Tag Archives: mobilization


Re-balancing the Body: Addressing the Hip (Flexors), Groin (Adductors) and Knee

Intentionally moving more throughout the day or implementing a stand-up work station is one of the most proactively potent things you can do to potentiate better overall health; but especially to the neuro-musculo-skeletal system.

We see patients do this all the time and then rave about the difference it has made; only regretting not doing it sooner.

If for whatever reason, movement modifications like the stand up desk is an obstacle, mobilization techniques like the one demonstrated below (a personal favorite & go-to) can work wonders towards opening up those hip flexors & lengthening those shortened adductors.

Movement Monday: AP Lunge

Functional Training: Identifying and Rectifying the Basics

A belated Happy New Year to all.  I hope that 2017 is off to your desired start, and if not, you’d better hop to it as we’re already one down and eleven to go.  No pressure though.

Being someone who gratefully works with a steady diet of athletes on a daily basis, this post is all about placing emphasis on stepping up your performance on activities like running by intelligently going beyond exclusive upright, uniplanar, cross-crawl repeats; aka running.  It is quite common for a seasoned runner to present with an issue, along with a lack the strength, stability, and/or mobility to correctly perform basic movements.  This can translate into the inability to move efficiently and pain free while navigating the obstacles of the day, but is exponentially put on display when those everyday tasks like walking, are altered in intensity and duration in the form of running.  Unsteady stabilizers, shortened tissues and insufficient or incorrect neurological firing patterns and muscle recruitment can all spell disaster and frustration for any athlete, but especially us runners.

Below, we’re going to go through a few tests and potential, subsequent remedies to work at, and then retest.  These are all designed to serve as self-help to hopefully identify and rectify a possible impedance to optimal performance.  

(It should be noted that the handful of tests and remedies shared in this article serve as a general assessment and are based on some of the most common issues seen in daily practice.  If you are truly having an issue or any question, your best bet is to work with myself or any of the other trusted and skilled practitioner.  There are a good variety of us, and each can provide their unique approach that may be right for you.)

Let’s dive right in:

Hip Hinge Test:


This is a good test to assess posterior chain mobility, mainly in your glutes and hamstring.


Maintain a braced and neutral spine, drive your hamstrings back and tilt your torso forward, allowing your arms to hang.  Hinge from the hips and try to keep your legs straight and shins vertical.  If you are unable to flex your hips to 90 degrees while keeping the shins vertical, actively mobilizing the hamstrings is a good place to work and then retest.

How to Fix It:

The banded hamstring floss is my personal preferred, do it yourself, hamstring mobilization technique.  Wrap a band around your upper thigh, just inferior to the hip and create tension by walking forward. Optimal positioning would be to also have both hands in front of you, on the ground, without rounding the back.  If this is not possible, use a chair as shown in the picture.  Keeping the back as flat as possible, create a flossing motion by repeatedly straightening and bending the banded leg and driving the hips back.


Bi-Lateral Squat:

This test is used to identify the commonly seen hip flexor and quadriceps dominance that most are plagued with for a variety of reasons, including prolonged, uninterrupted sitting. 


Stand with feet about shoulder width apart and perform a squat.  Ideally you should be able to lower to the point that your hamstrings are close to parallel to the ground, while keeping your tibias (shins) perpendicular to the ground.  If you find that your knees translate forward past your toes, it can be a contributor to a longer stride, leading to an unsteady lever arm that can lend itself to issues anywhere from the hips to the feet.  Ideally you want your squat and stride to be more posterior dominant, mostly in the form of gluteus maximus recruitment.





How to Fix It:

To work on this, stand with your knees about an inch from a chair and practice initiating your squat by hinging at the hips, sticking out your rear, and working on sustaining your balance as you lower your hamstrings towards a level parallel with the floor.  To return to the starting position, keep the knees and hip back and concentrate on firing and sticking out your rear.  Repeat until this becomes your default firing pattern when performing a squat.  The key things being worked on here are true core stabilizing balance and optimal recruitment of your glutes.


The flip side to reversing the anterior dominance, is training that gluteus maximus to fire.  When asked to, many aren’t even sure how to do this.  A good way to begin to reacquaint yourself with the designed ambulatory and running workhorse is by performing a knee to chest bridge.

dscn4509Pull in your right knee, and hold it against your chest.  While keeping the shoulder blades and head on the ground, push up with the left leg, getting into a bridge position while keeping your right leg against you.  Practice this for 12 to 15 reps on each side, concentrating on what it feels like to contract and relax the gluteus maximus that is responsible for pushing into the bridge, and propelling your forward efficiently when you run. Once this is mastered, not only in execution, but the ability to fire and feel the glute, appropriate progression in conditioning can be made.

Deep Squat:

This test is utilized to identify a variety of mobility issues necessary for proper movement as it can shed light on limited hip range of motion.


dscn4521Again, stand with feet slightly wider than shoulder width apart, but no narrower. Keep your toes pointed directly forward and attempt to lower downward into a deep squat, with your hamstrings resting on your calves, your spine neutral, and your knees slightly outside of your feet.  The photograph paints a better picture of what we are shooting for here.

A variety of dysfunctional movement patterns and restrictions can be identified through this test, but the most common are the inability to keep the spine neutral (back straight) or the backside from rotating underneath you, indicating a lack of hip flexion.  Another commonly seen issue is the inability to externally rotate the hips and get the knees outside of the feet.

How To Fix It:

If you noticed an inability to keep the spine neutral or the backside rotating underneath you, and we are zoning in on limited hip flexion as the culprit, we often see this as a product of a femur that sits anterior in the hip joint.  Again, not to be a dead horse (horrible saying), but this can be an additional product of long uninterrupted sitting, as the femur head gets pushed forward in the joint space.

dscn4562We can begin rectifying this issue by working on resetting the hips to their biomechanically optimal orientation.  Begin by kneeling on the ground and extending one leg out behind you. dscn4566Follow this by shifting the majority of your weight onto the grounded knee (mat or some sort of padding highly recommended for grounded knee) by aligning that knee directly underneath the hip.  Keeping that weight on the knee, sit the hips back in the direction of the grounded leg, which, when done correctly, creates a posterior, lateral pressure in the hip joint. 

dscn4571This can be further amplified by taking the foot of the grounded knee and placing it in front of the knee of the extended leg, and then sitting back again. (see picture)  Working on getting in and out of this position for 2 minutes on each side can assist in encouraging that femur into a more optimal position within the hip joint, allowing for improved range of motion in the hip, necessary for running.

If you noticed an inability to, or you struggled with getting the knees outside of the feet (while keeping the feet flat and facing forward), you can work on improving your external rotation in the hip.  Often times we see a lack of external rotation in runners who notice their knees knocking together, an inward pointing foot, or chronic, tender adductors (muscles along the medial thigh).

dscn4576To begin to rectify this issue, start with getting down on your hands and knees, and step one leg forward, keeping your shin perpendicular to the ground.  Keep the back flat, hips square dscn4580and lead foot facing forward.  Keeping the lead foot flat on the ground, drop the lead knee to the outside of you, while actively driving your hips into the ground.  Encourage this movement further by placing one hand on the knee and pushing the outward (see picture).  This movement, when done correctly, simultaneously mobilizes the hip into external rotation, while actively stretching the adductors.

A common theme seen here is generally reversing the anterior dominance, improving range of motion and mobility, and become better well acquainted with recruiting, firing, and utilizing your gluteus maximus and other posterior chain musculature for optimal hip extension and propulsion forward.  

These serve as just a sampling of the functional tests we implement with all of our athletes, but especially the runners, as part of an initial and ongoing assessment in order to identify, and correct any imbalances and asymmetries that may be contributing to that painful issue up or down the kinematic chain.  If you have any questions on how to perform these tests, feel free to reach out. If it “just doesn’t feel right,” or causes pain, definitely refrain and save it for working with your trusted healthcare practitioner or trainer.  These tests are designed to identify problematic issues, and the subsequent remedies are provided as potential ways to begin to fix the problem, contingent upon the fact that they are performed correctly.  Proper supervision and advisement from a trained professional is always well advised.

Happy training my friends, and good luck to you as we steamroll forward into another year.  Enjoy yourself out there and our beautiful Florida winter.  As always, if you ever have any questions pertaining to any musculoskeletal issues, the content above, or an overall natural and holistic approach to your health, feel free to reach out. (321-848-0987; dr.rclarke@gmail.com; clarkechiropracticwellness.com)

Be well and continue to STRIVE to THRIVE.


Starrett, Dr. Kelly. (2016) Deskbound; Standing Up to a Sitting World.  Las Vegas, Nevada: Victory Belt Publishing

Dicharry Jay. (2012) Anatomy For Runners; Unlock Your Athletic Potential For Health, Speed, and Injury Prevention.  New York, New York: Skyhorse Publishing





To Stretch or Not to Stretch

Pop into most gyms or swing by any race and you’re more than likely to observe numerous motivated souls performing the time honored tradition of stretching.  Starting with the good old days of gym class and continuing well into organized sports, stretching became ingrained in our minds as a necessary, injury preventative task suitable for pre and/or post activity.

But is this alleged work out staple really beneficial?

Could it actually be hindering our performance?

If so, is there a better alternative?

First off, let’s look at the most basic goal of the static stretch.  (Static stretching refers to getting into a position that elongates some aspect of the soft tissue, and holding it for some duration of time.) Outside of general habit, people tend to resort to stretching when they feel tight.  If this is the case, the goal of the stretch would be to “loosen up” by way of elongating tissue.  However, studies have shown that in order to actually physically lengthen the muscle by way of static stretching it must be held for 3-5 minutes, 4-6 days a week, for 10-12 weeks.

Moreover static stretching actually diminishes blood flow to the area being stretched.  We don’t want this when dealing with an injured or injury prone tissue that requires the oxygen and repair mechanisms delivered by blood.  And we definitely don’t want this when preparing to participate in an event where the muscles being utilized require any type of stamina or endurance, of which is metabolically maintained via utilization of oxygen that is delivered by, you guessed it, blood.

From a neurological standpoint, static stretching actually diminishes feedback to the central nervous system, especially to a part of the brain known as the cerebellum.  This is a part of your brain that is highly involved in motor coordination, balance and proprioception (having a sense of where your body parts are in space when not looking at them); a part of your brain that you want to be on point at all times, but especially when engaging in any type of activity.  Slower activation and reaction times, decreased coordination and balance all add up to subpar performances and increased likelihood of injury.

So what other options exist?

Well, you can start by implementing dynamic stretching as your warm up.  This would include movements like walking lunges, “butt kickers,” air squats, shoulder circles, etc.




In preparation for any activity a smart move would be to increase blood flow to the region being utilized.  We’re learning that static stretching can actually do the opposite.  However, performing a proper dynamic warm up, including a basic light jog, encourages blood flow, which equals more oxygen and quicker waste removal from the muscles.  It also literally warms up the tissue, many times alleviating that tight feeling which provokes so many of us to stretch in the first place.

So you decide to be proactive and try something different; ditching the static holds and intelligently warming up, yet you still feel stiff, tight and an overall lack of mobility.  So much so that you’re tempted to revert to your old ways and bend over and touch your toes for 30-60 seconds.  Slow down there. We just explained that unless you perform static stretching for an extended time over at least two months, the tissues don’t actually lengthen.  Contrarily this method also diminishes blood flow to the tissue and feedback to the brain.

A better option at this point would be aiming to improve mobility in your tissues.  For various reasons, whether it postural or remnants of an old injury, our tissues lose their full range of motion due to scar tissue or adhesions within the tissue.  When an injury occurs, traumatic or otherwise, eventually your body lays down new tissue in order to repair the damage.  Many times due to various reasons, the tissue does not get laid down in the proper orientation and can lead to a lack of mobility or discomfort within the tissue.

These adhesions or scar tissue can be addressed utilizing soft tissue mobilization techniques.  This includes everything from the foam roller or LAX ball to techniques frequently applied in our office, mainly consisting of deep tissue stripping, Graston and Active Release Therapy (ART) in order to efficiently eliminate these adhesions and restore mobility to the tissue.

It should also be noted that simply applying these techniques to soothe discomfort and restore mobility is only part of the job.  The next stage comes in the form of post mobilization movements.  We like to implement a unique, flowing combination of isometric and eccentric contraction, mixed with PNF stretching to encourage optimal recovery and stability.

The one thing static stretching may indeed supply is a mental benefit, especially if it’s been part of your regimen for years.  At that point it’s more of a habit that many hold on to for dear life, like our toes when performing that awkward hamstring stretch.

However, as new research and information becomes available it should be analyzed and if it makes sense, applied. This holds true for all aspects of health from high intensity interval training to eliminating gluten from your diet.  Even if you are one of the fortunate souls to have skated though an active life unscathed up to this point, if you’ve already made the effort and lifestyle changes to achieve a higher level of health, it would be foolish not implement the latest sound strategies due to habit or sheer stubbornness.

If you’re experiencing stubborn stiffness or tender tightness, or are still suffering residual effects from an injury that should’ve packed its bags and vacated a long time ago, we would be glad to collaborate with you in working towards the common goal of restoring mobility, banishing loitering injuries, and providing you with the tools to enable continued play well into the future.


Page P. CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION. International Journal of Sports Physical Therapy. 2012;7(1):109-119.

Wilson JM, Hornbuckle LM, Kim JS, et al. Effects of static stretching on energy cost and running endurance performance. J Strength Cond Res. Sep 2010;24(9):2274–2279

Nelson AG, Kokkonen J, Arnall DA. Acute muscle stretching inhibits muscle strength endurance performance. J Strength Cond Res. May 2005;19(2):338–343

Behm, D. G., Bambury, A., Cahill, F., Power, K. Effect of Acute Static Stretching on Force, Balance, Reaction Time, and Movement Time. Medicine & Science in Sports & Exercise 2004, 36, 8, 1397–1402.

Comana Fabio. “Debunkning Fitness Myths: Stretching” American Counsil on Exercise 2011, http://www.acefitness.org/blog/1575/debunking-fitness-myths-stretching