On the photo below you can see the classic issue with general population (mostly) today, especially “sitting population” – V. Janda’s lower crossed syndrome (anterior pelvic tilt). I will not be writing about this well-known syndrome but how to figure out whether you have an issue in this area (or not) and where it lies (potential causes and some consequences), without using technology. Of course, something is visible very often at the first glance – but often you need a deeper insight as well (especially with invisible things). Of course, I will limit my writing to 3 tests, otherwise the topic called “lumbo-pelvic-hip complex health” could be very wide.
Let’s immediately start with tests and some interesting conclusions:
Test 1 – Sahrmann’s test. It’s the very simple one. In single-leg stance, pull one knee to the chest and release. Inability to keep the knee above ninety degrees for 10-15 seconds indicates a weak psoas or a weak iliacus. Other signs:
– A cramp at the iliac crest in the region of the TFL;
– An immediate backward lean to compensate;
– A large pelvic shift to the right or left;
– A quick drop from the top with a “catch” at the ninety-degree point. (Dr. Shirley Sahrmann)
“If one leg adducts (comes closer) to midline, it probably means that adductors over compensate for weakness in the psoas or iliacus” – Perry Nickelston
Sahrmann’s test could look like this as well, or from the sitting position (maybe the best option because pelvis is posteriorly tilted so there is more room between femoral head and bone/cartilage restriction close to the socket, which means better ROM and more valid test – but that depends on individual anatomy of that region of course)
You can check the balance with this test as well – of course it’s not the main goal here so you can grab/hold something to maintain balance. The TFL, m. rectus femoris and m. sartorius – all of these muscles are capable of hip flexion up to the level of the hip (all have insertion at the iliac crest). Now, the psoas has its origin on the entire lumbar spine, the iliacus on the posterior of the ilium. The psoas acts directly on the spine. Possibly as a stabilizer and possibly as a flexor (and lumbar extensor a bit – more on this later). The psoas and the iliacus (m. iliopsoas) are the only hip flexors capable of bringing the hip above ninety degrees.
“In the case of a weak or under-active psoas or iliacus, the femur may move above the level of the hip but it is not from the action of the psoas and iliacus but rather from the momentum created by the other three hip flexors. With this knowledge in hand, I believe that our knowledge of back pain, “hip flexor strains,” and “quad pulls” is drastically expanded.” – Mike Boyle
“When a muscle is strained, the first thing to do is look for a weak or underactive synergistic.” – Dr. Shirley Sahrmann
M. iliopsoas isn’t short very often, just stiff/tight because there is a lack of core stability (I mean on weak ABS and deeper) and they need to help/protect spine to get more stable and injury free. Once we strengthen ABS and glutes we will decrease hip flexors tension and correct anterior pelvic tilt a bit (APT is not good starting position because it decreases hip flexion, hip internal rotation, end part of hip extension is compensated with low back very often, makes your hams tight, weak glutes/abs and so forth… a lot of issues with simple squat exercise as a consequence – plus “butt wink” comes earlier). Stop stretching hip flexors like a maniac, they just want to protect/stabilize lower back because muscles who need to do that more are “turned off” (abdominal and all around muscles). By doing that, lower back becomes even more unstable and injury prone. “Turn on” mainly ABS and glutes and feel the difference).
Attempting to bring the knee toward the chest and above the level of the hip forces the athlete or client to use, or attempt to use, the psoas and iliacus. What Dr. Sahrmann has noticed if it’s not the case (and some of my conclusions)?
– The athlete or client will flex the spine and bring the chest to the knee. Flexion of the lumbar spine is the leading cause of disk degeneration. Those athletes or clients who substitute back motion for hip motion get back pain.
– The athlete or client will maybe use the TFL and the other ischial hip flexors to flex the hip. In this case the athlete or client will begin to complain of a low-level strain in the TFL. This is a result of overuse of a synergist and will feed into a synergistic dominance of the TFL and further psoas and iliacus dysfunction. Plus, I would add that overused and tight TFL can cause the well-known lateral knee pain because it’s the Tensor Fasciae Latae (look at the photo below) – and everything because of dysfunctional m. iliopsoas very often. You can see how everything correlated is – human body is the one complex chain. The activation of the TFL muscle leads to an abduction, flexion and inward rotation of the hip joint. So it makes sense that he can be under tension as well if m. gluteus medius (and other gluteal muscles) is underactive during hip abduction. So, functionally strong glutes and hip flexors can make healthy TFL and knees very often.
– The athlete or client will maybe use the rectus femoris to create hip flexion. This is the mysterious “quad pull” seen in sprinters or on forty-yard dash day in football. In this case the etiology is the same as above, only the culprit is now the rectus femoris, not the TFL. The psoas and iliacus are to the anterior hip as the glute is to the posterior hip. Use of the hamstring as the primary hip extensor changes the lever arm of the femur and can cause anterior capsule pain, and hamstring strains – another Sahrmann’s point.
Test 2 – Single leg glute bridge test. The test is pretty simple – just perform a few reps of single leg glute bridge exercise (non-working hip is flexed with knee up and toward chest – on that way we are making posterior pelvic tilt a bit which should activate glutes better, but…). If hams cramp occurs it means it’s overactive (you are maybe hams dominant) and glutes underactive (the second option could be holding this position – ISO, if you can’t hold it for 10s without your hams cramping up – your glutes might not be firing properly leading to more stress on the hamstring). Of course, it doesn’t mean that it’s the case with every single person but it’s something that makes sense definitely because one of the most common causes of muscle cramps is overuse of a muscle. Hams are pretty shortened in this position, so why they would initiate hip extension if gluteal muscles are in much better starting position (especially when you close heel to the butt more)? Because they used to it… have you ever heard for “gluteal amnesia” (hate that term 🙂 )? It’s when your glutes “sleep” instead of being the primary hip extensors (they are not active enough). Our brains “need to learn” how to send right signals in glutes.
Test 3 – Thomas test. On the videos below, you can watch pretty good demonstrations of the test from the anatomical and practical demo standpoint. Take a look!
A simple practical demo
And the best one for the end
“If the thigh can reach the table, the knee is at 90 degrees, and the thigh is in line with the body, then your hip flexors aren’t tight. If the knee doesn’t achieve 90 degrees – in this case, this athlete has increased tone in their quads.” – Andrew Millett
M. iliopsoas is lumbar spine (and pelvic) stabilizer, hip external rotator a bit, and hip flexor as I said before. But m. psoas major is a lumbar spine extensor a bit as well – increases lordosis when tight/short by pulling lumbar spine down and upper parts back (although we shouldn’t extend it too much – lumbar complex includes joints so it can move, not like T spine because vertebras are more robust). Among the other things, that’s why your lumbar spine can suffer if you have tight iliopsoas (it makes anterior pelvic tilt as well because the iliacus has it’s origin on the posterior of the ilium as I said before and he pulls pelvis forward).
M. tensor fasciae latae – as I said before, the activation of the muscle leads to an abduction, flexion and internal rotation of the hip joint. I am writing this because you can notice a small internal rotation of the down leg while performing the test and it definitely means that this muscle is tight.
So, you noticed how mess just one dysfunctional muscle could make. All the muscles in this very interesting complex should be properly strong, long and flexible. I think we are not even close to understanding all the details of this complex, but this area is for sure maybe the most important when it comes to proper both performance and health – so we should keep investigating and thinking…
PS: Of course, keep working (or maintaining) on multidirectional hip mobility and core stability. This is the staple that mustn’t be forgotten.
For the love of movement,