Hip Flexor Stretching (I)
In a conventional hip flexor stretch, I often see much undesirable compensation occur in a search to feel big tension on the psoas or as one coach who will remain nameless has put it, make it feel like it is “tearing off the bone”. Most Thomas tests show a great deal more rectus femoris and TFL issues than psoas and hip hyperextension is not indicated for improved athletic performance. A standard half kneeling position with knee and hip angles of 90 degrees, is often beyond the limits of postural integrity at the pelvis, as Thomas tests often do not use a pelvic stabilization, and even without do not often show a thigh flat to the bed, 90 degrees at the knee and no deviation in the frontal and transverse planes. The following corrections will often lead to a strong sensation for athletes in the TFL and rectus femoris (particularly the lateral border) that was previously absent.
Pelvic Tilt:
Subtle pelvic tilt and rotation will be very common at a standard starting position, and unless the subject can perform the above parameters on a Thomas test, it is almost assured. One indicator (diagram in attachment) is palpation of the front (non-stretching) leg in the area just inferior to the anterior superior iliac spine (ASIS), pressing downward toward the femur. If the pelvic alignment is good, there should be limited compression possible. If the pelvic alignment is off, the femur will sit lower and significant compression will be possible both down and back under the ASIS.
Correction should involve cueing to lift the femur of the front/non-working leg at the proximal end against this compression and focus on keeping the shoulders square and pelvis tall, which will commonly result in an immediate stretch sensation in the TFL and lateral border of the rectus femoris in the rear/working leg. To this end, the oblique on the rear/working side should be braced to ensure pelvic stability versus anterior tilt and lumbar rotation.
The overall position should also be altered to allow better pelvic position. To allow optimal pelvic position the hip flexion of the front leg needs reflect the limits of postural integrity, and even a 2-3cm lift from a shoe can increase flexion of the front hip and significantly worsen pelvic posture when in a half-kneeling position.
To find a plausible position, the tests listed below or similar should be performed, with pelvis stabilised. To achieve a neutral pelvis hip flexion on the front side will need to be reduced and often a higher COM position with the rear leg on a bench is an appropriate starting point (see attachment).
Arm Movement:
A common cue is to reach laterally over and then back but this often leads to lumbar extension and rotation, with implications for the pelvis. A better approach is to first find a pelvic neutral position as per above, and from there reach upwards while depressing the scapulae and keeping the pelvis stable.
Foot position:
Often when performing hip flexor stretches the rear foot is left on the floor in a position that leads to tibiofemoral rotation. It seems well known that the ankle not the foot should held for a standing quad stretch but the principle is often forgotten in this instance. Rotation of the tibia on the femur will have strong effects on the stretch possible for muscles on the lateral thigh, where the myofascial complex around the TFL, ITB and lateral border of rectus femoris is a very common problem area. As far as possible, a neutral tibiofemoral orientation should be maintained.
This is particularly an issue for bent knee stretches focused on rectus femoris with the ball of the rear foot on a bench or wall (with any long duration static stretches involving the ball of the foot against a bench or wall MLA height is crucial). Very often due to the static and seemingly mindless nature of the task athletes easily allow rotation of the tibiofemoral articulation and lose tension on the lateral myofascial structures. This is most easily tested by palpation of the posterior thigh just above the knee, where biceps femoris will shorten if this tibiofemoral rotation occurs.
A reasonable solution is to either focus very strongly on alignment or otherwise take loading off the foot and ankle by using a rope/band just above the ankle.
Relevance to standing quad stretches: Depending on segment length, many athletes will show big anterior tilt when reaching back and a rope is generally indicated. Again a manual test is great as we can view alignment in the frontal and transverse planes, and clearly for most we around not getting ankle to butt with a neutral pelvis and no hip abduction (i.e. knee under hip). If care is taken again athletes will feel strong sensation in TFL and rectus femoris with pelvic control and a lack of hip abduction.