You shouldn’t stretch your hip flexors if you have hip pain

Posted on November 23, 2018

(Last Updated On: November 23, 2018)

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:

Cause of hip pain

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.

femoral anterior glide

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!

femoral anterior glide

-> 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).

-> Looking at pelvic tilts -The hips only tell you part of the story (an anterior pelvic tilt doesn’t mean your hips are flexed)

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.

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Posted in: Hip Pain, Pain