E106: Modified Thomas Test for Hip Flexor Tightness
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Pain in the front of your hip when lifting up your knee?
Hurts when you step into the car?
Gets worse after doing core exercises with your legs?
Hip Flexor Tendonitis is a very common condition that can plague runners, mainly those of the distance variety. If you run ½ marathons or further, you are at high risk of Hip Flexor Tendonitis.
You don’t have to run in pain any more. Rehab for Hip Flexor Tendonitis is highly successful when done correctly. I, personally, have not had this injury, but I have managed many cases of it over the years.
Funny, one of my most popular videos still to this day is on “Stretching the Psoas.”
I have learned a lot more since making that video back in 2009.
I’ll share the updated comprehensive video below… It’s 30 mins long but there’s a good reason for it. Consider it like an episode of Married with Children and watch for 30 mins.

What is Hip Flexor Tendonitis?
Tendonitis is irritation to a tendon. This can be chronic (long term) or acute (new injury).
The main hip flexor is the iliopsoas. The what, you say? The iliopsoas… you have probably heard of it called the psoas, but it is really two muscles and one tendon. The tendon is what you could be having an issue with.

What causes Hip Flexor Tendonitis?
Hip Flexor Tendonitis is caused when the hip flexors become dominant in the running gait.
You’re probably thinking how can this happen, right? Do some floor core exercises, and you’ll probably find your hip flexor can get super tight super fast. Muscles have what is called a normal “length/tension relationship.” They want to be a certain length so they can work well. If your core is not holding your pelvis in an optimal position, then your hip flexor length will change.
Think about being at work… I’m sure you have optimal working conditions.
– Not too cold but not too hot.
– Not too many emails.
– Not too much background noise.
Muscles need their optimal environment in order to not breakdown. Having proper core strength and the ability to hold the pelvis in the correct position when running will decrease the probability of having downtime from this injury.

How can you rehab Hip Flexor Tendonitis?
As you can guess, in order to rehab Hip Flexor Tendonitis properly, we need to create the optimal environment. This is not hard to design, but it is a lot of work on your part. Rehab exercise progression usually includes one that goes from easy to challenging.

Before making things more challenging on the muscles, we always teach proper pelvis and trunk position. This is often a mental game that is frustrating to runners, but it is one that’s very teachable.
Here’s a theory of progression that we often use in cases of Hip Flexor Tendonitis:
Open chain exercise to closed chain exercise
Lightweight to heavyweight
Complete rest to incomplete rest
What does rest have to do with it?
Running form, lifting form, posture, you name it… it all breaks down as you become out of breath. So we need to teach you how to have control of it. The Lewit Exercise is a great starting point for a core program. We always teach breathing and bracing before we start any core program. This is extremely challenging to most people.

What kinds of treatments can be done for Hip Flexor Tendonitis?
Here are some other treatments that can assist you in recovering from Hip Flexor Tendonitis:
Active Release Technique
Deep tissue massage
Anti-inflammatory injections
Regenerative Cell Therapies
Chiropractic adjustments or mobilizations
Strength training/rehab
PRICE therapy
Running gait training
Eccentric Exercise
Postural Endurance
Dynamic Mobility
General Strength
Plyometrics
Movement Pattern Correction
Co-contraction

#ModifiedThomas #california

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