Hip Flexor Dysfunction
Updated: Oct 29, 2018
At the request of one of our clients, Jan, this week’s topic for discussion is hip flexor dysfunctions.
We’ve probably all heard a friend or colleague mention that they’ve done a hip flexor or got a hip flexor injury, but what exactly does this mean? how does it occur? how do we treat it? and what can we do to prevent it?
The reason we want to discuss the hip flexors is that they have a very important functional role to play, and when things go wrong or get stiff through our low back and pelvic areas, these muscles are often affected and can create ongoing pain if not addressed.
The Hip flexors are in-fact a group of three muscles, there are several other muscles that have hip flexion as part of their function, for example some of our groin muscles, but for the purpose of today’s blog we are going to focus on the three main hip flexors, which are:
1. The Psoas Major – runs from the front of all 5 of our lumbar vertebrae (in the abdomen) across the front of the hip and inserts on the lesser trochanter of the femur.
2. The Iliacus – originates on the inside of the pelvis, also running across the front of the hip to join with the tendon of the psoas and insert on the lesser trochanter of the femur.
Together the psoas and iliacus form the iliopsoas muscle which is the strongest flexor of the hip; and the one that creates the most problems.
3. Rectus femoris – which is also our central quadriceps muscle. It starts at the AIIS or a bony lump at the front of the pelvis and runs down the centre of the thigh to insert into our patella and further down into the front of the shin.
The hip flexors, like any muscle, can be strained or torn, and this is common in sports that require a lot of lunging movements, such as tennis and cricket or those that require repetitive kicking.
Because of their origin on the front the lumbar spine and insertion below the hip, they are also very prone to getting tight, when we engage in activities that require a lot of hip of back bending. i.e - when we sit.
When we sit with our knees bent we bring the origin and the insertion of the iliopsoas muscle closer together. If this muscle, or any muscle, sits in one position for a long period of time it will gradually adapt to that position and shorten, causing tightness through the front of the hip when we then try to stand and walk.
Because iliopsoas is such a powerful muscle and it inserts onto our lumbar spine, when we then stand and walk it creates a compressive force and a forward pull on the lower back which results in a closing down of the joints through the lumbar spine and additional lower back tightness.
Now it’s an interesting argument as to what came first, the back stiffness or the hip flexor tightness. Was the back stiff and because it wasn’t moving the hip flexor muscles got tight? or were the hip flexor muscles tight and due to this inflexibility, the back got stiff. Regardless of the cause the opposite structure will usually become involved and needs to be treated as well.
It’s important to note that if the hip flexors are already tight from excessive sitting, it predisposes us to more acute injuries from lunging or kicking activities as well as contributing to lower back stiffness.
As this issue of hip flexor tightness and low back stiffness progresses it creates an imbalance through the lumbopelvic region which can force our hips to tilt forward. This accentuates the hip and low back tightness and stretches out the lower abdominal, gluteal and hamstring muscles which then get weak.
Hip flexor pain is usually felt as a deep and poorly localised ache across the front of the hip and into the inside of the groin. As the hip flexor continues to get tighter it can rub across the top of the pelvic bone and give a clicking or snapping sound known as 'snapping hip' syndrome. In addition to this it can also create an ache through the lower back and abdomen.
In our experience hip flexor tightness is the most often missed component of low back pain. And when we see clients with low back pain who have had a course of treatment and not fully recovered it is often because the hip flexors have been overlooked.
The good news is that hip flexor dysfunctions are readily treatable. A good treatment plan always begins with an accurate diagnosis, which should focus on assessing the hip joint and the lower back to ascertain all the contributing factors. You will have discomfort on a passive hip extension stretch as well as when activating the muscle, such as when doing a straight leg raise. There will generally also be a restriction into lumbar extension or when bending backwards.
Treatment consists of avoiding the aggravating activities, releasing through the hip flexors (not comfortable), mobilising through the lumbar spine and then progressing through a series of stretches and strengthening exercises for the hip and lower back to correct any abnormal biomechanics and restore normal length and strength to the muscle.
So here’s 3 tips to help minimise the risk of hip flexor injuries arising in the first place:
1. Make sure your chair is set up correctly and avoid sitting for longer than 45 minutes at one time. Stand up and walk around for 30-60 seconds to prevent your hip flexor muscles tightening up.
2. Engage in regular low back mobility and stretching exercises, especially if you are prone to sitting for long periods (click the image below for a demonstration)
3. Engage in regular hip flexor stretches (click the image below for a demonstration)
If you do experience any of the symptoms mentioned above or suffer from recurrent back stiffness, then consult your healthcare practitioner sooner rather than later.
So that’s a brief overview of how hip flexor problems can occur, If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will happily answer them for you.
If you think you may already be suffering from hip flexor tightness or low back pain and want relief now, then call us on (08) 9486 8653 and we will arrange an appointment for you.