From A Better Quad Stretch:
“This isn’t a great stretch for those with hip pain. Form becomes absolutely crucial and you’re honestly just playing with fire if you have hip issues and you do this stretch.”
From Standing Version of the Best Damn IT Band Stretch:
“Whenever you stretch the hip flexors it is crucial to have concurrent glute / external oblique activation. “
I’ve gotten a lot of questions about this. Let’s delve in.
Two themes:
1) Having hip pain / issues does NOT = let me stretch the ever-loving-fuck out of my hip flexors. I am so tired of people assuming every damn issue in the body is from tight hip flexors. HEY T-NATION.COM, I’M TALKING TO YOU. THANK YOU FOR MAKING THE WORLD A WORSER PLACE.
I need a drink.
And 2) Other muscles are important if you do stretch the hip flexors.
Why people get hip pain
While hip pain issues arise from a few factors, there are two causes I overwhelmingly see:
1) The issue is actually from the lower back. This typically (but not always) manifests in the back of the hip. Think nerve issues like sciatica.
2) The issue is truly at the hip. This manifests more in the front / side of the hip with sensations like snapping or pinching feelings.
This will deal with 2). Why does 2) happen?
It’s nearly always because the hip is constantly held in extension. In standing the person’s posture would be as such:
See how the knees and feet are behind the hips? Just like if you were to pull your leg behind you. This is HIP EXTENSION.
What happens here is the head of the femur is constantly pushing forward on the front of the hip capsule. (Femoral anterior glide.) Bottom of the leg goes backwards => top of the leg goes forward. Similar to a lever.
But you decry, “I sit all day! My hips are always flexed! I need to stretch my hip flexors.”
Sitting can cause the same issue with the femoral head as always standing with the hips in extension. Because the majority of people’s weight is on their ass when they sit, this is where the majority of gravity is pushing. Pictures will illustrate this better. The femoral head is where your ass is.
Rotate the diagram and:
Again, notice the femoral head is being pushed forward all the time.
Next, let’s compare some of these positions with the ways most stretch their hip flexors.
You should be starting to see too many similarities…
Some anatomy
So if a person’s hip pain is caused this way, which it very often is (if it’s not it’s probably from the lower back), their hips are often in extension / the femoral head is always being pushed forward. Therefore, the hip flexors, namely the psoas, is often long / underused / weak and the hip extensors, namely the adductor magnus and hamstrings, are tight / stiff / overused.
Hip often in extension / femoral head always being pushed forward = hip flexor(s) are likely LONG and hip extensor(s) are likely SHORT / STIFF.
Unfortunately, this does get more complicated. Because not all the hip extensors are overused. The glute max and posterior gluteus medius are typically not working as well as they should. Because they attach to the head of the femur and pull it backwards, you can see how if these muscles aren’t working well the head of the femur glides too far forward.
View from the back of the legs. Glute max and glute med can pull the leg backwards. (Hip extensors.)
-> More details on the glutes: Rethinking how and why you’re training your glutes
Despite what T-Nation would have you believe, anatomy and movement isn’t as simple as all hip flexors are short so all hip extensors are weak, or vice versa.
An example: Take someone with hip issues and have them perform a prone straight leg raise:
You’ll typically see the hamstrings and adductor magnus overwhelmingly perform the movement. They will contract way harder and way before the glute max ever does, despite all the muscles being hip extensors. If you can’t see it, placing one finger on the glute with another on the hamstrings usually gets the point across: you often feel the finger touching the hamstrings get pushed into well before the finger touching the glute does.
Quick summary so far
Hip pain issues are very often due to the hips being in extension. This elongates the psoas muscle and often the glute max and posterior gluteus medius are not working optimally (they contract too late / not at all).
Back to the typical way people purport you should stretch for hip pain:
What is this stretch doing? It’s putting the hip into extension without contraction from the glutes, and it is elongating the psoas. In other words, it is doing all the things that typically cause hip pain!
Why on earth would we do this stretch for someone with hip pain? We’re putting them into the same exact position which is causing them pain!
-> Many people who have hip pain walking have the pain when their leg swings behind them. This is why: Relieving hip pain while walking
Again, not everyone on earth has an anterior pelvic tilt or tight hip flexors. (Eh em, T-Nation and internet gurus).
In fact, the stretch that will be best for someone with hip pain is almost always a hip extensor stretch. Like the Backward Rocking stretch:
Why? Because the hips are in extension / the femoral head is pushing forward all the time; do the opposite i.e. put the hips into full flexion and push the femoral head backwards, and wa-lah, pain relief.
Furthermore, if someone has a hip history, you can see, if the hip is placed into extension, it is crucial the glutes be contracted to help pull the femoral head BACKwards. Doing any type of direct hip flexor stretching for people with a hip history is often a bad idea though. At least until their symptoms calm down.
This is crucial because someone like Dan (pictured above) figured out he had issues with his TFL, however, the last thing he wants to do is a bunch of stretching for the TFL where he is putting his hip into more extension. After all, his hips’ natural position is already extension. He especially doesn’t want to be doing this if his glutes are not concurrently contracted. He has to attack loosening his TFL from a different manner.
Rick McMurria
August 10, 2017
My symptoms seem to be exactly what you describe here. My PT first told me to stretch my hip flexors but that was 4 weeks ago and I really have not seen any improvement. Yesterday they told me to start doing the stretch you’re talking about but did not tell me to stop the hip flexor stretch. My questions are, how long should I be doing the backward rocking stretch each time and how often? I’ve tried it a couple times today but have not gotten any relief. Also, my hip flexor only really hurts when sitting or when my hip is at greater than 90 degrees. Should I stop sitting for a while or sit differently? Also what do you recommend to fix the anterior pelvic tilt permanently. I believe I’ve had it for a long time. (I’m 46). Thank you for your time.
b-reddy
August 11, 2017
Hey Rick,
-A few sets of 12 reps is a good number.
-If you can lessen your sitting, that helps. But you’ll probably need to change how you sit as well.
-Anterior pelvic tilt: https://b-reddy.org/2015/11/23/8-weeks-towards-correcting-your-anterior-pelvic-tilt/
Rick McMurria
February 16, 2018
Hey Brian, I just wanted to update this to reflect my progress (or lack thereof). I had x-rays and the Dr told me I had arthritis and there was not much I could do about it except wait until the pain got unbearable and then they would do a hip replacement. I didn’t like that answer so I asked for a second opinion and an MRI. The second Dr said that he agreed that I have arthritis and the MRI also showed a tear in my cartilage. (I forgot the name of the cartilage.) He said he wasn’t sure if the pain was coming from the tear or the arthritis and he said the only way to find out was to repair the tear. Since that might not fix my pain problem and the pain isn’t unbearable I elected to just deal with the pain. Since then I have read a little and I’m beginning to feel like the problem is FAI. Of course I’m not a DR. I developed that opinion by reading this web page.
http://www.jtsstrength.com/articles/2015/05/08/the-hip-impingement-solution/
I’m curious what you think of the DR diagnosis vs the FAI. I’m starting the FAI exercises anyway just to see if it helps.
b-reddy
February 20, 2018
Hey Rick,
Sorry about your lack of progress.
With FAI, it’s important to get a grasp for the general structure of the hip. I’ve written a good deal about this in the following:
https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
https://b-reddy.org/2015/07/29/on-structural-adaptation-limitations-of-the-hip/
https://b-reddy.org/2015/08/03/hip-mobility-issues-in-basketball-players-why-the-lack-of-internal-rotation/
Most of the time, I’ve been able to get clients to where their FAI can be well managed. Tear or not. If interested: https://b-reddy.org/2013/06/20/the-remote-client-process/
Lindsey Z
August 22, 2017
How do you recommend sitting? Usually for me (I have iliopsoas tendonitis which sometimes turns into bursitis) standing up and getting going after sitting for a long time on a traditional chair with knees bent and hips flexed is the most painful and it feels like my entire right leg wants to give out and collapse. I can’t figure out how to do my job and sit all day without this right when I stand up pain.
b-reddy
August 25, 2017
Hey Lindsey,
This often requires some trial and error. Along with potentially needing to appreciate individual hip differences, for instance: https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
In brief, the two things I adjust, or at least start out with, are adjusting the seat height and making sure the knees are not inside the feet.
The higher the seat height, the less flexed the hips will be. Flexed hips, with internal rotation (knees turned in) is often the position of hip flexion people are most sensitive to. So we lessen the hip flexion, and open the knees.
That said, I’ve found hip pain and sitting positions to be much more variable than other joints. With knees, I can almost always say “do this.” But not with hips. Some people will find lowering the seat height feels better for them, due to the anterior glide issues mentioned in this article. (The higher the seat, the lower the knees relative to the hips, the more the femoral head can be pushed into the hip.)
This is where the trial and error comes in. It’s not as if you can say “Place the seat as high or low as possible.” Where a person is starting from, the type of chair e.g. how soft it is, how far the feet are placed out in front of the person, can all factor in. What I will say though is typically when making adjustments, a person will realize quite quickly “Oh, that feels better.” It just can take some time to figure that out.
Matt
September 9, 2017
I get paint in my hips when doing the rocking stretch. Is it normal when you have elongated and weak hip flexors? Im worried its FAI.
b-reddy
September 10, 2017
Short version: Try opening your knees more (but keep the feet together).
If that helps, long version here: https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
Sanny
October 9, 2017
I have APT(age23) , so i am doing kneeling hip flexor stretch to loose my hip flexors but recently while doing the stretch, i have got problem with femoral nerve in my left leg noticed that it always gets hurt while stretching and makes some sense of numbness..even pain at hip juncture along the nerve, having thees symptoms post exercise too. If i stop exercising for few days it will be back to normal , but when i start exercising again i get noticing the pain and irking again….
Though i had given enough rest for few weeks , i again noticing the same pain and discomfort while doing the stretch …Im worried how to loose my hip flexors without hurting my femoral nerve
b-reddy
October 10, 2017
Hey Sanny,
Check these out:
-https://b-reddy.org/2011/11/07/a-better-quad-stretch/
-https://b-reddy.org/2015/11/23/8-weeks-towards-correcting-your-anterior-pelvic-tilt/
Siri Miller
October 19, 2017
Hi Brian,
This article sounds like it hits the nail on the head for me. Forgive me for my lack of correct terminology in the following statements. I’ve noticed that I stand with my upper back rounded and push my hips forward. My hip flexors feel as if they are pinched and pained and my upper thighs right below the hip flexors constantly feel pain. I’ve begun to notice that I use my hip flexors for everything and rarely use my gluteus. I also suffer from lower back pain. When I sit in an L sit (with my legs horizontally straight on the floor and my back perpendicular reaching for the sky) my lower back will not go straight. It curves. This position also pinches my hip area extremely. I have no problem arching my lower back if my legs are bent, in a butterfly position, or sitting on a chair where my legs are bent. I guess my questions are as follows, do you have more exercises to strengthen the glutes in which I won’t use my hip flexors (which I seem to do all the time, even when sitting)? Also, are there any other hip flexor relief moves for overused hip flexors as well as hip extensor strengtheners? Sorry for the long rambling post. I find it hard to explain the pain and sensations in my body.
I forgot to mention that I also have extremely tight hamstrings! Very tight. I am hyper-flexible in almost every other aspect of my body, but when it comes to this hip, lower back, thigh, hamstring area, I am stiff and unable to do “easy” stretches.
b-reddy
October 20, 2017
Hey Siri,
I’d recommend looking at these.
General understanding for what may be going on at the hips:
https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
https://b-reddy.org/2015/07/29/on-structural-adaptation-limitations-of-the-hip/
https://b-reddy.org/2015/08/03/hip-mobility-issues-in-basketball-players-why-the-lack-of-internal-rotation/
And this for specific help: https://b-reddy.org/2013/06/20/the-remote-client-process/
Stu
November 29, 2017
Thanks for this great article. I’ve spent the last few months trying to hone my squat form by deloading and getting proper depth, trying different stance widths, etc. In addition, I do the famous frog stretch (which I’m guessing I shouldn’t be doing based on this article), third world squats, and a few other mobility exercises.
Squats cause me pain in the hips. It just won’t go away. And my numbers are atrocious. I workout 5-6 times per week, can bench 225×5 but can’t comfortably squat more than 135×5 without feeling like my body is going to fail. And my numbers on squat will not progress. I feel that my glutes are definitely holding me back as well. Should I do glute bridges? Would that help with the hip pain as well?
b-reddy
December 1, 2017
Hey Stu,
I doubt bridges would be the fix. More than likely, you need to change how you squat. Some other corrective work could be helpful, but squat technique is probably the big one.
If you’re interested in getting more specific help: https://b-reddy.org/2013/06/20/the-remote-client-process/
Jorge Maiquez
December 20, 2017
Hi Brian,
I crashed my bike 5 weeks ago during training (amateur triathlete- 40), and the entire impact was on my hip (the head of the femur). The emergency room doc said nothing was broken, sent me home on crutches and told me to make sure to stretch the muscles in the hip area because things could get tight and my range of mobility might be affected.
It’s been a very slow recovery! I was on crutches for a full 4 weeks, and during that time I was not able to shift weight from my left (good) leg to the right without feeling like someone was sticking a knife into the outside of my hip. That pain is pretty much gone now, but I still walk with a slight limp, and it still hurts when I shift all my weight from the good to the bad leg (rocking from side to side until the legs lift off the floor). But this time, the pain feels more like a tendon/muscle type pain (for lack of a better description). I still can’t put on my left sock from a standing position because it feels like my right hip/quad/groin is about to give out.
And when I do a standing leg raise, where I raise my bad leg to my chest, it feels like something is compressing in the fold between the leg and the pelvic area- lots of grinding/crunching discomfort (not really popping).
As per the doc’s recommendation, I’ve been stretching for about a week, but I think it’s making things worse. I’ve not been very scientific about it, just doing stretches that I remember from “the old days”. Your article makes it crystal clear to me that I’m doing it wrong. I actually did the “typical stretch” for hip pain regularly, and I even did the moronic thing of doing that stretch by placing the backward (bad) leg on a chair and then dipping quite deep to give the hip an extra deep stretch (I think that’s when the compression/grinding pain started).
I’ve stopped all stretching now because it’s clearly not doing me any good. Besides the Backward Rocking stretch, which stretches would you recommend for me to get hip mobility back without messing myself up even more?
Also, I sit pretty much the whole day. Should I try to lie down more often?
Apologies for the long comment and for all the questions! I’m just starting to panic a little now out of fear that this will become (yet another) chronic pain that I carry with me. And I need to start training again ASAP, before my wife throws my grumpy ass out of the house.
Thanks for putting all this awesome content out there! I really appreciate the level of detail, expressed in a way that even a dope like me can understand.
Thanks & all the best,
Jorge from Stockholm, Sweden
b-reddy
December 26, 2017
Hey Jorge,
Sorry to hear about your accident.
Unfortunately, this article isn’t aimed at your situation. You’re detailing an acute event, but the article is much more aimed at chronic hip pain. That is, hip pain that has progressively come on, opposed to being caused by a one-off accident.
Overall, you’ve only been off crutches for a week. Things are going to feel weird.
I understand the desire to be proactive, but you could easily still be in the healing phase from the crash, where you just need to wait things out, while slowly upping your activity level within tolerable levels. (https://b-reddy.org/2016/10/24/the-variables-and-an-equation-to-consider-when-starting-a-physical-activity/) If you bruised the bone, that can take upwards of a year to fully heal, depending on the severity. Doesn’t mean you need to be inactive for a year, but the point is at five weeks, it might still be very early in the process.
Again though, it doesn’t hurt to be proactive. But if you’re looking to get more specific, I’d have to take a closer look: https://b-reddy.org/2013/06/20/the-remote-client-process/
Jorge
February 14, 2018
Hey Brian,
I only just realized that you replied to me- apologies for not getting back earlier.
In any case, the weeks since writing my initial message have given me some perspective. Your analysis was right on the money. I was still healing from the crash, and was panicking for no reason. I’m now completely healed (as far as I can tell anyways) and have resumed my training.
Anyways, I just wanted to say thanks for taking the time to respond to my message- much appreciated!
All the best,
Jorge
b-reddy
February 16, 2018
You’re very welcome. Glad to hear you’re all healed up!
Lauren Flinn
January 8, 2018
Hi Brian,
Over the past six months I have started to exercise regularly (5 days a week). The only place that I have had pain in during these months is my hip flexors (luckily pretty minor). They are becoming aggravated when I am doing core exercises – lifting and lowering legs, etc. Anything that is on my back with legs up, I can feel it in them so I know something is wrong. How can I help this? How do I get something to activate? I don’t have any pain when I squat, but I do have really tight hamstrings (every time I do deadlifts, my hamstrings are tight and sore for a few days). I also have a desk job.
I have been doing that classic stretch (one leg up, one down) you have above almost every time before and after a workout, hoping for some sort of relief. It has never provided any. I will try the rocking stretch tonight. Las week, I accidentally overdid it working out and on Saturday, I had pretty severe pain in my groin. I rested the rest of the weekend and feel better already.
Through reading the comments, I know my case isn’t as severe but I’m trying to get this taken care of ASAP so it doesn’t escalate into something bigger that is harder to treat. If you could provide me with tips to help avoid pain in the future or if you think I should see a PT that would be great.
Thank you so much!
b-reddy
February 6, 2018
Hey Lauren,
Sorry for the delay. Somehow I missed this comment.
I would read around the site for femoral anterior glide. Anterior hip pain during something like leg lifts is a classic symptom.
https://b-reddy.org/?s=femoral+anterior+glide