Question from Chris Hughen.
Context: She has one child. She doesn’t have pain. Her hips look super externally rotated. She recently has a miscarriage.
The miscarriage, depending on how far into the pregnancy it was, could be relevant. If she was pregnant for long enough, there could be an increase in flexibility just due to the hormones circulating in her bloodstream. This happens in the first 14 weeks of pregnancy.
What orientation would her pelvis be in? As the baby moves down and forward, the pelvis will at least become oriented forward (like an anterior tilt). The hip sockets, the acetabula, will face more backward and downward (retroversion). This depends on how big a person she is. The weight of the baby pulls the body forward. Typically, the mom will not follow,
Did she have a C-section? Sometimes, if the pelvis is too closed in the back, a C-section may be necessary because the canal that the baby passes through is too small.
With this retroverted pelvic position, external hip rotation becomes more comfortable. That would then make sense why she appears to gravitate towards that position.
These positions also change muscle activity. The anterior hip muscles are concentrically oriented (shortened). The posterior hip muscles are eccentrically oriented (lengthened). The tension in the hamstrings, then, could be limiting the squat. That is, they just can’t stretch any further. If you give her an exercise or drill that restores more balanced muscle activity, then that may be enough to restore her mobility. This person is likely, when tested, lacking hip internal rotation.
A word of caution on using the hip thrust for this client: if this position is indeed the one she’s stuck in — wide at the top of the pelvis, narrow at the bottom of the pelvis — the hip thrust could be reinforcing this position.
Do you have any suggestions for starting a hinge progression with her?
Start in quadruped. Put her in the rib cage and spinal positions that you want. Teach her to flex her hips as much as you want. Then you can try an unweighted hinge. Then maybe a more traditional deadlift pattern.