WHY BASIC HIP FLEXOR
STRETCHES DON’T ALWAYS WORK

Do you do a daily stretching routine only to find that your muscles tighten back up throughout the day? Do you continue to stretch your hamstrings but still can’t touch your toes? This is because many stretches focus on individual muscles, but we MUST remember, the body works as a kinetic chain and it’s the relationships between the various muscles and joints throughout the body that must be addressed if you want to create and maintain increased flexibility.

As a postural therapist I’ve found one of the most effective ways to integrate the entire body’s muscular integrity and reduce muscular tension is by restoring function of the primary hip flexor. For many of my clients, we achieve this by integrating an exercise called Supine Groin Stretch or The Tower. “The Tower” mainly addresses the ilio-psoas muscle, otherwise known as the “primary” hip flexor, but in doing so, it affects all the muscles into the spine and shoulders as well as the legs and feet.

THE ILIO-PSOAS MUSCLE

The psoas is considered the fillet mignon of the human body. It’s a special muscle, as it is the only muscle to connect the upper and lower body; therefore, it can have multiple effects on posture, function and pain. As you can see in the diagram below, the psoas attaches to the lumbar (lower) spine and winds through the pelvis before attaching to the femur (the large thigh bone). The tower releases the ilio-posas muscle thereby re-educating the hips to function properly.

So the big question is, why don’t basic hip flexor stretches do this? The answer lies in he fact that stretching individual muscles doesn’t affect the relationships those muscles have to the other muscles and joints in the body. This excerpt explains how the tower is actually influencing the body, but don’t fret if you get lost in the technicality of this explanation. The video below gives a fantastic illustration.

In the tower, 90-degree, dorsi-flexed position of the foot impacts the position of the femur. As the femur is forced back to its neutral position, the pelvis is then able to rotate over the femur as it’s intended to. Simultaneously, the mid-back and shoulders let go as a reaction to what’s happening in the lower body. Gravity promotes thoracic extension, as the floor prevents the upper body from going into flexion or rotating. As a result, the shoulder blades can return to a more functional position. This chain reaction influences the curves of the spine, decreases rotation, decreases disparities in the pelvis, and re-educates the proper function of the hips. Furthermore, with one hip in extension and one in flexion, we are able to separate the function of the hips. This re-education of hip separation that occurs without the ability for the upper body to compensate takes each hip individually from flexion to extension which is required for proper gait mechanics. The top levels of the tower mainly affect initial contact. Terminal stance is being impacted toward the bottom levels. Ultimately the tower will allow the hip to function as designed, in flexion and extension, rather than adduction or abduction, as the pelvis rotates back over the neutral femur and returns to its functional position.

Click HERE to see the amazing video of the inner workings of the body in the tower. This is a fantastic illustration of what the tower accomplishes.

THE ANTERIOR PELVIC TILT with FEET THAT POINT OUT

Hopefully that video helped to clarify the body’s response to the tower, but to further demonstrate I’m going to give a specific example of how the tower may influence a common posture we see every day. Let’s take the person who stands with their knees and feet turned out. In a case like this we say the “femur” is externally rotated. People with this all too common posture no longer walk with their primary hip flexors (ilio-psoas), but are forced to compensate for the lack of proper hip function by also recruiting secondary hip flexors (such as the adductors), due to the dysfunctional position of their load bearing joints.

In some of these cases, the femur is being rotated externally by strong tight hip flexor muscles, which also put the pelvis in an anterior pelvic tilt as seen in the picture below.

Pete Egoscue describes this posture as Condition 1 – the anterior pelvic tilt. Here is an excerpt from his book “Health through Motion” to describe this posture:

“Keep in mind that the body is a unit and that the body is linked functionally from head to toe. The anterior tilt of the pelvis is often caused by the strong, tight hip flexor muscles and puts excessive arching into the low back. The more a person walks with the tight hip flexors, the more they pull down on the spine and exacerbate the problem. To relieve the tension on the spine, the upper back rounds – taking the shoulders forward – and the head tilts downward. To relieve the tension in the hips, the femurs externally rotate, taking the knees and feet outward. This is a formula for pain up and down the body.”

For people with an anterior tilt and external femurs, the tower can be an effective exercise. It will allow the femur to rotate back to a neutral position by holding the foot at 90 degrees. As the muscles relax and the femur position becomes more functional, it allows the pelvis to return to its neutral position and come out of the anterior tilt. This decreases lordosis (the excessive curve in the lower back). This chain reaction up the body relaxes the curve of the upper back and shoulder muscles taking the spine out of kyphosis (a fancy term for excessive curvature in the upper back). This whole reconnection of the kinetic chain will help to remind the hips how to function correctly again and help to reposition the other load bearing joints unlike a basic hip flexor stretch.

So now do you understand why just stretching the flexors may not give you the long- term relief you are looking for? When our hip flexors are tight, we can’t just stretch this individual muscle, because the rest of the body needs to be addressed, as it’s been compensating for the dysfunctional position of the pelvis.

HOW TO USE THE TOWER

Click on the picture/video below to find out more about The Tower, how to set it up, and what to look for at each level. In many cases, your therapist may prescribe shoulder exercises to be performed at each level of the tower in order to release the scapula and thoracic back, allowing for a better hip release.   They will most likely also prescribe corrective exercises to be done prior to the tower and after to stabilize the more functional pelvic position.

SHOULD EVERYONE USE THE TOWER?

A quick word of warning: In rare cases, such as someone with extreme knee hyperextension or excessive torque from the femur to the lower leg bone (tibia), the tower can cause some discomfort in the knees. If you experience knee pain in the tower, your therapist may prescribe some exercises to be done prior or choose a different exercise.

Another diagnosis that requires consideration before using the tower is hip degeneration. Although the tower can be beneficial in some cases of hip degeneration, staying toward the top levels so as not to aggravate the symptom may be advised. This also may apply to people with severe stenosis or spondylolysthesis.

If someone has a posterior tilt, a therapist may advise placing rolled towels under the neck and lower back to help to re-educate the body to find its neutral S shape curve. They may also advise using only the bottom level of the tower. This may also be recommended for people with internally rotated femurs.

One final thought: If you have a severe hip rotation / disparity and are having issues with the tower, another exercise called the double pedal may be an option your therapist suggests. This device locks both feet in the tower. In doing so, this exercise traps the hips, femur, and pelvis in a bilateral position without the hip separation the tower provides, so as not allowing for any rotation. It is still advised to progress to the single pedal tower and allow for the separation of the hips, once the rotation is reduced.

In my personal experience, when I first used the tower I experienced some minor issues, but by integrating a few scapular release exercises at each level, and adding some corrective exercises both before and after the tower in my exercise menu, I’m now able to successfully use this tool and have regained more function to my body than I EVER dreamed possible.

So go out there and experiment and feel free to contact me if you have any questions. As with any exercise, first and foremost, LISTEN to your body. Not “every” exercise is good for every “body.”

Lisa Decker M.S.
PAS, CES, PES, CPT, CAMQ
www.alignedfit.com
lisabethdecker@gmail.com

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