Struggling with Hip Pain in NYC? Beyond the Ache: How Stability Supports Hip Health
As a physical therapist who has worked extensively in outpatient orthopedics and sports rehabilitation—and as a Hospital for Special Surgery (HSS) Hip Preservation Certified clinician —I’ve come to deeply appreciate the complexity and elegance of the hip joint. The hip doesn’t just move us—it centers us. And when it's not functioning well, the entire kinetic chain suffers.
Whether you're dealing with a non-arthritic hip condition like femoroacetabular impingement (FAI), a labral tear, or recovering from surgery, hip stability is key to long-term joint health and performance. At KNÓSIS, we help clients understand the balance between deep stabilizers and global mobilizers, and why restoring that balance is essential for pain-free, efficient movement.
The Architecture of the Hip: Stability in Motion
The hip is a ball-and-socket joint—robust, mobile, and heavily relied upon for weight-bearing tasks. Its stability arises from:
The structural congruency of the femoral head and acetabulum
Passive restraints like the labrum, joint capsule, and ligaments
Dynamic neuromuscular control from surrounding muscles
In my clinical practice—whether working with professional dancers or active individuals—I often see that it’s not the major movers that determine joint health, but the deep stabilizers. These small muscles ensure joint centration and absorb subtle loads, creating the foundation for safe and efficient motion.
Who Needs Hip Stabilization?
Hip stabilization work is essential for:
Individuals with FAI, where bone shapes cause joint impingement
Those recovering from labral tears, hip arthroscopy, or periacetabular osteotomy
Patients with hip dysplasia or shallow sockets
Athletes experiencing chronic groin pain or core instability
Anyone post-surgery who needs to prevent compensatory movement patterns
The key here is not just strengthening, but strategic neuromuscular re-education—which is where deep stabilizers come in.
Deep Stabilizers vs. Global Mobilizers
Deep Stabilizers
These are endurance-based, low-threshold muscles. They include:
Obturator internus
Deep fibers of gluteus medius and minimus
Pelvic floor musculature
They fire at low intensity for sustained periods, keeping the femoral head centered in the acetabulum and preventing unnecessary shear.
Global Mobilizers
These are high-threshold, force-producing muscles that drive movement:
Gluteus maximus
Tensor fasciae latae (TFL)
Hamstrings
Rectus femoris
They’re essential for sprinting, jumping, and lifting—but when deep stabilizers are inhibited, these mobilizers take on too much responsibility, often leading to poor load distribution, compensation, and pain.
Pain and Load Reduction: How They Disrupt Muscle Balance
Pain alters motor control—this is something I witness daily. It inhibits the deep stabilizers and up-regulates the mobilizers, creating what I often refer to as a "neuromuscular seesaw."
For example, glute inhibition may lead to hamstring dominance. Over time, this leads to joint instability, movement inefficiency, and secondary injuries.
Similarly, deloading the hip (through inactivity, injury, or post-op precautions) results in a rapid down-regulation of stabilizers. Research from prolonged bed rest and microgravity environments (think astronauts!) shows that these anti-gravity muscles shut down without proper loading.
Muscle Synergies and Movement Choices
Healthy movement isn’t just about strength—it’s about options. When muscle synergies are working well, your body has redundant strategies for achieving stability and mobility. But when those synergies break down, options shrink, and the system becomes rigid and compensatory.
At KNÓSIS, we train patients to rebuild those synergies, restoring adaptability, efficiency, and resilience.
How to Reactivate the Deep Stabilizers
Before introducing high-intensity or open-chain movements, I guide clients through a low-threshold, motor-control-based progression. This includes:
Subtle awareness exercises to engage deep muscles without recruiting mobilizers
Slow, controlled movements (which naturally favor stabilizers over mobilizers)
Isometric holds that challenge joint control under light loads
Breathwork and postural alignment, improving intra-abdominal pressure and lumbopelvic coordination
Often, clients report immediate relief when the hip "centers" correctly in the socket—a moment when stabilizers finally do their job.
Why Low-Threshold Training Comes First
Jumping into strengthening before building foundational control is like constructing a house on sand. Without stabilizer activation:
Mobilizers become dominant and fatigue faster
Joint loading is inefficient
Movement patterns remain compensatory
Low-threshold training ensures proper sequencing and lays the groundwork for progressive overload.
My Go-To Closed-Chain Exercises for Hip Stability
Closed-chain exercises provide joint compression and proprioceptive feedback that is critical for re-establishing neuromuscular control. My favorites include:
Standing Hip Abduction – More effective than side-lying for GMed activation
Standing Rotation – Refines control through deep rotator engagement
Squats and Lunges – Integrate hip, core, and knee stabilizers
Step-Ups – Train dynamic control in single-leg stance
These movements simulate real-life demands and help clients transition from rehab to performance seamlessly.
Final Thoughts
Rebuilding hip stability isn’t just about "getting stronger"—it’s about restoring the right relationships between muscles, understanding how pain and unloading affect movement, and progressively loading the joint in ways that feel safe and centered.
If you’re recovering from hip injury, dealing with chronic pain, or preparing to return to high-level activity, this process begins with deep stabilizers.
At KNÓSIS, we don't just treat the site of pain—we evaluate the whole system and train the Thinking Mind and Feeling Body to work together.
