The saying to keep it simple silly holds, but when it comes to fixing tight hip flexors pain, you have to understand why you should not stretch something that feels tight. A tight muscle should only be stretched out when you had a prolonged event that required you to not use that muscle(s). A case where stretching of a tight muscle is appropriate is during the rehabilitation of a body part that has been cast or splinted.
When muscles are have been cast or splinted, there is shortening the basic contractile unit of muscle fiber called sarcomeres. This effect impacts your ability to produce power and strength. The shorter the sarcomeres, the more difficult it will be to get good contraction of a muscle. When you perform static stretching of a muscle, you lengthened the sarcomeres.
This article will point out the case that your tight hip flexors are not due to a sarcomere and muscle fiber issue. But before we dive into the 3 common reasons for having a tight hip flexor, we will point out what a tight hip flexor muscle can do to your body. A tight hip flexor muscle will result in a compensated pelvis to be rotated anteriorly, thus resulting in one side of the pelvis to be in an exaggerated lumbar lordosis, pubic bone to be positioned more forward and down, and tailbone (coccyx bone) to be tipped up and back. Imagine a teapot with the spout placed down (like the pubic bone) to serve tea. The handle is the position of the coccyx. Every bone and joints that are associated with this posture adapts and will be malpositioned, accordingly.
The list of common local complaints is included below.
- Lower back pain.
- Feeling like you have one leg shorter than the other leg.
- Sacroiliac joint pain or dysfunction.
- Groin pain or femoral-acetabular impingement.
- Sciatica nerve pain.
The list of common complaints due to compensations of a tight hip flexor muscles is included below.
- Patellofemoral joint knee pain.
- Neck pain.
- Rib or costochondritis pain.
- Carpal tunnel syndrome.
As you can see from these lists, that you need to address tight hip flexor muscles. What should you do? The answer is to understand why you have tight hip flexor pain. First, you need to distinguish if your hip flexors are short and weak or short and strong. Muscles should act as a muscle. A muscle demonstrating short or limited flexibility should be stronger than if a muscle is more flexible.
When a muscle is showing limited mobility and demonstrating weakness upon strength testing, this is not a true muscle function behavior. The 3 causes in this article will dive into what this pattern means to your tight hip flexor muscle.
How to test for hip flexor strength?
Lay on your back and bring your left knee to your hip level. Have another person attempt to push your knee back down towards the table. Make sure the push is not too abrupt and not too slow. Have them count to 3-4 seconds as they are pushing your leg back down. Test the right leg by repeating the same steps, but to the right side.
Weak hip flexor muscles will have a hard time resisting the push to your thigh.
Cause No. 1: Underlying weakness of your spinal stabilizer muscles.
Anatomy of a Sailboat
As your hip flexors are designed to bring your femur towards your spine, as in a marching move, you need good strength in your extensors’ spinal muscles to counterbalance the force of the hip flexors force. Imagine your muscles are the sails of a sailboat that attaches to the mast. Your mast is your spinal column. There are two mainsails called the mainsail and the jib. In order to move the sails, you need a strong upright mast to fixate and pull the sails around. When you have good control of the sailboat, the boat moves according to your desire. If you have good control of your muscles to spine, you move with ease. Remember how well you can control your muscles is dependent on the spine acting strong and erect.
When your hip flexor muscle is weak, this indicates that the muscle cannot connect and fixate onto the lumbar spinal column well. You show weakness upon testing.
photo credit: From Frank Netter’s Anatomy Book.
The answer to switching from having weak to a strong hip flexor muscle is to make sure your vertebral segments are strong and straight like a sailboat’s mast. Now we know there needs to be the natural lumbar spine lordosis curve, but the mast analogy helps many to understand. We are implying that posture is key to unwind a tight hip flexor and allow the muscle to be strong. As there are five vertebrae segments, this allows the spine to move, bend, and twist. However, they should move within their anatomical and functional ranges of motion. Nothing more and nothing less. A pole or a sailboat’s mast needs to be straight and strong, but all elements have some give and bend to it.
Your Psoas Major muscle directly connects to all 5 vertebral segments, and every contraction impacts all 5 vertebral segments. There are few other muscles that directly connect to the lumbar spine. When there is an uneven pull of the muscles surrounding the spine, you get excessive shearing forces that impact the stability and connection of the vertebral segments, ligaments, and other connective tissues like the surrounding fascia. There are an important muscle and ligament nearby the hip flexor muscle called the Quadratus Lumborum muscle and iliolumbar ligament, respectively. When you do not have good harmony and equally distributed tension pull 360 degrees around the lumbar spine, the hip flexors show up as being tight and weak.
Imagine four sailors are responsible for pulling their own sail to steer the boat. If one sailor is not holding its weight, the other three sailors have to work much harder to overcome this deficit. If two sailors are not doing their role, it puts more demand on the remaining two sailors. The work effort is showing up as tight hip flexor muscles. The capacity of the sailors to produce strength to steer will be reduced due to fatigue and the idea that two sailors cannot control a big boat as well as having four sailors. This is showing up as hip flexors being weak.
You can have strong and tight hip flexors if the direction(s) of the “unhelpful” other muscles are in the position that does not require the assisting hip flexors to be overburdened. We find that a strong hip flexor will become weak over time because it is too exhausting to sustained this added work.
What can cause your surrounding spinal muscles to not be helpful or a spinal column to not as stiff and straight?
- Any trauma such as a car accident or fall.
- Any surgery to your abdominal, pelvis, lower back, and rib cage. Example. Cesarian surgery.
- An occupation that requires repetitive or sustained tasks.
- Playing contact sports.
- Lack of fitness and bodyweight control.
The good news is that your body is very good at regenerating itself and overcoming crazy types of events. You just need to be aware and start taking small steps to bring a stable spine and pelvis, so the hip flexors can regain the leverage and capacity it needs to work. Nothing more or less.
Perform these for 3 repetitions and 3 sets to stabilize your spinal alignment.
Stuart McGill big 3 exercises
Mobility release to the Quadratus Lumborum muscle.
Grab a tennis ball and place it on one or more of these “X”. Lean onto a wall and slide down the wall with the ball pressed against your lower back. Raise the same side arm up towards the ceiling. Hold for 5 breaths of 5 seconds inhale and 8 seconds exhale.
Cause No. 2: Underlying issues to the digestive or renal systems.
It is logical to address the location of where you feel pain. If you look at your anatomy, your abdominal organs play a huge role in the stability of your lumbar spine. As a muscle can pull the spine into a pattern of instability, the fascia and ligaments of your visceral organ can result in the same pattern. This is a case of structure impacting function. You can see in the picture how the mesenteric ileojejunal roots are connected to your lumbar spine. The renal fascia and ligaments impact your lumbar spine.
In the order of survival, your visceral organs play a larger role in survival than your musculoskeletal system. When an organ needs more functional support and nutrients, your body will redirect the blood supply from your muscles to your deficient visceral organ. This is a case of function impacting the structure. When any living tissues in your body become deficient over time, it develops locally and mechanically stiff areas to itself. Visceral organs are living tissues that can become stiff and loses their ability to slide around in your abdominal region.
Both of these situations of structure or function being the origin of a tight hip flexor pain, you need to have pliable and flexible abdominal muscles. This is where we use visceral manipulations to access for any mechanical lesions and allow the blood flow to occur back to the hip flexor muscles. Everything will regain its natural order and you will have better mobility and movement.
Try these exercises.
Manchurian massage. Start from the navel and slowly rub a circle that is getting bigger and bigger. Eventually the circle will be as big as the entire stomach region. Repeat 10 times. You will notice spots around the abdominal region that feels less mobile than others. Spend a bit more time around these regions.
Distraction Self-massage. Get on your knees. Get around an area where you can bend at your waist and support your head with a sofa or cushioned chair. Grab your entire stomach with both hands and pull it forward, like you are stretching it out. Once you have pulled it, you twist and tug on your stretched out stomach tissues. Think that you are manipulating your organs and skin away from the spine. This will allow more mobility at each layer of tissues.
Cardio, cardio, cardiovascular training for more blood flow. A great choice that we recommend is to stand up from a chair and sit down for 30-40 repetitions. Perform 2-4 sets. This is great to get your heart rate up without the pounding to their joints and thought of the pain that many people worry about.
If you need more information about visceral manipulation, click here to learn more.
Cause No. 3: Poor reflexive recruitment of your everything to your lumbopelvic region.
The last category involves integrating movement and the timing that is required. Your hips and spinal stabilizers need to be active prior to moving for a task! The muscles have to be on prior to the thought of action. How does that happen?
As you enter into an environment or situation, your sensory system is working to gather information on what is happening. Your brain is interpreting and deciding on what you might do, before you do it. The data that your brain uses to make the “best guess” decision is based on prior experiences and history. Every memory is stored with the emotional and sensory information being more important. This is why we are more emotional creatures of habit!
If you have reoccurring tight hip flexor pain or lower back pain when you pick up a pencil, you have to enhance your sensory system to rewire your experience in the future. This sounds complicated and truly is working at the subconscious movement level. There can be pages and pages of information that we can dive into, but we will focus on balance and feet health. This will give you a bottom-up approach to restoring the timing of your lumbopelvic muscle firing sequence.
Click HERE to learn more about how vestibular rehabilitation will help unlock your tension and ease your pain.
Try these exercises.
Single leg balance. Stand on one leg and maintain balance with a quiet relaxed breathing pattern. If you are able to maintain an upright balance for 20 seconds, then proceed to do the exercise with your eyes closed. Be smart and be safe with this. Practice towards 10 seconds.
Standing on the sofa cushion, eyes closed, with head turns. This sounds like what it says. If you cannot perform this without losing your balance with your eyes open, do not proceed with closing your eyes. Practice standing on a cushion, eyes open, and turn your head left and right. Spend 60 seconds perfecting this exercise.
There you have three sources of having pain from a tight hip flexor and the compensations that occur with this posture. As your body moves together, you may notice a weak hip flexor can be a result of an issue to these listed muscles: the ipsilateral Scalenes, the contralateral Pectoralis minor, and the ipsilateral Tibialis anterior.
We specialize in recurrent muscle tightness and the pain the comes with it. Get your expertise second opinion with a click of the orange button below.
Danh Ngo PT, DPT, OCS, SCS
Doctor of Physical Therapy
Board Certified Specialist in Orthopedic and Sports Medicine
Certified Advanced Movement Specialist – RockTape
Mind Body Health Results Coach