Runners are subject to a number of dysfunctional movement patterns at the hip and few are probably more frequent than an inability to control the femoral head within the acetabulum. Often in runners, this poor control results in an anterior translation of the femoral head limited only by the soft-tissue structures of the anterior hip capsule (Sahrmann’s anterior femoral glide syndrome) presumably as a result of relative stiffness issues and poor motor control of the psoas and the gluteus maximus with or without synergistic dominance of a number of muscles (hamstrings, TFL, piriformis…). These are frequently the athletes who feel a “pinch” in the front of the hip when they are at the bottom portion of the deep squat or top of a knee hug or some other hip flexion exercise.
As the anterior capsule is a commonly injured place with runners and a frequent presentation of weak glutes and weak psoas major, should we initially be utilizing the common 1/2 kneeling hip flexor stretching?
In corrective exercise, the concept of reciprocal inhibition is one that is utilized more than many others. It says that if an antagonist has excessive tone, it is going to force a reduction in tone of muscles on the other side of the joint. If, for example, the iliacus and TFL are hypertonic and gluteus maximus hypotonic, it makes most sense to first inhibit the hip flexors with a nice static stretch before attempting to facilitate the gluteus maximus with a hip extension type exercise. While it makes sense from that stand point, does it make sense for those unable to control the femoral head? Remember, those with poor gluteal function lose the femoral head anteriorly as the hip extends and flexes (as a result of poor containment of the psoas), so taking a hip into maximal available extension may not be the best idea.
How then, should this be approached?
Perhaps before utilizing reciprocal inhibition, a little bit of motor control work should be used. Things like supine isolated contractions of the gluteus maximus progressed to a glute bridge to neutral may be a better choice. Additionally, prone ER stretching (hip in neutral) may help in cases where medial rotators dominate and some trigger point ball work can be useful in opening up the deep rotators on the back side of the hip that may be holding the femoral head anteriorly. Then complementary mobility work to help facilitate posterior glide of the femoral head with hip flexion should be undertaken with initiatives like quadruped posterior rocking and supine hip flexion with a towel roll to help depress the femoral head with flexion can be used.
After adequate control is established, then some 1/2 kneeling stretching and reciprocal inhibitory techniques may be used.