The Hip Hinge

The squat and deadlift are prerequisites for a healthy spine. If a person cannot squat, they must have the ability to perform a good deadlift to pick an object up off the ground.

While there are exceptions to every rule, a neutral spine is generally recommended when lifting heavy weights. To maintain a neutral spine while squatting or deadlifting, a person must be able to perform a proper hip hinge. In other words, they must be able to move from their hips while keeping the spine in neutral. Clinically, this is very challenging for many clients. Most people spend their day in a flexed lumbar spine position. The spine is flexed while driving to work, sitting at work, and more. Since the lumbar spine is chronically flexed, when the body needs to perform a forward bending movement, it favors flexion from the low back instead of using the hips. Clinically I often find that the T10-L4 vertebrae are stuck in a flexed position. This places extra stress at the L5-S1 (lumbosacral junction), leading pain in the lower lumbar/sacroiliac joint region.

 No hip hinge: Thoracic and lumbar spine flex as the person bends forward

No hip hinge: Thoracic and lumbar spine flex as the person bends forward

 Proper hip hinge: Thoracic and lumbar spine remain in a neutral position as the person bends forward

Proper hip hinge: Thoracic and lumbar spine remain in a neutral position as the person bends forward


Is lumbar Flexion Bad?

As a society, we have been told that lumbar flexion is bad for the spine. Visual images of discs shooting like laser beams across the room often come to mind. 

This statement is not true! Adequate lumbar flexion is a necessary movement for normal spinal health. Problems with lumbar flexion occur when someone attempts to lift a heavy weight from a flexed spine without adequate mobility and stability. Lumbar flexion is not inherently bad, but has the potential to be problematic if the proper movement requirements do not exist!  We must be able to move through all planes of movement in order to have good spinal motion. 

Clinically I often find that T10-L4 vertebrae are stuck in a flexed position.

HOW TO PERFORM A HIP HINGE

We now know that lumbar flexion is not bad for the spine. However, if we are lifting weights, remembering to keep the lumbar spine in neutral is beneficial. A neutral spine is achieved by mastering the hip hinge. I often recommend starting with a dowel placed along the spine for cueing. Here are the cues I give when teaching the hip hinge:

  1. Make sure the tailbone, low back, middle back, and neck are all contacting the dowel
  2. Bend forward maintaining each point of contact along the spine
  3. Focus on the hip joints as the center of rotation (many clients cannot identify their hip joints regarding movement)
  4. Maintain a small bend in the knees to 'unlock' the pelvic and allow for greater movement
  5. Keep the abdominals engaged while returning to standing to avoid excessive extension from the low back

Mastering the hip hinge is very important for clients with hip, pelvic or low back issues. This skill teaches a cIient proper lumbopelvic disassociation. If someone has difficulty performing a hip hinge, start in sitting. Work on moving into trunk flexion from a seated position while maintaining a neutral spine. When they can perform this movement, gradually progress to standing. Eventually work on moving from standing to sitting to make the pattern more functional!

Jim Heafner PT, DPT, OCS