The correlation between the hip flexors and back pain

It is estimated that 8 out of 10 people living in this country will at some point experience some sort of back pain. That’s an alarming 80 percent of the country! Poor posture, mechanical imbalances and lack of physical activity are the major prevalent reasons behind this epidemic. Although a recent UN study now ranks Mexico as the most obese country in the world, America is still a close second with a 31.8 percent adult obesity rate. Obesity has been linked to knee, hip and ankle pain, all of which have a direct impact on the lumbar spine.

While back pain can result from a number of factors, perhaps the most common cause of it is weak and tight hip flexors.

The hip flexors are a group of muscles that enable to thigh bone to flex or allow the knee to bend towards the trunk. Activities like stair climbing, squats, lunges and sprinting all require engagement of these muscles. Collectively referred to as iliopsoas, they consist of two major muscles, the psoas major and the iliacus. The psoas major originates form the lumbar spine area and attaches in upper region of the upper thigh hip bone. The psoas is the primary hip flexor. The iliacus originates and attaches in front of the upper thigh hip bone.

Hip Flexors 2

In my experience, almost everyone has some sort of issues with their hip flexors. I’m yet to find a person with super pliable and strong hip flexors. Many of us have tight and weak hip flexors and don’t even know it until it chronically gets bad and starts to affect the low back. Prolonged sitting, not enough emphasis on glute training and excess abdominal crunching are 3 of the major causes for tight hip flexors.

When we stay in a seated position for a very long time, the psoas shortens and pulls on the lower back. Imagine the psoas as an elastic band. When the body is standing in a neutral position, the band is fully stretched in its highest elasticity. But when the body sits, the elasticity of the band gets slack and the length is reduced as a result. When the psoas stays in this slacked position for a long time, it causes the pelvis to tilt anteriorly causing arching of the low back and overstretches and lengthens the glutes.

When the butt gets too slack due to overstretching from prolonged sitting, it automatically gets weak requiring the need for more glute training. Certain abdominal crunches like the prone jackknife where there is repeated hip flexion has also been known to tighten the hip flexors. This is the reason why some us feel a an uncomfortable burning sensation in our upper thigh area while performing these exercises. This ultimately leads to low back pain due to excess stress on the psoas.

The good news is that there are ways to loosen the hip flexors and permanently prevent back pain. Activation mobility drills, self myofascial release work, strength exercises and dynamic stretches are the remedy.

1. WALL MARCHING (PSOAS ACTIVATION): This is a great drill for anyone who sits at a desk for the majority of the day. Stand in front of a wall at arms length with a neutral spine. Place both hands on the wall so you’re in a vertical push-up stance. From there, lift one knee to about hip height or slightly higher. Your pelvis should tilt posteriorly as your upper back rounds slightly. Don’t worry about that. Just make sure it doesn’t round excessively. Hold that position for about 5 seconds and switch to the other knee. Aim to do 8 to 12 repetitions per side.

2. SELF-MYOFASCIAL RELEASE: This is the most uncomfortable of all the hip flexor drills because of it’s direct contact on the fascia. However SMR is the one of the most effective ways of loosening tight muscles and restoring blood flow. A foam roller or small hard ball is needed for this, though using a lacrosse or tennis ball will work much better. Place the foam roller or ball directly under the hip flexor muscles on the floor and roll around it for a couple of minutes. To intensify this, locate a tight spot and stay on it for 20 to 30 seconds. After about a couple of minutes of doing this, you should feel some warmth in your upper thigh region indication increased pliability and restoration of blood flow.

3. STRENGTH EXERCISES: The reverse lunge and hip thrust are two great exercises for fixing tight hip flexors. As mentioned earlier, the glutes weaken and stretch as a result of shortening of the hip flexors. These two exercises serve to activate the glutes while stretching the hip flexors simultaneously. In a reverse lunge, the hip flexors of the back leg is relaxed and stretched while the butt activates. The same theory applies in a hip thrust where the hip flexors get a deep stretch at the top of the thrust while the opposing glute muscle gets contracted.

4. DYNAMIC STRETCHES: Many hip flexor stretches exist for loosening of the psoas and iliacus. Most of them are effective and will certainly help the cause if done correctly and held for a good amount of time. However one of my favorite and perhaps the most common is the half-kneeling stance hip flexor stretch. From a half kneeling stance, drive the butt of the knee on the ground forward until you feel a mild stretch in your hip flexors. It is imperative to drive from the glutes and NOT the lower back. The spine should be neutral all along and arching of the lower back must be prevented. Hold this for about 30 seconds and repeat on your other leg.

These movements and exercises must be performed routinely for results to occur. Make sure you incorporate them in your workout sessions and work and keep the intensity mild. As always listen to your body and consult with a fitness professional if you need any help.

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