When “Tight” Hip Flexors are NOT Tight

Thursday, April 11, 2024

AMT BLOG/Performance/When “Tight” Hip Flexors are NOT Tight

When “Tight” Hip Flexors are NOT Tight

How to Get the Most Out of the Modified Thomas Test for ”Tight” Hip Flexors

.I can’t count how many times I've had clients come in to see me reporting they have tight hip flexors and that stretching isn't helping.

And of course upon further examination, they often don't have “tight” hip flexors but hypertonic and/or weak ones that are being driven from other parts of the body or for different reasons.

The one test you can use to determine if the hip flexor muscles (Psoas, Rectus Femoris, TFL) are truly short, tight or just hyperonic is the Modified Thomas Test.

Like any test, its value and efficacy relies on the practitioner's execution and interpretation of the information attained.

So it's important to be precise and consistent in how you perform this test so you can reproduce it with every client and the information attained is not skewed.

Test and Determine What is Optimal?
Before assessing range of motion, you must know what is considered a Positive and Negative test or what is Optimal vs Non-Optimal.

With the Modified Thomas Test, in regards to mobility testing, you are looking to see if the thigh hits the table easily without too much deviation from the hip centred position.

If the hip range is limited or the leg starts to deviate from its midline, then there is some tissue tension that is limiting range. But, it still doesn't mean the muscles on the anterior hip are tight or short.

Muscle Energy Techniques
To better determine if a muscle is short or hypertonic, you can use muscle energy techniques such as 5 second contract-relax of the tested muscle to see of more range is attained.

If after a 5 second isometric contraction created greater relaxation and increased range of motion in the muscle group, it can be better determined that the tested muscle group is more likely hypertonic than tight,
But, now you have to figure out why it feel “tight” in the first place.

Go back and think about your:
- Anatomy
- Attachments
- Function
- Nerve root innervation

And this will help you start to think about possible causes and contributors.

Remember, muscles are dumb, they only do what the nervous system tells them to do. And oftentimes it's to protect, stabilize or perform a task that other muscles are supposed to be doing.

Manual Muscle Testing
Now that you have determined that your client does not have tight hip flexors, but hypertonic ones, it's time to perform your manual muscle testing to see which muscles are inhibited or truly weak.

When performing manual muscle testing it is important to test in the short range for a few reasons:

- Gives a more accurate rating of strength, as most people work in the mid range and seldom in the short range, so testing in the short range can determine weakness more easily

- Larger runway for muscle failure. If your client completely loses tension of the muscle there's far less risk of injuring tissues in their short range, as opposed to the long range.

- Leverage for the clinician. The hip flexors are one of the strongest muscles of the hip and should be tested with a lot of force. Testing in the short range provides a mechanical advantage for the examiner to apply more force if needed.

In this example, manual muscle testing was negative for weakness/inhibition so the next step is to look at myotomes and the nerves that innervate the hip flexor muscles.

Myotome Testing
If the muscles around the hip test strong and can maintain a good joint lock in the short range, looking at the electrical network that supplies information to the muscle would be the next step in this example.

Technically we are working backwards in the order of operation and priority in the AMT system as myotomal testing would have been done prior to local muscle and joint testing,but for the context of this video, we reverse ordered it.

First, test the lower extremity myotomes in a neutral spine position to see if there are any conduction issues working your way from L1 to S1 on both sides of the body.

Myotomal Sensitization Testing
If you found some of your myotomes a little suspicious or not quite as strong as the others, you can sensitize the test by placing their cervical spine in the position that you found earlier from your Global Movement Scan, that didn't look quite right.

In this case, Blake hinges in his lower cervical spine, displaying some instability, so placing the cervical spine into extension and performing myotome testing again displayed a significant decrease in motor output in L5 on the LEFT and L1 on the RIGHT.

L5 Weakness on the LEFT

L1 Weakness on the RIGHT

In this example of a client reporting limited hip extension due to “tight” hip flexors, we found that some of the signalling causing inhibition and hypertonicity at the hip flexor muscles was a myotomal issue on both sides and at different levels, and contributed from higher up in the cervical spine.

This patient presentation is more common than you think, but now that you know what to look for and the connections involved, you can better help your clients improve their hip mobility issues simply by looking a little higher up for the problem and treating the body as a system instead of a bunch of individual parts.

Remember, that the body is a series of tubes that runs from top to bottom and carries electrical signals, fluids, waste products, etc and if one end of the tube is obstructed, it can have a down flow effect.

​Learn more about how to integrate Myotomal Sensitization Testing and the intricacies and interconnectedness of the human body can have HUGE impact on your clients and athletes outcomes, check out the AMT system HERE and become the GO TO professional.

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Hi, I'm Tom Swales

Founder of the Advanced Movement Therapist Certification & AMT System

I'm a seasoned Physiotherapist and Strength Coach and on a mission to elevate orthopedic healthcare globally. I love to simplify complex practices and through the AMT system I'm empowering clinicians to deliver precise treatments and speed up patient recovery.
Let's set new standards & get patients better, faster!

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