Working with the Hip Joint

By Til Luchau
[Myofascial Techniques]

As anyone with hip pain can confirm, when the hip joint does not move easily, all manner of troubles ensue. For example, walking is more arduous, and since the average person take more than 5,000 steps per day, even a little difficulty or discomfort in each step will build through the day, dragging on the walker’s body, motivation, and mood.1 Hip joint discomfort will take the fun out of stair climbing; make getting into or out of a bed, chair, or vehicle difficult; and can make bending, side-lying, tying shoes, and many everyday movements unappealing, uncomfortable, or even unbearable.
Stiff or painful hips have far-reaching effects on the rest of the body’s function, as well. Back pain is more common in those who lack hip joint mobility.2 An easy, balanced posture, and the benefits this brings, also depends on a mobile hip joint, which may be one reason why Ida Rolf, PhD, the originator of Rolfing structural integration, called the hip joint “the joint that determines symmetry.”3
The hip joint’s ball-and-socket structure allows it a great deal of potential mobility, second only to that of the shoulder.4 In this column (and in Volume 1 of Advanced Myofascial Techniques, Handspring Publishing, 2015), we discussed techniques for the larger myofascial structures that can limit hip joint mobility, such as the Push Broom sequence (Image 1). It is also worthwhile to pay attention to the hip joint itself. Once the bigger structures of the hip have been addressed, hands-on work with the hip joint can help address mobility restrictions or pain related to the deep connective tissues that surround the hip joint, such as the iliofemoral ligaments (Image 2), said to be the strongest ligaments in the body;5 the hip’s joint capsule and surrounding bursa; the labrum and synovial membrane (Image 3); and the joint’s articular surfaces.
When healthy, the hip joint’s articular cartilage (Image 2) has extremely slick surfaces, said to be more slippery than ice sliding on ice.6 This nearly complete lack of friction arises from large, water-binding molecules in the cartilage’s surface. In addition to making the articular tissue exceptionally slippery, this synovial hydration causes the cartilage to swell slightly, much like a sponge would, giving it excellent shock-absorbing and compression-handling properties.
The joint’s crucial hydration is sealed in by the labrum, the fibrocartilage lip around the acetabular socket, and the joints’ inner synovial membrane (Image 3), which attaches to and blends with the fibers of the labrum. This suction-cup arrangement creates a small amount of negative pressure within the joint, which both adds stability and helps maintain the synovial fluid in the joint space.
Although named for the largest ligament of the hip joint, the Iliofemoral Ligament Technique (Image 4) affects much more than just this single structure. This technique’s aim is to improve the comfort, mobility, and hydration of the hip joint by gently distracting (lifting) the femur away from the acetabulum. (Incidentally, this same technique can also be used to distract the innominate/hip bone away from the sacrum, and so is also helpful for working with hypermobile, inflamed, or uncomfortable sacroiliac joints.)
When applying this technique, keep in mind it is easier the higher (more proximally) your hands are on the medial femur. Since this is a potentially sensitive and private area, as your first step, be sure to explain your process and get explicit permission from the client. Practice first with a colleague or friend; when done correctly, your partner will likely report that your hands’ placement feels much less invasive than you might imagine.
Keep in mind, too, that this technique requires you to be mindful of your ergonomics. You’ll want a table height that allows you to simply lean backward, rather than exert yourself or lift with your arms, back, or shoulders. This position will keep you comfortable and will allow you to use this technique with clients of all sizes.
With practice, the Iliofemoral Ligament Technique will give you an effective and efficient way to work with the hydration, client proprioception, and structural adaptability of the deepest structures of the all-important hip and sacroiliac joints.

Key Points: Iliofemoral Ligament Technique

• Hip, groin, or lower back pain (since any of these may arise from hip joint irritation).
• Hip stiffness or movement limitations.
• Recovery from hip surgery, strain, or labrum tear.
• Femoroacetabular impingement (FAI).
• Jaw pain, tension, and temporomandibular joint dysfunction.

• Increase options for movement, proprioception, and intra-articular hydration of the femoroacetabular joint.

• With the client prone and the hip comfortably flexed (the “Push Broom” position), interlace the fingers on the medial side of the proximal thigh, using the client’s knee against your leg as a fulcrum, in order to:
Gently distract (lift) the femur away from the acetabulum. Feel for or imagine a gentle stretch of the iliofemoral ligaments and a slight opening of the joint space.
Gently distract (lift) the same-side hip bone laterally away from the sacrum. Feel for, or imagine, a slight opening of the sacroiliac joint.
• Vary your angle, feeling into and distracting different aspects of the femoroacetabular and sacroiliac joints; wait for several breaths in each position.

• Explain your purpose and get permission before working in this potentially sensitive area.
• Use only very gentle distraction after hip replacement or surgery.
• Stay comfortable: lean back with straight arms to avoid strain.

For More Learning
• “Pelvis, Hip & Sacrum” in the Advanced Myofascial Techniques series of workshops and video courses.
• Advanced Myofascial Techniques, Volume 1, chapter 9 “Hamstrings” and Chapter 10 “Hip Mobility” (Handspring Publishing, 2015).

1.  D. R. Bassett et al., “Pedometer-Measured Physical Activity and Health Behaviors in US Adults,” Medicine & Science in Sports & Exercise 42, no. 10 (October 2010): 1,819–25.
2.  G. Mellin, “Correlations of Hip Mobility with Degree of Back Pain and Lumbar Spinal Mobility in Chronic Low-Back Pain Patients,” Spine 13 no. 6: 668–70.
3.  I. P. Rolf, Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being (Rochester, VT: Healing Arts Press, 1989), 143.
4.  C. Starkey and S. D. Brown, Examination of Orthopedic & Athletic Injuries (Philadelphia: F.A. Davis, 2015), 945.
5.  W. Platzer, Thieme Atlas of Anatomy (Stuttgart, Germany: Thieme, 2006), 380.
6.  I. P. Herman, Physics of the Human Body (Berlin: Springer Science & Business Media, 2008).

Til Luchau is a Certified Advanced Rolfer, the author of Advanced Myofascial Techniques (Handspring Publishing, 2016) and a member of the faculty, which offers distance learning and in-person seminars throughout the United States and abroad. Contact him via and’s Facebook page.