PT on the Net Research

Hip Flexor Gripping


Question:

I have a client who, when laying supine, can't even bring his hips and knees to 90 degrees without his hip flexors gripping. I checked and he does have really tight hamstrings! An article I read said an individual's hip flexors “gripped" during lunging, etc. It said more than likely, the individual has tight Adductor Magnus and Piriformis muscles. Is this likely the case? What exercises and stretches would you recommend?

Answer:

You raise a good question. There are many different connotations of “gripping.” I will use it in the sense that the subject cannot get into good hip flexion. With that being said, you are on the right track to investigate the posterior chain and the adductors as well. I would also look into the orientation of the pelvis. Is it tilted anteriorly or posteriorly? One side could be affecting the other, and the relative position of the one side could either be anterior or posterior to the other. If anteriorly rotated, the hamstrings will already be tight and lengthened, so further stretching could be counter-productive. Likewise, the adductors will also be lengthened on that side.

If one side of the pelvis is posteriorly rotated, the gluteal complex and deep external rotators may already be longer, and further stretching will not be effective. A simple test is to have the subject walk with a long stride. See if the stride length and gait cycle is fairly symmetrical. If not, the pelvis may be the place to start. I suggest taking that simple assessment and then use it as the exercise. Have the client start with multi-plane lunges and gradually increase the length of the stride. This will help mobilize the pelvis bilaterally. This approach will work the anterior chain, posterior chain and adductors and abductors in a functional manner. At first, it may seem “against the grain” as these motions have been difficult in one plane of motion. But doing this in three planes of movement often does a “self” mobilization. Of course, if there is further discomfort, I would stop these. I recommend about five to eight reps, two sets. Another effective exercise is a wallbanger.

  1. Stand in the “stand tall” position, abdominals drawn in, with the feet about shoulder-width apart. Feet are pointed forward.
  2. Stand about six to 12 inches away from the wall. The distance will vary among clients depending upon their range of motion through rotation and strength of their lateral gluteals.
  3. With the right shoulder closest to the wall, reach out to the left. Be sure the client rotates the hips toward the left foot, flexes the knees, drops the hips and maintains a neutral lumbar spine.
  4. As the client reaches to the left, the natural reaction is for the right hip to move toward the wall. Let the client’s right hip “bang” into the wall, and immediately return to the starting position. It is critical the client does NOT hold the reaching position, as this removes the elastic recoil tendency of the muscle and thereby removes the eccentric loading required in this movement pattern. (The range of motion and rotation will vary depending upon the client’s ability to eccentrically load through the transverse and frontal planes. This action will become greater as the person improves range of motion, which will inherently and functionally improve strength.)
  5. Return to the start position by rotating the hips back to the left and then to the upright position.
  6. Perform eight repetitions and progress to three sets of 15 reps.
  7. Repeat with the left shoulder closest to the wall and the action requires reaching to the right.

Lastly, assuming no clinical symptoms, I highly suggest this client seek either a physical therapist or massage therapist to perform some pelvic mobilizations techniques to get the ilium to move more freely.

Hope this helps, and good luck!