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Debunking the Tight Hip Flexor Myth: Understanding the Modified Thomas Test

Are Your Clients Really Dealing with Tight Hip Flexors or an Anterior Pelvic Tilt? 

It’s a common narrative: hours spent at a desk, followed by complaints of tight hip flexors and an anterior pelvic tilt. But before we jump to conclusions, let’s challenge two misconceptions surrounding hip flexors. 

The Problems: 

  1. Who determines the ideal pelvic posture when we’re all built differently? 
  1. Rarely do we observe a positive Modified Thomas Test on range. 

While these issues exist, it’s crucial to explore other factors before making assumptions about our clients’ conditions. 

Understanding Anterior Tilt:

Anterior tilt isn’t a diagnosis; it’s a description of pelvic position relative to anatomical neutral. It occurs when the front hip bones (ASIS) are lower than the back ones (PSIS). But is it “wrong” for everyone? 

Assessing Hip Flexors:

Let’s dive into the anatomy of hip flexors. These muscles, including the Psoas Major and others, play a crucial role in hip flexion. However, blaming tight hip flexors for an anterior tilt isn’t always accurate. 

The Modified Thomas Test:

To assess hip flexor function, we employ the Modified Thomas Test. This updated version fixes the pelvis at a neutral position, allowing for more precise measurements. 

 How to Conduct the Test: 

  1. Support the client supine, with one leg hanging freely off the table. 
  1. Fix the pelvis in a neutral position. 
  1. Measure the drop of the hanging leg with precise bony landmarks. 
  1. Repeat on both sides for comparison. 

Interpreting the Results:

A good measurement should consider symmetry between both sides. An asymmetry doesn’t necessarily mean tight hip flexors; other factors may be at play. 

Addressing Hip Flexor Dysfunction:

If dysfunction is identified, it’s crucial to address it effectively. Rather than solely focusing on stretching, consider techniques like Muscle Energy Techniques (MET) and specific strength exercises. 

Conclusion: 

Understanding the Modified Thomas Test provides valuable insights into hip flexor function. By assessing accurately and addressing dysfunction effectively, we can help our clients move better and more freely. 

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