Now my primary aim with these blogs is to cover the big-hitters. The big mistakes and pitfalls that we all do at various times that end up causing the most common problems that we see in our clinic. And today's usual suspect is probably the sneakiest son of a gun of the lot of them. The Hip Flexors.
The Hip Flexors, as their name would imply, create flexion at the hip (basically they lift your leg up towards your chest). There are a few muscles that do this, but the two worst of them are Rectus femoris and Psoas major.
Rectus femoris is part of your quadriceps (or your quads), the big, strong muscles on the front of your thighs. Most of your quads attach just below your hip to the top of the front of your femur (the long bone of your upper leg) so they don’t flex your hip. Rectus femoris, however, does go past the hip and attaches up onto those knobbly, bony bits either side at the front of your pelvis.
Psoas major starts very high up on the inside of your leg then goes all the way up through the groin and attaches to either side of the front of several vertebrae in the lumbar spine.
Both of these muscles move your thigh and torso closer together when they contract. Both can tighten up because of how we use them day-to-day and both can mess up how your low back and pelvis work together.
Have you ever tried to stand up only to find yourself stuck, bent double and groaning as you walk your hands up your thighs to help you stand up straight..?? Well, part of this is inflammation in some of the tissues and structures in the low back, not taking kindly to, being compressed as you become more upright. Part of it can also be your hip flexors, that have set in a shortened position whilst you’ve been sat down, and now will only lengthen and let you stand upright very slowly.
There are a number of reasons why hip flexors will tighten up:
1. Exercise
We’ve all at some point had some stiffness and soreness in muscles the day after we’ve done a bit more in the way of activity. The hip flexors do the same. Especially if you do full sit-ups (which are awful. Don't do them) and especially-especially if you try and do lower abdominal exercises. Most of the time you're just making your hip flexors worse. If you want better abs and core, check out my video on core strength and exercise.
2. Sitting poorly
Wherever we sit, whether it’s at a desk, in the car or on the sofa we commonly end up with our shoulders in front of our hips. Either leaning or slouched. This puts our hip flexors in more of a shortened position in which they can tighten up and ‘set’. Even worse if we sit on something low or soft where our bum is lower than our knees. It puts you in a very bad position. If you want to know how you might be accidentally making yourself worse just by sitting down, and some clever little tweaks you can implement to improve the way you sit, they’re all in my post on how to sit like a pro.
3. Protection
When an area of your body is suffering, whether from sudden, direct trauma or from a slow continuous overworking, inflammation is produced. Inflammation increases pain levels to stop you from doing anything that would cause further damage. It creates swelling in the area to make it harder to move and it also prompts the muscles in the area to all tighten up, in order to splint the area and protect it. When your low back is unhappy, all the muscles that attach into it tighten up to protect it, including that powerful hip flexor Psoas major.
So, as frustrating and painful as tight hip flexors can be, unfortunately the body usually has a good reason for making them tighten up and it’s almost always because of something that we’ve done to ourselves. For that reason, trying to combat them with repetitive, strong hip flexor stretches, at best tends to work poorly and at worst can make things worse. I have seen countless people at their wits end, knowing they have tight hip flexors, which are contributing to their low back pain, but despite almost constant stretching, they seem to get no relief.
How do I help tight hip flexors?
Fortunately, there are a few simple solutions.
The best thing to do is to stop making them tighten up in the first place!! Now we all know the phrase, “Prevention is better than cure”, and for these kinds of problems it is especially true.
Here's some Do's and Don'ts;
Don't do full sit-ups.
Don't sit all scrunched up.
Don't sit for too long
Do more core work (rather than “Ab” work).
Do make sure you’re sitting properly.
Do get up and mobilise every hour.
Mobilising every hour might seem like a lot. Especially when we are all busy and have work to get done. And I appreciate we can’t just stop for a wander or a yoga class every hour, but fortunately that isn’t what I'm suggesting. My post on Mobilisation covers a full spinal mobilisation routine that is tried and tested, VERY effective and can be done in less than 30 seconds (and less than 20 when you’re more practiced at it, but I have a lovely little addition to those mobilisations, especially for your errant hip flexors.
Now I know it seems like I just said that stretching your hip flexors is wrong and then give you hip flexor stretches to do in the next breath, but I’m not talking stretching. I’m talking mobilisation. And if you have seen my post on mobilisation, then you’ll understand.
In a nutshell, we don’t want to put lot of ‘pull’ through something that is already very tight, especially if it’s painful or tightening up for a good reason. What we need to do is interrupt the tightening up process by simply taking it through it’s full, pain-free range of motion, little, but often. Part of the mobilisation I run through in the ‘Move It Or Lose It’ blog will already help to mobilise the hip flexors a little bit, but there is a little more you can do with it so I wanted to make sure you have that in your arsenal too.
To do this exercise you need to stand. You may want to stand by something you can stabilise yourself with.
Pick a leg, either leg and take a good step back with it, keeping a bend in both knees. Chances are that the foot that you've just stepped back is no longer pointing forward and is now turned outwards more, it should be pointed forward, so here's how we correct it. You need to look down at your back foot and then pivot it so that foot AND your pelvis are now facing forward again. The heel of your back foot might need to come up to do this. That is fine. Just by doing this you may feel a stretch in the groin of the leg you've stepped back with.
If you're not feeling anything yet, or to get a little more out of the position, drop down a little lower sending your front knee a little further forward and your back heel further back and down. This should add a little extra tension to your hip flexors. You don't want a lot of tension or ‘pull’ through here, as you could end up pulling something and making things worse! Just bring it through full, pain-free range of motion, until you can feel it come to tension, pause for a beat and then come back up and repeat with the other side. Do this every hour you sit for. It only costs seconds, but pays off massively!
If you have a wearable fitness tracker that reminds you to get up and move every hour, then there really is no excuse. Even on long drives. I ALWAYS make sure that I find somewhere to pull in (safely!) and to hop out and run through the mobilisations. Every hour. It may seem like a faff, but the extra time it adds to the journey is no more than a set of traffic lights turning red on you would, but the difference you feel at the end of your journey is completely worth it. The longer the drive, the more important it is and I have numerous patients that have tried it out and are complete converts!
And that's about it for the horrible hip flexors. Remember your "do's & don'ts" and to keep them mobilised and you can save yourself a lot of potential low back issues and groaning as you get out of your seat, which isn't a great look. But like so many of these things, the hip flexors do not work in isolation and they do not tighten up or cause problems for no reason. If you're getting problems, whether you think it's your hip flexors or not, go see your chiropractor. Get it fully assessed because you definitely want to make sure that you're not going to accidentally make something explode or fall off.
If you have any questions about anything we’ve gone through then just let us know, otherwise stay safe, stay well and stay mobile and I’ll see you back here for the next blog post.