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

00:00:0000:00:03
This is Brent coming at you with our
00:00:0300:00:07
this video we're going to go after the hip flexor complex, using a very common
00:00:0700:00:10
testing position which is the Thomas test position. I think you guys will find
00:00:1000:00:14
that stretching the hip flexors using the Thomas test position is both very
00:00:1400:00:18
comfortable for you, as well as your patient or client. I think you'll also
00:00:1800:00:22
find that with some good body positioning, you can use both hands to
00:00:2200:00:27
specifically target the hip flexor that you're trying to get extensibility out
00:00:2700:00:31
of. I'm going to have my friend Leanne come out, she's going to help me demonstrate this
00:00:3100:00:36
exercise. Now, first things first, if I want to stretch Leanne's hip flexors I
00:00:3600:00:40
need to be able to pull her femur into extension, which means it's got to be off
00:00:4000:00:46
the table, none of this can be up on the table. So I'm going to queue Leanne to sit on
00:00:4600:00:50
her tailbone, no lower, and then from there I'm going to have her grab her
00:00:5000:00:54
opposite leg. She's going to pull her opposite leg into her torso, this is
00:00:5400:00:58
going to posteriorly tilt her pelvis. As she posteriorly tilts her pelvis
00:00:5800:01:03
that'll give me a little bit of lumbar flexion, which will help me protect her
00:01:0300:01:08
from going into excessive lumbar extension as she goes back. I think what you
00:01:0800:01:11
will find is a lot of the people who need good hip flexor stretching, are the
00:01:1100:01:15
same people who have a history of low back pain, and we don't want to do
00:01:1500:01:19
anything to reignite or exacerbate low back pain, that can definitely be a
00:01:1900:01:23
problem moving forward in our routines. From here, I'm going to go ahead and throw a
00:01:2300:01:26
towel over her foot, that's just so I don't get foot prints on my shirt, and
00:01:2600:01:32
then I'm going to go ahead and use my torso to stabilize this leg. If I use my torso
00:01:3200:01:37
to stabilize this leg two things happen: number one, Leanne can relax, she no longer
00:01:3700:01:40
has to pull on this leg which is going to make it easier for me to get autogenic
00:01:4000:01:45
inhibition or those releases I'm looking for on the opposite leg. Second, by using
00:01:4500:01:51
my torso I have both hands free to make sure I can dial into the hip flexor, or
00:01:5100:01:56
dial in to great technique for this stretch. First things first, I'm going to use
00:01:5600:02:02
this hand to control her pelvis through this leg. She's at her end range, so if I
00:02:0200:02:06
feel her tilting this way, I can actually get her to tilt back by just pushing
00:02:0600:02:10
this way. If I think she's going into an anterior pelvic tilt, I can lean a little
00:02:1000:02:14
bit with my torso and force her back into a posterior pelvic tilt. So I
00:02:1400:02:19
can do a lot to control her pelvis and make sure she stays neutral here, just by
00:02:1900:02:24
controlling this knee, and controlling this foot with my torso. Now, let's talk
00:02:2400:02:28
about all of the different things we can do with this part of the stretch, the
00:02:2800:02:33
actual stretch part of the stretch, to let it dial in to the specific hip
00:02:3300:02:37
flexor I'm looking for. Now, if you have iliacus and psoas tightness, that's
00:02:3700:02:42
what you've assessed to be tight, probably the best bet is to posteriorly
00:02:4200:02:46
tilt as far as you can, making sure that lumbar spine is actually flat,
00:02:4600:02:53
that'll pull the psoas longer, and then I'm going to go femur in neutral, that
00:02:5300:02:57
way I know there's no compensation happening, and then I'm going to push down
00:02:5700:03:01
into extension until just past that first resistance barrier, and hold until
00:03:0100:03:07
I get a release. So psoas iliacus, we're going to go posterior pelvic
00:03:0700:03:12
tilt, neutral position of the femur. Now, if I want to turn this into a TFL
00:03:1200:03:17
stretch, the TFL does internal rotation of the femur, as well as a little bit of
00:03:1700:03:24
abduction, and external rotation of the tibia. So I can pull her foot in, that's
00:03:2400:03:29
internal rotation of the tibia, I can pull her tibia this way, which is
00:03:2900:03:34
external rotation of the femur, and then use my hand and my leg a little bit to
00:03:3400:03:38
pull her into just a little bit of abduction, and she should go from feeling
00:03:3800:03:44
this stretch more in the lower ab, or just just inside her ASIS, to now just passed her
00:03:4400:03:50
ASIS on the side here where her TFL lies. Do you feel that? -Yes. Good. So we went from psoas
00:03:5000:03:54
to TFL just by turning her in a little bit, and pushing her in a little bit. Now,
00:03:5400:03:59
if I had assessed that her pectineus was tight, your pectineus as an adductor
00:03:5900:04:02
muscle is a little different in the sense that it has an innervation from the
00:04:0200:04:05
femoral nerve, that femoral nerve is the same nerve that innervates all of our
00:04:0500:04:10
hip flexors, so it has a tendency to get tight with the hip flexors. If I wanted
00:04:1000:04:12
to make this a little bit more of a pectineus stretch, I'd actually go in the
00:04:1200:04:18
opposite direction of my TFL. So now I'm just going to push her into a little bit
00:04:1800:04:28
of abduction, and extension. So we've got psoas, TFL and pectineus.
00:04:2800:04:34
And then, of course, the last one, which I see abused a little bit, to get rectus
00:04:3400:04:38
femoris all I really need to do is get her back into neutral, and kick that leg
00:04:3800:04:43
to just past 90. The reason I say this gets abused a little bit is I see people,
00:04:4300:04:46
number one, take this stretch a little too far.
00:04:4600:04:51
Instead of that mild discomfort they go for darn near pain, and they try to pull
00:04:5100:04:56
this leg up towards the table. One thing I can definitely tell you is more
00:04:5600:05:00
is not better. The harder you stretch somebody, the more muscle spindle
00:05:0000:05:04
activity you'll get, and the more their muscle is going to fight back against you.
00:05:0400:05:08
That's not going to help you get autogenic inhibition, that's not going to help you get
00:05:0800:05:13
a release, that's going to lead to an increase in extensibility and soft
00:05:1300:05:17
tissue adaptation. So all we need is a little mild stretch here, and just using
00:05:1700:05:23
my leg to pull it back just past 90, use my hand, once again I'm going to correct her
00:05:2300:05:27
pelvic position. You can kind of see me adjusting here to make sure her foots on
00:05:2700:05:32
the right place on my torso, I'm using this hand, I'll push her just a little bit past
00:05:3200:05:37
the first resistance barrier, and I'm going to hold until she lets go. So there you
00:05:3700:05:42
have it, we've got psoas with straight on with a posterior pelvic tilt,
00:05:4200:05:48
TFL is adduction, turning her leg in, turning her foot and tibial internal
00:05:4800:05:53
rotation, we've got pectineus which was pushing
00:05:5300:05:58
into abduction a little bit, and rectus femoris was taking a leg under. And
00:05:5800:06:03
then of course, you're going to hold with mild discomfort until you get a release
00:06:0300:06:07
to happen, and you can wait for two to three releases as you push further
00:06:0700:06:11
and further into that resistance barrier. Now, be very careful, as you get somebody
00:06:1100:06:14
out of this position, just like we were careful to get Leanne into this position,
00:06:1400:06:19
we don't want to drop this leg and let her pelvis pull her into an anterior
00:06:1900:06:22
pelvic tilt, hyperextension of lumbar spine and
00:06:2200:06:25
then she's having low back pain again. So what I'm going to have Leanne do is go ahead
00:06:2500:06:31
and grab this leg again, both hands, once she has this leg I'm going to
00:06:3100:06:33
go ahead and get out of the way of this leg, because we're going to have her
00:06:3300:06:37
step down on this leg, and I'm going to help her
00:06:3700:06:41
pull up, and then she can just slide off the table, onto that leg that
00:06:4100:06:46
we just stretched, no low back pain. I hope you enjoy this manual stretch.
00:06:4600:06:50
If you haven't done manual stretching before I suggest you practice on a few
00:06:5000:06:54
people before you actually practice on a client or patient. For my trainers out
00:06:5400:06:57
there you can practice on a few of your personal trainer buddies.
00:06:5700:07:01
Everybody loves to be stretched! So I hope you get a huge increase in
00:07:0100:07:04
extensibility from this stretch, I hope you are working on your technique,