The patient generally presents with leg stiffness, weakness in the hip flexors, and impaired foot dorsiflexion in the second through fourth decades, although symptoms may be apparent in infancy or not until late adulthood. The gait disturbance progresses insidiously and continuously. Patients may also have paresthesia and mildly decreased vibratory sense below the knees and urinary urgency and incontinence late in the disease. On neurological examination, generally there are no abnormalities of the corticobulbar tracts or upper extremities, except possibly brisk deep tendon reflexes. In the lower extremities, deep tendon reflexes are pathologically increased and there is decreased hip flexion and ankle dorsiflexion. Crossed adductor reflexes, ankle clonus (Video 82, Cross‐Adductor Reflex; Video 84, Sustained Clonus), and extensor plantar responses are present. Hoffman's and Tromner's signs, as well as pes cavus, may be present. Occasionally, slight dysmetria may be seen on finger‐to‐nose testing in patients with long‐standing disease.

Hey Martha! Thank you so much for your comment! You’re right, if you’re flexing the hip it’s hard to stretch it! The last three you mentioned are so helpful for focusing on the adductor group, although yes, they aren’t helping stretch the rectus femoris in those positions. I was trying to include a variety of stretches to include every hip flexor muscle. I’m very curious about the lying hip flexor stretch now, though. It’s been a go-to with every trainer I’ve worked with, and I’ll have to look into this more. What are your favorite hip flexor stretches for patients? Thank you!
The rectus femoris is one of the four quadriceps muscles -- the quadriceps are the major muscle group of the front of the upper leg. The rectus femoris attaches to the anterior inferior -- the part toward the feet -- portion of the iliac crest and runs to the base of the patella, also known as the knee. The femoral nerve supplies the rectus femoris with nerves. This is the only muscle that crosses the hip joint, which enables it to work as a hip flexor and a knee extender muscle.
It's easy to compensate in this position by hyperextending your lower back, but it's crucial that you don't. Instead, I want you to focus on squeezing your glutes and hamstrings, which will push your hips forward into a full-on "schwing." If your right foot is back, you should feel an intense stretch on the right front side of your hip. Hold it for a long time, like a minute or two, and then switch sides.
The sartorius supports the more powerful iliopsoas and rectus femoris in accomplishing hip flexion. This long, narrow muscle arises from the front of your hipbone, crosses your front thigh and inner knee and inserts at the top of your shinbone. The unique position of the sartorius enables it to support other leg motions, including knee extension, leg rotation and outward thigh movement. Sartorius strains, which commonly occur in runners and hurdlers, usually occur where the muscle arises at the hipbone. Pain and leg weakness are common symptoms. As with the other hip flexors, stretching and strengthening exercises serve as good preventive measures.
Start kneeling on your mat with knees hip-width apart and hips directly over knees. Press your shins and the tops of your feet into the mat. Bring your hands to your low back, fingers pointing down, and rest palms above glutes. Inhale and lift your chest, and then slowly start to lean your torso back. From here, bring your right hand to rest on your right heel and then your left hand to your left heel. (If you can't reach your heels, turn your toes under; it will be easier to reach your heels in this modification.) Press your thighs forward so they are perpendicular to the floor. Keep your head in a relatively neutral position or, if it doesn't strain your neck, drop it back. Hold for 30 seconds. To come out of the pose, bring your hands to your hips and slowly, leading with your chest, lift your torso as you press the thighs down toward the floor.
Beverly Hosford, MA teaches anatomy and body awareness using a unique method that involves a skeleton named Andy, balloons, play-doh, ribbons, guided visualizations, and corrective exercises. She is an instructor, author, the NFPT blog editor, and a business coach for fitness professionals. Learn more about how to align your business with her coaching guide, Fitness Career Freedom and your body with her Fundamentals of Anatomy Course.
How to: Sit down with your knees bent and feet flat on the floor in front of you (a). Place your right ankle on top of your left thigh and flex your right foot (b). Put your hands behind your body, fingertips facing away from your body and begin to press your hips toward your heels until you feel a stretch through your outer left hip. Keep your back tall and chest open (c). Hold for six to eight breaths, then repeat on the other side.
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