Michelle writing another article on the benefits of the hip thrust?

In my opinion, the hip thrust is one of the most underutilized weapons in the arsenal of training female athletes. With potential transferable benefits in performance, injury prevention and lower body strength, it is hard to believe that it isn’t the cornerstone of most female strength training programmes.

Female Field Athlete Biomechanics

To truly examine the potential benefits of the hip thrust, one must first understand the demands placed on the female body during field sports. Obviously, it goes without saying that demands of each sport differ, but most field/team sports demand that athletes sprint, cut, jump and move laterally at varying degrees^[1].

The female body deals differently with these forces than males, and as a result this predisposes us to certain types of lower limb injury.

One Small Step for Man, One Giant Step for Female Knee Extensors

Evaluation of the female biomechanics indicate three issues amongst female atheletes:

1. Ligament Dominance
2. Quadricep Dominance
3. Lower Limb Asymmetry

Ligament Dominance

When the surrounding musculature is unable to absorb force adequately, the ligaments can take over, a phenomena called ligament dominance^[2]. Ligaments that sustain this high amount of force over a short time period are more likely to rupture. To prevent against this occurring in the lower limb, the posterior chain muscles must be activated sufficiently (glute maximus, glute medius, hamstrings and calf muscles). Forces that aren’t absorbed by the muscles will be imparted to lower limb joints and ligaments (most commonly the knee and ankle)^[3].

Females are more predisposed to land with the knee in a valgus position (knee joint turning medially, ankle pointing laterally)^[3]. This makes it difficult for the posterior chain to activate to support the landing, and increases the likelihood of ligament dominance.

Quadricep Dominance

When landing from a jump/height, women have been shown to rely on their knee extensor muscles (quadriceps) and activate their hip extensors (posterior chain muscles) to a much lesser extent than males^[4]. Landing with the knee in extension makes the anterior cruciate ligament (ACL) more vulnerable to injury. The ACL acts to resist forward movement of the tibia^[5], and by using your quadriceps to stabilise the tibia, you create this anterior shearing force to the tibia and therefore the ACL.

Preferential use of the posterior chain muscles as opposed to the quadriceps is advantageous to the athlete. The hamstrings act to posteriorly pull the tibia, and thereby reduces force transmitted by the ACL^[4]. Males are more likely to activate their hamstrings predominantly when landing, whilst females tend to activate the quadriceps predominantly. This landing pattern is speculated to make women more prone to ACL injuries^[6].

Lower Limb Asymmetry

Females tend to be single-leg dominant during tasks requiring side-to-side lower limber symmetry (sudden changes of direction, pivoting, cutting etc.), more so than men^[4]. These tasks are a common part of many field sports, and may lead to players developing lower limb single-leg dominance^[7]. Single-leg dominance may be associated with injury risk during these activities, as it encourages unequal weight and force distribution between the lower limbs. In fact, one study (albeit with a small sample size) found 100% of injuries to occur to female netball players to occur to the dominant leg^[7].

Discrepancies between lower limbs may be also linked to chronic overuse injuries (read: stress fractures, osteoarthritis)^[8]. Lower limb motor asymmetry is associated with increased injury risk in non-contact sports, but studies are inconclusive about the degree at which this becomes significant for females^[9].

Incidence of Lower Limb Injury Amongst Female Athletes

With the common biomechanical causes of injury discussed, the prevalence of lower limb injuries amongst female athletes will be evaluated. We will mostly focus on the more popular field sports amongst females in Ireland. The author deems these sports to be Gaelic football, rugby, camogie, basketball, soccer, swimming and running.

Simply being female statistically places you at a higher risk of lower-limb injury than our male counterparts, which is wonderful. Other evidence suggests that being above the ripe-old age of 24, history of injury and a lower level of fitness when you start training also contribute to your injury risk^[10].

Within popular sports in Ireland, lower limb injuries are common. One study of female Gaelic footballers found lower extremity injuries to account for 70% of all injuries^[11]. Another study conducted amongst county (elite) camogie players found the lower limb injured in 71.4% of cases^[12]. Areas commonly injured included the hamstrings, Achilles tendon, ankle and quadriceps. Ankle sprains are also common in sports such as basketball and soccer^[13].  Females are three times more likely to tear their ACL^[14].

With lower limb injuries so commonplace amongst female athletes, what if there was an exercise programme we could prescribe to address this?

Resistance Training & Injury Reduction

With the issues with female biomechanics and our predisposition to injury accounted for, we now enter the good stuff: what we can do to reduce the prevalence of lower limb injury. Obviously, one must first make the disclaimer that this is all speculation based on the literature, and given that this is a blog post and not a scientific study, all claims are to be taken with a pinch of salt.

The Role of Resistance Training

Resistance training has long been associated with a reduction in injury amongst athletes, particularly when it addresses movement biomechanics^[15]. Resistance training is the most effective means of increasing muscle mass and improving muscular strength and endurance^[16]. Earlier in the article, we discussed how increasing muscle activation and power can reduce the force transmitted to ligaments and joints, which can potentially reduce injury. Obviously, the reason athletes don’t get injured isn’t due to the fact they have a six pack and rippling quads, but the evidence suggests it can’t hurt. Literally.

The Hip Thrust: The Biomechanical Gift That Keeps On Giving

Direct Training for the Hip Extensors

Earlier on in the article, we discussed at length how females are more predisposed to absorb impact through their quadriceps (knee extensor muscles). The hip extensors are also involved to some extent in dealing with these forces. By increasing the strength of the hip extensors (posterior chain musculature), we may decrease reliance on the knee extensors (and by proxy, ligaments and joints) to absorb impact^[17].

The hip thrust is unique to other conventional movements in that its primary goal is aimed at increasing strength and output of the hip extensors. It recruits the glutes, spinal stabilizers and knee extensors^[18]. Traditional strength training programmes for athletes tend to focus on more traditional movements to build lower body strength (e.g. squat, deadlift). A systematic review of the effects of the barbell hip thrust found it to best activate the hip extensors when compared to the deadlift/other conventional lifts^[19].

Certainly, for the female athlete, if we are biomechanically lacking in posterior chain activation, directly training the hip extensors may be a step in the right direction to reverse this.

The Quadricep Dominance

The hip thrust may also directly address another deficit that may predispose females to lower limb injury – overreliance on the quads. Studies directly comparing the hip thrust and back squat found the back squat to better activate the quads ^[20],[21]. It is important to note that the hip thrust does still activate the quads, just to a lesser extent.

I would hypothesise that activating the quads more than the posterior chain during strength training may encourage the athlete to be more “quad dominant” on the field too. However, I would also imagine this difference to be minimal. You aren’t going to end up quadzilla purely from back squatting, nor are you going to end up solely Kim K from hip thrusting.

I would simply make an argument to include some form of hip thrust in strength training programmes.

Single-Leg Hip Thrust: King of Hip Stability

Single leg hip thrusts, as with any single-leg exercise, can be used to address asymmetry in the lower limb. Single-leg hip thrusts increase recruitment of the hip adductor and abductors^[22]. This may help to increase the stability of the hip and knee joints. Furthermore, increasing the strength of the stabilizing muscles has been associated with improved knee and hip joint balance^[23].

The Effort of a Hip Thrust

Field athletes aren’t training for a powerlifting competition or a bodybuilding show. Their prime goal is performance on the pitch. Exercises commonly prescribed as part of strength programmes for these athletes commonly include deadlifts, squat variations and lunge variations. These movements can be quite demanding on the central nervous system. As is well-documented in literature, fatigue and impaired recovery have a negative impact on performance in sports, and is associated with injury^[24]. Anecdotally speaking, I would say that it is easier to recover from hip thrusts than movements that recruit more of the body (e.g. deadlift).

Obviously, I am not saying that the hip thrust alone is the key to reducing fatigue. Exercise selection is only a part of smart programming. I am merely suggesting that it may be a less fatiguing alternative to other compound movements, and achieve a similar response.

Conclusion

We conclude yet another one of my love letters to the hip thrust with my usual washing-my-hands-of-any-responsibility spiel. This is only an opinion. Without any study directly examining any of my hypotheses, that’s all they can be: hypotheses. A semi-educated guess.

I do not write this article with the intention to discredit any programme for athletes. Don’t read this and decide to never squat or deadlift again. Those exercises have their own benefits and transferrable skills to sport that aren’t covered by the constraints of this article. I am merely arguing for the inclusion of the hip thrust in female training, and my rationale for same.

Finally, if you have any feedback or comments, I would love to hear from you. If you notice anything incorrect or misleading, please let me know.

Peace, love and hip thrusts,

Michelle xo

References

1. Taylor, J.B., Wright, A.A., Dischiavi, S.L., Townsend, M. A., Marmon , A.R. (2017) ‘Activity Demands During Multi-Directional Team Sports: A Systematic Review’, Sports Medicine. Available at: https://link.springer.com/article/10.1007/s40279-017-0772-5.
2. Ford, K.R., Myer, G.D., Hewett, T.E. (2003) ‘Valgus Knee Motion during Landing in High School Female and Male Basketball Players’, Medicine & Science in Sports & Exercise. Available at: https://journals.lww.com/acsm-msse/Fulltext/2003/10000/Valgus_Knee_Motion_during_Landing_in_High_School.19.aspx.
3. Hewett, T.E., Ford, K.R., Hoogenboom, B.J., Myer, G.D. (2010) ‘Understanding and preventing ACL injuries: Current biomechanical and epidemiologic considerations – update 2010’, North American Journal of Sports Physical Therapy. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096145/.
4. Stearns, K.M., Keim, R.G., Powers, C.M. (2013) ‘Influence of Relative Hip and Knee Extensor Muscle Strength on Landing Biomechanics’, Medicine & Science in Sports & Exercise. Available at: https://journals.lww.com/acsm-msse/Fulltext/2013/05000/Influence_of_Relative_Hip_and_Knee_Extensor_Muscle.17.aspx.
5. Duthon, V.B., Barea, C., Abrassart, S., Fasel, J.H., Fritchsy, D., Ménétrey, J. (2005) ‘Anatomy of the anterior cruciate ligament’, Arthroscopy. Available at: https://link.springer.com/article/10.1007%2Fs00167-005-0679-9.
6. Harput, G., Soylu, A.R., Ertan, H., Ergun, N., Mattacola, C.G. (2014) ‘Effect of Gender on the Quadriceps-to-Hamstrings Coactivation Ratio During Different Exercises’, Journal of Sport Rehabilitation. Available at: https://www.researchgate.net/publication/257300436_Effect_of_Gender_on_the_Quadriceps_to_Hamstrings_Co-Activation_Ratio_During_Different_Exercises.
7. Maulder, P.S. (2013) ‘Dominant limb asymmetry associated with prospective injury occurrence’, South African Journal for Research in Sport, Physical Education and Recreation. Available at: https://www.ingentaconnect.com/content/sabinet/sport/2013/00000035/00000001/art00009.
8. Zifchock, R.A., Davis, I., Hamill, J. (2006) ‘Kinetic asymmetry in female runners with and without retrospective tibial stress fractures’, Journal of Biomechanics. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0021929005004471.
9. Clark, N.C., Clacher, L.H. (2020) ‘Lower-limb motor-performance asymmetries in English community-level female field hockey players: Implications for knee and anjke injury prevention’, Physical Therapy in Sport. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1466853X19306212.
10. Neely, F.G. (2012) ‘Intrinsic Risk Factors for Exercise-Related Lower Limb Injuries’, Sports Medicine. Available at: https://link.springer.com/article/10.2165/00007256-199826040-00004.
11. Ní Chaomhánaigh, E. (2018) ‘Injuries in adolescents and coaches’ attitude to injury prevention in Ladies Gaelic Football’. Available at: https://research.thea.ie/bitstream/handle/20.500.12065/2871/Emma%20N%c3%ad%20Chaomh%c3%a1naigh%20Thesis.pdf?sequence=1&isAllowed=y.
12. Buckley, C.S., Blake, C. (2018) ‘The incidence of injury in elite camogie, an in-season prospective study’, BMJ Open Sport & Exercise Medicine. Available at: https://bmjopensem.bmj.com/content/bmjosem/4/1/e000315.full.pdf.
13. Brant, J.A., Johnson, B., Brou, L., Comstock, R.D., Vu, T. (2019) ‘Rates and Patterns of Lower Extremity Sports Injuries in All Gender-Comparable US High School Sports’, Orthopaedic Journal of Sports Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775559/#:~:text=In%20all%20girls’%20sports%20except,track%20and%20field%20(2.6%25).
14. Sutton, K.M., Bullock, J.M. (2013) ‘Anterior cruciate ligament rupture: differences between males and females’, Journal of the American Academy of Orthopaedic Surgeons. Available at: https://pubmed.ncbi.nlm.nih.gov/23281470/.
15. Faigenbaum, A.D., Myer, G.D. (2010) ‘Resistance training among young athletes: safety, efficacy and injury prevention effects’, British Journal of Sports Medicine. Available at: https://bjsm.bmj.com/content/44/1/56.short.
16. Hass, C.J., Feigenbaum, M.S., Franklin, B.A. (2012) ‘Prescription of Resistance Training for Healthy Populations’, Sports Medicine. Available at: https://link.springer.com/article/10.2165/00007256-200131140-00001.
17. Stearns, K.M., Keim, R.G., Powers, C.M. (2013) ‘Influence of Relative Hip and Knee Extensor Muscle Strength on Landing Biomechanics’, Medicine & Science in Sports & Exercise. Available at: https://journals.lww.com/acsm-msse/Fulltext/2013/05000/Influence_of_Relative_Hip_and_Knee_Extensor_Muscle.17.aspx.
18. Contreras, B., Cronin, J., Schoenfeld, B. (2011) ‘Barbell Hip Thrust’, Strength and Conditioning Journal. Available at: https://journals.lww.com/nsca-scj/Fulltext/2011/10000/Barbell_Hip_Thrust.7.aspx.
19. Neto, W.K., Vieira, T.L., Gama, E.F. (2019) ‘Barbell Hip Thrust: Muscular Activation and Performance: A Systematic Review’, Journal of Sports Science & Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544005/.
20. Barbalho, M., Coswig, V., Souza, D., Serrão, J.C., Campos, M.H., Gentil, P. (2020) ‘Back Squat vs. Hip Thrust Resistance-training Programs in Well-trained Women’, International Journal of Sports Medicine. Available at: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1082-1126.
21. Delgado, J. (2017) ‘Comparison in muscle activity between the back squat, Romanian deadlift and barbell hip thrust during hip extension’. Available at: https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=3025&context=theses.
22. Eckert, R.M., Snarr, R.L. (2014) ‘Barbell Hip Thrust’, Journal of Sport & Human Performance. Available at: https://www.researchgate.net/profile/Ryan_Eckert/publication/268513513_Barbell_Hip_Thrust/links/564b755f08ae3374e5ddafb7.pdf.  
23. Hyrsomallis, C. (2009) ‘Hip adductors’ strength, flexibility and injury risk’, Journal of Strength and Conditioning Research. Available at: https://pubmed.ncbi.nlm.nih.gov/19620912/.
24. Kellman, M., Bertollo, M., Bosquet, L., Brink, M., Coutts, A., Duffield, R., Erlacher, D., Halson, S., Hecksteden, A., Heidari, J., Meeusen, R., Mujika, I., Robazza, C., Skorski, S., Venter, R., Beckmann, J. (2018) ‘Recovery and Performance in Sport: Consensus Statement’, International Journal of Sports Physiology and Performance. Available at: https://www.researchgate.net/profile/Michael_Kellmann/publication/322006975_Recovery_and_Performance_in_Sport_Consensus_Statement/links/5a6a48590f7e9b1c12d1813c/Recovery-and-Performance-in-Sport-Consensus-Statement.pdf.