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Tight Hip Flexors: Impact on Gymnasts and Addressing the Right Culprit

The first topic I wanted to post is about the awareness of tight hip flexors in gymnasts. If not addressed properly, hip flexor restrictions can contribute to the possibility of lower back and knee injuries, decreased skill performance, and deductions during competition.  In my experience, this is something that I have seen many times when coaching athletes or watching practices/competitions.

I’m sure many coaches see their gymnasts standing in line with “archy back” posture or coach athletes who have enough space below their split to drive a car under. What many coaches don’t recognize is,  in most cases a lack of hip flexor mobility may a big contributing factor for both.  If this person is you, don’t worry hope is on the horizon.

Tight 1 jt & 2 Caitlin

I’ll walk through some basic anatomy (nerd alert) in lay terms just for a better understanding, then talk about some ways to look at whats causing a problem, and then offer some tips on how to increase flexibility/range for athletes. There are actually a few contributing hip flexor muscles, but I’ll focus on the two major ones.  I know for some people reading anatomy is about as exciting as watching grass grow, but understanding which muscle goes where is an important concept for the rest of this little excerpt.

The two major hip flexor muscles are responsible for bringing your leg up to the marching position, and are known to the medical world as the iliopsoas and rectus femoris muscle. There are other surrounding hip muscles and connective tissues that can also play a role, but this post will focus on the two muscular components I mentioned in order to not get too complex.

  1. The first, the iliposas, is comprised of two smaller muscles (psoas major and iliacus)  that start from the lower back/inner pelvic area. They combine together and travel across the front of hip joint, then attatch as one unit to the upper part of the big leg bone known as the femur. This hip flexor only crosses the hip-joint, so it is considered a 1 joint hip flexorIlopsoas
  2. The second, rectus femoris,  flexes the hip but is also one of the quadricep muscles responsible for kicking the knee straight. It starts from the front portion of the pelvis bone, goes across the front of the hip joint next to the iliopsoas, travels all the way down the front of the thigh, then joins with the other quad muscles to attatches below the kneecap on the lower leg bone (tibia). As described, this muscle  crosses over both the hip AND the knee joint, so it is considered to be a 2 joint hip flexor

Rectus Femoris

These muscles have a huge role in gymnastics and without it, we would certainly be more like jelly fish day to day. It has roles both acting ipsilaterally/one side at a time, or bilaterally/left and right at the same time. There are a variety of times within gymnastics it comes into play. Here are just a few examples of skills we need hip flexor strength for

Hip Flexors acting 1 side at a time:

  • basic lunging and kicking
  • any basic running technique
  • cartwheel step locks,
  • split leaps, side aerials
  • back handspring step-outs
  • any single leg holds like full turns or fan turns
  • the one sided hurdle leg for tumbling/vaulting
  • very important for layout step outs on beam
  • splitting giant on bars for snap- ins to toe fronts, or toe catches/hiccups
  • men’s skills such as flares, side flipping elements on floor, scissor work on pommel horse

Hip Flexors acting together:

  • assisting abs for any closed flip position like tuck or pike
  • assisting abs in snap motion for back handspring/Yurchenko flip
  • assiting abs to generate tap for basic swings, and release moves
  • straddle motion for jumps or quick snap through for Tckachev, toe catches, clearing legs on straddle back
  • kipping and in bar skills like stoops/stalders
  • maintaining compression off press handstands/cast handstands when using proper technique
  • clearing feet when doing stalder press handstands, or pike press handstands
  • performing stoop for jams, compression against gravity in endo’s
  • Men’s skills such as L-Holds/straddle holds/dip cuts on parallel bars, straddle strength elements on rings

As you can see, we’re pretty much always having gymnasts engage hip flexors and typically they are very strong in our athletes. In addition to this overuse in the gym, we also as a society spend a lot of time sitting outside of practice (driving in the car, sitting at school/out of school for homework, sitting at work, lounging at home on the couch, sleeping on your side with your knees up). You would be amazed how much time you spend with your hips flexed if you broke down the hours of the day. This is a possible reason (along with compensation) that many times despite doing flexibility or stretching our gymnasts still show hip flexor restrictions.

In many of the athletes, it is one contributing factor to the typical “archy back” posture female gymnasts develop overtime.  Tight hip flexors are usually one piece of the puzzle along with: decreased lower ab strength or poor  lower ab motor control during skills, weak and/or hyper-flexibile hamstrings, excessive lower back mobility, the presence of compensatory movement strategies. All of these factors might predispose the gymnast to lower back and knee injuries down the road. This is why this topic is so important to look at and recognize. Along with injury prevention, it will help allow gymnasts to reach larger split angles, and increase their ability to get into a better tight arch position for skills like bridges, back/front handsprings, beam series involving handsprings, and Yurehcnkos.

The first step in the process is understanding which one of the hip flexors is causing most of the issues, the 1 joint (ilipsoas) or the 2 joint (rectus femoris). In Physical Therapy, we use one tool known as the Thomas Test to determine this. I’ll explain the test, but also provide a picture of what to do and how to detect common errors. Within the pictures I had the athletes raise one arm to see the positions better.

  1. Have the athlete lay on a spotting block with their buttocks very close to the edge, so their legs can fully hang off.
  2. Then have the athlete hug their legs to their chest,
  3. While keeping their back pressed flat (no tunnel of back), have them drop one leg while holding the other leg to their chest. The leg that is being lowered is the leg you will be looking at to determine if the athlete has tightness or not.

Normal 1 jt and 2 jt Incorrect Thomas

4. Look at the athlete from the side and determine if these things are visible…

  • If after step 4 the back of the athletes thigh (hamstring) does not touch the mat, this is considered a tight 1 joint hip flexor/iliopsoas. 

Tight 1jt & 2 jt Cassied

  • If after step 4 the back of the thigh DOES  touch the mat, but their knee is appears to be make less than a 80 degree angle, this is considered at a tight 2 joint hip flexor/rectus femoris

Tight 2jt

  • If after step 4 both of these problems are visible, the athlete may have restrictions in both their 1 joint and 2 joint hip flexors 

Tight 1 jt & 2 Caitlin

  • This test can also detect tightness of the Iliotibial Band (connective tissue band on outside of leg) or sartorious (another muscle of the upper leg) if the athletes leg moves out to the side excessively, but looking for these is to be addressed at another time

Being able to perform the test and detect a problem is something that takes a couple of tries to set up and get a keen eye for. However, once you know what to look for, it is extremely useful. If you can identify which of the muscles is causing you the issue, you will be able to stretch them appropriately and not be wasting your time. In my experience, I have found many more gymnasts with tight 1 joint hip flexors than 2 joint. This is typically due to excessive back mobility and compensation problems. Below I will outline some good stretches/ways to increase range for 1 joint or 2 joint hip flexors specifically.

Increasing 1 joint/Iliopsoas mobility (pictures for references attached)

  • Having the athlete perform a Thomas Test like position, and have someone else apply slight pressure down to top of their thigh as they hold the opposite leg to their chest. Be sure to keep their lower back pressed flat against the mat. Find the point where the athlete feels a stretch, and hold for 30 seconds. Repeat 2-3 times each leg after a proper warm up.

Assist 1 jt

  • Have the athlete perform the half kneeling stretch that usually comes before a split with PROPER FORM. It is very common for gymnasts to do this improperly and use their naturally flexible lower back to compensate. Force the athlete to keep their back in a neutral position and engage their core, then shift their weight forward until they feel a stretch in the front of their hip. Once the stretch is felt hold for 30 seconds.

Improper Half Kneel Proper Half Kneel

  • Have your athlete use a foam roller or golf ball/lacrosse ball to break up tightness and small trigger points within their iliopsoas. This can be done on the floor, beam, or laying on the edge of a spotting block. You should apply enough pressure to feel uncomfortable, but no intense pain. Perform for a few minutes each at the beginning of practice with a good warm up or after as a cool down.  If you find a sore spot hang out on it for a bit your going for that “hurts so good” sensation. Not too aggressive though, it’s not a test to see how much Sallie “tough as nails” Jones can take.

Hip Flexor MFR

  • Have the gymnast lay on their stomach flat on a low or medium beam with one leg on the ground, and one leg (tight leg being stretched) extended the down beam. Have the gymnast engage their core, and press up into a “seal” position with minimal arch in their back. You can assist by holding their extended leg on the back of the thigh. Have them press up until the stretch is felt, being a stickler for proper form.

Incorrect 1 jt Beam stretch Proper Beam 1 jt Stretch

Increasing 2 joint/rectus femoris mobility (pictures for references attached)

  • Perform the same Thomas Test like position above, but instead of pushing on their thigh (because it will probably be touching the spotting mat), try to bend their knee to 90 degrees  while they hug the opposite leg against their chest. Make sure they keep their back pressed flat against the mat, and do not push to hard on them. A gymnast can also pull the leg themselves if they are coordinated. It has to be done on the edge of a mat so the leg can be reached with their hand. If they can not reach without compensating proper form, use a strap or loop around their ankle to assist them.  Hold for 30 seconds, repeat 2-3 times each leg. Again, be sure to to do this after a proper warm up.

Assist Stretch 2 jt Self Stretch 2 jt

  • Perform the same half kneeling stretch as noted above with proper form and core engaged, then have the athlete bend their knee and grab their ankle to pull farther. If possible, do the bending of the leg for them while they worry about proper form. The gymnast tends to sacrifice proper form to grab the foot and they then don’t get a good stretch. Again, a strap around the foot can be used to assist the athlete. This can also be done by using a mat or wall to keep the knee bend as the athlete slides out into a split.
  • Proper Half Kneel 2 jt Split 2 jt
  • As above, use a foam roller or Lacrosse ball to roll out the front of the thigh and quad muscles. Due to it being a longer muscle there is a lot more ground to cover, and usually the hotspots can be found throughout. Also, a rolling pin or “the Stick” can be used to have the athlete release tightness within the muscle. As noted, its best done after a good warm up and at the end of practice after circulation is increased and again not too heavy to cause excessive pain.

Foam Roller 2 jt

  • Perform splits with proper lower back form and the back knee bent and elevated up on a mat. Use the uphill slope on a springboard, or bend the leg up to a small spotting block and have the athlete slide out with good posture until they feel the stretch. Doing this tensions the rectus femoris and allows the increased mobility to come primarily from the two joint hip flexor.

2 Joiny Split

As I touched on many times above, it’s crucial that you monitor and correct the gymnast’s form as they stretch/do flexibility and utilize a proper warm up prior to flexibility exercises to reduce injury risk. Concerning monitoring proper form,  gymnasts will often compensate or knowingly/unknowingly cheat if no one is correcting them. Keeping the lower back posture neutral will ensure they are actually stretching their hip flexors, and not just contributing to further hyper mobility of their lower spine by arching. Along with this, you must stay on top of your athletes when you catch them waiting for turns or doing drills with bad posture. Keep cueing them to be aware of the posture and encourage them to “pull their belly button towards their spine” at all times. The foam roller and golf ball/lacrosse  ball techniques are fantastic tools for coaches and athletes, along with being inexpensive. To save time all of these techniques/stretches can be done after practice at home, added as side stations during idle times, or be added as a part of a warm up/cool down.

It may be a little time consuming to test out which hip flexor is causing the issue, but it will be balanced out by time not wasted doing the wrong stretch. If you wish, add in a few stretches of each type to cover all your bases. It’s also great education for athletes to be in tune with the problem and the benefits of working on it.  If your a coach, don’t think you are off the hook here. You are human just like your athletes and can get into trouble if you let your hip flexors wind up like a cable. Don’t be afraid to test co-workers and use the techniques on your own, it may help save you from a progressive back injury down the road.

I hope this information is helpful and useful for whatever area you work in. Feel free to share, comment, and discuss with your own ideas regarding the subject. Best of luck,

Dave

References:

  • Lorenz, D., Reiman, M. The Role and Implementation of Eccentric Training In Athletic Rehabilitation: Tendinopathy, Hamstring Strains, and ACL Reconstructions. NAJSPT. March 2011: 6 (1); 27 – 44
  • Bradshaw E.J., Hume P.A. Biomechanical approaches to identify and quantify injury mechanisms and risk factors in women’s artistic gymnastics. Sports Biomechanics. 2012; 11(3) 324 – 341 
  • Cook G., et al. Movement –  Functional Movement Systems: Screening, Assessment, Corrective Strategies.  First Edition. On Target Publications, 2010.
  • Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. Third Edition. Baltimore, MD: Lippincott Williams & Wilkins; 2011.
  • Myers, TW. Anatomy Trains: Mysofascial Meridians for Manual and Movement Therapists. Second Edition. 2009
  • Oscar E. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Lotus Publishing: California; 2012
  • Page P., Frank C.C., Lardner R.. Assessment and Treatment of Muscle Imbalances: The Janda Approach. Sheridan Books; 2010
  •  Magee D. Orthopedic Physical Assessment. Fifth Edit. St. Louis: Saunders Elsevier; 2008.
  • Neumann DA. Kinesiology of the Musculoskelatal System: Foundations for Physical Rehabilitation. First. St. Louis: Mobsy Inc. 2002:103 – 111.
  • Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. Third Edition. Baltimore, MD: Lippincott Williams & Wilkins; 2011.
  • Image References: Rectus Femoris: http://www.higher-faster-sports.com/images/rectus-femoris.jpg
  • Image Reference: Iliopsoas: http://www.criticalbench.com/muscles/hip-flexors-muscles.jpg

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