functional Consequences
- Hip extension restriction: a consequence of sedentary hip flexor shortening, drives anterior pelvic tilt and lumbar hyperextension, contributing directly to low back pain
- Hip internal rotation restriction: associated with hip joint pathology and capsular tightness, drives altered gait mechanics and medial knee stress
- Hip external rotation restriction: reduces the ability to achieve optimal foot position in loaded movements and contributes to iliotibial band tightness
- Hip flexion restriction: limits the ability to squat, climb stairs efficiently, or maintain a forward trunk lean in daily activities
The Assessment Approach
Hip mobility assessment should distinguish between passive range of motion in each direction, active controlled range of motion in each direction, and the quality of movement through that range under load. A clinician assessing hip mobility will screen all six planes of motion and identify whether restriction is at the joint itself, in the periarticular soft tissue, or is a neurological protective response to perceived instability.
The Priority Exercises
- 90/90 hip stretch: simultaneously addresses external and internal rotation in a supportive position, progressed by adding active rotations
- Half-kneeling hip flexor stretch with posterior pelvic tilt: specifically addresses hip extension restriction by placing the hip flexor under stretch while eliminating the lumbar compensation
- Hip 90/90 isometric holds: load the hip in end-range positions to build active strength and reduce neurological protection
- Lateral step downs: train hip abductor strength and control through a functional range of motion