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Should we reconsider hip flexor stretching? | Boddicker Performance

Filed under: corrective exercise, injuries, Running

Should we reconsider hip flexor stretching?

by on Apr 20th, 2010

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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.

Best regards,

Carson Boddicker

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Leave a Comment »11 Comments
  • Mark Young April 20, 2010

    I wholeheartedly agree. Great thought!

  • Rob Murphy April 20, 2010

    Carson,

    So basically reciprocal inhibition in this area is a more appropriate technique for those with fewer issues as opposed to those who have many more (and are the ones it is often recommended to)? Or perhaps I am not correctly understanding what you were conveying in this post.

    Normally you’d see half kneeling stretch followed by glute bridge, as one example, but you’re saying that a lot of folks probably need to focus more on that motor control aspect (as with the glute bridge and other examples you presented) and only implement a stretch prior to such work after they’ve established some level of proficiency with motor control.

  • Pete Brown April 20, 2010

    Great stuff. Lots a great info, learning a ton from you Carson! Thanks.

    I see a lot of pelvic control and weak oblique issues in a lot of runners who try and hammer on their hip flexors as well.

  • Jim Hansen April 20, 2010

    I can only understand about 1/2 of this, but it explains the hip issue I have had for years. The postural restoration work I had this winter has certainly addressed the issue: the pinching is gone, but the psoas still is weak. I guess I should do more bridges and lay off the hip flexor stretches that I just started to do again. Great blog, Carson, as it seems to address a lot of my running issues. What are the resources I should look into to learn more? Are you getting this from the Postural Restoration class you took or are you miixing in more therapies?

  • Mike T Nelson April 22, 2010

    I like that you are thinking out of the box Carson! Keep it up!

    As odd as it sounds, I don’t like static stretching for pretty anything—other than making athletes weaker. haha.

    Most runners have goofed up hips–no question. Most I see is referred from the feet/ankles. The body will protect the ankle by limiting power at the hips if it thinks there is an ankle issue.

    Working on the ankle and then re-coordinating the hip I find to work best.

    Thoughts?
    Rock on
    Mike T Nelson PhD(c)

  • Carson Boddicker April 23, 2010

    Rob,

    Yes, half kneeling hip flexor is a later progression, and in my mind is still going to be both necessary and valuable in the long run. I still will use the 1/2 kneeling varieties, but not at first, and especially if they can’t show me good control.

    Best,
    Carson Boddicker

  • Joe June 23, 2010

    the psoas/illiacus are usally weak with femoral anterior glide syndrome. the psoas pulls the femoral head into the socket (superior and posterior) and the illiacus takes the role of the subscapularis of the shoulder at the hip. so those muscles should be strengthened not stretched.

    the posterior hip capsule and the external hip rotators are usally stiff with the femoral
    anterior glide syndrome. so after applying soft tissue work the rotators should be stretched with hips in neutral as well as hips flexed. so their should be stretching into internal rotation with hips in neutral not the opposite.

    after eliminating or lessen the butt gripping mechanism of the hip rotators and activation of the psoas glute activation comes by itself.

    stretching of the psoas is better done via leg lowering (->fms)(maybe elevated w/ extended rom) or with a (really) low load long duration approach like the egoscue supine groin stretch.

    but it’s just my (unprofessional) opinion,
    joe.

  • Dan May 29, 2013

    @ Carson: Are you proposing that the illiacus and psoas major are function differently? You state the iliacus becoming hypertonic. However, after reading all of Dr. Shirley Sahrmann’s textbooks I do not see where she separates the two muscles. In almost all of the cases she refers to the iliopsoas being weak and/or long.

    @ Joe: Nowhere does Sahrmann talk about stretching the hips INTO internal rotation. She almost always mentions that the external hip rotators are weak or short, not strong or stiff (big difference). I agree with the fact of not stretching the iliopsoas, however at the end of your post you tell about a good way to stretch the iliopsoas? I’m a little confused.

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