The Importance of Hip Hinging | Modern Manual Therapy Blog

The Importance of Hip Hinging

Are you teaching hip hinging? What about dead lifts? If it were not for exposure to strength training influenced great clinicians like Charlie Weingroff and Gray Cook, I am sure I would have discounted the importance of this functional movement.

Here is a demo vid of one of my favorite hip hinge regressions in tall kneel via my man Perry Nickelston of Stop Chasing Pain.

Mini case time!

Case 1:
  • 11 yo female, difficulty playing viola and tall kneeling in church due to severe LBP
  • MSE is DP, breakouts show severe loss of active and passive hip extension and moderate loss of thoracic extension
  • in tall kneel and sitting upright in viola playing position, she had excessive lumbar lordosis with no idea how to pelvic tilt
  • after some light psoas release, thoracic PA and hip extension mobs, her tall kneel and sitting was no better
  • we started in quadruped with light tactile cuing for posterior tilts in the lumbar spine only, this was instructed by a previous PT, but the pt was concentrating the movement in her thoracic spine
  • next was starting sitting on her heels with a dowel behind her back, I had her flatten her lumbar spine excessive lordosis against my hand and keep it there as she slowly moved up into tall kneeling
  • she could only go about halfway into tall kneel before losing the neutral spine
  • both of these movements were instructed to her mother, who is an OT, and upon follow up the next week, she was able to hold tall kneel for about 4 minutes without pain, compared to 10 seconds prior to the last visit
Here is a great video via republic of strength on hip hinging and KB deadlifts

Case 2
  • 75 yo female, told by another PT she needed a knee surgery
  • major loss of right knee extension with pain on descending stairs and all closed chain activities
  • her main complaint at first was inability to get out of a chair without using both of her arms for years
  • we started hip hinging with a dowel and doing bottom bumps against a wall
  • after quickly mastering that, I gave her a 20 pound kettlebell and had her do deadlifts with the same bottom bump against the wall
  • she performed about 50 reps, then I had her try to get out of a chair with the same movement without using her arms
  • she easily got of the chair - GREAT! - now do that 40 more times, which she did!
  • she was so happy she started crying and gave me a hug
Would I have done the hip hinge or deadlifts on either of these patients a few years ago? Possibly, but I doubt it. Granted, they also needed, and still need some OMPT and other strategies to get them moving more efficiently, but some of the main threat perception is eliminated. Take down the DP if you can first, then concentrate on the DNs and the patients will be much happier, faster.

Keeping it Eclectic....


  1. Hi Erson,
    Love your blog. Just had a question regarding DP and DN movements. I'm in the process of reading Grey Cooks functional movement systems and it says you should use the DP movement as your marker but to treat the DN first then reassess the DP movement?

  2. That's a generalization, he is often misquoted at saying attack the distal DN first, then reassess the proximal DP. Thus many SFMA trained clinicians forget to address the proximal DP. While working on distal assymetries in motor control and motion may help proximal problems, manual therapy or other treatments to the area the patient is complaining of should also be a primary focus to improve movement and function.