Although there are at least seven hip flexors (ilipsoas complex, tensor fascia lata, rectus femoris, sartorius, pectineus, adductor brevis, gracilis),^1-3 the most common neural patterning problem lies in the psoas major.  This is of significant functional importance as the psoas major is the only hip flexor that can produce significant amounts of force with the hip flexed above 90°, as the other hip flexors become maximally shortened around this position (P. Levangie, Personal Communication, 2008).  Consequently, if the psoas major isn’t producing enough force or producing it at the right time, the body compensates by generating sufficient momentum via force production of the other hip flexors to achieve above 90° hip flexion.  While these ideas are somewhat prevalent and well-understood among physical therapists, Michael Boyle was the first to bring these ideas to the field of strength and conditioning in his article “Understanding Hip Flexion.”    

Many of the nagging injuries (or inconveniences) associated with the hip flexor musculature can be alleviated by re-patterning proper hip flexion.  The focus of this process is on activating and strengthening the psoas major in “isolation” then progressing to a complete range of hip flexion.  While it is not necessary to use goniometers in a weight-room setting, it may be of interest that healthy hip range-of-motion in the sagittal plane includes about 120-130° of hip flexion and 10° of hip extension.  As a result, full range-of-motion in this plane is about 130-140°.  You may notice that, when an athlete is first positioned at a position of 90° hip flexion, they are unable to flex the hip more than 5-10° above this position.  With the goal being 30-40° of additional flexion, the hip flexion re-patterning progression presented below leads to significant increases in functional range-of-motion within a few training sessions.  The idea of activating the psoas major also comes from Coach Boyle’s article.  His original presentation of many of these exercises was instrumental in the development of the progression that follows.           

The process of re-patterning proper hip flexion follows a simple progression:
*click on the "image" under the exercise name to view the video

1)   Above 90° hip flexion (so-called psoas isolation); gravity minimized

2)   Above 90° hip flexion (so-called psoas isolation); gravity maximized

3)   Full range hip flexion; gravity minimized

4)   Full range hip flexion; gravity maximized

5)   Above 90° hip flexion (so-called psoas isolation); gravity minimized with external resistance

6)   Above 90° hip flexion (so-called psoas isolation); gravity maximized with external resistance

7)   Full range hip flexion; gravity maximized with external resistance

8)   Full range hip flexion and adduction with external resistance

In my opinion, addressing hip adduction is more complicated than hip flexion because the same single muscle is rarely the problem.  In fact, some hip adductor pains may not be a result of a muscular problem at all.  For instance, if an athlete develops a tight posterior hip capsule (common in ice hockey players), hip internal rotation ROM will be lost.  As a result, some of the hip adductors will be under constant tension and will have to produce extra force to create the necessary ROM.  While one or several of the hip adductors may become injured, strengthening these muscles may do little to prevent the reoccurrence of these injuries.  Restoring proper ROM through the mobilizations (and related static stretches) presented in PART 1, and through manual therapy (A.R.T. is probably the most effective in this situation) will do more to prevent these injuries than strengthening the adductors. 

Restoring a proper hip adduction pattern follows a progression from closed- to open-chain movements, and there is some overlap with hip flexion as the two patterns are often coupled during normal human movement. 

1) Closed-chain hip adduction

2) Closed-chain hip adduction with external rotation

3) Closed-chain hip adduction with external resistance*

4) Closed-chain hip adduction with external rotation with resistance*

5) Open-chain hip adduction

6) Open-chain hip adduction with hips flexed

7) Open-chain hip adduction and flexion with external resistance

*It would be appropriate to precede closed-chain movements with external resistance with unresisted open-chain movements (not shown).  

In general, the exercises should be performed for 3 sets of 8-12 repetitions as part of a dynamic warm-up and/or as a paired exercise during resistance or core training sessions.  Because unilateral hip flexion is almost always paired with contralateral hip extension, I recommend performing a strong gluteus maximus contraction on the “down-leg” during the hip flexion exercises.  I also recommend maintaing a “braced” core during all exercises, as this will help prevent movement of the lumbar spine and reinforce the role of the core in providing a stable base for extremity movement.   

While your athletes are performing these movements, ask them how/what they feel.  I’ve found that sometimes movements LOOK like they’re being performed correctly, but the athlete may not be utilizing the correct musculature to produce the movement.  Coach Boyle was the first to introduce me to the concept that the best athletes are the best compensators.  By questioning athletes on what they feel, you not only ensure that they’re using the right muscles at the right times to produce the right movements, but you develop the athletes’ self-awareness.

My hope was to present step-by-step progressions to utilize as part of an off-season and/or pre-season program for hockey and soccer players that will help minimize the risk of hip flexor and adductor injuries in these populations.  By spending a couple weeks on psoas activation, we can help ensure that this muscle will be producing adequate force to produce full range hip flexion.  External resistance is added to improve the strength of all the involved musculature in single-plane (hip flexion) and multi-plane (hip flexion and adduction) open-chain patterns, similar to those used in athletic movements.  Naturally, the rate at which you progress your athletes will depend on their experience with these movements, their training history in general, their injury histories, and their mastery of each step.  If you have any comments or suggestions on these progressions, I’m always interested in constructive feedback and available to answer questions.  Please feel free to email me at kn@prodigyperformancetraining.com.   

Kevin Neeld is a Certified Strength and Conditioning Specialist (CSCS) holding a degree in Health Behavior Science with a concentration in Fitness Management, as well as a minor in Strength and Conditioning.  Kevin is the founder of Prodigy Performance Training, a company providing athletic development services for dedicated athletes along the East Coast, from Delaware to Massachusetts.  

After completing a successful college hockey career at the University of Delaware (‘05-’06: MVP; ‘06-’07: Team Captain, Lifetime Achievement Award, 2nd Team All-American), Kevin continues his work in ice hockey serving as a coach, educator, and program consultant in the sport.     

Kevin possesses the unique ability to combine his backgrounds in research, academia, and athletics to create highly effective programs for athletes and clients of all backgrounds.  Specializing in ice hockey training and corrective exercise, Kevin has helped guide athletes of all ages and abilities to optimal health and performance.

In addition to his writing for SBCoachesCollege.com, Kevin has written for peak performance training sites such as T-nation.com, BodyBuilding.com, SportsRehabExpert.com, and StrengthCoach.com.  He is also the author of Hockey Training University’s “Off-Ice Performance Training Course”, expected to release by Fall 2009.  To learn more about how Kevin can help you achieve your training goals, visit his site (www.KevinNeeld.com) or contact him via email at kn@prodigyperformancetraining.com.

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