Mobility vs flexibility for hip and groin pain rehab

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's your co-host Sebastian with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time to show, welcome. You've realized we've started to do shorter format ones so you guys can get nice little juicy pieces on your way to work. So, today we are going to cover the concept of flexibility versus mobility in regards to specifically groin pain cases. I've been seeing, we have been seeing a lot of people with groin pain, which is pain on the front side of the hip.

We've seen probably thousands over the last few years and the reason why is because our YouTube channel got super popular with groin pain videos and now we make a bunch of them. And because we've seen so, so many people, especially even with telehealth, we've gotten really good at it. So, there are some things that do come up. Flexibility is one of them. And so, let's discuss how hip flexibility as well as thoracic spine flexibility, or sorry, mobility come into the picture. And I'll tell you the difference between flexibility and mobility and some simple tools of how to get it. Now, when you have a physical exam done with a hip or groin injury, it's important to note, is your range going to come back to normal or is it kind of gone already?

An easy way to decide this is when you have a good physical exam done, meaning the person actually puts their hands on you or they can watch you move and ask you good questions, We can figure out what we call enfields. Enfields are the key to deciding, without doing any imaging, what the architecture or what the limitation is in your hip. So, if we try to bring our knee towards our chest and you notice that the knee is dramatically drifting outward and the foot is kicking in and when you're in a seated position, and there's nothing you can do at all to push it back in, and it feels painful to do so, but also it feels like a block of wood inside there blocking it, then that is probably something which is more not going to come back.

It's going to be more of like hip arthritis or a old labral tear or something like that. There's going to be some bony growth or something that's a firmer tissue which is limiting it. This is what we call dremen sign. Now, for people who have a different enfield called a block of cheese enfield versus a block of wood, it's kind of squishy, right? And you can bring the knee up. It doesn't always kick out. Sometimes it does, but you can kind of push it back in. It may be painful to do, but it feels kind of squishy, like a firm block of cheese. Not a gouda, maybe, but more of like a Swiss cheese.

And so, it just feels like a different end feel. And so, when I talk to people about if their hip range of motion is going to come back or if it needs to come back based upon their current pain in their groin, I discuss with them first reasonable expectations. Is it going to come back and the reasons why it won't? If you have hip arthritis, like a large amount, not even a little amount. Like, I've met so many people who have been told, hey, you got arthritis of the hip, yeah, you're going to need hip replacement in like 20 years or 10 years. Or it's like, that's, a lot of that I think is very terrible advice.

It may be true for some individuals, but for the most part, you can, they say you can arrest the process of the bony growth. If you change your movement strategies, change your habits, change your diet, you can arrest the process, but there's nothing you can do to really reverse engineer it other than surgical debris. But not everybody needs to have all that range of motion back based upon their activity. So, if they do have a dramatic loss of range of motion, I just tell them, look, if you can go about your life and you're picking tasks or hobbies that don't need all this extra range, then you'll probably be fine.

Like, if you want to go on walks and hikes and walk your dog, you'll probably be fine. If you're trying to climb a mountain or rock climb or do Olympic weightlifting, then you might kind of need it again. And that would be a decision that we would make together about if they need a hip replacement or not. Now, those are those individuals. Now, if we're talking about a block of cheese scenario, that range of motion can actually come back. And I've seen it come back pretty dramatically over the course of even just a few weeks. And so that comes down to normalizing mechanics of the hip. Also, getting some nice core support.

Now, this concept of how to get it back has been debatable over the years. Some people say static stretching is helpful. Some people say more, quote unquote, mobility work. Today, let's describe a little bit about the differences between the two and the overall, like, attributes that you'll have at the end if you decide one way or the other. So, flexibility. If you take your finger and you take your next finger and you try to bend your finger backwards, you're going to notice you can bend your finger backwards further than you can actually bring it back under your own power without stretching it.

That is the difference, basically, between mobility, which was the ability of you to move your finger through range of motion and how much range that is versus flexibility, which is passive range of motion. And so, people can always push it past further their active range of motion, which is, again, mobility. What we want is mobility because what is the point of having flexibility if you can't control the movement? It's kind of like you're a skeleton. You may have dramatic range of motion, but you don't have the power or the ability to move it, which is what I think what we're all really asking for.

How do we have better hip range of motion? How do we feel less stiff? And I think the answer to this is going to be more mobility aspects than flexibility. Okay. So, now that we got those two things out of the way and we've decided that mobility may be a better option, now we can prioritize mobility in certain regions based upon what we call the mobility-stability model or the regional interdependence model, which you guys can Google if you'd like. I'll give you the basic rundown here, but the idea is that certain joints architecturally in the body are designed to house more range of motion. Whether you want to call flexibility or mobility at this point, it doesn't really matter.

Range of motion in a ball socket joint, like a hip, is always going to be more than other types of joints. The range of motion is always better. The ankle has a ton of range of motion. It has what we call triplanar motion. It has a lot of range in three different planes of movement. The knee, ton of range, but only in forward-backwards. Same thing as the elbow. Those are called hinge joints. So, the motions that architecturally are available by design, by some deity or by Darwinism, those are the ones you want to get back. But it doesn't mean you can't get back the other ones, the nitty-gritty of the small range of motions if they're limited, but I think those are the ones people tend to focus on.

So, let's talk about groin issues now and which areas we may want to add mobility to. I think hip mobility would be a big win for most people, especially extension. And when you get extension back, that is the key to getting flexion and internal rotation back, which is pain as you bring your knee toward your chest. I don't think a lot of people realize that. They try to jam up into flexion and internal rotation, bring their knee across their chest, and then feel a pinch point in the front when you can actually clear that by pumping the joint into extension, getting more extension range mobility, and then the other range of motion or mobility comes back.

So, I'll tell you how I would do this in a moment here, but let's just move to our next joint region up, which is considerably more of the lumbar spine. The lumbar spine, I wish I had a graph on this, but I'm sure you can look up how much range of motion rotationally does the lumbar spine segment, one segment have individually. There's five for most people. And I think the answer was something like one degree. It's like nothing. And so, we know this because if you look at the range of motion availability based upon the facets or small joints of the lumbar spine, they don't actually allow for rotation.

They allow for flexion and extension. That's just what they do. And so, for people trying to do like windshield wiper and like low back twisting mobility things, and they're trying to do like Russian twists and things like that, like that's jamming the spine into a rotation, the lumbar spine. And so, that's maybe not what we want to prioritize here. Maybe we prioritize stability there, which is more of like the design of the region. The next area, which is high payoff for people with groin pain, believe it or not, is their thoracic spine or their mid-back. Tons of people have mid-back stiffness.

Tons. I'd say probably more than people with low back, sorry, hip stiffness. And when they lack hip shoulder, sorry, mid-back range of motion, they end up rotating more and putting more rotational force at the lumbar spine, which destabilizes the core, which ends up creating sometimes a cast seat effect, which can create more groin issues, believe it or not. So, the easy things to do are working around the area to build mobility in the areas that can tolerate mobility and actually have the architecture for it. And that's going to be thoracic spine and the hip. Now, just considering too, the thoracic spine, I think it's 45 degrees total range of motion amongst the 12 segments.

So, you can calculate that out. It's much more than one degree for the lumbar spine, which is probably going to be five degree total. Now, what I think what I've seen over the years is people decide, hey, I need mobility in this area, so I'm going to find on YouTube this random, flowy, like, scorpony-like type of animal, flowy mobility thing. And not to say those are wrong to do. I've certainly done those myself. But what the problem is, is I think we all fail to realize that Rome wasn't built in a day, strength doesn't happen overnight, and neither does mobility. So, really, the best choice of mobility exercises are going to be the ones that you actually stay consistent with.

And I know I will not do yoga consistently. I will not at all. And there's nothing wrong with yoga, but I don't like it. I don't want to do it. And I won't do it. And if you told me to do some animal flowy, on the ground, you know, try to go, wasn't there like a new thing now where people were going on to YouTube and acting like apes or something like that? Cool. Do it if you want to. But you got to consistently do it. Hey, so I tend to think the ones that I would consistently do are ones that are more of like our larger range of motion with less load exercises, like doing wider stance split squats are a great way to get hip extension mobility.

A great way to get knee flexion or get better hip flexion range of motion is going to be just deep squatting. Again, can we do it with our back flexed? Probably not with high load, but it doesn't mean you can't keep a lower load and go through the full range of motion. Like 25 pounds, body weight, these are all okay to do. And just greasing up those hips will get you better range of motion and mobility, period. Now, with the thoracic spine, I think the gateway to getting more of the rotation that we're all looking for, so our stiffness decreases, is going to be with thoracic extension. Thoracic extension is the gateway to getting rotation.

And if you want that at 45 degrees that you originally had access to when you were younger, a lot of you, if you're sitting at a desk a lot, you are in spinal flexion, thoracic spine flexion a lot. I've seen this a ton with distance runners. A lot of their thoracic spines have a ton of flexion in them. There's a lot of reasons possibly why this would be happening. I'm not going to discuss it in this podcast, but they would really benefit from thoracic spine openers. Extension is the easiest way. Again, which is the best choice? The one that you're going to stay consistent with. I tend to think hanging from objects or doing overhead activities is best.

Some people may choose rock climbing. Some people like to swing on swing sets or do calisthenic work. Those are all great choices. Personally, what I would pick is I would try to access rotation, maybe mainly by throwing objects. If I didn't have thoracic extension first, there's a chance I may do something like hanging or calisthenics drills because that's probably what I would do the most of. Because again, it's mobility. It's more I have to keep myself attentive. I need to grab onto an object and hang and swing and so on. And then I would probably start throwing objects. I play baseball. You guys have heard it many times before.

I like throwing objects. And that is something I will consistently do on a weekly basis. I would do it every day, every other day if someone would play catch with me. And what we know about throwing objects is when the shoulder goes into external rotation, it couples with thoracic rotation on the same side. It couples with it. It derives the movement. It makes it happen. And you don't have to do anything else. So the moral of the story here is, number one, you want mobility, not just flexibility. You may not get all your range back. You may not get all your flexibility or mobility back based upon the hard end, feel or not.

But if you catch it really early, you can still get some of the range back. How would you keep that range and keep the mobility? It comes down to what you would chronically do and what activities you actually like. I would look back into what you used to do as a kid or a teenager if you had a fun sport. Like skateboarding would count. Bike tricks would count. Rollerblading would count. If we're talking about hip mobility, there's tons of things that can count. And usually the thoracic spine mobility ones are going to be overhead activities or throwing ones, in my opinion. If you guys have been dealing with something like this, you're looking for some structure of your workouts, reach out to us.

We do something called the Discovery Session. It's very affordable. We are licensed in different states to do telehealth. And if you're in those states, we can diagnose you. So go ahead and reach out to us. We'd love to help out. We see tons of our people virtually. Our contact is in the description for the podcast player. I'll see you guys next time on the show.