Normal: Lie on the edge of a sturdy table, bring one knee to your chest and let the other knee hang off the edge, keeping the lower back flat on the table. If your thigh is touching the table and your hanging knee is roughly at a 90° angle, you don’t have hip flexor tightness. — Photos: ONG SOON HIN/The Star
There are many reasons why people get lower back pain.
From muscle strains to poor posture, lack of exercise, injuries, herniated discs and ageing issues, lower back pain is the leading cause of disability worldwide.
ALSO READ: Basic facts about back pain
If the pain level is mild discomfort and tolerable, chances are you’ll rub some ointment, wear a pain relief patch or go for a massage.
But if the pain is unbearable, you’ll probably pop some painkillers, put a hot pack on your back and rest in bed without consulting a doctor.
A day or two later when the pain subsides, you’ll resume your regular routine and life continues.
The root cause of the back pain, however, has not been addressed.
Unbeknownst to many, tight and/or weak hip flexors can also contribute to lower back pain.
The hip flexors are a group of muscles located at the front of the hip that allow us to move our knee towards the chest.
They play a major role in walking, running, standing up from a chair and other movements.
The primary muscles here include the iliopsoas (a combination of the psoas major and iliacus muscles) and the rectus femoris (the main muscle in the quadriceps or thigh).
The iliopsoas is the strongest of the hip flexors and they are responsible for externally rotating the thigh and stabilising the spine.
As most of us in the workforce are sitting hunched over our desktops, laptops or mobile phones for hours, our hips are constantly in a flexed position, which causes the muscles in the area to shorten and tighten.
Over time, they become weak from this shortened state, lead-ing to muscle imbalances in the pelvic area, which causes the pelvis to pull forward (anterior pelvic tilt).
The result: pain in the hip or groin area, and sometimes, lower back pain.
The more we sit, the worse the pain, but we can do something about it.
The Thomas test can help to assess hip flexor muscle length, particularly focusing on the iliopsoas and rectus femoris muscles.
This physical examination to assess and evaluate flexibility of the hip flexors was invented by Welsh orthopaedic surgeon Dr Hugh Owen Thomas in 1875 to faciliate his work.
Due to its simplicity to perform, the test is now widely used by orthopaedic surgeons and physiotherapists in evaluating conditions such as iliopsoas tightness, rectus femoris restriction and hip joint abnormalities.
Performing the test only requires a sturdy table and someone to assess the deviations, if any.
To test yourself:
- Lie on a table with both your legs hanging off it.
- Pull one knee towards your chest and hold it with both hands.
This action flattens the lumbar spine against the table, reducing anterior pelvic tilt (i.e. no arch in the lower back).
- Relax your opposite leg so that it is hanging off the table.
The observer should now check the hip and knee position of the hanging leg, and compare it to the pictures for the conclusion.
Remember to do both legs and see what you find (see media gallery below).
Based on the results, stretching and strengthening exercises may be recommended to alleviate lower back and/or groin pain.
I will discuss and demonstrate these options in my next column (in StarHealth on Dec 14 and online Dec 19).
Note that if the test comes out normal, but you still feel tightness in the hip flexors, the problem may stem from elsewhere in your body, so it’s best to seek advice from a medical practitioner.
Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. For more information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Thomas test results
Normal: Lie on the edge of a sturdy table, bring one knee to your chest and let the other knee hang off the edge, keeping the lower back flat on the table. If your thigh is touching the table and your hanging knee is roughly at a 90° angle, you don’t have hip flexor tightness. — Photos: ONG SOON HIN/The Star
Tight iliopsoas: The thigh of the leg being examined is supposed to be flat on the table, but here, it is completely off it, indicating an extremely tight iliopsoas.
Tightness in two areas: The hanging leg is extended past 90° due to a tight rectus femoris (quadricep muscle), and the gap between the thigh and the table reflects a slightly tight iliopsoas.
Tight tensor fascia latae: If the extended leg falls to the side of the table (lateral deviation), it indicates tightness or weakness in the tensor fascia latae, a muscle on the outer side of the hip.
Tight rectus femoris: The back of the thigh is on the table (no iliopsoas tightness), but the lower leg extends past 90°, showing tightness in the quadricep muscle. — KAMARUL ARIFFIN/The Star
