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Gaining Hip Extension Mobility
In Part 1 of this blog series, I discussed the importance of hip extension for running efficiency and decreasing risk for injury. In part two of three in this series, I am going to discuss a simple way to assess hip extension mobility and easy ways to improve our hip extension range of motion at home. Let's get down to business!
First and foremost, we must simply have enough hip extension mobility available. As a reminder, hip extension is when our leg travels behind us, and this motion becomes limited when the muscles along the front of our hip (our hip flexors) become tight, the hip joint itself becomes stiff, and/or our hip muscles are weak.
Our hip flexor muscles include the psoas, iliacus, pectineus, rectus femoris (part of the quadricep muscle group), sartorius, and tensor fascia lata (all shown above). These muscles become restricted for a variety of different reasons including a sedentary lifestyle, prolonged sitting, hip flexor weakness, poor posture, or performing repetitive hip flexion like running and cycling. When these muscles get tight, we lose the ability to extend our leg back into extension due to decreased flexibility of those hip flexor muscles. This becomes somewhat of a domino effect on our body. A tight and restricted hip creates a mechanical disadvantage for our gluteal muscles, and it may decrease their ability to activate properly when extending our hip. This, in turn, can increase our risk for injury by causing an over-reliance on our low back or hamstrings to compensate and also decreases our power production and propulsion during running.
How do we know if our hip extension is limited?
We can assess hip flexor flexibility by performing a simple screening test called the Thomas test. This test is performed by sitting on the edge of a firm table or bed. You will lie completely flat on your back with the end of the table just above the back of the knees. You will pull one knee straight into your chest while the other leg stays down close to the table with the knee in a relaxed position, as shown below in the first photo. You want to make sure that your low back is staying flat on the surface the entire time. This test is positive for anterior hip tightness if the bottom leg pops up from the table, if your low back is unable to stay fixed to the surface you are lying on, or if the bottom leg begins to rotate or pull out to the side. All of these signs indicate that you may have tight hip flexors. If you look like the first picture shown below and are able to keep the bottom leg parallel to the floor or the surface you are laying on, then you do not have restricted hip flexors. Yay! If you look like the second picture shown below, then we've got some work to do!
I also find it important to reiterate that decreased hip extension range of motion may not just be due to tight hip flexors. There can also be other reasons that we are unable to get our leg parallel to the table. This can also occur due to restrictions at the front of our hip joint capsule, creating stiffness at the joint level that limits our ability to extend the hip. This may occur in addition to muscular tightness and restriction, and a licensed physical therapist will be able to assess if you have a restriction at the joint level and address it through hands-on, joint mobilization techniques.
I have tight hip flexors. Now what?
To address our mobility limitations due to hip flexor tightness, stretching alone will likely not be enough. We can utilize myofasical release techniques performed at home or by a licensed physical therapist, stretching, and strengthening exercises to help improve our hip extension. Today, we are going to cover a couple of self-myofascial release techniques and some of my favorite hip flexor stretches.
Self-Myofascial Release
Self-myofascial release techniques using a foam roller or lacrosse ball are very useful to help decrease soft tissue tension throughout the hip flexors and are paired wonderfully with stretching and strengthening. You want to focus on the primary muscles responsible for hip flexion that cross the front of the hip joint including the iliopsoas, quads, and tensor fascia lata. I have included a couple self-myofascial release techniques below to address some hip flexor muscles:
This picture demonstrates using a lacrosse ball to work into the Tensor Fascia Lata (TFL) muscle, which is one of our many hip flexor muscles. This muscle is commonly a culprit that contributes to a limitation in hip extension, along with the iliacus, psoas, and quad muscles. For this self-myofascial release technique, you want to lie down on your stomach, supporting your weight on your elbows, knees and feet. Position the lacrosse ball under your hips and roll over the ball to massage the area, one side at a time. Do not go higher than the bony part in front of your hips (anterior superior iliac spine).
The picture above demonstrates using a foam roller to release our quads, which also contribute to a lack of hip extension when they become tight or restricted. You'll place the foam roller on the floor and lie on your stomach with the front of your thighs over the foam roller. Roll the entire front of the thighs from the top of the hips to the top of the knee caps in an up and down motion. You should pull yourself with your elbows and forearms. Pause at any spots that feel especially tender or tight. Keep your quadriceps relaxed. Maintain abs tight and proper low back posture during the exercise to decrease any risk of low back pain or injury.
Stretching
Now that you're all rolled out and loosened up, it's time to stretch! There are so many hip flexor stretches out there, and it is extremely important to find the right stretch for you. It should be a comfortable, pain-free stretch that you are able to maintain correct form throughout. Very often in the clinic, I find that most people are performing these stretches the wrong way. With that being said, it is so important with all hip flexor stretching that you are drawing in your belly button to brace your core, not allowing your low back to arch. This will help properly isolate your hip flexors and decrease risk for pain or injury to your low back. If you notice your low back is arching, then we need to modify the stretch so that you can perform it correctly. I have included some of my go-to hip flexor stretches to help people gain hip extension mobility necessary for walking and running. If you are having any pain or discomfort with these exercises, you should not perform and consult with a licensed physical therapist or physician to come up with an individualized plan.
Standing Hip Flexor Stretch
Stand with your feet staggered and the back knee slightly bent. Tilt your pelvis backward and slowly bring your weight forward onto your front leg until a stretch is felt in front of the hip. Keep your belly button drawn in toward your spine to keep your back in a neutral position for the stretch. Maintain the position for at least 30 seconds and repeat 3-5 times on each side.
Kneeling Hip Flexor Stretch
Begin by kneeling on one knee creating a 90° angle with the opposite hip and use a chair for support. Tilt your pelvis backwards to flatten your lower back and transfer your weight forward until you feel a gentle stretch on the anterior aspect of your hip of the lower leg. Maintain the position for at least 30 seconds and repeat 3-5 times on each side. Make sure to keep your upper body upright and your lower back flat (not arched) to decrease strain on low back.
Edge of Bed Hip Flexor Stretch
Lie on your back with your buttock at the edge of a table with your knees pulled toward your chest. Then, keep one knee as close as possible to your chest and extend the other leg over the edge of the table. Let the knee relax to feel a stretch at the front of the hip. Hold for at least 30 seconds and repeat 3-5 times on each side. When you're done, bring the knee back up to protect the lower back.
Look familiar? If you recall from earlier in the blog, this is the same position that we utilized for testing our hip flexor flexibility. If you have trouble keeping your back in a neutral position during the standing or kneeling exercises, perform this one! I like this stretch because it allows us to use the table as direct feedback to make sure we are keeping our low back flat on the table and out of an arched position.
Couch Stretch
Start in front of a step, chair, or couch and kneel down, then place the foot onto the elevated surface behind you. You can always place a towel/cushion under the top foot or below the knee for comfort. In this position, draw your belly button in towards your spine and tuck your tailbone under you to tilt your pelvis posteriorly. You should feel the stretch in front of the hip and thigh. Hold the position for at least 30 seconds for 3-5 repetitions on each side.
Once we have gained proper hip extension range of motion, the next step is making sure we have enough strength and motor control of our hip extensor muscles to push into full hip extension. This will be key to increasing our efficiency while running. Stay tuned for the next (and final) blog post in the series, where I will be covering how to address the strengthening component of hip extension.
Thanks for reading!
*Disclaimer: Always consult with a licensed physical therapist or physician before beginning any exercise program. This is general information and is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your licensed healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.
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