• Crystal Hazelton, PT, OCS

Tight hip flexor?

Updated: Aug 22, 2019

Are you struggling to loosen the front of your hip, but it’s just not giving?


When you feel tightness in the front of your hips, it is usually due to one of two things:

Tight hip flexors ~~ OR ~~ Poor alignment of your hip


Let's talk about tight hip flexors:

Which muscles are the hip flexors?

Iliacus, psoas major, rectus femoris, tensor fascia latae, sartorius and pectineus. This blog is focusing on the iliopsoas (yep, iliacus plus psoas). Because this important muscle gets blamed for many many problems!


The psoas muscle is responsible for hip flexion, lumbar side bend, lumbar rotation, and lumbar flexion. The iliacus is responsible for hip flexion.

The iliopsoas muscle has 4 functions:

1. Flex the hip (knees towards chest).

2. Flex the lumbar spine (chest towards pelvis)

3. Side bend the lumbar spine (lean sideways)

4. Rotate the lumbar spine.


Life activities that make hip flexors tight:

Posture

Post-partum posture that never returned to “normal”. Specifically your low back over-arching (lordosis), which causes a forward tilt of your pelvis.


Weak abdominal muscles

This is, IMHO, the secret sauce to fixing tight hip flexors.

In-clinic, when I see a true spasm in the iliopsoas muscle with associated shortening of the muscle, I usually also see weak and poorly coordinated abdominal muscles. The iliopsoas muscle tries to accomplish what the core is not doing, it is not as effective at this, so it spasms. For example, when getting out of a deep couch, if a person does not/cannot use their abdominal muscles to bring their chest forward over their hips, the hip flexors will jump in and do more than their share of the work. This causes spasms and tightness. So, improving abdominal muscle strength and coordination allows the iliopsoas muscles to relax when not needed. Relaxing a muscle versus stretching a muscle is another topic worthy of it's own blog post!


Sitting

Some people feel sitting a lot puts the hip flexor (iliopsoas muscle) in a shortened position, which causes tightness. This can absolutely be true. And for those people, a typical hip flexor stretch works wonders in addition to sitting less! Manual therapy--or skilled massage of the iliacus and psoas can also make a huge difference when there is a muscle spasm. Here is a pic of my all time fave iliopsoas stretch!



Take a deep breath in each pose and sink further into the stretch upon exhaling.



But for those who don’t get relief with stretching, I propose the position of sitting is problematic because the pressure of our thigh bone in sitting actually over stretches our hip flexors--Geeky technical alert --the weight of our body pushes down, and the pressure from the chair pushes up on the femur. This upward pressure of the femoral head then overstretches both the front of our joint capsule and iliopsoas muscles, causing a tensioning irritation and overall joint imbalance. Therefore, the answer is not to continue over-stretching the already over-stretched front of the hip. The answer is to re-balance the joint.



If you’ve stretched and stretched and stretched and don’t see improvement, maybe stretching isn’t the answer!

Instead of stretching the front of your hip, try re-balancing your hip joint alignment:


Foam roll and stretch the back of your hip.

This helps place the ball of your hip joint into the socket where it belongs. When the muscles on the back of your glutes are too tight they push on the back of your femoral head (“the ball”). This pressure moves the femoral head forward into the naturally weaker part of your joint capsule and onto your hip flexor. This pressure on the hip flexor creates the sensation of tension, which our brain interprets as “tight muscle”. But actually , the sensation you are feeling may be due to an overstretched tensioning. Loosening the posterior gluteal muscles allows the femoral head to sit in the socket of your acetabulum properly.


Lean towards one side. Roll forward and back 5x. Try leaning at different angles to find most effective release. This targets the deeper hip muscles.

Cute Golden Photo Bomb! Lean towards one side, and pause to cuddle a furry friend. Take the leg you are leaning on and cross your ankle over your knee. Move forward and back over the roller and side to side. Try 5 rolls each direction. This targets the more superficial gluteal muscles, especially the piriformis.

Strengthening the deep hip stabilizers

Now that you successfully released the tight gluteal muscles, and your femoral head is happily resting where it belongs, it is time to strengthen the deep stabilizers of your hip joint so you can keep the ball in the socket and have happy, un-pressured hip flexors!


Pre-activate the back of your glutes and lift as high as possible feeling the burn in the "pocket" of your jeans (aka deep hip rotators), not the "seam" (aka TFL). Try using a pillow between your knees if you aren't feeling it in the right spot.

You should feel the muscles working in the green area, which represents the deep hip rotators. Change the exercise if you are feeling the muscles on the side of your hip or "the seam" of your pants doing the work. This is your tensor fascia latae, which is often over-used.


There are some other more complicated solutions related to how you walk and/or run. But try these simple rebalancing tips first. And if your hip flexors are still feeling achy and tight, come in for a full body movement assessment to get to the core of your concern!



© 2019 by Crystal Hazelton, MPT, PT, OCS.