What’s the one thing that many runners, cyclists and desk-bound office workers have in common? Quite regularly, after assessment, I find that it is tight hips.
While 27 muscles cross the hip joint — and tightness in any one of them can cause aches, pains and limited range of motion — one of the most common culprits of reduced hip mobility are shortened or tight hip flexors.
Before discussing how this might affect posture and create pain in the back, let's first look at hip flexor anatomy.
The iliopsoas (the most commonly “tight” hip flexor) is composed of two muscles;
1. the psoas and
2. iliacus
Both share a common insertion onto the hip.
The psoas originates on the bodies of the lumbar (lower spine) vertebrae and the iliacus originates on the iliac fossa, (the body of the pelvis).
However, although the commonly thought of hip flexing muscles there are others that perform the same, or part or the same function of drawing the knee upwards towards the spine, or the spine forwards bring the a forward flexion of the hips.
The tensor fasciae latae (TFL) originates on the ASIS of the iliac crest and inserts onto the IT band.
The rectus femoris (one of the four quad muscles) also inserts onto the pelvis, making it a hip flexor.
While each muscle functions slightly differently, their overall combination allow them to flex the hip joint, anteriorly rotate the pelvis, and extend the lumbar spine.
IMPORTANTLY, due to its attachment on the vertebral bodies of the lumbar spine,
the psoas also plays an important role in lumbar spine stabilization.
This often forgotten function of the psoas should not be overlooked as a tight or shortened psoas can cause serious postural problems.
When you stand up, it pulls the lower back vertebrae forward and down toward the femur, often resulting in lordosis (overarching in the lumbar spine), which is a common cause of low back pain and stiffness; it can also contribute to arthritis in the lumbar facet joints.
Conversely, a weak and overstretched psoas can contribute to a common postural problem in which the pelvis is pushed forward of the chest and knees. This misalignment is characterized by tight hamstrings pulling down on the sitting bones, a vertical sacrum (instead of its usual gentle forward tilt), and a flattened lumbar spine.
Without its normal curve, the lower back is weakened and vulnerable to injury, especially at the intervertebral discs.
To truly assess flexibility of the hip flexor musculature, the Thomas Test should be used. This quick test can be performed by any athlete, coach, or therapist.
It is important to realise however, that individuals exhibiting a negative result from the Thomas test, may simply have increased TONE (resting muscle tension) of the iliaspoas due to poor core stabilization.
That is, in individuals whose core stabilising muscles are not performing optimally, the body increases tone in the hip flexors to help create some stabilization.
For many who work in offices, or sit for prolonged periods, perhaps driving for
example, lower back pain is a very common complaint which could well be attributed to a number of causes;
1. Poor core muscle function leading to increased hip flexor tone (to stabilise the lower spine)
2. Tight or shortened hip flexors in turn inhibit the activation of the gluteal muscles in hip extension, compromising pelvic stability and causing a over-reliance on the hamstrings and lower back.
For these individuals, the ideal course of action is to first decrease the tone of the hip flexors muscles followed with specific exercises that help develop better core control and glute activation. The following 5 stretches and moves, are a great way to start opening up through the hips.
HIP FLEXOR SPIDERMAN STRETCH
Use this slow, hip flexor stretch before attempting the glute activation exercises, to help inhibit the hip flexors, particularly the powerful psoas muscle, while you get your glutes firing.
Perform a dynamic version of this during your warm up before running by walking with a long lunging step, and reach upwards with the opposite arm to forward leg. Be sure to tuck your tail-bone under, and avoid arching your back as you do so. Perform this static stretch later in the day.
Begin in a forward lunge position and drop your back knee to the floor.
Raise your arms and hands up over your head and look up.
Press your hips forward and down toward the floor. Feel a stretch through your torso, hip, groin and thigh. Fold forwards over the front knee, placing hands on floor, either side of your foot. Slide the back leg back to extend the hip, and push gently downwards at the hip. Place one hand on the floor on the inside of the foot, and rotate your body, reaching up with the other arm.
Hold the stretch for about 15 seconds, release and repeat on the other leg.
You can modify this stretch based upon your own flexibility and limitations, but be sure to keep your forward knee over or behind your ankle -- not in front of it, and squeeze the glute of the rear leg to prevent arching the back.
KNEELING QUAD AND HIP FLEXOR STRETCH
The quadriceps and hip flexors can be tight and overactive. This stretch helps to loosen them up. To perform this stretch, kneel on the ground with one leg forward, knee bent, and your foot flat on the floor. You might like to place a cushion beneath the kneeling knee for comfort. Make sure that your front thigh is parallel to the floor at 90 degrees to your shin. Squeeze your gluteal muscle as you push your pelvis forward. Hold this for 30 seconds then go back to your first position. Repeat on your other leg. Continue alternating as many times as you want. Use this slow, hip flexor and quad stretch before attempting the glute activation exercises.
Perform a dynamic version of this during your warm up before running and this static stretch later in the day.
PIGEON POSE
Begin in a kneeling on all fours position
Straighten one leg out behind you, and draw the other leg across and in front of the mid line of your body. Ensure you keep your pelvis square with the floor, and slide the hips backwards, folding your upper body forwards and down towards the floor.
You should aim to keep the pelvis parallel to the floor at all times
Your general hip mobility will determine how far you are able to take this stretch, but it should be felt at the upper, outer side of your glutes of the forward leg.
THE BRIDGE
2 sets of 30, twice daily
This is the easiest way to get your glutes firing as well as activating your core. The movement is small and targeted, so go slowly and you will feel your glutes "waking up."
Lie on your back with your hands by your sides, your knees bent and feet flat on the floor. Make sure your feet are under your knees.
Tighten your abdominal and buttock muscles.
Raise your hips up to create a straight line from your knees to your shoulders.
Squeeze your core and try to pull your belly button back toward your spine. The goal is to maintain a straight line from your shoulders to your knees.
Performing the bridge with the feet further away from the buttocks will engage more of the hamstrings.
Progress the exercise by performing a SINGLE LEG BRIDGE. This will help identify specific muscle weaknesses and enable you to isolate the glutes one side at a time.
To further progress this, perhaps try an elevated bridge or holding weights placed just on your hips to increase the resistance.
THE DEAD BUG
2 Sets 30
Lie on your back with a neutral spine and your hips and knees at right angles with your palms pressed into your thighs just above your knees.
Pull your abs to your spine keeping your ribs and pelvis still as you lengthen your right arm and leg out until they are almost parallel to the floor. Keep your torso and spine completely stable as the arm and leg move.
Return to the starting position, and repeat on the left side to complete one rep.
To progress the exercise, really extend the arm and lower the leg to the floor, pointing the toes BUT ensure your lower back remains flattened (neutral), controlling the movement with the deep abdominal stabilisers.
PROPRIOCEPTION EXERCISES
2 x 15-20 sec hold each foot
Proprioception exercises are important in challenging the neuromuscular control you have over your muscles. Balance type exercises can be used to improve the function of all muscles, ligaments and tendons throughout the body, but particularly in the feet. An ankle wobble board can be used, initially in a sitting position, followed by standing on both legs and progressing to single leg balancing.
If you don't have a wobble board, simply balancing on one leg can be effective. Once you can manage this, you can challenge your balance by moving your arms, twisting your body and bending the knee. For a real challenge, try to balance with your eyes closed.