Accelerate Health

Here is an interesting article on the hip flexors.  I find the hip flexors to be a major source of lower back pain.  Enjoy!

By Andrew Paul

For www.EliteFTS.com

Due to a recent influx of hip flexor questions, I decided to put together a few thoughts on the issue. Hip flexor injuries are all too common, especially at the beginning of training camps. Athletes spend the entire off-season developing the posterior chain and getting big squat and deadlift numbers. While the posterior chain and its role in hip extension is very important, the hip flexors are usually forgotten.

Let’s first examine the major hip flexors. There are really three worth mentioning. The prime mover is the rectus femoris. This is a two joint muscle and acts as a hip flexor and knee extensor. The synergists in this case are the psoas and the tensor fascia latae (TFL). What is interesting is that throughout the range of motion, the synergists become the prime movers. Once the femur reaches about 90 degrees of hip flexion, the psoas takes over for the rectus femoris. This is because the rectus has reached a shortened state and is incapable of putting out a necessary amount of force.

Try this easy test. Stand up tall with your hands behind your head and your elbows wide. From that position, attempt to lift one knee past hip height while maintaining posture. There are a few compensation patterns to note. The first is if you just can’t do it period. Second, your TFL might cramp up. Think of it this way—if your psoas is weak, your TFL will attempt to carry the load, resulting in a cramp. Third, in order to raise your knee to the appropriate height, you lose posture, and finally, your hip tilts. This is the quadratus lumborum’s (QL) attempt to help in the fight.

The standing psoas strength test

Compensations

Inability to lift knee/TFL

Loss of posture

Hip tilt

This test is the basis behind Gray Cook’s hurdle step test in the functional movement screening, and all of the compensation patterns indicate a weak psoas. So what does this mean? That’s a good question.

In Shirley Sahrmann’s book, Diagnosis and Treatment of Movement Impairment Syndromes, she talks about the role of synergists in movement. Her take is that when you have a continued muscular problem in a prime mover, look for a weak synergist. For example, if you have continued hamstring strains, you may have weak glutes. If you have continued pec strains, you may have a weak subscapularis. In this case, continued hip flexor strains equal a weak psoas. So what do we do about the problem?

In my article, “A Strength Coach’s Guide to Dealing with Pain, Part 2: The Knee,” I discussed many different strategies to lengthen the hip flexors. Now let’s talk about strengthening the hip flexors. It’s interesting to note that tightness, very often, is a result of weakness. Weak, overworked hip flexors shorten and contract in order to create the illusion of movement. An involuntary muscular spasm is the muscle’s best way of creating stability. Strengthening in this case will relieve the need to spasm.

Here is an easy, four step progression to strengthening the psoas. Again, to strengthen the psoas, we need to get our knee past 90 degrees.

Lying band hip flexion

Start with you knees past 90 degrees. This will ensure that actually get there to begin with.

Lying cable hip flexion

Standing hip flexion

Side standing cable hip flexion

With all of the development of the posterior chain and hip extension strength, it’s easy to forget about hip flexion. In his book, Ultimate Back Fitness and Performance, Stuart McGill actually notes hip flexion power as being the most prevalent limiting factor in sprint speed, not hip extension.

References

1. Boyle Mike. Advanced Program Design DVD.

2. Sahrmann Shirley. Diagnosis and Treatment of Movement Impairment Syndromes.

3. McGill Stuart. Ultimate Back Fitness and Performance.

Andrew Paul currently serves as the assistant director of strength and conditioning at the University of Missouri where he works with the football, softball, and volleyball programs. His new e-book, The Strength Coach’s Guide to Shoulder Training, gives a great overview of common shoulder injuries as well as injury preventative measures you can use to combat them. The book can be found at: www.thestrengthcoachsguide.com. Andrew is certified as a certified strength and conditioning specialist through the National Strength and Conditioning Certification and as a certified strength and conditioning coach through the Collegiate Strength and Conditioning Association. He can be reached via email at paulap@missouri.edu.

Elite Fitness Systems strives to be a recognized leader in the strength training industry by providing the highest quality strength training products and services while providing the highest level of customer service in the industry. For the best training equipment, information, and accessories, visit us at www.EliteFTS.com.

By Denise Marie Jenderzak, LAc, Dipl. Ac, Dipl. CH.

In many cases of stubborn and difficult-to-treat shoulder pain that is accompanied by loss of motion, the subscapularis muscle is often the hidden source. Understanding the role of the subscapularis muscle in shoulder movement and proper treatment of this muscle are extremely important in addressing the root cause of many lingering shoulder conditions that are not responding to treatment.

The subscapularis is often involved in many patients experiencing shoulder problems, but is often overlooked in treatment. Therefore, it is important to routinely check this muscle, particularly when working with patients who have difficulty lifting their arm overhead or reaching behind their back. The subscapularis should also be examined when treating supraspinatus tendonitis, frozen shoulder or shoulder impingement conditions. Treating this muscle is often the key to completely restoring full range of motion for those conditions.

Click here for the full article.

Posted by Mike Allen, Acupuncturist