If you’ve ever heard someone talk about ‘strengthening their core,’ you should clarify what muscles they’re referring to. This is especially true when you consider how to the ‘core muscles’ affect other regions of the body like the back and hip.
What Does “Strengthening Your Core” Mean?
The term “core” is broad and typically used to refer to the musculature of the lumbopelvic-hip complex. Though when most people think “core exercises”, they’re thinking about abdominal exercises…and on occasion exercises for their low back. These muscles would include the rectus abdominis, transverse abdominis, internal/external obliques, multifidi, erector spinae, quadratus lumborum and other muscles.
In this article we’ll discuss the forgotten aspect of core strengthening: the hips.
Hip Anatomy and Relationship to Low Back Pain
The gluteus maximus, gluteus medius, and gluteus minimus are not ancient greek warriors, as their names might suggest, but are actually muscles in your hip.
Together with a group of muscles known as the deep hip lateral rotators (Piriformis, gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus), they provide significant strength and stability to your lower back.
A systematic review from 2019 found that individuals with low back pain tend to have weaker gluteus medius.1 Likewise, pain intensity was higher, functional disability was higher, and maximum voluntary contraction was lower in those patients with chronic low back pain.2
Now there’s a bit of a “chicken and egg” dilemma here. Are patients with weak hips prone to develop low back pain, or do your hips weaken overtime by virtue of having low back pain? It’s likely a little bit of both…a vicious cycle, if you will. However, one thing is for sure. Your hips are an integral part of your “core”. Knowing this, let’s discuss some exercises that can improve your hip strength.
Side note: There are a lot of great strengthening exercises for your hips like deadlifts, kettlebell swings, etc. However, for the purposes of making this immediately accessible with no equipment necessary (except maybe a therapy band if you have one), I will focus on body weight and gravity resisted exercises.
Basic Hip Strengthening Exercises
- Start by lying on your side with your knees bent to 90 degrees. A band around the knees isn’t necessary but it may be used to provide greater resistance.
- There is some debate on whether this exercise is best performed with your hips in neutral (knees in line with your hips) or slightly flexed at ~30 degrees. Gluteus medius is likely activated more when flexed, gluteus maximus when positioned in neutral. Feel free to perform in both positions 🙂
- Keep your feet together and lift the knee of your top leg up toward the ceiling
- Keep your hand on your pelvis to make sure you don’t allow yourself to rotate backward
- Hold 2-3 seconds when your knee reaches the highest point without your hips rolling backward
- Perform 3-4 sets of 15 repetitions (fewer if you have a resistance band you can use)
- Lie down on your back with your knees bent and your feet flat on the bed/floor
- Tighten your stomach as if someone was going to punch you in the stomach and keep your hands at your side
- Lift your hips/buttocks up away from the floor and squeeze your glutes at the top of the motion; holding for 2-3 seconds
- Perform 3-4 sets of 10-12 repetitions; note that this exercise can sometimes cause hamstring cramps and the glute squeeze at the top can help to minimize this
Sidelying Hip Abduction
- Lie down on your side with your bottom knee bent and your top knee straight
- Again, keep your hand on your pelvis to monitor and ensure this time that your trunk does not sidebend as you lift your leg
- Keep your knee straight as you lift your top leg upwards toward the ceiling and slightly backward; It may help to position yourself just in front of a wall to slide your heel up and down
- Perform 3-4 sets of 10-12 repetitions
Advanced Hip Strengthening Exercises
- Just like the regular bridges listed above, lie down on your back
- Keep just one knee bent and your other knee straight
- Tighten your stomach as described above and lift your hips up away from the table, pressing down through the heel of your bent leg
- Be sure to keep your opposite leg straight and avoid allowing your hip to drop on that side (ie. keep your pelvis level and don’t let it rotate)
- Perform 2-3 sets of 8-10 repetitions; an alternative position for this exercise would be to bend your opposite knee and rotate your leg to rest your ankle on the thigh of your working leg in a “figure 4” position
Lateral Plank (with or without clamshells)
- Start off lying down on your side
- Prop yourself up on your elbow and your bottom knee with your knees bent to 90 degrees
- Keep your knees, hips, and shoulder all in a straight line
- Lift your bottom hip off of the floor until your trunk is straight; this exercise will work your bottom hip/glutes
- To make this exercise more challenging and to work both hips at the same time (though in different ways), perform a clamshell with your top leg just as described above
- If you’re just holding the plank, perform 3-4 repetitions for 30 seconds…If you’re adding the clamshells, perform 3 sets of 12-15 repetitions
Quadruped Hip Extension
- Position yourself on hands and knees with your hands under your shoulders and knees under your hips
- Keep your head looking straight down and your back as flat as possible (it may help to perform this in front of a mirror at first if possible to check your alignment)
- While maintaining the 90 degree bend in your knees, as well as your flat lumbar spine, lift one leg backwards as if you’re trying to leave a footprint on the ceiling…in other words your knee stays bent and you’re extending your hip
- Perform 3-4 sets of 10 repetitions on each side, alternating sides between sets
This article was written by Dan Murphy DPT, OCS. Dan graduated from Washington University in St. Louis in 2016 and lives just outside of Chicago with his wife and 2 year old son; though he and his wife are expecting a daughter in a few months! He enjoys playing board games and any outdoor activities with friends and family.
- Sadler S, Cassidy S, Peterson B, Spink M, Chuter V. Gluteus medius muscle function in people with and without low back pain: a systematic review. BMC Musculoskelet Disord. 2019;20(1):463. Published 2019 Oct 22. doi:10.1186/s12891-019-2833-4
- Kankaanpää M, Taimela S, Laaksonen D, Hänninen O, Airaksinen O. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79(4):412-417. doi:10.1016/s0003-9993(98)90142-3