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Manual Hip Flexor Stretch (Thomas Test Position)
Manual Hip Flexor Stretch (Thomas Test Position) is a stretching exercise designed to help stretch and lengthen the muscles in the hip region. To perform this exercise, you will need to begin by lying on your back with your feet flat on the floor and your knees bent. You will then need to gradually straighten one leg over the other at a 90 degree angle, keeping your foot on the floor. To finish the stretch, you will need to reach your hands around the top of
Transcript
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This is Brent coming at you with our
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this video we're going to go after the hip flexor complex, using a very common
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testing position which is the Thomas test position. I think you guys will find
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that stretching the hip flexors using the Thomas test position is both very
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comfortable for you, as well as your patient or client. I think you'll also
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find that with some good body positioning, you can use both hands to
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specifically target the hip flexor that you're trying to get extensibility out
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of. I'm going to have my friend Leanne come out, she's going to help me demonstrate this
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exercise. Now, first things first, if I want to stretch Leanne's hip flexors I
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need to be able to pull her femur into extension, which means it's got to be off
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the table, none of this can be up on the table. So I'm going to queue Leanne to sit on
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her tailbone, no lower, and then from there I'm going to have her grab her
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opposite leg. She's going to pull her opposite leg into her torso, this is
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going to posteriorly tilt her pelvis. As she posteriorly tilts her pelvis
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that'll give me a little bit of lumbar flexion, which will help me protect her
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from going into excessive lumbar extension as she goes back. I think what you
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will find is a lot of the people who need good hip flexor stretching, are the
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same people who have a history of low back pain, and we don't want to do
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anything to reignite or exacerbate low back pain, that can definitely be a
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problem moving forward in our routines. From here, I'm going to go ahead and throw a
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towel over her foot, that's just so I don't get foot prints on my shirt, and
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then I'm going to go ahead and use my torso to stabilize this leg. If I use my torso
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to stabilize this leg two things happen: number one, Leanne can relax, she no longer
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has to pull on this leg which is going to make it easier for me to get autogenic
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inhibition or those releases I'm looking for on the opposite leg. Second, by using
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my torso I have both hands free to make sure I can dial into the hip flexor, or
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dial in to great technique for this stretch. First things first, I'm going to use
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this hand to control her pelvis through this leg. She's at her end range, so if I
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feel her tilting this way, I can actually get her to tilt back by just pushing
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this way. If I think she's going into an anterior pelvic tilt, I can lean a little
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bit with my torso and force her back into a posterior pelvic tilt. So I
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can do a lot to control her pelvis and make sure she stays neutral here, just by
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controlling this knee, and controlling this foot with my torso. Now, let's talk
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about all of the different things we can do with this part of the stretch, the
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actual stretch part of the stretch, to let it dial in to the specific hip
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flexor I'm looking for. Now, if you have iliacus and psoas tightness, that's
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what you've assessed to be tight, probably the best bet is to posteriorly
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tilt as far as you can, making sure that lumbar spine is actually flat,
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that'll pull the psoas longer, and then I'm going to go femur in neutral, that
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way I know there's no compensation happening, and then I'm going to push down
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into extension until just past that first resistance barrier, and hold until
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I get a release. So psoas iliacus, we're going to go posterior pelvic
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tilt, neutral position of the femur. Now, if I want to turn this into a TFL
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stretch, the TFL does internal rotation of the femur, as well as a little bit of
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abduction, and external rotation of the tibia. So I can pull her foot in, that's
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internal rotation of the tibia, I can pull her tibia this way, which is
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external rotation of the femur, and then use my hand and my leg a little bit to
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pull her into just a little bit of abduction, and she should go from feeling
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this stretch more in the lower ab, or just just inside her ASIS, to now just passed her
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ASIS on the side here where her TFL lies. Do you feel that? -Yes. Good. So we went from psoas
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to TFL just by turning her in a little bit, and pushing her in a little bit. Now,
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if I had assessed that her pectineus was tight, your pectineus as an adductor
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muscle is a little different in the sense that it has an innervation from the
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femoral nerve, that femoral nerve is the same nerve that innervates all of our
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hip flexors, so it has a tendency to get tight with the hip flexors. If I wanted
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to make this a little bit more of a pectineus stretch, I'd actually go in the
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opposite direction of my TFL. So now I'm just going to push her into a little bit
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of abduction, and extension. So we've got psoas, TFL and pectineus.
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And then, of course, the last one, which I see abused a little bit, to get rectus
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femoris all I really need to do is get her back into neutral, and kick that leg
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to just past 90. The reason I say this gets abused a little bit is I see people,
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number one, take this stretch a little too far.
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Instead of that mild discomfort they go for darn near pain, and they try to pull
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this leg up towards the table. One thing I can definitely tell you is more
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is not better. The harder you stretch somebody, the more muscle spindle
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activity you'll get, and the more their muscle is going to fight back against you.
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That's not going to help you get autogenic inhibition, that's not going to help you get
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a release, that's going to lead to an increase in extensibility and soft
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tissue adaptation. So all we need is a little mild stretch here, and just using
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my leg to pull it back just past 90, use my hand, once again I'm going to correct her
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pelvic position. You can kind of see me adjusting here to make sure her foots on
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the right place on my torso, I'm using this hand, I'll push her just a little bit past
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the first resistance barrier, and I'm going to hold until she lets go. So there you
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have it, we've got psoas with straight on with a posterior pelvic tilt,
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TFL is adduction, turning her leg in, turning her foot and tibial internal
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rotation, we've got pectineus which was pushing
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into abduction a little bit, and rectus femoris was taking a leg under. And
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then of course, you're going to hold with mild discomfort until you get a release
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to happen, and you can wait for two to three releases as you push further
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and further into that resistance barrier. Now, be very careful, as you get somebody
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out of this position, just like we were careful to get Leanne into this position,
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we don't want to drop this leg and let her pelvis pull her into an anterior
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pelvic tilt, hyperextension of lumbar spine and
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then she's having low back pain again. So what I'm going to have Leanne do is go ahead
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and grab this leg again, both hands, once she has this leg I'm going to
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go ahead and get out of the way of this leg, because we're going to have her
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step down on this leg, and I'm going to help her
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pull up, and then she can just slide off the table, onto that leg that
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we just stretched, no low back pain. I hope you enjoy this manual stretch.
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If you haven't done manual stretching before I suggest you practice on a few
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people before you actually practice on a client or patient. For my trainers out
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there you can practice on a few of your personal trainer buddies.
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Everybody loves to be stretched! So I hope you get a huge increase in
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extensibility from this stretch, I hope you are working on your technique,
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