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Know Your Numbers: The Thigh to Chest Test

Know Your Numbers: The Thigh to Chest Test Barefoot Rehabilitation Clinic
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09 Apr Know Your Numbers: The Thigh to Chest Test

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The King Daddy of hip mobility tests is the thigh to chest test.  It’s the best. ~Barefoot Rehab

So … your hips are bothering you, hey?

Don’t make me go Canadian on you. (Did you know Dr. Curtis is Canadian?  Watch his perfect Canadian hair in the 2 minute video below.)

If you don’t know your hip flexion range of motion, you’re reading the right post.

The hip joint is arguably the most important joint to be concerned about.

The hip should have the strongest muscles in the body surrounding it.  Nobody ever wrote a song about a small butt and the hamstrings are the primary stabilizer of the knee.  When those muscles aren’t clear of adhesion and strong, it’s only a matter of time before the low back, knees, and ankles take a beating.

The most important test to determine hip integrity is supine hip flexion or the thigh to chest test.

We will measure hip flexion before extension, external rotation, internal rotation, abduction, and adduction because the most functional movement for Homo sapiens concerning the hip is flexion.  Think of hip flexion any time you are sitting, whether on a chair or on the toilet bowl.

Because we Homo sapiens tend to lose range of motion when we hold sustained postures without allowing new blood to clean up the area of debris and garbage (aka free radicals), checking the range that we need to be able to sit and not load the low back becomes of paramount importance.

Disclaimer of Peace for Therapist and Fitness Coaches

If you work with clients and their ranges of motion in any capacity, you may be upset at what I’m about to say.

There are only two structures that limit this range of motion.

The structures that limit the thigh to chest test are:

  1. Posterior hip capsule
  2. Adductor magnus

Notice what is not on the list.

  1. Hamstrings
  2. Glutes
  3. Hip external rotators

The above data comes from the Integrative Diagnosis diagnostic system and the test-treat-retest method of developing musculoskeletal expert intuition.

Feel free to test the tissue above yourself.  I did, and have found restricted hip flexion to be caused by the above tissue.  Or, when range of motion does not improve, structural dysfunction such as disc or hip space-occupying-lesion, is present.

Judge for yourself.

Mobility: Thigh to Chest Test | Supine Hip Flexion (SHF)

The ability to easily bring one’s thigh to the ribs is something that anyone should be able to do, when healthy.  The “Thigh to Chest Test”, or in mechanical terms, supine hip flexion, will let us know if you have that ability.

What do I need to Measure this Test? You will need a place to lie on your back and a partner to help you measure this test.

You can not do this alone because you want to test this range of motion passively (without your own muscles moving the joint).  Doing so will give you clearer picture of the integrity of the joint than if you were do the test actively (with your own muscles).

What is the Thigh to Chest Test assessing? The mobility of your hip joint integrity. These structures include bone, ligaments, tendons, cartilage, and muscles.

What Specific Dysfunctions are relevant here? Besides adhesion of the two structures that limit hip flexion, there are a wide range of hip and lumbar pathologies that can permanently limit the range.  The primary suspects are hip osteoarthritis, CAM/Pincer malformations of the hip, lumbar disc pathologies that take up space outside of the spinal canal (and thus limit hip range of motion), etc.

What You Need to Know: The most common symptom present during SHF will be a “pinch” sensation in the front of the hip joint.  This is an impingement that usually combines soft tissue and bony pathologies.

How to Test: Have your friend stand with your hand behind your thigh.  Their instruction should be to bring their thigh straight up towards your armpit. In some cases, your leg might want to move away from the midline of your body. Do not let this happen.

Dr. Curtis demonstrates the thigh to chest test in the 2 minute video below.

Write this number down.  Any mobilization, stretching, or treatment interventions are attempts to increase this number.  If the number isn’t increased after a month, you’re wasting your time.

PASS:

A pass for this test is the ability to touch your lowest ribs with your thigh (best visualized from the side).  Be sure that the thigh comes straight up towards the ribs from the lying position.  The thigh might want to come away from the midline of the body.  Do not let this happen.

  • Range: thigh touches the lowest ribs.
  • Effort: Fast and easy.
  • Symptoms: No symptoms.  No symptoms includes the feeling of a stretch.  Ideally, there would be no stretch.

FAIL – LOW RISK:

A fail is any range between touching the lowest ribs and 2 finger-breadths away.

fail-thigh-to-chest-test-low-risk

  • Range: Between touching the lowest ribs and 2 finger-breadths away.
  • Effort: Fast and easy.
  • Symptoms: You may feel a pinch in the front of the hip (indicating an “impingement”) or a stretch/pain in the groin (indicating likely “adhesion” in the adductor magnus) or hamstring (indicating “adhesion” in the posterior adductor magnus or referral symptoms from the hip or low back).

FAIL – HIGH RISK:

A fail, with an individual having no business doing any non-essential squatting exercises, is any range where the thigh is more than 2 finger-breadths away from touching the lowest ribs.

fail-thigh-to-chest-test-high-risk

  • Range: More than 2 finger-breadths away from touching the lowest ribs.
  • Effort: May be slow, labored, and your partner might feel your hamstring contract to avoid the motion.
  • Symptoms: You may feel a pinch in the front of the hip (indicating an “impingement”) or a stretch/pain in the groin (indicating likely “adhesion” in the adductor magnus) or hamstring (indicating “adhesion” in the posterior adductor magnus or referral symptoms from the hip or low back).

Movement Faults

The right away for your assisting doctor to perform this test is to bring the thigh straight up to the chest.

The primary movement fault is when the assisting doctor allows the hip to move away from the midline of your body (or abduct) as the thigh comes toward your chest.

Another movement fault that occurs is when the thigh that is resting on the table starts to magically rise off the table as your assisting doctor pushes the opposite thigh.  This is a compensation.  Your range of motion number stops when that opposite thigh starts lifting.  Do not let the doctor push through it to come up with an artificial number.

Your hip will regret those lies.

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I Know My Numbers – What do I do now?

Insanity: doing the same thing over and over again and expecting different results. ~Albert Einstein

There are a plethora of mobility and stretching resources out in the interweb for you to experiment with.  It is not our intention to give prescriptive answers, simply to bring awareness to where your body currently is in time.

Use whatever tools you’d like to use for a month, stretching about ten minutes a day, for three days a week, for a month.

After a month, re-test.

If you’ve gained range of motion, wonderful!  Wash, rinse, repeat, and continue stretching.

If you’re no more flexible or mobile than you were before, STOP THE INSANITY AND THE STRETCHING!  It’s now time to see a Manual Adhesion Provider or Active Release Technique Provider to diagnose your condition and potentially remove the adhesion in relevant tissue to restore your mobility before you go on layering strength on top of unhealthy tissue.

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While you’re awaiting 30 days from now to reassess, you might as well get baseline measurements for your ankles and your low back.

speechbubblesWhat are your thigh to chest test numbers? Please share range, effort, and symptoms below and we can discuss what you should be doing to restore musculoskeletal integrity.

If you know of a friend or family member with hip pain or a restricted thigh to chest test, please forward this information to them so they can get the help they need.  Fixing your adhesion matters because it improves flexibility (and allows you to pass this test), improves function, reduces pain, and restores normal movement to the body so you can enjoy the things you love. Call us at 862.205.4847.

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, is a Sports Therapy & Chronic Pain Resolution Specialist with Barefoot Rehab in Parsippany, NJ.  When you're in pain that hasn't gone away and you've been to at least 3 other doctors, Dr. Chris wants to help you. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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