The Hip Flexor Series – Part 1 – How To Assess Your Hip Flexor Tightness

Over the next 5 posts, I’m going to be taking you through a full hip flexor series which will include posts and videos on how to assess, improve and maintain your hip flexor complex.

This muscle attaches directly on to the pelvis, therefore it plays a key role in altering pelvic inclination levels. Because of its strong ability to change pelvic inclination, excessive tightness or hypertonicity to this muscle group can cause a range of imbalances and movement issues. Due to the rise of sedentary jobs, Hip Flexor Tightness (HFT) is becoming increasingly common. It is key to note this muscle group isn’t always the issue and often it gets blamed for a lot of problems that it has nothing to do with.

Before you join the bandwagon in excessive stretching and foam rolling, it is crucial to ensure you do actually have tightness, otherwise your efforts are wasted.  The following simple assessments can be used to assess the hip flexor complex and support the use subsequent stretching, mobilisations and Self Myofascial Release (SMR).

Postural Analysis

Usually the most commonly seen sign of HFT, can be seen within a standing posture. As previously spoken about, the hip flexor complex attaches directly on to the pelvis, therefore within a standing posture, true hypertonic hip flexors will manifest as an excessive Anterior Pelvic Tilt (APT) (Solberg, 2008). An idea of what this will look like can be seen in Figure A below.

Figure A – Excessive APT

This is usually a key sign of overactive hip flexors, however it is not absolute as other factors such as weak glutes and abdominals are also contributing factors (Clark and Lucett, 2011). If you find your standing posture is with your pelvis tilted as in Figure A, tight hip flexors can be suspected and further assessments are warranted.

 

Squat Analysis

Another tool trainers and therapists often use is a squat analysis. This tool is particularly helpful for looking at functional movements and the ability of the muscles to control these movements.  During a squat, the hip flexor complex has a range of different roles, primarily it acts directly on to the pelvis to control inclination levels, however the psoas also plays an important role on lumbar spine stabilisation (Osar, 2017).

During a squat analysis, excessive hip flexor tightness often presents as an exaggerated forward lean of the torso (Clark and Lucett, 2011). This can be seen from Figure B below.

Figure B – Excessive Lean Forwards

Similar to the postural analysis, this compensation can reside from other issues. If you present similar to this, it is an indicator of tightness, but not a conclusive finding.

 

Thomas Test

If both previous tests are positive and an excessive APT in a standing posture, as well as an excessive lean forward while squatting can be seen, it is likely that some level of HFT is involved. In my professional opinion, the only true test for assessing hip flexion extensibility is the Thomas Test. This test should be completed if both previous issues are found, or hip flexor tightness is suspected in general.

This test is completed with the client lying supine and one leg drawn in to the body. The supported leg should be cradled, but not excessively squeezed in to the body. The unsupported leg is then allowed to drop of the end of the couch. If true HFT is found, the leg will not be able to reach parallel and will sit away from the couch as seen in figure C below (Hattam and Smeatham, 2012). If the knee is excessively extended this suggests tightness of the rectus femoris (Hattam and Smeatham, 2012). Lastly if the leg is slightly abducted, Tensor Fascia Latae (TLF) tightness can be suspected (Hattam and Smeatham, 2012).

Figure C – Thomas Test

If you have completed all three tests above and provided positive results for them all, it is safe to say you are likely to have a degree of HFT and further treatment is warranted. The next post out of the series, will look at the correct methods to stretch both the hip flexors and hip capsule to improve this.

References

Clark, M. and Lucett, S. (2011). NASM’s essentials of corrective exercise training. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Hattam, P. and Smeatham, A. (2012). Special tests in musculoskeletal examination. Edinburgh: Churchill Livingstone.

Osar, E. (2017). The psoas solution. California: Lotus Publishing.

Solberg, G. (2008). Postural disorders and musculoskeletal dysfunction. Edinburgh: Churchill Livingstone Elsevier.