My Journey Through Fire and Scar: A Physical Therapist’s Guide to Hip Flexor Recovery

Reclaiming My Stride: From Burn Patient to Physical Therapist

The world after a severe burn is a landscape of unexpected challenges. Beyond the visible scars and the initial fight for life – a fight that for me, began on September 3, 2012, when a car accident led to 80% burns, 30 surgeries, and ten and a half months hospitalized at Community Regional Medical Center in Fresno – there’s a quiet, persistent battle for function, for the simple ability to move without pain or restriction. For me, now a Doctor of Physical Therapy, reclaiming mobility, particularly in my hips, was one of the most stubborn hurdles. When your skin is replaced, scar tissue pulls, and months of stillness make muscles forget, “just move” feels monumental.

Physical therapy was critical from the moment I was admitted. I vividly remember my physical therapist mentioning “hip flexor tightness” during those early, grueling physical therapy sessions. Lying there, exhausted, as they performed what felt like a weird pretzel – the “Thomas test” – revealed a deep stiffness I felt with every attempted shift. It was uncomfortable, a spotlight on another area my body was failing.

In those moments, grappling with my limitations, and profoundly inspired by my physical therapist, Ascencion “Ace” Santoyo, I began to truly understand mobility’s impact. Ace was a driving force in my recovery, motivating me through pain and inspiring me to transform my life. His impact set me on a new path towards becoming a physical therapist myself. Later, pursuing my degrees and doctorate in physical therapy, I gained academic understanding of my lived experience. I learned how hip flexors – iliopsoas and rectus femoris – are crucial for upright movement, how tightness pulls the pelvis, causing low back pain (my unwelcome companion), and how scar tissue, bed rest, and protective posturing contribute to this restriction in burn survivors like me.

Learning about these muscles wasn’t just clinical; it was a scientific explanation for my daily battle. It validated the restriction I felt. But knowing the enemy is just step one. The real journey, as both a patient who received physical therapy and now a physical therapist guiding others, is fighting it, inch by painful inch. My ultimate goal? To one day work at Community Regional Medical Center, the place that rebuilt me.

Understanding what you’re fighting involves assessment. The “Thomas test” is a simple way to sense hip flexor tightness, a tool every physical therapist learns. As a physical therapist, I use variations, and it’s something you can try (ideally guided by a professional). Here’s a simplified guide:

Understanding Your Hip Flexor Mobility: A Simplified Thomas Test Guide

This test helps figure out if your iliopsoas (main hip flexor) or rectus femoris (quad muscle that also flexes the hip) is tight. You’ll need a sturdy table or bed you can lie on with your legs hanging off the edge.

• Get Positioned: Sit right on the edge of the table/bed.
• Lock Down Your Pelvis: Bring both knees up to your chest and hold them there. Gently roll back onto the table, keeping your lower back flat against the surface. This is CRUCIAL – it locks your pelvis in place so you get an accurate reading of muscle length, not just back flexibility. Keep holding one knee firmly to your chest throughout the test. This is your non-tested leg.
• Lower the Test Leg: While still holding the non-tested leg to your chest and keeping your lower back flat, slowly let the other leg (the one you’re testing) relax and hang down off the edge of the table. Don’t push it down, just let gravity do the work.
• Observe the Thigh: Look at the back of the thigh of the leg hanging off the edge. Does it rest flat on the table? Or is it lifted off the table?
• If the thigh is lifted off the table, it suggests tightness in the iliopsoas.
• Observe the Knee: Look at the knee of the leg hanging off the edge. Is it bent to roughly a 90-degree angle, or is it straighter (less bent)?

• If the thigh is flat but the knee is relatively straight (less bent than 90 degrees), it suggests tightness in the rectus femoris.
• If the thigh is lifted and the knee is straight, it suggests tightness in both.
• Repeat: Do the same test on the other leg. Compare the results.

This physical therapy test isn’t the be-all and end-all, but it gives you clues. For me, early on, it showed significant limitations in both, a direct result of my injuries and immobilization. Knowing which muscle was restricted helped target my physical therapy efforts.

My personal strategy, born of necessity and refined through my knowledge of physical therapy, became a relentless pursuit of length and strength. It wasn’t about bouncing or pushing through searing pain – a quick route to injury I learned the hard way. It was about consistency, patience, and listening to my body. This is the philosophy I bring to Padilla Physical Therapy and Fitness in Wasco, California, serving communities like Bakersfield, Shafter, McFarland, and Delano.

For the iliopsoas, the kneeling hip flexor stretch became my daily ritual. Getting into position was hard initially, scar tissue protesting. I started small, barely shifting weight, focusing intensely on tucking my tailbone – a crucial technique I now teach in physical therapy. Holding for 30 seconds felt eternal, but I stuck with it. Slowly, agonizingly, I shifted further, adding variations like reaching overhead. I even adapted the “Thomas test” position on my bed for a passive stretch before sleep.

The rectus femoris required a different approach, focusing on bending the knee with a neutral hip. The standing quad stretch was accessible, but scar tissue made grasping my ankle difficult. I used a towel initially – a simple modification I recommend in physical therapy. The kneeling version was more intense, a level I worked up to. The key, I learned and emphasize, was keeping knees close and avoiding back arching – that old compensation. These stretches were slow, sustained coaxing of muscle and scar tissue.

But stretching alone wasn’t enough. My studies in physical therapy confirmed what my body knew: tightness leads to weakness, especially in the glutes – the hip extensors. My tight hip flexors were braking my glutes. Strengthening became equally vital. Glute bridges, donkey kicks, planks – rebuilding the support system my body needed for efficient, pain-free movement. Teaching my glutes to fire, taking over from overworked hip flexors. This integrated approach is fundamental to how I practice physical therapy.

Progress is the goal, but it’s a marathon, not a sprint. To help structure this, here’s a sample weekly roadmap and a guide on how to evaluate your progress, based on what I’ve found effective in my own journey and in physical therapy practice:

Weekly Roadmap for Hip Flexor Mobility (Sample)

This is a template; adjust based on your body’s response. Consistency is key!

• Daily:

• Warm-up: 5-10 minutes of light movement (walking, gentle leg swings).
• Targeted Stretching: Perform stretches for the specific muscles identified as tight (Iliopsoas, Rectus Femoris, or both). Hold each stretch for 30 seconds, 2-3 repetitions per side. Focus on proper form and gentle tension, not pain.
• Movement Breaks: If you sit for long periods, stand up and move around every 30-60 minutes. A quick standing hip flexor stretch can be helpful.
• 2-3 Times Per Week (Non-Consecutive Days):

• Strengthening: Focus on glutes (bridges, donkey kicks) and core (planks, bird-dogs). 2-3 sets of 10-15 repetitions for each exercise, focusing on control and proper muscle activation.
• Dynamic Mobility: Incorporate dynamic movements like controlled leg swings (forward/back and side-to-side) or walking lunges to move the hips through a fuller range.
• Weekly:

• Self-Evaluation: Use the guide below to check in on your progress.
• Rest/Active Recovery: Allow your body time to recover. Gentle walks, foam rolling, or light yoga can be beneficial.

Guide to Evaluating Your Progress

Track these points weekly to see how you’re improving. Be honest and patient with yourself.

• Re-check the Thomas Test Position:

• How does the tested thigh position feel compared to last week? Is it closer to the table?
• How does the knee flexion feel? Is the knee bending more easily towards 90 degrees?
• Note any changes in the thigh drifting outwards (TFL) or inwards (Adductors).
• Pain Levels:

• Is your general low back pain reduced?
• Do you feel less stiffness or pain in the front of your hips or thighs during daily activities?
• Is stretching less uncomfortable than when you started?
• Functional Movement:

• Does walking feel easier or smoother? Do you feel less restricted?
• Is it easier to stand up from a chair?
• Do you feel like your posture is improving?
• Are activities that were previously difficult becoming a little easier?
• Consistency:
• Were you able to stick to your weekly plan? Consistency is a huge part of progress.
• Listen to Your Body:
• Are there any new aches or pains? Adjust your routine if needed. Some discomfort during stretching is normal, but sharp or increasing pain is a warning sign.

This journey, from patient fighting for every inch of movement within the walls of Community Regional Medical Center to a physical therapist helping others in their fight at Padilla Physical Therapy and Fitness in Wasco, California, has been deeply personal and often frustrating. Progress isn’t linear. Scar tissue feels tighter some days, muscles more resistant. Pain flares, doubt creeps in. But the small victories – being able to stand a little taller, walking a little further, feeling less strain in my lower back – are powerful motivators. And now, seeing those same small victories in my physical therapy patients is incredibly rewarding.

My opinion, as both survivor who lived through it and a physical therapist dedicated to helping others: Hip flexor mobility is non-negotiable for anyone recovering from significant physical trauma, especially burns. It’s not just about athletic performance; it’s about fundamental human movement, preventing secondary issues like chronic back pain, and reclaiming independence. It requires a dedicated, consistent effort, a willingness to be uncomfortable, and an immense amount of patience with a body that has been through hell and is fighting its way back.

It’s also about understanding the body’s interconnectedness. You can’t just stretch one muscle group in isolation, especially when scar tissue and weakness are part of the equation. It’s a holistic approach – lengthening the tight areas, strengthening the weak ones, and constantly working on postural awareness. My personal experience taught me this; my education in physical therapy gave me tools to teach it to others.

To anyone facing mobility challenges: be patient, persistent, and kind to yourself. Celebrate small gains. Find what works for your body; every story and its scars are unique. Reclaiming your stride is possible, a profound act of reclaiming yourself. It’s a journey I’ve lived, inspired by the care I received, and one I’m dedicated to guiding others through physical therapy, hoping one day to do so within the very walls where my own recovery began, serving Wasco and the surrounding areas like Bakersfield, Shafter, McFarland, and Delano.