Unlock the keys to optimal hip function and movement efficiency through comprehensive neuromuscular retraining.
By Curtis Cramblett, CFMT,CSCS,CAFS
Creating lasting change in the body isn’t just about stretching or strengthening a muscle here and there—it requires a layered approach that addresses mechanics, activation, motor control, and endurance. This guide breaks down the process of building durable results, with a focus on hip flexion dysfunction and corrective strategies.
For treatment to “stick,” it must progress through four interconnected layers:
Mechanical – Remove passive stiffness or adhesions
Manual therapy, joint mobilization, and soft tissue work.
Goal: restore available range of motion.
Neuromuscular – Local – Activate stabilizers
Target muscles: deep hip rotators, pelvic floor, multifidi, diaphragm.
Teach proper firing patterns: timing, intensity, and relaxation.
Core-first activation: transverse abdominis, diaphragm, pelvic floor.
Ensure core stability precedes limb movement.
Motor Control – Global Movement Integration
Train efficient whole-body coordination across the tensegrity system.
Progress from local control into functional patterns.
Strength & Endurance – Build resilience
Strength and endurance ensure mechanics remain stable over time.
The problem:
When stabilizers underperform, the hip flexors (TFL, rectus femoris) often dominate.
The solution:
First, clear mechanical dysfunctions.
Then restore deep hip rotator function and posterior depression.
Common faults:
TFL or rectus femoris firing during clam shells.
Loss of elongation through the sit bone, leading to pelvic hiking instead of stabilizing.
Cue: “Keep your sit bone long and heavy.”
Components: hip extension + plantarflexion + eversion + internal rotation.
Benefits:
Reduces hip flexor dominance.
Activates deep hip rotators and glutes.
Promotes elongation and core-first activation.
Clam shells → focus on deep rotators, not TFL/rectus.
Reverse clam shells → build control between internal and external rotation.
Side-lying PD holds → with or without foot resistance.
Add tactile cues at pelvis and femur for feedback.
Combine posterior depression with functional movements:
Sit-to-stand patterns.
Backward lunges.
Cycling drills (pedal stroke with PD emphasis at the bottom).
Progression: local → global → functional.
| Stage | Exercise | Focus |
|---|---|---|
| Mechanical | Manual therapy to hip joint & soft tissue | Clear stiffness, restore mobility |
| Neuromuscular – Local | Clam shells at varying hip flexion | Activate deep rotators |
| Reverse clam shells | Balance internal/external control | |
| PD holds against therapist hand or wall | Teach elongation + stabilizer firing | |
| Motor Control – Global | Side-lying PD with foot resistance | Core-to-leg integration |
| Sit-to-stand with elongation | Transfer stability to function | |
| Strength & Endurance | Cycling drills with PD emphasis | Maintain form under load |
| Backward lunges | Endurance of pattern in dynamic tasks |
Always clear mechanical dysfunction first → this opens the “door.”
Follow immediately with neuromuscular retraining → teaches the body to “walk through the door.”
Reinforce with motor control, strength, and endurance → prevents regression.
Always cue core-first response (pelvic floor, TA, diaphragm, multifidi) before prime movers.
Integrate functional movement early—every gain must transfer into real-life tasks.
By following this layered framework—mechanical, neuromuscular, motor control, and endurance—you create lasting change instead of temporary relief. The key is progression: clear the path, activate the stabilizers, integrate into function, and build resilience over time.