Happy New Year

Hi Everyone,

I realize that it has been a while since my last post so I apologize for that, but I wanted to wish everyone a happy new year.

I just wanted to drop a quick note about hip flexor strength. In the past few years, I've heard a lot about how all we need to do with hip flexors is lengthen them because most of us have relatively short flexors of the hip. The notion that we need to lengthen our hip flexors and strengthen our glutes and hamstrings most likely came about because of simplicity. Like most "trends" that come along in our industry, this one is easy to follow and doesn't take much problem solving. After all, most of us are short in our psoas and iliacus, and dormant in our posterior chain. Professor Janda's Lower Cross Syndrome and Dr. Sahrmann's Femoral Anterior Glide Syndrome have been great resources for discovering common faulty patterns and muscle imbalances.

1. Femoral Anterior Glide Syndrome 2. Janda's Lower Crossed Syndrome
(Diagnosis & Treatment of Movement Impaired Syndromes - Sahrmann) (picture courtesy of Jon-Eric-Kawamoto - http://www.jkconditioning.com/)

However, a short muscle doesn't necessarily mean a strong muscle. More specifically, it doesn't even mean it is an active one. Because of our lifestyle, most of us tend to be sitting a lot and because of this we rarely get into full extension at the hips. What happens over time? We get passively short hip flexors. Does this mean that we should stretch out our hip flexors? Absolutely. Does this mean that our hip flexors are strong? Absolutely not. And herein lies the problem: We think that a strong muscle must mean a short muscle. Why can't we have a long (or neutral) muscle that is strong. The fact is, we can all get stronger at each joint. Will this produce short muscles with overuse? Probably, but it doesn't mean that we can't lengthen it through a good stretching program.

Consider the hip flexor power that is needed from Usain Bolt when he runs 100m in 9.69 seconds or from Perdita Felician to drive her front leg during the 100m hurdles.

Why do you think most Functional Assessment Screens have some variation of a hurdle test or leg drive? Very simply, the practitioner can see how the client/patient steps up or over something. Generally, you will see the femur externally rotate allowing the abductors such as tensor facia lata (TFL/ITB) and anterior gluteus medius to take over rather than having the psoas and iliacus "pull" the leg straight up and over.

Here are a couple of screens or exercises that you can take your clients through to see how well they integrate their hip flexors: step-ups, stability ball plank to knee pull-in, and single-leg deadlift to knee drive (see http://www.humanmotion.ca/ for exercise videos). In each of these, try to get the person to actively drive straight up with the knee without trying to meet the knee by flexing the trunk. To further test length of hip flexors as well as hip muscle imbalance, try a modified Thomas Test. Very broadly, if the extended leg doesn't extend down to the table, psoas and iliacus is likely tight and will inhibit glute function = ant. pelvic tilt. If knee falls out laterally, TFL/ITB are likely tight and dominant. Rectus femoris is tight if the knee is less than 80 degree to horizontal (Sahrmann, 2001). Images courtesy http://www.jkconditioning.com/.

Once these exercises have been correctly displayed, the client is now ready for strengthening exercises such as proper pikes (as displayed by Pavel Tsatsouline - http://www.dragonsdoor.com/), roman chair alternating pikes, and weighted step-ups.

Remember, we want strength through a full range of motion, so strengthening and stretching will provide the mobility needed for proper joint stability!

References:

1. Sahrmann, S. (2001). Diagnosis and Treatment of Movement Impairement Syndromes.

2. Janda V. Muscle spasm – a proposed procedure for differential diagnosis. Manual Medicine, 1991:6136-6139.