Andreas Toni Bremer-Boreski
Hip Assessment Program
In the following screens, we are not looking to discover an anatomical problem. Instead, we are
looking to uncover a mechanical (movement) problem. First, let’s understand that pain can be
generated from more than one specific thing, pain is not always the site of the issue, and we are
only looking for pieces of the bigger picture. We are looking for pieces of the pie, or weak links!
Never forget to retest and reevaluate after performing drills. The goal is to treat the person, not
the injury.
Movement screening:
SCREEN; Perform a slow tempo squat to the fullest depth and hold the bottom position for a
few seconds, slowly return to the start position and repeat 5 more times. What did you notice?
Did you feel any pain? What part of the squat caused it, and where was the pain located?
NOTES4ME; as you watch the squats, are the feet turning out? Is one of them? Are their knees
trailing in the correct path? Are their hips shifting? Is their spine shifting?
SCREEN; stand on one foot and balance for 30 seconds. Did you notice any pain?
NOTES4ME; are they standing with a tripod foot? Does their leg stay inline with the middle of
their body?
SCREEN; Lastly, perform a single-leg squat to the fullest possible depth without losing control.
What happened?
NOTES4ME; did their knee cave? did their hip shift?
Mobility assessment:
SCREEN: lie on your back, pull your knees together and bring them towards your chest. What
did you notice? (pinching in the front which was helped by banded joint mobilizations)
specifically the behind the leg one to stretch the front out.
NOTES4ME: if there was pain in the front of the hip, or a blocking sensation there may be a hip
impingement at the frontside of the hip socket
SCREEN: FADIR test, lie on your back. Passively push the 90 degree bent knee towards the
midline of the body, while pulling on the shin. If there was a pinching pain at the front of the hip,
try the anterior banded mobilization drill, and retest to see if the pain changed.
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SCREEN: FABER test, lie on your back, cross one leg over the knee and let the ankle rest
underneath the opposite knee. Keep both of your hips flat on the ground and let the knee drop,
if it is more than two fist fulls away from the ground, there may be an issue. Assisted hip
airplane drill will help mobilize this impingement, if you failed this test, go try that and retest.
SCREEN: hip internal/and external rotation, lie on your back, bend the knee and lift the thigh 60
degrees and rotate away from the midline of the body. Was there a difference leg to leg? Any
pain? If you have pain in the front of the hips, try banded joint mobilizations, and assisted hip
airplanes. If you have pain deep in the glute, you need to assess the piriformis for long and
short syndrome. If you have short piriformis syndrome you will show limited internal rotation. If
you have long piriformis syndrome, you will have excess mobility on the painful side. If there is
short piriformis syndrome try the piriformis stretch, either seated or lying down, cross your ankle
over teh opposite knee, grab the back of your thigh and pull your legs towards your body. 3 sets,
30 seconds each. (the left leg had the capability to move the same distance as the right
externally, but it was a bit tougher to move. Stretching the piriformis seemed to help.
Flexibility assessment:
SCREEN: The Thomas test, stand at the edge of a bed or a bench, with your hips in contact
with the edge. As you fall back towards the bench, grab both knees and hug them into your
chest, while lying on your back, have one leg drop and relax completely, then let the other drop.
Stand up and repeat the test on the other leg. If you struggled, your TFL may be malfunctioning.
Try foam rolling the sides of your thighs for a few minutes.
Strength and load assessments:
Load tolerance testing lets you see how much load your tendons can have applied to them
before they start to become strained! This is good information so you know whether you are or
aren't overtraining, or straining.
SCREEN: if you have pain at the front of your hip, try this. Sit on the edge of a bench and raise
your knees a few inches. Any pain? If not, push down on the knee and see if that triggers any
pain. If you experience pain, you may have a hip flexor sprain, in the case of this do not stretch
out your hip flexors, you'll want to introduce hip flexor isometrics as a part of your rehabilitative
exercises.
SCREEN: lying on your side, straighten your bottom leg and lift it about twelve inches, hold this
position while a friend pushes down. If there is pain you must add adductor isometric exercises
too!
SCREEN: External derotation test, lying on your back raise one leg 90 degrees, and forcefully
rotate the leg externally (pushing the foot towards the midline) if there was no pain, now try to
use your lower back to push further into this resistance. This test is positive if there was pain.
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SCREEN: single-leg bridge test, start with your foot elevated on a bench and your knee bent to
90 degrees, hold your hips in the air for 10 seconds and see if it brings any pain. Next straighten
your leg out a little bit more and try the same thing. If this brings out any pain then you may be
dealing with hamstring tendinopathy, meaning you exceeded your load tolerance level in your
hamstrings tendons.
NOTES4ME: notice how they are performing the bridges, are they coordinated? Are the glutes
getting involved enough? Is one getting more or less involved? Ask if the person feels any
difference in the muscles holding them up from side to side, is there anything that is putting
more effort in from side to side?
Side note, looking outside the hip. Sometimes hip pain can be a symptom of a back
issue.
The Rebuilding Process
Lets target those weak links we've discovered!
Soft tissue mobilization:
As mentioned, the TFL foam rolling. In addition we have; adductors foam rolling, and piriformis
foam rolling.
Adductor foam rolling: lie flat on your belly with your elbows on the ground, next bring you knee
up and to the outside of your body leaving the inside of your thighs exposed to the ground. Put
the foam roller perpendicularly against your thigh and massage from knee to hip!
Piriformis foam rolling: using a ball, seated on the floor, cross one leg over the other knee, lift
your body up a bit and put the ball underneath your glute max, find a painful spot and sit on it for
a few minutes. ONLY massage the piriformis if you have short piriformis syndrome.
Joint mobility:
lateral hip banded joint mobilization: (for clearing up restrictions in the hip capsule) starts by
attaching a heavy band to a stable object, wrapping it around the highest point of a single leg,
assuming a lunge. Once in a lunge use your hand to push your knee towards the midline of your
body, and then let it back to the start position.
Quadruped banded joint mobilization: (for clearing up restrictions in the hip capsule) start with
wrapping a stable band around your leg, as close to the hip as possible, assume all fours
position, then internally and externally rotate the banded thigh, pausing for 5 seconds at each
top position.
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assisted hip airplane/tippy bird: assume a single-leg stance. Lock your rib cage down by bracing
your core. With your hands supporting you on a wall or a barbell for balance, next hip hinge over
your leg while kicking your leg back directly in line with your shoulder behind you. Jam your heel
into the ground and assume a tripod foot. Then open up your hips to the highest point, hold for 5
seconds, 10 reps, then close your hips as far as possible also holding for 5 seconds, 10 reps.
Stretching:
Piriformis stretch: (seated and supine) in both techniques you'll start by bending both legs 90
degrees, then cross one leg overtop of the other knee and rest that leg on top. After this you can
either lay down and pull your knee towards your chest, or sit and bring your chest towards your
knee.
Pigeon stretch: the pigeon stretch is a progression of the piriformis stretch. Find a tall box,
bench, or bed and place your leg on top in an externally rotated position. With your leg
completely flat on the box, lean your torso forward until you feel a light stretch. Play with it and
lean in different angles. 3 sets of 30 second holds.
Kettlebell weight shift: start in a half-kneeling position (one knee on the ground) with your front
leg pointing laterally away from your body 45 degrees ish. Your back leg should be in an
externally rotated position, in an upright posture, hold a kettlebell in front of you below your hips.
To perform this exercise, shift your weight towards your leading leg, forcing your knee outside
so it tracks over the middle of your foot. Your back hip will remain in an extended position during
the entire lift.
Rebuilding strength
Isometrics:
Adductor isometric: lie on your back, with your knees bent, place a small ball (or a pillow)
between your knees and hold it in place. Squeeze the ball like you want to pop it with about
75% of your current strength. 5 second holds 2 sets, 20 reps. You can progress this exercise by
eventually straightening your legs.
Copenhagen side plank: WHEN you eventually reach a point where you no longer have pain
when you perform the isometric adductor exercise you may move onto this exercise. To further
increase your load tolerance start in a side-lying position, you should be perpendicular to a
bench. Your torso should be inline with your legs, then, with your highest leg, put it on top of the
bench, and assume a side plank position. You can keep your hand on your hip. 2 sets, 10 reps,
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5 second holds. (engage your adductors more by bringing your pelvis in a more levelled
position)
Hip flexor isometric: lie on your back, put your hands underneath your lower back, knees bent
90 degrees, feet up and dorsiflexed, loop a small resistance band around your feet, brace your
core and then straighten one leg, hold for 5 seconds and do the other leg. 2 sets, 20 reps. (the
right leg wanted to come outside a little more than the left.
Glute medius isometric: 1. Banded squat hold, get into a squat stance, do a mini squat and
hold it, while keeping your feet glued to the ground, drive your knees out so you can't quite
make the tripod foot, hold this position until your glutes start burning for 5 reps. Around 10-30
second holds. 2. Lateral wall sit, stand next to a wall with at least 12 inches of space from your
outer foot, bring your inner thigh up to 90 degrees and lean your body into the wall, watch your
knees for caving in is common in this exercise. 5 reps, 10-30 second holds.
Bridge & hip thrusts: lie on your back (or bench for hip thrusts) with your knees bent. Squeeze
your butt muscles then lift your hips, squeeze your glutes as hard as you can for 5-10 seconds
before coming back down. If you get hamstring cramps, bring your heels closer to your butt. Or
you may also jam your feet into the ground and push away from your hips. 2 sets 20 reps 5-10
second hold. For hip thrusts keep the contraction no longer than 5 seconds.
Marching resisted hip bridge: lie on your back with your feet extended and sit on top of a bench.
Brace your core and raise your hips in a bridging movement. Squeeze your glutes hard, you
may loop a small resistance band around your feet and pull one knee into your chest. Keep your
core braced. 2-3 sets of 10 each
Side plank clamshell: lie on your side with your legs bent and a resistance band around your
legs, then raise your body so your elbow and knee are on the ground, and rotate your leg into
an open position and hold for 5 seconds. 2 sets, 10 reps
Movement Re-education
Hip airplane/tippy bird progression:
1. Single leg rdl bodyweight: Assume a single leg stance. Lock your ribcage down by
bracing your core. Spread your arms out to the sides and rotate your torso forward over
your stance leg while kicking your leg back behind you. Keep your leg trail completely
straight and the knee of your stance leg in a locked slightly bent position. Next imagine
your body is a seesaw, keep a straight line from your shoulder to your foot as much as
possible, throughout the whole exercise. Once you've gone as far as you can while
maintaining control, hold for 10 seconds before returning to the standing position. Make
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sure to jam your heel into the ground creating a tripod foot. Doing this exercise correctly
you should feel tension in your upper hams, and glutes. 1-2 sets 10 second hold.
2. The airplane: Once you can perform the single leg rdl, get into the bent over position of
the exercise but this time rotate your torso away from your stance leg. A helpful cue is to
move your belly button towards your stance leg and then rotate it to the side. Perform
3-5 rotations before standing up again. 1-2 sets 10-20 reps. (when you notice you
cannot move into the closed hip position on the right leg, stretch out your lateral
movers by kinda lying on your side and doing a pigeon pose)
3. Single leg rdl weighted: do the same exercise as part 1. But this time you don't need to
hold the bottom position, and you may hold a weight in the opposite hand of the stance
leg. 2-3 sets 10-15 reps
4. Touchdown squat: assume a single-leg stance, drive your hips backwards and bring your
chest forward. Your foot should have a balanced amount of weight from the front to the
back, you should be in tripod. Keeping the knee in line with the middle of the foot, bend
your knee until your heel touches the ground gently, and return to the start. Also watch
your pelvis, your hips should be leveled throughout the exercise.
RNT progression:
RNT PROGRESSION stands for reactive neuromuscular training
RNT squat: assume normal squat stance with a small resistance band around your knees, as
you squat keep your knee in alignment with your knees. As you drive your knees out make sure
your foot stays glued to the ground. 2 sets 20 reps.
RNT split squat: assume a lunge position, wrap a band around the outside of your thigh so it's
pulling towards the midline of your body. As you squat, keep your knee aligned with the middle
of your foot. 2 sets 20 reps.