Last week I finally used a massage gifted to me for Mother’s Day. I explained to the therapist that I’ve been struggling with pain in my hip, side, and low back for a while now. She surprised me by focusing on the psoas in my hip flexor, and she was bang on.
The psoas (pronounced SO-az) is a core muscle that connects the lower spine to the thigh bone. Your two primary hip flexors are the iliacus and psoas muscles, sometimes abbreviated to the “iliopsoas.” Together, these muscles work to pull the torso and thigh toward each other, which allows you to lift your legs, bend forward, or bring your knees to your chest. The psoas plays an integral role in supporting the proper alignment of your spine and has little to do with your hips. This muscle enables you to maintain an appropriate posture; if its functionality is impaired, you may experience back pain or discomfort.
The therapist massaged the muscle by pressing in on the front of my inner thigh near my pubic bone and had me lift my knee toward my chest while she did so. My right psoas was so tight she had to focus on it for several minutes, but it helped a lot. I made sure to continue releasing, stretching, and massaging the muscle using the green ball for the next couple of days.
The pirate stretch is great for tight hip flexors. Kneel, then put one leg out to an angle and lean toward that leg. Don’t forget to breath!
Then an email popped into my inbox that made me wonder if maybe I needed more than stretching and release. Maybe I need some strengthening also. Just because something feels uncomfortable doesn’t mean it has to be stretched. Stretching and massage may feel great, but they won’t necessarily fix the root problem. What the muscles might actually need is to be strengthened. As this sports med therapist says, “Many people with low back pain are actually suffering from hip flexor strain or tightness. Hip flexors tend to get tight, and then they get weak.”
Yes, tight hip flexors are common. They can be caused by many factors, including: sitting at a desk or for long periods (like me just driving 7 hours each way to see family the weekend before I went for my massage), genetics (some people are born with tighter hips), or repeated or overuse of hip flexors. Tight hip flexors can limit your range of motion and can also contribute to weak glutes. To prevent tight hip flexors, you can:
- Stand up and move often throughout the day
- Warm up before exercising
- Start slowly when trying a new activity and gradually increase the intensity
But weak hip flexors are also very common. This can be due to a sedentary lifestyle (did you know Americans sit an average of 9.5 hours a day!) since sitting for long periods of time can shorten and tighten hip flexors, while a lack of exercise can weaken them. A lack of walking can also lead to weak hip flexors, but so can being a runner. Hip flexors can become tight and weak from repetitive use, especially during distance running. Tight hip flexors can cause a shorter stride, which can lead to injury.
We do lots of hip flexor stretching and strengthening at PIH, like lunges and skater squats on the Reformer or single-leg reaches. But if you want to do more at home, some options are straight leg raises, glute bridges, mountain climbers, and lunges. One that I like is this resisted march which can be done against a wall or in a plank position, either on the floor or against a bench.
Keep your hips square to the wall as you “walk.”
Weak hip flexors can be a recipe for pain and injury, especially when combined with sitting for long periods, so let’s keep them strong and healthy!
