Weakness or Tightness?

Patients and clinicians both want to stretch "tight" muscles. For the hips, there is often a strong perception of stretch in the hip flexors. This may also feel like compression anteriorly with squatting. Try testing these "tight" muscles with a sustained and progressive break test, not just going for 5/5 immediately, but starting off light and progressing the force.

Often, the "tight" muscle tests weak, especially from an endurance standpoint. This doesn't manual therapy isn't indicated, as that can restore proper efficient contraction by reducing tone and restoring motor control. It's just that the patient usually needs to stabilize and strengthen the newly restored mobility.

The example below is from a patient with persistent anterior hip pain and weakness status post THA. He's a PT as well. Prior to treatment he tested very painful and weak to 90-90 hip flexion. He also had very painful empty end feel at 90 degrees hip flexion and painful arc moving passively back to neutral.

Treatment was simple

• EDGE Mobility Band with rotatory oscillations
• PNF manual resistance in hip flexion and extension (don't call them agonist reversals, the PNF police will get you!)

He then tested having full pain free active/passive hip flexion and MMT was almost as strong and the uninvolved side. The full mini case is on Modern Manual Therapy Premium!

HEP

• repeated hip flexion reset
• eccentric resisted hip flexion to stabilize, progressing to eccentric/isometic goblet squats

Weakness or Tightness?

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