Initial tests:
i) Thomas test and Ober’s test- Starting positions should involve (pelvis stabilized) knee and hip angles that induce no deviation in the frontal and transverse planes (if subject pulls their own knee to chest some lumbar flexion and rotation will occur, I prefer a second tester or a rope used, otherwise keep in mind free leg may be +15-20 degrees higher in “hip flexion” due to lumbar movement). It should be noted which of psoas, rectus femoris, TFL is likely to be limiting.
]ii) Eccentric Lunge test- subject starts from the top of a lunge (Feet hip width, stance matching 90 degree knee angles at ground) and lowers very slowly while maintaining neutral pelvic tilt and even, parallel ASIS height (i.e. pelvis level in both side on and front on views), any shift in pelvic tilt or ASIS position means the limit has been reached. If the rear knee moves laterally (even slightly) out from under the hip to give abduction, or the rear ankle deviates (even slightly) to give tibiofemoral rotation, or we otherwise see anterior pelvic tilt or a lack of even, parallel ASIS height, the limit has been reached
Respecting attachments:
The psoas attaches to lower lumbar vertebrae. Pushing the hips forward and shoulders back will give anterior tilt and the feeling of a big stretch through this muscle, however it is often RF/TFL which is the problem.
The rectus femoris attaches to the ASIS, and compensation in position of the ASIS with anterior tilt or rotation will decrease stretch. Additionally, leaning forward from the hips in a conventional ground based position (see pictures above and attachment) will decrease knee flexion and therefore decrease stretch.
The TFL also attaches to the ASIS, and changes in position of the ASIS with anterior tilt and particularly in rotation and lateral flexion of the lumbar spine will decrease stretch on this muscle.
Control vs Gravity:
The starting position should be elevated to range of motion indicated by initial tests. With a relaxed position on the ground weight is through the pelvic structures and compensation is likely (as per attachment).
Key compensations:
Pelvic position: Anterior tilt, ASIS drop and rotation on back leg in too deep a position, indicating loss of lumbopelvic stability. Ropes/other equipment should be used just above the ankle in rectus femoris and standing quad stretches if compensation is occurring at the pelvis (tilt), hip (abduction) and foot (rotation)
Foot position (–> tibiofemoral rotation): Be very careful to maintain a neutral foot/ankle position or use a position where the foot is not loaded/in contact, e.g. with the lower leg on a bench and the foot off the edge or with a rope pulling from just above the ankle to take the foot posture out of play.
Arm/Trunk position: Leaning back, to the side and rotating will generally cause lumbar substitution and interfere with lumbopelvic stability. The attachments of RF and TFL are from the ASIS down and lumbar movement is not increasing stretch.
Cues: Tall pelvis, level pelvis, reach up, femur up/taut below ASIS (use palpation), ankle in line (use palpation).
Sequencing: Piriformis and hip rotator stretches prior to hip flexor and quad stretching will allow deeper positions with less compensation in frontal and sagittal planes.