Knee and anterior hip pain are amongst the most common injuries and sensitivities for runners, and ultra-trail runners, in particular. The demands of ultramarathon distances and severe vertical gains and losses can put extraordinary strain, not just on the joints of the knee and hip, but also on the surrounding soft tissues — both to power the legs up the mountainous climbs, but also to cushion the landing as we descend back down.
Thus, it’s important that runners have strategies to improve and maintain both knee and hip joint range of motion, as well as mobility and extensibility of the soft tissues of the hip flexors and quadriceps.
But what if the conventional stretches exacerbate our pain, or cause different pains? This is the challenge when addressing quadriceps and hip flexor stretching — and the motivation for me to create a new strategy to mobilize these key areas with maximal potency and minimal side effects.
A group of runners descending outside Durango, Colorado. The literal ups and downs of ultra-trail running can add a lot of wear and tear to hip and knee joints and surrounding tissue. Photo: iRunFar/Eszter Horanyi
Why Should We Stretch the Quadriceps and Hip Flexors?
Quadriceps and hip flexor stretching is useful to address the following aches, pains, and needs:
Hip flexor tightness and hip pain — Hip pain and stiffness of all kinds is often due to deficient range of motion of the myofascial structures of the anterior leg, pelvis, and even abdomen.
Low back pain — The same holds true for lumbar spine pain. Stiffness in the anterior tissues can cause compressive stiffness and pain in the low back.
Knee pain — Tissue stiffness in the anterior thigh and above can both compress the knee as well as contribute to painful torsions and shearing forces.
Iliotibial (IT) band pain — IT band pain, even when centered at the lateral knee, often has its origins above in the hip, pelvis, and abdomen.
Restorative mobility — Even without overt pain, most of us sit much more than nature intended. This requires having strategies to restore full hip flexor — and functional hip extension — mobility.
The Challenges of Stretching the Hip Flexors and Quadriceps Muscles
Stretching the quads and hip flexors may seem straightforward, but it’s not without its challenges. When considering any medical intervention, even in sports medicine, we must be aware of side effects and contraindications — specific cases for which an intervention may impart an effect that may harm a client more than it helps.
Such is the case when trying to address knee and anterior hip pain. Very often, when trying to address the tissues involved, conventional stretching strategies can either directly aggravate the sensitive area, or cause painful side effects in other parts of the body.
The standard standing heel-to-buttocks quad stretch or the kneeling couch stretch each have their limitations and drawbacks. They include:
Compression on a Sensitive Knee
Many athletes with knee pain have significant quadriceps and hip flexor stiffness. Yet, to kneel on their knee — as indicated in the standard kneeling couch stretch demonstrated below — puts the full body weight directly on the knee joint. For most people, this is too painful and risks exacerbating the very condition we’re trying to heal.
The standard kneeling couch stretch for the quadriceps and hip flexors. Photo: iRunFar/Meghan Hicks
Lumbar Spine Compression
Runners with knee or hip pain often also have low back sensitivity. Stretching either the quadriceps or hip flexors often inadvertently places the lumbar spine in excessive, compressive extension, as demonstrated in the photo below. This can cause or worsen low back pain and is not a worthwhile trade.
The standard standing quadriceps and hip flexor stretch with too much low back extension. Photo: iRunFar/Meghan Hicks
Insufficient or Incomplete Stretch Effect
Fully addressing tension in either the knee or hip often requires a multi-joint, whole-body strategy. Fascial tensions higher up in the hip — and even the pelvis and abdomen — may contribute to range-of-motion loss far below at the knee. Conventional quadriceps and hip flexor stretches often fail to encapsulate all the relevant tension in the system.
Introducing Joe’s Couch Stretch for the Quadriceps and Hip Flexors
I was first exposed to this technique from my mentors, Gregg and Vicky Johnson, who use a similar technique for holistic restoration of anterior hip, pelvis, and thigh tissue mobility. I have adapted it to anchor the foot against an object, in this case a couch, though a wall is also effective.
How to Perform
To perform:
- Lie parallel to a couch, with the stretch leg up. Be sure the lower leg is flexed to at least 60 degrees, putting the knee almost to waist level.
- Flex the upper, stretch knee and anchor the toes against the couch.
To accentuate the stretch:
- Cinch the lower leg as high as you can toward your chest.
- For IT band stretch effect, actively adduct the thigh downward toward the floor.
- For trunk and abdomen effect, stretch the top arm upward, and/or perform small forward and back rotations with the shoulders and trunk.
Prescription
Joe’s Couch Stretch is most effective after performing some soft tissue mobilization. This might include:
- Foam rolling or other self-massage to the quadriceps
- Self-massage to the medial or lateral hips and thighs
- Self-massage of the viscera in the abdomen
This is a terrific and rather easy prolonged hold stretch. Try holding for 30 to 90 seconds or longer, several times a side. Perform one to three times per day for restorative stretching, and three to seven days a week for range-of-motion maintenance.
Good luck!
Call for Comments
- Have you tried Joe’s Couch Stretch?
- Was it effective for you?
