Note from TG: If there was ever a blog title conceived specifically for this website, this is the one. Jason Bourne, an F-16 fighter jet, and a lumberjack punching a grizzly bear in the face while eating a bag of beef jerky could have steel cage match and it wouldn’t be as manly as this title.
My good friend (and Boston(ish)-based physical therapist) Andrew Millett wrote this fantastic guest post today.
Fair warning: parts are a bit “heavy” with technical terms and verbiage, but there are still plenty of insights and suggestions (and videos!) that are applicable to everyone reading, because……
Everyone NEEDS to Deadlift
There are a few absolutes in this world. Some of those absolutes are:
Gravity
The Earth is round
Humans need oxygen to survive.
The Human Body needs food and water to survive.
And I’m sure I am forgetting some others.1
Another absolute I could add to that list is that…Everyone NEEDS to Deadlift!
Now, that I’ve got your attention, finish reading this article before you decide to send your hate e-mail or hate mail if you are still living in the dark ages.
Let me clarify my point: Everyone needs to do some form of hip hinging in order to maintain good back and lower extremity health.
The movement of hip hinging is a vital component of everyday life.
Whether you want to lift up your kids without blowing out your back or you are trying to deadlift your car for reps, being able to hip hinge properly is an integral component to reducing injury risk as well as attaining a high level of performance.
What is “Hip Hinging?”
Hip Hinging is the ability of a person to maintain a neutral aligned spine while predominately loading the hips and having the primary movement come from the hips in an anterior to posterior direction.
For the visual learners, this is what it looks like:
As you can see from the video, we ideally want a neutral spine position and the majority of the movement comes from the hips moving in an anterior to posterior direction. The knees remain in a soft knee position. This means that the knees are not in a terminally extended (straight) position nor are they overly flexed (bent).
What movements use hip hinging?
The hip hinging move is used for a multitude of movements. It can be used in the:
- Deadlift
- Good Mornings
- Variations of the Glute Ham Raise
- Certain Athletic Endeavors
For activities throughout your day, it could include:
- Properly picking up your kids.
- Lifting a heavy box from the floor to a different location.
- Picking a pencil up off the floor.
The list is endless. Being able to properly move through this movement pattern, whether it be for performance or daily life, is a NECESSITY!
How do I know if I can hip hinge?
Well, check out this video below for a quick and easy test to tell if you are hip hinging properly:
Place a broom, golf club, dowel, etc. on your back as shown in the video. Place one hand on the top portion at your head and the other hand at your sacrum (tail bone). Make sure to keep the three contact points between your head, thoracic spine (mid back), and sacrum.
Next, while maintaining “soft knees”, attempt to push your butt back like you are trying to tap the wall with it.
As you are doing this, you are going to need to counteract falling backwards by leaning your upper body/trunk anteriorly (forward). Time and time again, I will see people attempt to do this movement with just pushing their hips backwards and then in turn, fall backwards or lose their balance.
Your hips should always be more superior than your knees. If your hips are in line with your knees in the transverse plane, then you are squatting, not hip hinging.I can equate it going to an upscale club or lounge.
You walk up to the club and there is a line. It is up to the “bouncer” aka the strength coach/physical therapist in this example, to let you past the velvet rope and into Club Hip Hinging.
Once your in the club, there is a VIP section.
In this example, that VIP section is the Deadlifting VIP. If you aren’t on “the list,” then you aren’t making it into the “VIP” section.
For the physical therapists, strength and conditioning coaches, performance coaches, etc. who want to know if someone can perform hip hinging and/or deadlift variations, then screen your clients and patients.
Screening/Assessment
***Disclaimer*** If you are NOT a physical therapist, you need ask your client if you may put your hands on them to screen them. Also, if someone has pain with any of these screens/assessments, structure your programming appropriately and refer out to a PT, sports chiropractor, etc.
Tell them you want to screen them so you can adjust their programming so it is customized for them.
99.9% of people won’t have a problem with this, but you need to look out for yourself and make sure your clients are fine with this.
First piece of information I would like to know is, what does their hip flexion motion look like.
Place your client on the ground and passively/gently move their hip through their available range of motion (ROM).
Then, we want to check and see if they have the passive straight leg raise (PSLR) mobility. Gently raise their leg until you feel some resistance.
Per the Selective Functional Movement Assessment (SFMA), we would like to see 80 degrees of the PSLR. If the client doesn’t have 80 degrees, all is not lost. We have to modify their training regimen. We will get to that later in this post.
Next, if the client has 80 degrees of PSLR, we want to see if they can stabilize in that ROM. Ask them to actively raise their leg, keeping the knee straight up in the air without letting the opposite leg come up off the ground/table. We like to see 70 degrees of active straight leg raise (ASLR).
If they have 70 degrees of ASLR, then we can progress further in our assessment/screening. If they do NOT have 70 degrees, have the client place their hands on the ground. Then press into the ground with their hands and try again.
If their ASLR improves, then they have either a:
- Core Stability Issue
- Anterior Pelvic Tilt
What the pressing down into the ground/table does is activates the anterior core musculature and in turn, places the trunk in a more neutral position.
Since the hamstrings attach on the pelvis, if the pelvis is in an anterior pelvic tilt, this can cause the SLR to appear limited because it is starting in a stretched position.
If pressing down into the ground/table does NOT improve anything, then try these ASLR correctives:
Active-Straight Leg Correctives (via FunctionalMovement.com)
1) Active-Straight Leg Lowering to Bolster
2) Assisted Single Leg Lowering to Bolster
If there is an improvement in the ASLR, now, have the client stand up and tell them to bend over and touch their toes.
If the client can bend over and touch their toes with ease and without trying to blow a gasket or bouncing up and down, then this is another assessment check point that can tell us that they may potentially be able to deadlift/hip hinge.
The toe touch test comes from the SFMA.
What does the toe touch tells us?
We want to see if the client has the ability to posteriorly shift their hips when performing the toe touch. This tells us that the client can get into their posterior chain to load their hips. When watching someone perform the toe touch, find their greater trochanter (hip bone on the side of their hip region) and watch to see if that area moves backwards during the toe touch
In the first video below, you can see the person can shift their hips backwards.
In this next video, if the person doesn’t perform an adequate posterior weight shift, then they wont be able to touch their toes.
If your patient or client doesn’t have the ability to touch their toes, then try these correctives as recommended by FunctionalMovement.com.
This series of correctives is called the Toe Touch Progression.
First, place a 1/2 foam roller or a 10 lb plate underneath your client or patient’s toes as shown in the picture below.
Then, while maintaining the feet on the plates and the knees straight, instruct the person to bend over and gently try to touch their toes.
Perform 10 repetitions then switch to the heels elevated as shown below and perform 10 more repetitions.
You can also place a foam roller or a small ball between the person’s knees and instruct then to squeeze it during the toe touch. When you instruct the person to squeeze the ball, it up-regulates inner core musculature and places the core/trunk in a better position to perform the toe touch.
Next, have the client perform the toe touch again. If they can know touch their toes or it has improved as compared to before, then we know that this simple corrective has taught their brain/body to learn how to perform a posterior weight shift needed to perform hip hinging and/or deadlifting.
Now, their toe touch may have improved, but in a few hours or when they wake up tomorrow morning, it may be back to the way it was before the toe touch progression corrective.
With the body and the brain when we see a quick improvement such as this one with the toe touch, we are tapping into the Central Nervous System (CNS) and the brain.
It is “teaching” the brain/CNS a new way to move.
As Erson Religioso has mentioned on his website, Modern Manual Therapy, the brain/CNS is easily tricked, but it is difficult to convince. What that means is that with the toe touch, we have opened a window to the CNS that has allowed for a chance or an improvement to the system, we want to do whatever we can to “keep that window open” through various correctives and behavior modification in our daily lives.
If the client’s toe touch hasn’t improved, then there may be something else from a mobility, stability, or motor control standpoint that a licensed healthcare practitioner may need to dig a little deeper to discover why the toe touch hasn’t improved. Refer them to someone in your network, but we will go into more detail now on other ways to train this client even though their toe touch isn’t sufficient enough to deadlift from the floor.
Well, there are many options that you can provide your client to receive a great training effect. The next few examples all work to help load the posterior chain musculature as well as helping to improve core/trunk stability.
Most of these exercises should be felt in the gluteal and hamstring musculature.
Cable Pull-Throughs
- Sit back into hips.
- Maintain a neutral spine; no rounding or extending of the lumbar spine/TL junction.
- Make sure to extend through the hips at the end of the movement, NOT through lumbar hyper-extension.
Hip Thruster/Single Leg Hip Thruster
- Start with upper back resting against a bench and hips/knees flexed.
- Maintain a “neutral spine” or “ribs down” position.
- Extend your hips upwards and squeeze butt at the top.
- Finish with your knees, hips, shoulders, and ears in a straight line.
Barbell Supine Bridge
- Place an airex pad or exercise mat over hips/under bar to provide some padding.
- Maintain a neutral spine, “ribs down” position and drive hips to the sky.
- Make sure not to try and lift too high by extending through the lumbar spine.
Elevated Kettlebell Deadlift
- Stand directly over the kettlebell (KB).
- Push your hips back like you are trying to touch your butt to the wall behind you.
- Maintain a neutral spine position.
- Grasp the KB, drive your heels through the floor, and lift up through your hips/legs.
- Squeeze butt at the top. Make sure to extend your hips and not your low back. Imaginary line should be between your ears, shoulders. hips, knees, and ankles.
Once the client or patient demonstrates proper form with an elevated KB deadlift, eventually lower the elevation height to make the exercise more difficult and eventually perform off the floor as long as proper form is maintained.
Trap Bar Deadlift
https://www.youtube.com/watch?v=p-sA3PG1kGY
- Step into the trap bar/hex bar.
- Push hips back like you are trying to touch your butt to the wall behind you.
- Grasp handles and maintain a ribs down, neutral spine.
- Imagine their are oranges in your armpits. Try to squeeze them.
- Drive through the heels and extend your hips. Shoulders, hips and knees should be in a line at the top of the movement.
- If the client/patient can’t demonstrate proper form with the Trap Bar DL from the floor, then you can place blocks or some other implement underneath the weights to elevate it so they can demonstrate proper form.
Rack Pulls
- Step up to bar. Push hips backwards and grasp bar.
- Same points as mentioned above.
- Can use pronated grip (palms facing you) OR mixed grip (one palm facing you, one facing away from you).
Once someone can demonstrate proper form with these movements, then you can start by progressing towards the floor.
If someone’s goal is to deadlift from the floor and they can do it with proper form and pain-free, then we’re on our way to hitting that goal.
If someone’s goal is to be able to pick-up their kids or move and feel better, then the exercise variations mentioned above are great ways to help with that.
