My Hip Hurts! Training with a Hip Labral Tear, Part 1

So your hip hurts? The good news is there are always safe workarounds in the case of injury or lingering issues. Coach Sarah Walls begins her two part series on understanding how to apply safe training to the lower body with a labral tear in the hip.

Priority #1: Breathing

If you were to say to me in 2006, Hey Sarah! Guess what?!? In 10-years you will be laying the foundation for high performance by pounding the crap out of breathing drills. I would have believed you***. It's pretty obvious, when you think about it, but the evidence for it's true importance has only been surfacing over the past couple of years. 

This is an insanely complex topic that can literally have an effect on the obvious: your ability to recover effectively between bouts of intense exercise allllll the way to the obscure and surprising: regaining normal range of motion about joints that have been previously all kinds of locked up.

So, here ya go. My long-winded explanation of why you or your child may be doing do many drills to re-pattern their breathing. The concept of training breathing patterns now forms the foundation for all SAPT athletes.

Below I've organized a loose hierarchy of what proper breathing actually accomplishes for us humans:

Life Support

Like everything else in the body we adjust to sub-optimal patterns and just assume everything is A-OK (ex: somehow staying alive when only eating frankenfoods). In this case, I'm referring to our bodies amazing ability to be totally out-of-whack and yet not collapse in on itself, biomechanically speaking.

But, as professionals in the industry of human performance, we know that those common mal-alignments in the body ultimately stem from poor pelvic balance and that is in fact causing the postural asymmetries.

What causes the problem with the pelvis in the first place? Traditionally, we’ve chalked it up to an increasingly sedentary environment - too much sitting, not enough moving. Even for children. In fact this problem first develops in children, all children.

So, let’s take it deeper. There is actually something else going on besides our chair bound, screen driven environment. It just so happens that if you look very deep, like inside your body, you will discover that the muscle responsible for respiration, the diaphragm, is actually itself asymmetrical! In fact, the thorax is packed with asymmetrical situations: the heart sets on one side, the liver on the other to adjust the diaphragm is divided into two domes (on the right and left sides) one dome is smaller and weaker than the other. This sets off a precipitation of events. All of which ultimately influence our athletic performance, efficiency, injury patterns and more.


Okay, let’s break this down. It’s important, so try to stay with me… I’m also working hard to keep up with myself. All kinds of important parts of the body attach and interact with the diaphragm. Since, by our bodies’s design, one side of the diaphragm is stronger than the other that means that certain compensatory patterns always develop. Always. If you are a human you have this pattern. 

The diaphragm is stronger on the right side, this ultimately means that we favor (and overwork) the right side of the body. While the left side becomes weakened and inefficient. 

From here we can see the commonplace asymmetries develop: one shoulder higher than the other, the rib cage set at predictable angles from right to left and front to back, the pelvis rotated predictably.

Injury Potential

Alright, we’re getting back on solid footing. The by-design asymmetry of our diaphragm causes the postural asymmetries that cause, over time, injury. 

How many times has a well meaning coach had an athlete statically stretch chronically tight hamstrings? Do they ever regain the proper ROM? Nope. But, those tight hamstrings are actually indicative of a risk for injury that points to pelvic misalignment and, you guessed it, points then towards diaphragm and thorax corrections that MUST occur before high performance can ever be achieved.

How many times has a pitching coach focused their injury prevention program to address only the throwing side? Good gracious that’s just layering on the problems.

Sub-Optimal Performance: Layers of dysfunction

Let’s continue to talk about the pitching coach who runs a one sided arm care program. Hey, it kind of makes sense. You throw with one arm, why wouldn’t focus on strengthening the musculature on just that side? 

Because you frack up the entirety of the athlete, that’s why.

Never, ever layer strength on top of dysfunction. The potential for injury skyrockets (that’s my opinion) and it becomes very difficult to make the foundational corrections (to backtrack). 

The result? The athlete has now gotten “stronger” and tighter and more imbalanced in the pursuit of performance. 

What should the approach have been? Fix the imbalances first, prioritize this as essential to performance, then and only then, begin to strengthen.

Recovery during repeated efforts

When respiration isn’t occurring efficiently, an athlete’s ability to recover between bouts of training (or plays in a game) will be suboptimal. Potentially leading to injury, compromised decision making (think ability to read a developing play), lost points, or a Loss.


We’ve established that the diaphragm will cause poor pelvic balance. But what does that mean for gait? 

“Walking and breathing are the foundations of movement and prerequisites for efficient, forceful, non-compensatory squatting, lunging, running, sprinting, leaping, hopping, or jumping ONLY WHEN three influential inputs are engaged: proprioception, referencing, and grounding.” PRI 

Pulled muscles, ligament tears, rolled ankles can all be traced back to a pelvis, and thus, breathing problem.

That tilted and rotated pelvis can be a real problem!

How many great (or on their way to great) athletic careers have been stopped in their tracks by an injury?

How to fix: Zone of Apposition

Moving forward with the understanding that breathing really is the key to life, we have to ask: how do you fix this?

There is something called the Zone of Apposition (ZOA) and this is the area where the diaphragm and ribcage over lap each other. We want to maximize this overlap through proper ribcage positioning.

Here’s the good news: train the ribcage to be in the proper position and now those imbalances start to clear up:

  • Better ROM at all joints
  • Better recovery for bouts of work
  • Less compensatory patterns throughout the body

Now we can work on performance

How SAPT uses/integrates breathing drills to achieve performance improvements:

  1. Ground based - 90/90, etc
  2. Against gravity —> Static
  3. Against gravity —> dynamic & sub-max
  4. Against gravity —> dynamic & max

What the athlete gets in return:

  • Better movement patterns (without forcing it)
  • Fewer injuries
  • Better recovery (between intense bouts and sessions)
  • More bulletproof and awesome

With regards to training the ZOA, it's not a matter of if it needs to be trained, rather the important aspect is for the coach to assess and determine what level the athlete needs to be placed at to get started and progressed forward.

***I'm sorry, I lied - in 2006, I was 25 - knew virtually nothing - and it was hard to tell me anything unless it was about box squats, deadlifts, or the bench press. 

Breathing Mechanics: Why Football Players Should Care

Breathing? Really? How could something as simple and common as breathing possibly affect football performance? If you're willing to spend about eight minutes to read this, you won't be sorry! Proper breathing mechanics are an aspect of sports performance that is a) largely ignored by a decent chunk of the athletic community (but is growing in exposure thanks to the PRI, Eric Cressey, Chalrie Weingrof, Kevin Neeld, Mike Robertson and a host of other smart coaches.) and b) are the 6 Degrees to Kevin Bacon of athletic movement. Everything connects back to breathing mechanics. Note- this is going to barely scratch the surface of all the breathing literature out there, so fitness nerds, don't get uptight about missing information. The point of this article is to explain the importance if breathing mechanics and provide some practical applications for coaches and players. If this post sparks your interest and you want to learn more, I recommend a search on the Posture Restoration Institute (from which I derived most of the information); all their articles are a good starting point.

A brief anatomy lesson is needed before we proceed.

The diaphragm is an umbrella shaped muscle and when it contracts, it pushes your organs down. This creates a large space in your lungs thus lowering the pressure. The one thing I remember from physics is that air moves from high pressure to low pressure. So, when there’s a lower pressure in your lungs, air whooshes in. (ha! And you that you sucked it in. Nope, it forces itself in. This blew my mind when I first learned the secrets of inhalation.)

Diaphragms are cool and important (understatement!) but breathing requires accessory muscles too.  Our intercostals (rib muscles) and scalenes and sternocleidomastoids (neck muscles) contribute to the life-giving act of breathing. We need to use ALL THREE areas.

You can test yourself to see what area you tend to rely on most often based on if you get a cramp during exercise. For example, my neck (scalenes and SCM) is hyperactive during exercise and I get neck cramps during sprint work. Got a stitch in your side? Probably relying more on intercostals than your diaphragm.

Think of it like this: Harry Potter is the diaphragm, Hermione is the intercostals, and Ron is the neck muscles (mainly because Ron is so temperamental and is easily irritated, much like the scalenes).

As a coach or player, here's a quick test of breathing mechanics. Lye supine with your knees bent at 90 degrees against a wall. Place your hands just beneath your rib cage (this helps determine if the abdomen is expanding 360 degrees during inhalation). Take a DEEEEEEEP breath and exhale.

Like this, minus the overhead reach.
Like this, minus the overhead reach.

If an athlete is breathing properly we should see three things:

1. Circumferential expansion of the the abdomen (front and back)

2. Rib expansion (front and back too)

3. Li'l bit of apical (upper ribs) elevation. Note: too often THIS is where you'll see the breathing take place. You can tell because the shoulders will rise up towards the ears.

It's when one of these areas is impaired that we see dysfunction (pain/injuries) occur. Harry Potter is awesome but he would never have defeated Voldemort if he didn’t have Ron and Hermione.

1. Breathing affects EVERYTHING. The average person takes roughly 20,000 breaths per day. That's a LOT of contractions of the diaphragm. Aberrant breathing patterns will not only alter the ability of the diaphragm to function efficiently but it creates hyperactivity and hypertonicity (high tone/tension in the muscle) of the accessory muscles AND of muscles down the line (believe it or not, it can affect hip mobility!).

2. Think about the accessory muscles (and their neighbors): scalenes, SCM, levator scapulae, pec minor, trapezius... if those guys are tight and irritated, that will wreck havoc on cervical posture and shoulder mobility and function. Why do you care about that? If the cervical posture is whacked out (aka, your neck)  those muscles are not going to function properly, it'll be harder to strengthen them in the way they need it and that puts you at a greater risk for concussions. Shoulder function/mobility is especially important for quarterbacks. If the shoulder isn't moving properly, say hello to rips, tears, and strains of the rotator cuff, bicep tendons, and labrums. Hooray.

3. All that tension spreads to the rest of the body. It increases the sympathetic state (flight or fight response) and thus not allowing the body to fully recover after workouts/practices/ games. This will eventually run down the athletes. The increased sympathetic state will increase anxiety, mess with sleep patterns, and can even decrease pain threshhold; all of these equal poopy workouts and even worse recovery.

Hopefully, after all that, I've convinced you that breathing patterns, make that PROPER breathing patterns, are extremely important and integral to athletic success. Again, if you truly want to improve performance, you should see a professional and get assessed and trained. (that was a shameless plug, I know, but it's true!)

But, run through 4 quick and simple things coaches and players can add to/be cognizant of to create a better breathing environment.

1. Posture Re-education:

Why? Three words: Zone of Apposition.

"Achieving the optimal ZOA really depends on the shape/orientation of your ribcage. If your lower anterior (front) ribcage tends to be elevated (as in picture on the left), it can alter the length-tension relationship of your diaphragm resulting in aberrant breathing pattern, lumbopelvic instability (hips and spine...BAD place for instability) and a cascade of movement dysfunctions." - Bill Hartman

Read about the Zone of Apposition on PRI's website.

2. Breathing Re-Education

As mentioned above in the "what you should see" part, we need to teach our athletes (and ourselves) how to

a) Achieve circumferential expansion. This does not mean just the belly sticking out during inhalation, but we need lateral expansion too (out to the sides and back of the body). A lot of people will "hollow" that is, draw in the belly and elevate the ribs and shoulders. This needs to stop. A drill like this will help.

b) Breathe with the abdomen and chest moving at the SAME TIME. The accessory muscles (notably the neck muscles) should be relaxed. Here's a video from Bill Hartman that encompasses both points:

c) Learn to get our ribs down with a neutral spine! Too often athletes have the mega arch (lordosis) in the lower back. This needs to stop! Compare the two pictures above, see how the lower portion of the ribcage is down on the "correct" picture? This is how we need to inhale and exhale. Exhalation should be active: the abs should be involved to help pull the ribs down.

3. Coaching Breathing

We need to teach athletes how to get to a neutral spine with the ribs down. The picture of the supine breathing above is a perfect drill for that. The floor gives feedback so the athlete can feel their spine and whether or not it's neutral. It's a great way to teach a "packed neck" too (meaning, no cranking on that neck into extension). The left hand can help monitor rib position to teach the athlete what "ribs down" feels like.  THIS MUST HAPPEN FIRST before we expect them to move well during more strenuous exercise. Have your athletes spend a few minutes before training breathing in proper position.

4. Breathing drills

Breathing "reps" should be 3-4 sec inhale through the nose, a 5-8 sec exhale through pursed lips with a 1-2 sec hold. A great drill is the supine 90/90 position from above. It's a low level drill that will help the athlete be successful. Here's another example:

And this one, especially for those who live in a more "extended" posture:

There are more advanced drills, but these should be enough to get your athletes rolling.

So to recap:

Breathing mechanics are important. It affects all aspects of athletic performance. Breath well.

Re-educate posture and patterns.

Breathing is important.