I feel like we’ve been discussing anterior pelvic tilt lately in several articles and an Inner Circle webinar on my strategies for fixing anterior pelvic tilt. I wanted to show a video of a great example of how a simple assessment really tells you a lot about how pelvic positioning should influence how we coach exercises such as squats and deadlifts.
In this video, I have a great example of a client that has limited knee to chest mobility and with boney impingement. However, if we abduct the leg a bit, it clears the rim of the hip and has full mobility with no impingement.
As you can see, because he is in anterior pelvic tilt, he is prepositioned to start the motion in hip flexion, so therefor looks like he has limited mobility. I have a past article on how anterior pelvic tilt influence hip flexion mobility, which discusses this a little more.
While you are working on their anterior pelvic tilt, you can work around some of their limitations. I hate when people say there is only one way to squat or deadlift.
Our anatomy is so different for each individual.
Some need a wider stance while others need more narrow. Some need toes out while some need more neutral. Do what works best for your body, not what the text book says you are supposed to look like.
There is one more reason that you may be struggling with this in addition to the lack of strength and dynamic stability that I previously discussed that centers around mobility.
If you look at the picture below of Janda’s lower body cross syndrome, what do you notice about the position of the hip?
Because the pelvis is already anteriorly tilted, the horizon (your leg perpendicular to the ground) is not really 90 degrees of hip flexion. You are starting the movement already in a position of hip flexion, so would naturally have less ability to flex the hips. You may have the same exact amount of hip flexion as someone else, but if you are starting in a flexed position, you would have the illusion that you actually have less.
Simplifying this and the numbers to make it easy to understand, take a look at the picture below. See how the hip is sitting in 45 degrees of flexion because of the anterior pelvic tilt. That means if you raise the hip up 45 degrees, you are actually in about 90 degrees of hip flexion.
Many people have told me that they started to work hip hip stretches and even hip capsular stretches to increase their hip flexion. One could argue that you actually wouldn’t want to do this. If you don’t improve your pelvic tilt first, then you may actually be overstretching your muscles and joint.
Rather, focus on your anterior pelvic tilt by strengthen the core, glutes, and hamstrings while working on lengthening the hip flexors and back extensors. This is a simplistic view of correcting an anterior pelvic tilt but a good start in the right direction.
This isn’t rocket science, but something to consider. Sometimes we get in trouble by assuming that the body is perfectly aligned in neutral and that raising the leg parallel to the ground is 90 degrees when it isn’t always the case.
This week’s guest post is a video demonstration of the single leg hip thrust with band-resisted hip drive by Eirik Førlie. I received a lot of feedback regarding my posts last week on hip flexion strength and hip flexion exercises. Eirik sent me this exercise demonstration and thought it would be great to share.
Single Leg Hip Thrust with Band-Resisted Hip Drive
First of all I would like to say thanks to Mike Reinold for letting me write a guest post here. I’ve been reading and learning a lot through his blog so it’s kinda cool to write a post here. I wanted to share a new exercise I have been performing.
I’m always looking for exercises that will give me the most bang for the buck, just like everyone else. I figured that this exercise would be good for both sprint mechanics and also can be a good progression for some of the exercises Mike was recommending by incorporating hip flexion drive into other exercises.
My goal with training, when I started doing the exercise, was to improve my sprint mechanics. I was always finishing trainings with single leg hip thrusts, moved on to add motion, and then to simultaneously flex the other hip (basically a hip flexion drive). It felt very natural, so I tried out with a band to resist the hip flexion. Here is a video demonstration:
What the Single Leg Hip Thrust with Band-Resisted Hip Drive Does
You’re training single leg hip extension with simultaneously contralateral hip flexion which pretty much happens in every sport and daily activity. Reminds me of quote from Bret Contreras:
[quote]“Movements such as walking, running, sprinting, kicking, jumping off one leg, cycling, skating, and freestyle swimming involve simultaneous hip extension and hip flexion. In each of these activities, when one hip is extending the other is flexing” – Bret Contreras[/quote]
Hold a quick second at the top position and feel the contractions in the glutes. It’s great in that it teaches you do disassociate the hips. You really need to focus on separating the hips, one going into extension while the other flexes, and using its full ROM in both actions. If you’re using the momentum from the extending hip to get the other hip in flexion, the bench will probably fly all over the place, so there’s a nice extra way to check if you’re doing it correctly and making sure you don’t hurt anyone else.
On top of that it blends in some anti-rotation work in the mix, as you need to remain stable and straight to avoid falling over.
Although it might be a more advanced progression, you can use it for a lot of things such as improving your sprint mechanics, enhancing hip extension and hip flexion strength, learning to separate and open up the hips, and improving coordination and stability.
About the Author
Originally from Norway, Eirik Førlie is currently a sport and exercise science student in London, England. You can learn more at his website www.eirikforlieenglish.wordpress.com. The single leg hip thrust with band-resisted hip flexion is a nice tool to have in the toolbox, although even he admits that name is not the most convenient!
Last week, Chris Johnson wrote a nice guest post on the importance of hip flexion strength. I received a lot of questions about what to do next, how to strengthen, and how to assess functionally. I wanted to add to the discussion a little bit and talk about more than just the assessment of static hip flexion strength. As Chris points out, we still may be missing the boat on assessing hip flexion strength. The research certainly supports it. Many of us tend to focus on Janda’s lower cross syndrome and assume that the hip flexor group is chronically shortened and needs to be inhibited, while we focus on the abs and glutes for motor control.
In my experience, a tight or shortened muscle group does not always have to mean that the muscle group is strong and does not need strengthening. But by all means, if you are going to focus on hip flexion strengthening, you have to also assure that mobility is optimal.
I also think that another important concept to consider is that sometimes a lack of hip flexion strength can be due to poor movement patterns and compensation. There are many muscles that help flex the hip to some extent (sartorius, TFL, rectus femoris, pectineus, adductor longus, adductor brevis, gracilis, and even the back extensors are agonists with the hip flexors). Sometimes our postural habits, such as seen with the lower body cross syndrome, can alter our normal muscle firing. In this example, the psoas is at a disadvantage in the shortened position with an anterior pelvic tilt. This ultimately results in the body using secondary hip flexors to achieve the hip flexion motion, either due to alignment issues or inhibition.
Functional Assessment of Hip Flexion
So to piggy back on Chris’s excellent article and recommendation to test hip flexion strength, I would add that we also test functional movement patterns into hip flexion. The hurdle step of the FMS would do this well, and compensatory patterns seen may indicate deficiencies with hip flexion. The hurdle step takes a good look at the hip flexion movement pattern, but since it doesn’t require the person to maximally flex their hip, it isn’t always specific to the psoas. Using Chris’s demonstration of a hip flexion strength assessment in the seated position is a good adjunct test to perform, as the psoas is needed to flex the hip past 90 degrees in the seated position.
Michael Boyle also often mentions a quick assessment that he does that tests the ability to hold your leg in hip flexion. In this assessment, you passively raise the hip into flexion and then let go, trying to keep the hip flexed. It’s harder than it looks for some people, especially those with inhibited psoas function. Here are a couple of a quick video clips of two different demonstrations of the technique (sorry, filmed an impromptu clip of this at the home office, where the magic happens…). In the first example, notice the difference in height of the leg on the left and right:
Did you notice that the right leg flexes much more than the left? This is actually a demonstration of a compensation pattern. Notice on the right that he lets his pelvis tilt posteriorly and his lumbar spine flex, which looks like a false amount of hip flexion mobility. On the left, he is cued to not allow lumber motion and his true mobility is revealed.
In the second clip, I’m a good example because I have some deficits. I consider no drop to be perfect, a mild drop but still able to keep the knee above 90 degrees to be a mild deficit (like me in the video), and the leg dropping to 90 degrees or below to be a problem. As with any test involving hip flexion, again, be careful not to posteriorly tilt the pelvis and flex the spine.
Exercises to Enhance Hip Flexion
I don’t think it is rocket science to show many of the common hip flexion strengthening exercises, though I would add that the most important aspects of the exercise needs to be lumbopelvic control and flexion past 90 degrees. We need to train hip flexion without compensatory patterns at the spine and contralateral pelvis.
That being said, there are a few drills that I have used over the years that I think tend to help. The first is a simple resistance band drill that involves laying on your back with a resistance band around your ankles. This is a popular drill with many of the strength coaches that I have worked with but also works well for the rehab patient. I know Michael Boyle talks about this in his sports hernia talks.
In this drill, it is easy to just focus on contralateral leg extension, but that isn’t the real goal of the drill. The main goal is to drive into hip flexion and maintain. I like this drill because it works on hip flexion drive as well as disassociating the two hips. This exercise can be progressed and there are several similar drills in other positions, but I like to start supine as it helps keep the spine stabilized. Like anything else, an abdominal brace with neutral spine is a must.
Another technique I like to work towards is incorporating hip flexion drive into other exercises. Here is an example of incorporating hip flexion drive into a walking lunge.
Why do I like this type of exercise? The lunge (especially when using ipsilateral weights like I do in the video) incorporates glute and quadratus activity into a quad exercise. As these muscles contract to switch the leg into mid stance and stabilize the spine, adding a hip flexion drive again works on disassociating the two sides of the pelvis.
Again, this isn’t rocket science, especially to the strength community, but some rehab specialists don’t always have this train of thought. So don’t forget to assess functional hip flexion ability and to incorporate some of these hip flexion exercises into your programs.
Mike is the President and Co-Founder of Champion Physical Therapy and Performance, located in Boston, MA. Champion offers an integrated approach to elite level physical therapy, personal training, and sports performance.
Click below to learn more about seeing Mike and his team for 1x consultations or ongoing physical therapy, personal training, or sports performance training: