Are You A Hip-Hanger? Ideas on How Not to Stand for Hip Pain Relief

 
Information, Posture

Is there such a thing as a better way to stand for hip pain relief?

In the previous blogs, we’ve talked about some common standing postures that may influence the forces crossing the hips and lower back, pain experienced in these regions, and suggestions of how to stand for hip pain relief.

Hip Hanging is Easy – But May Not Be A Good Way to Stand For Hip Pain Relief

In this blog, we’re going to take a look at another common posture – we call it ‘hanging on the hip.’ Hanging on the hip is where weight is transferred sideways towards one leg and then the bodyweight is allowed to ‘hang’ on this hip. This could be considered a very ‘normal’ posture. If you take a look around at a shopping centre or social function, you’ll see a lot of people standing hanging on their hips. We do this because it’s quite energy efficient. Hip-hanging allows you to hang off the tension in the fibrous ligaments around the hip joint and a long fibrous band (Iliotibial band) at the side of the hip and thigh. This means you don’t have to use as much energy as you would when actively using muscles to hold you up against gravity.

anatomy of the outside of the hip, ITB, TFL and Gluteus maximus

BUT, hip-hanging does change how and where your body absorbs those gravitational forces. So, if you have hip pain and you are on your feet a lot, it may be worth your while to check how you are standing. Prolonged hip-hanging may contribute to certain types of hip pain. There may be better ways to stand for hip pain relief.

Different Hip Conditions: How hip Hanging May Affect Your Hip Pain.

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Joint-Related Hip Pain – Labral Tear, Osteoarthritis, Acetabular Dysplasia, Femoroacetabular Impingement 

There are various different conditions of the hip joint that may result in hip joint-related pain. You can learn more about the anatomy of the hip joint and hip-joint related pain in our Hip Pain Explained page or search for a condition in our Specific Conditions page. Let’s discuss here, how hip-hanging can influence hip joint loads.  

 

The hip is made up of a ball (head of femur) at the tope of the thigh bone and a socket (acetabulum) on the pelvis. These normally sit snuggly together. As you can see in the picture below, when you hang on one hip, the pelvis rotates around the ball and socket joint, reducing the amount of socket covering over the ball.  

This altered position changes where loads (created by weight bearing and the affects of gravity) are absorbed. Instead of the forces being spread evenly across the whole top of the socket, when hanging on one hip, the forces are more concentrated on the outer edge of the socket. It is in this region of the socket, that we often first see injury or degenerative change in hip joint structures such as the labrum and cartilage. If you have hip-joint related pain, sustained or repetitive hip-hanging may be one factor contributing to your pain. 

hip hanging reduces the amount of socket covering over the ball of the hip

Hip Pain Related to Ischiofemoral Impingement, Buttock Pain & Sciatica 

Ischiofemoral impingement refers to an impingement or compression of the soft structures located between the sitting bone (ischium) and the top of the thigh bone (femur). The ‘ischiofemoral space’ is indicated in the picture below by the yellow arrows. 

The amount of space you have here depends on: 

  1. your natural bony shape  
  2. how you position your body & therefore your bones  

how hip hanging can affect the hip joint with Ischiofemoral impingement

As you can see in the picture above, there is much more space between these bones when you stand evenly on both legs, compared with if you hang on one hip. When hip-hanging, as the pelvis rotates around the ball and socket joint, the sitting bone (ischium) moves closer to the thigh bone. The thigh bone is also at a greater angle, closing the space further.  

The soft structures that sit in this space include one of the short rotator muscles (quadratus femoris muscle) and a couple of tendons that join their muscles to bones in this region, (hamstrings tendon, iliopsoas (hip flexor) tendon). The sciatic nerve also runs through this space on its journey from the lower spine into the back of the thigh. Repetitive or sustained compression of these structures in the ischiofemoral space may in some people result in muscle or tendon-related pain or sciatica (pain related to the sciatic nerve). If you have pain related to ischiofemoral impingement, it is advisable to avoid sustained or repetitive hip-hanging. 

Soft-Tissue Related Hip Pain – Gluteal Tendinopathy, Greater Trochanteric Pain Syndrome 

Pain at the outer side of the hip is often related to soft tissues (things that aren’t hard like bones or joints) – muscles, tendons, bursae, fascia. As we mentioned in the beginning of this blog, hip-hanging involves resting your body weight on these structures.  In the picture below, the long yellow line running down the outer thigh represents the iliotibial band (ITB). The pink region represents the deeper gluteal muscles that sit at the side of the pelvis (gluteus medius and minimus) which join via fibrous tendons onto the top of the thigh bone (femur).  

hip hanging effects on tendons of the outside of the hip

When you stand and hang on one hip, the ITB wraps more firmly around these tendons, compressing them against the underlying bone. Now remember, this is normal and these tendons are used to absorbing quite a lot of compression. However, if you have a painful tendon condition such as gluteal tendinopathy or Greater Trochanteric Pain Syndrome, hip-hanging may add to the irritation of these structures. Reducing time spent in such positions may assist in reducing your pain.  

 

You can read more about these conditions in our Specific Conditions page and we also have some great blogs on this topic coming up soon. Sign up to our newsletter or follow us on social media, so you don’t miss them. 

What to do about hip-hanging 

If you have hip pain and find yourself hanging on your hip a lot, try to break the habit. Asking your partner, friends or children to let you know when they see you hip-hanging can be really helpful, as these postures become so automatic. 

 

 

 Here’s what to do if you find yourself hip-hanging: 

 

  1. Think tall 

(Gently elongate your body, taking the crown of the head towards the sky) 

  1. Draw in the hip from the side, bringing both thighs back to the vertical  
  1. Equalise your weight across both feet
    (This should happen automatically with the first 2 tips) 
  2. Achieve a relaxed, balanced posture without consciously gripping any muscles – we are still aiming for a low-energy standing posture!

 

 

Kirsty McNabDr. Alison Grimaldi

Authors

This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.

Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

Your Hip Pain Professional Can:

  • Assess whether your standing posture is likely to be contributing to your hip pain 
  • Help with cues that work best for you, in achieving a low load, energy efficient posture 
  • Address any associated muscle weakness or tightness 

References 

  1. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Grimaldi et al. Sports Med. 2015 Aug;45(8):1107-19
  2. Physical impairments in symptomatic femoroacetabular impingement: a systematic review of the evidence. Freke et al, Br J Sports Med. 2016 Oct;50(19):1180.
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Don’t miss our next blog……

Next week we look more at pain at the side of your hip – gluteal tendinopathy or trochanteric bursitis or Greater Trochanteric Pain Syndrome (GTPS) – how do you know if you have these? Check out next week to find out more!

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