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-hell 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.
Austin Horne
March 4, 2014
Hey! Nice article as this seems to be a lot of the opposite of what you read on the internet. I’ve been having pain for the last 5 months that radiates from the front of my hip down into my groin or inguinal ligament area. Sometimes this pain can be felt on the right sight of my lower back where the back meets the hip. I initially had what felt like a groin pull with strong hip pain on my right side and after a few weeks that pain died down significantly but I still get pain in the aforementioned areas after I exercise(but usually not during) that alleviates with rest over a couple days. I initially thought maybe I had a hip flexor strain and now my muscles are chronically tight from the injury and need to be freed up some.
After reading this though, I am not positive that is the case. I have always had poor posture and was ignorant not to stretch the hips before exercising. I also always used to sit at a desk for 8+ hours a day. So essentially, my hips were tight even before the injury. I’ve had an x-ray and CT scan of my pelvic area and both were normal so I’m a little lost.
I guess my question is what exercises/ stretches should I be looking at doing? Most people would say do the lunge like stretch or the quad stretch but when I do these, my body feels good for a couple of hours but the areas seem a little agitated later on. Does stretching very tight muscles cause some slight pain/discomfort the first week or so after doing PT routines? I do not want to damage myself any further.
reddyb
March 6, 2014
Hey Austin,
There are some exercise recommendations in the article, as well as in the comments. As far what exercises you should be doing, I’d have to work with you in some capacity. (Example here: http://b-reddy.org/2013/06/20/the-remote-client-process/ )
Much of what you’re describing sounds more like a lower back issue than a hip issue. (Of course, you could have things work on at both regions.)
I believe your last question is to the effect of, “Do I need to get worse before I get better?” And the answer to that is no. Sometimes this will happen as there is always some trial and error in starting out something new. But this isn’t necessary, it’s not a physiological requirement for loosening up tight muscles, and it’s something to be avoided as much as possible.
youngspewer
March 6, 2014
Sounds like a young book worm dude spewing out a bunch of boloney…..
reddyb
March 6, 2014
YoungSpewer! Where you at?
Joe D
March 7, 2014
take it to him Brian!
🙂
Joe Danna
March 7, 2014
All the time and effort Brian puts into this makes him my kind of bookworm then. I’m totally addicted to this site. Keep up the good work kid. Keg on the way!
reddyb
March 7, 2014
Haha! Thanks Joe. I appreciate it.
Natalie
March 12, 2014
My situation is similar to Joe because I had labral tear surgery on my right hip. It will be 3 years in October since I had the surgery. Although the pain that I had was gone because I can now do things that I couldn’t do before the surgery even standing for longer periods of time were painful which they now aren’t.
The problem I am having is my range of motion, tightness in the hip and even the way I bend or sit isn’t correct. I had the hip pain prior to surgery for about 5 years, taught Zumba, lifted weights (at least up until about a year before the surgery) all while having the tear so I think I was bending in ways so that it wouldn’t hurt and over compensated. So I am having problems with not going back to old habits, which I think I have and may even made some of them worse. I still can’t balance properly on my right leg, I can’t do any single leg exercises. Not because of pain but because it doesn’t feel like it’s bending the way it should.
My uneducated guess I feel like my TFL has a HUGE tigger point/muscle knot or something. Because you can see it and feel it pop out when I do certain things. In looking at that backward rocking exercise you posted on this thread I feel like that would help and feel really good on my TFL but I can’t even rock back like that in a fluid movement to where my hip feels in place (if that makes any sense) It feels like to me that when I stand or try and balance on my right leg that the TFL takes over to balance and the hip again doesn’t feel in place. So not sure if you can maybe point me in a direction to try and fix this. I thought about going back to the doctor but I figure they will just send me to PT since I don’t think its torn again or anything.
Even when I am sitting down I don’t feel like I sit properly. I also think my ankle mobility on my right foot has something to do with it because it doesn’t feel like it bends like it should. Which is probably all related somehow since all of this is on my right side. The only time I feel like I am sitting somewhat properly is when I am on the toilet (sorry if that’s TMI!!! LOL) but one of the lower ones….not ones that are higher up. But even then if I feel where the hip bends on the outside I can feel my TFL (at least I think that is what muscle it is) is all tense and tight even twitches when I push on it. Any help would be greatly appreciate!!
reddyb
March 17, 2014
Hey Natalie,
I’m sorry, but with that much going on, and your history, without seeing you in some capacity I’m really just guessing. I do help people remotely (more info here: http://b-reddy.org/2013/06/20/the-remote-client-process/ ), where you can send me some pictures / videos of what you’re talking about, and I can tell you if I feel I could help you first. Or point you to some other things I’ve written.
Lastly, do you have a particular aversion to PT? Exercise, in some shape or form, is likely going to be your answer to your problems.
Natalie
March 17, 2014
Brian – Thank you so much for your response! At first I thought I lost my whole comment because I went back to look and it wasn’t there….I was like NOOOOO I have to retype that whole thing! LOL! Anyways….the remote client thing sounds like a possibility for sure. I would love to hear your thoughts and for you to be able to maybe help me further. I don’t have an aversion to PT I guess I just got frustrated with it before because I am not sure it helped much after my surgery. I went to PT for 3 months after my surgery and maybe it was because I started doing too much too soon, like lifting and teaching zumba, I also too a crossfit class and I guess since then its been more locked up. It almost feels like it needs pulled out of the joint and that TFL just wants to hold on and not let go! LOL But I would be absolutely fine with going to PT or doing some kind of PT exercises. I actually work at a Rec Center and workout over my lunch hour so I have access to a gym. Another thing I wanted to mention is tightness where my hamstring connect to my glute. I think those are the muscles that connect anyways…if not its right at like the sits bone. Like if I am laying on my back bend my knees then let my knees fall out there is so much tightness right there. Sometime it almost feels like it could cramp up. I am a case I am telling you! Hahaha!
Joe D- YES!!! I feel the same thing!!! I can get it to fire if I am doing like a kickback but I cannot balance on that leg and do a single leg squat for the life of me! My TFL is definitely bigger then my left side (unaffected side) and you can see it pop out when I am lying on my back with my knees bent and then bring my knee together to the midline it REALLY pops out! And it twitches and is like super hard like its over worked! My gait I think is really affected by my whole issue too….I am very self conscious about the way I walk 🙁 I am not sure about the hip impingment though….I feel like it could go back but that damn TFL is tense and tightens and won’t let my hip relax into it.
Joe D
March 17, 2014
Natalie – what is probably prohibiting you from rocking backwards is hip impingement or anterior femoral glide (Brian has great info on this). I’d see a good PT.
I am interested in your TFL though. I have the exact same problem, it’s bigger than the unaffected side because it’s essentially “working” to compensate for muscles that are not. Do you have issues with your glutes on that side? Weak or inhibited? Mine are not weak per se, but if I try to do a 1 legged squat it’s very hard for me to get that glute to fire properly. Like I have to focus really hard on it to make it happen.
Would love to hear your experience with it.
Brian – should we take this convo offline (sorry to hijack your thread) Also, am considering the remote client process for myself, would just love to get your thoughts. Can’t fix this thing!
Natalie
March 17, 2014
Joe D- YES!!! I feel the same thing!!! I can get it to fire if I am doing like a kickback but I cannot balance on that leg and do a single leg squat for the life of me! My TFL is definitely bigger then my left side (unaffected side) and you can see it pop out when I am lying on my back with my knees bent and then bring my knee together to the midline it REALLY pops out! And it twitches and is like super hard like its over worked! My gait I think is really affected by my whole issue too….I am very self conscious about the way I walk 🙁 I am not sure about the hip impingment though….I feel like it could go back but that damn TFL is tense and tightens and won’t let my hip relax into it
reddyb
March 18, 2014
A kickback or a single leg squat are probably too hard of exercises for you right now. While everyone is always doing them, doing them properly, without compensation, is actually quite difficult.
reddyb
March 18, 2014
Hey Joe,
Feel free to discuss!
My experience with a larger TFL has been what you’re stating: A hypertrophied TFL often goes with a posterior glueteus medius that could be working more. Basically, the person’s knee is turning inwards more than it should be. TFL helps turn the knee in; PGM helps turn the knee in.
So, I tend to have a considerable focus on this person doing activities where their knee does not turn inwards. Standing on one leg, squatting, abduction, etc.
nvernon
April 12, 2014
Hey so I ran into this article on google and was just curious if you could solve a mystery of mine.
So I’ve strained i believe my levetor scapula on my left side a couple of times lifting weights usually on lat pull downs but now when i stand for long periods of time my left shoulder is a little uncomfortable and also been getting a little lower back pain every here and there and anterior hip pain but only after i flex it up as if to stretch my gluts (pulling my knee toward my chest).
What would this entail i’m baffled i’ve seen things saying it could be overused lats from certain fitness professionals online and also in books it seems like i could have tight hip flexors.
What do you think? I’m a fitness professional as well but there are so many different views it seems
reddyb
April 16, 2014
Not exactly sure what you’re asking.
If you’re asking if I think tight hip flexors, and thus stretching them (like I outline in this article), is a good idea for your hip pain, that would be almost certainly no.
If you’re asking if overused lats are the reason for your hip issue when you flex your hip, then I’d say that’s not where I’d be spending my time trying to correct things.
Lukas
May 15, 2014
Hey mate thanks for this article.
So I had this problem of lower back pain and an this forward tilted hip and it stopped me lifting 2-3 years ago. I went to several physiotherapists, but they couldn’t help me..
One even told me to stop doing sports for ever and only swim for the rest of my life (I was 17 lol), but they scanned my spine and it was just fine..
So as you already said in another article, I went on the internet and found out that i should stretch my hip flexors and that i probably had tight quads also. But whenever I did leg extensions in the gym, i magically felt instant pain relief and better posture…
I started lifting again few weeks ago and now i have this lower back pain and this unstable posture back. My posture is pretty similar to the guy in the first picture, and my knees are slightly rotated inwards.
Would you suggest to keep on lifting? Should I actually try to stretch my hamstrings and try to train my hip flexor again? This stuff is rly confusing since there aren’t many ppl around that know their stuff.
Thanks, Lukas
reddyb
May 19, 2014
Hey Lukas,
Sorry man, these questions are too involved to answer without seeing you, working with you, etc.
In general, there are always resistance training people can do. It’s more how you do things than what you do.
Thais
May 27, 2014
You. Are. Awesome. Thank you so much for writing this.
I practice a lot of yoga, and in the past few months I’ve had a lot of trouble with my hips. Lately, I’ve regressed noticeably in terms of hip flexibility; at least any pose that would bring my thigh and knee anywhere in the vicinity of my chest in a bent position. I would always feel an intense pain in the crease of my bent leg, and if on my left side, often my sciatica would get pinched.
I googled, asked around, and always got the same answer, tight hip flexors from sitting a lot. “Stretch the crap out of them!” “Sit on the floor, not the couch!” “Do more yoga!” Off I went and the more I stretched, haha, this stretch: [http://www.yogajournal.com/poses/2494], and sat on the floor, the yoga poses I was already having trouble with got harder and more painful to do. It got to the point where I couldn’t do poses that I had no trouble with even when I first started.
I always avoided sitting in a squat because I thought that would exacerbate my hip problems since I was “shortening” even more my hip flexors. Then I read your article yesterday. Total game changer. While I was at my computer, I grabbed a book, slipped it under my heels, and sat in a barefoot deep squat for the whole time, getting up to stretch my knees out every 20 minutes of so.
Last night I was laying in bed and stretching to relax my muscles when I decided to try a pose that has been intensely painful to do lately, this one: http://www.yogajournal.com/poses/2497. I don’t have any problems getting my thigh and knee to my torso as long as my leg is straight, like forward folds and such, but ask me to bend my knee and my entire leg tenses up in anticipation of the hip pain and I can’t do it. Last night though, I did it. Without having to warm up with an hour of yoga first, and with less pain than I’ve felt in months. I really wasn’t expecting so much improvement so quickly.
I think if I continue to sit in a squat and do that backward rocking stretch the pain in my hip flexor should eventually disappear. Do you have any other suggestions? Especially during passive activities, like sitting or standing, since it’s how most of my time gets spent. I don’t want to have to stretch to undo the damage caused by the way I stand and sit. I want to just not cause damage in the first place.
Oh, and I think I should mention, when I get tired while standing my hips definitely move forward and I tuck my butt in. Total “femoral anterior glide” happening unless I pay attention.
Sorry for the novel, but I’m stupefied right now at my improvement!
reddyb
May 30, 2014
Hey Thais,
Great to hear this mentality has worked well for you. I like that pose you sent me. Something you want to be careful about trying to do too much of too soon, but it’s of the same idea. It’s like a supine Backward Rocking.
As far as sitting, go through the comments on this post. I rattled off some sitting tips.
In terms of standing, check this out: http://b-reddy.org/2013/12/09/cueing-people-out-of-hip-extension-while-standing/
Hope that helps.
Mark S.
June 3, 2014
Hi
I’ve suffered with long term back problems that have become more severe in recent times but manageable. Mainly, I suffer with tight lower back muscles, recurring quadricep strain and pain in my hip flexor. Me and my chiro both believe it’s hip flexor related but he believes its tight. However, no matter how much I stretch neither the hip flexor nor my quad releases (massage only helps a little). I personally believe that my hip flexor is actually very weak but unsure how this would relate to a tight quadricep. I’ve stopped stretching my hamstrings as I suffer from anterior pelvic tilt but maybe your right in that I’m just in massive extension all the time. Sitting cross legged on the floor seems to help.
What advice would you give me? I appreciate any response you give.
Regards
Mark
reddyb
June 6, 2014
Hey Mark,
Sorry to hear about your issues.
If I can’t see the person, it’s very hard for me to give specific advice. Particularly with lower back issues. In general, you don’t want to focus so much on strengthening or stretching a particular muscle. Especially with the lower back, you want to focus on how that area is moving. I’ve written about this throughout the site. Feel free to search around.
Might be of interest to you: http://b-reddy.org/2013/06/20/the-remote-client-process/
Caitlin
June 11, 2014
Hi there,
My names Caitlin and I’m a 14 year old dancer, I recently (3 months ago) started to feel a pinching pain in my left hip flexor when i lifted my leg slowly to the front or side, It has started to get worse which is extremely irritating because i need to be able to lift my leg. When i was younger (8 years old) i suffered form a really painfull lower back – the chiropractor cracked it and it came right (it was my left hip in my lower back area) I have minimal knowledge but would these to injuries be linked and how can i stop the pain in my left hip flexor? My hip flexor hurts when i lean slighty (a few centimetres) foward on it.
Thank-you.
reddyb
June 13, 2014
Hey Caitlin,
Have you tried the Backward Rocking exercise? That’s usually a nice start.
This has some good info on adjusting your standing, such as making sure you don’t lean the hips forward: http://b-reddy.org/2013/12/09/cueing-people-out-of-hip-extension-while-standing/
Then, going with the theme of this post, and especially being a dancer, you’re going to want to look at the type of stretching you’re currently doing. Driving your hip into a bunch of extension, which many dancers routinely do, is something you’re at least going to want to take a break from.
See how the above goes for you. Hope it’s helpful.
Amber
June 28, 2014
Hello there,
I really appreciated coming across your site here. I have lordosis/anterior pelvic tilt, and have always been told to strengthen the glutes/abs, and stretch the hip flexors and lower back. However, it would appear only half of that information is correct, as I do stand forward at my job. I am a cake decorator and for the last 10+ years or so, I stand over a table, and my posture looks very similar to the photo you show above. Although I often put most of my weight on my left hip… Recently, I have been having bad pain in my right hip flexor/groin area, and barely able to walk…feels like one leg is longer than the other…and hip flexor stretches only aggravated it. It seems to get worse with prolonged standing, or at times with being seated as well.
After reading the info on your site, I have come to the conclusion that what I really need to be doing is strengthening my lower abs and stretching my lower back, hip extensors and hamstrings. Does this sound correct to you based on the information I gave you?
Thanks again!
Amber
reddyb
July 3, 2014
Hey Amber,
Just FYI, there is more info on a swayback posture here: http://b-reddy.org/2013/09/24/correcting-a-swayback-posture-by-changing-how-you-sleep/
and here: http://b-reddy.org/2013/07/21/looking-at-pelvic-tilts-the-hips-only-tell-you-part-of-the-story-an-anterior-pelvic-tilt-doesnt-mean-your-hips-are-flexed/
If hip flexor stretches aggravate your pain, then it would appear you’re heading in the right direction. Without seeing you in some capacity though, tough for me to say much.
rebecca
August 22, 2014
This was really interesting, thanks very much. I’m going to do some more research on this. I created a blog here [redacted broken link] to document my ‘hopeful’ recovery. I will be posted some pictures in the next few days of my posture when I first started out. Hopefully it will help people who have the same issues. Ps I’m not a doctor or medical student, just documenting stuff 🙂
Scott
August 24, 2014
Hello, Scott, 25, UK. Found this site through some strenuous googling to try and solve my hip pain. In the past I have always been told that I have had tight hip flexors and have had trouble hitting squat depth whilst keeping the weight on my heels. I was told it was tight hamstrings and hip flexors a lot. And so i was given the classic hip flexor stretch you mention above to do on a daily basis. Now I can’t even do a lunge without my stretch flexor feeling like it’s going to give way. To locate my pain it is right at the front of my hip slightly to the outside, left leg is the worst, I can bring on the pain quite easily if I lift my leg bend at the knee and rotate laterally outwards, opening up my hip, “opening the gate” as it’s known. My doctor said it was a groin stretch and to do adductor strengthening. This has not helped the pain. Little lost here as it seems there is so many things that it could be? Have you any applicable link to helping me solve this?
reddyb
August 26, 2014
Hey Scott,
You can try looking at the hip pain category: http://b-reddy.org/category/pain-2/hip-pain/
A pause from stretching your hip flexors, like I go over in this post, would likely be a good idea. Beyond that, I’d need to take a closer look at you. I wouldn’t be surprised if you had something structural going on at your hip preventing you from certain motions. Such as squatting past parallel.
I write about retroversion and anteversion in this post: http://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
But I don’t have anything on limited hip flexion ability yet. I know a couple of other people out there do. But I haven’t read anything in depth from someone else.
Lastly, stretching the hip should never be painful.