Dysfunctional Hip Flexors

Question:

Having just read Michael Boyle's article on Understanding Hip Flexion, I have identified a client suffering from a weak/dysfunctional iliopsoas causing rec fem dominance. My client describes a knotted sensation in his lower abdomen and pain on palpation. Can you suggest a plan of attack?

Answer:

The plan of attack for a client with a weak or under active iliacus or psoas is reasonably straightforward. In order to properly execute the plan, you will need to enlist the help of good manual therapist. Good manual therapists can be hard to find. This may be a massage therapist, chiropractor or physical therapist, but the key is the ability to get the hands into the tissue. Don't get hung up on which profession. Just find someone with good hands.

Once you’ve done this, adhere to the following protocol:

1. Treat the soft tissue. This has to be done manually, so find a good manual therapist who can get into the psoas. Foam rollers, etc. can't get into an area like the psoas.
2. Stretch. The Thomas position is best for psoas stretching. The Thomas position is the position used for the Thomas test for hip flexor length. Position the client on the table with one knee to the chest and the sacrum on the table end. Push down on the extended leg. Half kneeling psoas stretches will also work, but I prefer partner work in the Thomas position. The iliacus and psoas can be difficult to self stretch. Check the PTN Flexibility Library for examples.
3. Strengthen. This is also simple. We will do a seated contraction into hip flexion with the hands behind the back to maintain lumbar curve. You need to sit on something high enough so the feet don't touch the ground. Begin with three 10 second holds and progress to 10 times in 10 seconds.

I hope this helps.