The hip flexor muscles are located in the front of each hip and act to flex (bend) and externally rotate the hip and trunk. They also have an indirect function of stabilizing the spine due to the attachment on the lumbar spine. Individuals with weakness in the core musculature often develop compensations resulting in tightness of this muscle. It is one of the "helper" muscles that stabilizes the pelvic girdle and lumbar spine when the core is not functioning properly. However, increased stiffness or trigger points (involuntary muscle spasms) can lead to pain and dysfunction, contributing to hip, pelvic and low back pain and instability. In addition, the gluteus maximus muscle (largest muscle in the body) cannot work on the same side as tight hip flexors and can contribute to "dead butt syndrome"...more in another blog.
I have struggled with core strength most of my life due to chronic gut inflammation and digestive issues, rendering my deep abdominal muscles weak. Cleaning up my diet was essential, but the nervous system in its amazing protective mode continued to keep my fascia tight and contracted. I was unable to release my tight hip muscles until I discovered visceral mobilization, a form of myofascial release to the abdominal wall to improve mobility and function.
Since I specialize in treating pelvic girdle dysfunctions, almost every person I treat has tightness in the psoas muscle, one of the hip flexor muscles. I no longer dig deep to massage this muscle since I found a more effective treatment that is longer lasting and offers more of a cure. Here are my TOP THREE RECOMMENDATIONS for TIGHT HIP FLEXORS.
1. Just BREATHE
How many of us hold our breath and do not take a deep, restorative breath all day? I am guilty of holding my breath until the last task is done for the day and I need reminders throughout my day to take cleansing, deep breaths from my diaphragm. A study by Haugstad et al (2006) found that shallow breathing patterns contribute to tightness and stiffness in the psoas muscles. DIAPHRAGM BREATHING can be accomplished by lying on your back. Inhale for a count of 5, allowing the breath to go into the abdomen and pelvis (your abdomen should inflate). As you exhale, the abdomen should fall or deflate. Breathe in through your nose and exhale through your mouth, slowly and rhythmically about 10 times. Repeat as often as you are able throughout the day, to reduce stress or to help you fall asleep. You will feel a sense of calm and relaxation throughout your entire body, helping also with tension in other parts of your body.
2. Get Help From a Manual Therapist Skilled in VISCERAL MOBILIZATION
RESPIRATORY DIAPHRAGM RELEASE. Many of us struggle to take in a deep breath, often using the upper respiratory muscles to breathe, which encourages more tension in the neck and shoulders (sound familiar?). This can be habitual or because of restrictions in diaphragm excursion due to adhesions from surgery, gut inflammation or past traumas (think sports and falls). Visceral mobilization is a form of manual therapy to release deep fascia around the organs and retrain the nervous system in order for the fascia to relax instead of contract, or protect the area that was once under trauma or inflammation. Hip flexor muscles will remain tight if the diaphragm is restricted; no amount of stretching will release it if there are adhesions around the diaphragm.
RENAL (KIDNEY) FASCIA RELEASE. With each breath, the kidneys move up and down. On the inhale, the kidneys descend and on the exhale, they ascend and move up. Since the core muscles work in sync with the diaphragm on exhalation, a restriction in renal excursion could limit the amount the core can contract or pull on something else, such as the hip. The renal fascia is connected to the diaphragm and the psoas muscle, and is often restricted on the right side, since the liver is the size of a 3 pound bar of soap and sits directly on top of it. This is the reason so many individuals have tighness in the right hip.
LUMBAR PLEXUS RELEASE. The psoas muscle is innervated (nerve supply) by the lumbar plexus, in the flank region of the back. If the nerves of the lumbar plexus are restricted, it causes the iliopsoas muscle to contract and remain tight. By mobilizing the nerves that supply the hip flexors, function is restored and the psoas muscle can return to its normal length.
3. STRETCH THE HIP FLEXORS
There are various ways to stretch tight hip flexors and these are my top choices. By adding the arms, it engages the myofascial system more. It can also be modified by lunging instead of half kneeling. The stretch should be felt on the front of the thigh, hip and abdomen but not in the back. Stretches should be held for 30 seconds minimum and repeated 3-5 times on each side, daily or as often as needed. Individuals who spend most of the day sitting are at greatest risk of hip flexor tightness.
FOAM ROLLER STRETCH
Disclaimer: If any of these exercises causes or increases pain, seek help from your physical therapist or healthcare provider. Exercise should never cause pain!
Photo Cred: Atlas of Human Anatomy, Frank Netter, M.D., 1989.