by Jimmy McKay
I. Description of Motion:
Hip flexion involves decreasing the hip angle by moving the the distal end of the femur ventrally.1.
During hip flexion, the femoral head (convex) rolls anteriorly and glides posteriorly in the acetabulum (concave) moving the femur anteriorly and superiorly in the sagittal plane. Normal hip flexion range of motion is between 0-120 degrees.
Primary muscles involved in hip flexion (nerve innervation):2
Psoas Major (L1-L3)
Iliacus (L2-L4 Femoral)
Rectus Femoris (L2-L4 Femoral)
Sartorious (L2-L3 Femoral)
Tensor Fasciae Latae (L4-L5 Superior Gluteal)
Secondary muscles involved in hip flexion (nerve innervation):2
Gracilis (L2-L3 Obturator)
Adductor Longus (L2-L4 Obturator)
Adductor Magnus (Obturator & Tibial)
Adductor Brevis (L2-L3 Obturator)
Pectineus (L2-L4 Femoral & Obturator L2-L3)
Hip flexion is innervated by nerve root L2.
II. Mobilizing – Increasing Range of Motion :
Hamstring doorway stretch
Lie supine on the floor in a doorway.
Your hip should be even with the door frame.
Flex your hip with an extended knee so that your heel is resting on the doorframe. If you do not feel an adequate stretch, move your body inferiorly, closer into the door frame, to increase the stretch bring your foot closer to your head.
You should feel a stretch from your buttocks to your knee along the back of your leg.
Hold this stretch for 30-45 seconds, 3 times. Repeat with opposite leg. Repeat this stretch 3 times per day to increase hip flexion range of motion.
Supine Gluteus Maximus stretch
Lie supine on a firm surface, bend knees keeping your feet flat.
Cross right leg over left thigh resting right ankle on left thigh.
Grasp the back of left thigh with both hands.
Pull left leg towards your abdomen until a stretch is felt in your buttocks.
You should feel a stretch from your buttocks to your knee along the back of your leg.
Hold this stretch for 30-45 seconds, 3 times. Repeat with opposite leg. Repeat this stretch 3 times per day to increase hip flexion range of motion.
Standing Hamstring stretch
Stand with feet at hips width with left foot slightly in front of the right foot.
Begin with the left ankle in dorsiflexion, and flex the right knee slowly.
Shift the weight of your body to the right knee and slowly increase flexion in the right knee.
You should feel a straight in your posterior left leg.
You can increase the stretch by performing an anterior pelvic tilt.
You should feel a stretch from your buttocks to your knee along the back of your leg.
Hold this stretch for 30-45 seconds, 3 times. Repeat with opposite leg. Repeat this stretch 3 times per day to increase hip flexion range of motion.
III. Indications for Stretching:
Tight posterior compartment of the leg would limit hip flexion range of motion.
Muscle tightness of the following muscles would limit hip flexion:
Gluteus Maximus, Biceps Femoris, Semimembranosus and Semitendinosus.
Muscle Weakness of the following muscles would limit hip flexion:
Psoas Major, Iliacus, Rectus Femoris, Sartorious,Tensor Fasciae Latae, Gracilis, Adductor Longus, Adductor Magnus, Adductor Brevis and Pectineus.
Possible joint limitations due to hip pathology could include:
FAI (Femoroacetabular Impingement Syndrome) - FAI
and Osteoarthiris of the hip - Link
IV. Strengthening:
Knee Flexion Slides
Slowly bend and straighten your knee as far as possible pain free, sliding your heel up and down the bed or floor. Repeat 10 times x 3 sets.
Straight Leg Raise
Begin this exercise lying on your back with one leg straight and one leg bent (figure 4). Slowly lift your straight leg to approximately 45 degrees keeping your knee and toes facing the ceiling. Hold for 2 seconds and then slowly return to the starting position. Repeat 10 times x 3 sets provided the exercise is pain free.
To progress this exercise you can add an ankle weight to the leg being raised.
Elastic Band - Straight Leg Raise
While lying supine with an elastic band looped around your ankles, lift the target leg upwards. Hold for 2 seconds and then slowly return to the starting position. Repeat 10 times x 3 sets provided the exercise is pain free. Repeat the stretch with the opposite leg. To progress this exercise increase the level of resistance band.
V. Potential Clinical Syndromes or Etiologies:
Runners are a population that has notoriously tight posterior leg compartment as well as a tight gluteus maxiumus muscle. This can limit hip flexion as well as increasing an opportunity for injury to the hip extensors.
Other pathologies that can effect the hip joint are:
Femoroacetabular Impingement Syndrome (FAI)
Osteoarthritis of the hip
Total Hip Arthroplasty
Rheumatoid Arthritis of the Hip
VI. Additional Web Based Resources:
Femoroacetabular Impingement Syndrome FAI
Osteoarthritis of the hip - Osteoarthritis of the Hip
Total hip replacement Total Hip Replacement
Rheumatoid Arthritis of the hip - Rheumatoid Arthritis of the Hip
Hip Joint Testing [http://morphopedics.wikidot.com/hip-joint]
VII. References (AMA format)
1. Bandy W,Reese N.Joint Range of Motion and Muscle Length Testing.St Louis, MS:Saunders Elsevier;2010:473.
2. Neumann DA. Knee. In Neumann DA: Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. St. Louis, MO: Mosby/Elsevier; 2010
