The anterior region of the hip or the primary hip flexors are often seen as “tight,” consequently, we tend to program stretches, mobility exercises, and single leg strength exercises to apply a dynamic stretch to the back leg. However, there are a few considerations I have to address first before believing someone’s hip flexors are tight.
The primary hip flexors are the psoas, iliacus, tensor fascia latae (TFL), and rectus femoris. We also have adductors (groins) that help flex and extend the hip. Most competitive athletes tend to have an anterior tilted pelvis (pelvis rolled forward) because the demands of the sport (sprinting, cutting). The hip flexors have a significant degree of leverage to generate the forward motion. Also, besides the 7-8 hours of sitting in school, most people in general spend too much time sitting which reinforces this position. Another important consideration: when the pelvis is tipped forward, it creates a force couple (stiffness) of the lumbar extensors and hip flexors that we typically see in Janda’s Lower Crossed Syndrome.
So what can do to address the hip flexors to make sure we aren’t causing issues?
1) Assess: We use PRI’s adduction drop test and extension drop test to see if the pelvis is in alignment and if not, have we actually blown through some ligaments in the anterior hip (hopefully not!)?
Adduction Drop Test : is the pelvis neutral?
Finding: Typically the left side will not adduct. In the video you can see how tough it is for David to simply get my leg back into extension and in no way does it adduct (come down to table). This would be a “positive” test.
Extension Drop Test: testing the integrity of the anterior hip
Finding: If someone is positive on the Left and negative on the Right, then we expect the left side to be unable extend down to table. If it does, than that means we have blown through some ligaments.
Confused? Just think if someone can’t adduct and extend their hips (adduction drop) but their leg fully extends in the extension drop test (leg to table), they have probably blown through some ligaments in the front side of that hip!
I have seen quite a bit of high-schoolers who cannot adduct their hip but can easily drop to the table, namely females. When we see this, we have to take careful consideration of how they perform single leg work by preventing excess extension of the back hip and try to improve their hamstring, glutes, and adductor strength/control.
An easy place to start would be to make sure to prevent over extension on single leg exercises and during stretches. Here are some examples of bad and good ways of stretching or single leg work.
Not the best
Better (More neutral)
These are a few simple suggestions on where to start and maybe how to prevent more anterior hip laxity after assessment.