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.
Melanie
October 24, 2014
I have stiff hip flexors with some pain even if I try to sit cross-legged!! I can hear a popping/cracking sound if I rotate my right hip out to the side. Also right knee pain on the same side and lower back pain. I’m almost convinced I have early arthritis in the right hip~
Anyway, here I’ve been stretching the hip flexors like crazy in order to achieve my goal of doing a full front split! I managed to go into the full front splits (on the right side) this last weekend after stretching for almost 6 months. Although it’s quite painful and now I wonder if I’m making things worse and doing permanant damage!?
reddyb
October 27, 2014
Hey Melanie,
Trying to achieve a split can definitely be what’s causing your issues. Not everyone has the inherent hip structure in order to achieve a split.
In terms of “permanent damage,” you can likely make things better by not stretching your hips so extremely.
In Oz
October 28, 2014
Thanks so much for your site, it’s great seeing things explained so clearly, and makes a lot of sense as to why stretching the hip flexors isn’t always the answer.
I’ve had lots of back and hip issues, including sacro-iliac pain and a left labral tear, but both physios I’ve seen agree that the main issue is that my pelvis has gotten out of whack and my left glutes have switched off and my left hip flexors are over-compensating. Any past attempts to build up the glutes have resulted in too much anterior hip/groin pain on the left so the pelvic-specialist physio I’m seeing at the moment wants me to learn how to switch off my hip flexors and my pelvic floor (all of which have been over-compensating in unhelpful ways) before we can move ahead with strengthening stuff.
I do release stuff (such as rolling on a plastic massage thing) to try and switch off where the glutes are gripping at the back on that side.
It all makes sense to me, but I have to sit for long periods during the day as I study full time, and where the flexors run through the groin at the front on the left they are now feeling rock hard and sore and seem to be firing almost 24/7. The physio I’m seeing gets me to do lots of mental imagery stuff with different cues (where I have to imagine the sitting bones melting / widening, the femoral head getting heavy and sinking back into the acetabulum, etc) to try and get it all to stop gripping, but none of it seems to be working particularly well…just wondering what you think about these sorts of mental-imagery-exercises, and whether you know of anything else (dry needling? botox?) that could get this muscle to switch off so we can move forward with rehab and decrease the pain. Thanks in advance!
reddyb
October 31, 2014
I implement some mental imagery exercises myself, although it sounds like in a pretty different manner than what you’ve been doing. You can read a detailed account of this from me here: http://b-reddy.org/2014/01/05/implementing-the-concept-of-mirror-neurons-into-an-exercise-setting/
It’s a very small part of my approach, and in no way a substitute for actual movement -it’s a coupling measure; not a replacement, but I definitely use it.
My hunch with you is the manner in which you’ve tried to work your glutes was inappropriate. I see a lot of bridging and such from people, where they go crazy squeezing the hell out of their ass, and this doesn’t work in this context. It’s much more about getting the glutes to work properly; not merely working the hell out of them. One of my favorite methods to work the glutes can be found here: http://b-reddy.org/2013/02/27/proper-form-for-the-bird-dog-exercise/
(There is also a dissociation here with the glutes between daily life and exercise. Exercise you want to get them working properly. Daily life, you usually want to get them to stop gripping and relax.)
I also avoid foam rolling, rationale (with specific reference to the hip) here: http://b-reddy.org/2013/05/20/issues-with-foam-rolling/
Have you played around with your sitting position? That’s something with strong implications for the hip, especially with anterior hip pain. I cover this some in the above post and the comments.
Anything involving an injection I think is almost guaranteed crap.
Hope that helps.
Carol Aitchison
November 23, 2014
Hi, please could you advise me.
Nearly everytime I do lunges I get a left leg adductor magnus pull. I have been told that my left glute doesn’t fire aswell as it should. This has been an ongoing problem for a couple of years. I can still train reasonably when I am not injured and have done a marathon, several halfs and a couple of triathlons this year. I do all my exercises given to me by my physio and know that if I can stop getting adductor pulls then I would be able to do much better by being able to do lunges, squats, general leg strengthening etc. Any advice would be grateful, thanks – Carol
reddyb
November 25, 2014
Hey Carol,
I’m sorry but this is pretty vague. I’d have to take a good look at you in order to give you some kind of explanation.
There may be something to the left side glutes not firing well. I’m not sure what exercises you’ve been doing to try to get them to fire, but in my experience, most people go with bridges, squats, lunges, etc. These are not good choices.
Carol
November 26, 2014
Thanks for the reply, I have recently had a movement screen using physiotec so will see what my physio sets next time.
Mick Seymour
January 14, 2015
Brian, your blog is very intriguing to me and seems to support my main concern with my left hip. In short, I have arthritis in my left hip at the young age of 47. I have always been unusually flexible for a man and my hamstrings are very flexible and may be too flexible. I started having hip pain in the crease of my leg a few years ago after becoming very active with personal training and yoga. I am convinced that hip openers in yoga and now a consistent stretching outside of yoga have my hamstrings at a point where they are not pulling my femoral head backwards sufficiently. I think I am feeling my femoral head bumping up against the front of the socket and when I bend over to pick something up for example, I feel a slight pinch in the crease of my leg. I was also told that I have weak glutes by a physical therapist. This is my best guess and I am considering drastically altering my yoga pursuits or dropping it all together for a while to see what happens. If you had to strengthen glutes and the hip joint in particular so that my femoral head is pulled backwards, what 1, 2, or three exercises would you do to accomplish this or help this? Any guidance you give here will be appreciated. Love your blog.
reddyb
January 16, 2015
Hey Mike,
-Yoga is a typical activity which brings on hip pain of this sort.
-You may have your terms mixed up some. The hamstrings become *too* active in pulling the femur back; the glutes not active enough.
-There are the two exercises in this post, prone leg raise and backward rocking. Those are two I use quite often. Although I’ve gravitated more towards a quadruped leg extension (bird dog) instead of the prone leg raise.
Notes on the bird dog here: http://b-reddy.org/2013/02/27/proper-form-for-the-bird-dog-exercise/
If you go through the comments on this post, you’ll see other exercises discussed as well.
Dale
January 20, 2015
Your blog is very informative and interesting. So far I think I’ve fooled a number of physiotherapists, doctors, and just about everybody except for my massage therapist…. Transitional L5, large contained L4/L5 disc into the left L5 nerve root but affecting S1 ankle reflex as well as L5 big toe test. Progressively getting worse with PT/conservative care (5 months of that) after 5th flare-up (my first incident on that disc was 15 years ago). Fast-forward 7 months…. disc was trimmed (surgery), S1 ankle reflex is ‘just there’ instead of gone, muscle strength testing is improving, L5/S1 pain gone, foot drop gone, still some tingling. So far so good, but now the hip pain, sore (and rock-hard) adductors, sore (sometimes painfully so) groin, and fatigued shoulders, neck, and outer back muscles…. The question I have is how you know when you can start dealing with the hip issues safely without unleashing the risk of re-herniation. I have been ‘extremely tight’ since the first disc flare-up (yea, 15 years), but since there was no surgery involved, PT/massage kept that manageable early on. I’ve been ‘brewing’ everything else for the better part of half a year now while keeping that L4/L5 as still as possible. The groin pain is worse if it stays still then I try to move (say, sitting down for an hour, then get up). If I go for a walk it calms down, I can walk for hours without pain. Any thoughts?
reddyb
January 22, 2015
Hey Dale,
I start dealing with hip issues immediately. Off the top of my head, I’m not sure there is a single musculoskeletal / orthopedic issue in which someone should not be exercising immediately. This includes people fresh out of surgery. They should be moving the *day* of surgery.
Particularly with the hip and lower back, they are so closely connected one should really be addressing both concurrently. Technically, you can’t address one without the other. (Whether or not that’s intentional is a different matter.)
Dale
January 23, 2015
Yes, I was moving literally the day of the surgery and have followed the physiotherapists’ and surgeon’s instructions – possibly too literally. There was an exercise program (with an instruction to ‘walk as much as tolerated’ with no maximum stated) plus no bending/lifting/twisting. Daily, I do about 3 to 4 hours between cardio, walking, and the various exercises and stretches assigned (along with holding a desk job, though I use a standing workstation and take frequent breaks). Though I’m no expert, I think the hip issues and the disc issue (not the initial herniation but the last flare-up) were somewhat connected and prior to surgery an athletic therapist recognized the hip issues. I was working on that, but the leg pain got progressively worse. The disc issue seemed to be disguised by the hip issue when doing the physical testing (SLR, etc) and nobody else thought I had a disc issue except for me, my massage therapist, the EMG, and of course the MRI.
I believe that the program up to now has been controlling and strengthening the TA/multifidus primarily but also some work on glutes; the hip problems seemed to be in the background – I functioned for four or five months pretty much pain-free, but adding more exercises as sort of a normal post-discectomy progression started flaring up the hip issues (slowly) again, but it is now uncomfortable to the point that I need to deal with both now.
My physiotherapist has added three hip stretches which have helped some, though my adductors still get plenty upset and where the inguinal pain is from, that I don’t know. I know the gracillis and at least one other big one (adductor magnus?) are rather tight and can get painful.
The previous therapist recognized incorrect glute firing so she had me do an exercise for that, plus adductor+hip flexor + quad + hamstring stretches. They may have been helping the hip but my leg pain was pretty bad. Reading your article here got me interested in exercises for the hips and whether the hip flexor stretch really was the right thing to do – and also got me curious as to what would be safe to do with both a modified back and the hip issues. I really don’t want to be one of the 10% that re-herniate….
Thanks again!
Dale
February 4, 2015
I asked my physiotherapist about this and his concern is with a sacralised L5 and the 7-month post-op disc stacked on top of all of that, he does not want to move the pelvis around any more than necessary. There’s an extra inch and a half of leverage on the disc when compared to a normal human and he wants more time to make sure that the disc and back are stable first. If there was a good disc separating the two (as a normal person would have) then he’d probably go after the hips more aggressively. For now he wants me to go with massage/release on the hip muscles (glutes, TFL, adductors, piriformis), a few stretches for that, and let the hips shift around on their own as dictated by what my back wants to do.
reddyb
February 6, 2015
Perhaps we’re getting terms mixed up.
Preventing the lumbar spine from moving is the same as preventing the pelvis from moving. Preventing the pelvis from moving is *not* the same as preventing the hips from moving. The hips can flex, abduct, extend, adduct, externally rotate, internally rotate, all without the lower back moving. In fact, this is how you usually want to go about helping someone with a lower back history i.e. get their hips to move more and their back to move less.
This is why you can’t address one without the other. If you prevent the lower back from moving, then the hips have to move more. (This is a good thing.) If the hips don’t move enough, then the lower back has to move more. (This is a bad thing.)
In my experience, the overwhelming majority of “hip stretches” people do are concurrently stretching / moving their lower back. I discuss the adductors and the lower back in this post, as one example: http://b-reddy.org/2015/01/28/misunderstanding-femoral-adduction/
As an aside, and this may be pedantic, but with things of this nature, one shouldn’t be going after anything “aggressively.” At least not with the literal term of aggressive. (Focusing on one area and aggressively going after one area typically mean different things.)
Ben
January 24, 2015
Hello, Brian. I am an 18 years old and currently in my senior year of high school. I am fascinated by the way the way pain is referred in certain spots of the body when posture is misaligned, and I find this post very interesting. I’m an athlete in high school and I have experienced some hip dysfunction of my own. Last football season I broke my foot and was in a cast for a month and a half. When to unrestricted activities in the off season I developed a severe low back pain around my left sacroiliac joint and lumbar spine. I could not squat to save my life. I went to the chiropractor and massage therapist. They didn’t help, but they did inform me that I had a lateral pelvic tilt. After googling for many hours I came to the conclusion that my psoas was referring pain to my back and I began to stretch the crap out of my psoas/hip flexors and I did some self massage along the psoas. After about 3 months of no real lifting or physical activity, it seemed to be better. However, now I am experiencing troubles with the front of my hip. It feels like the tendons/ligaments (I’m unsure) are getting caught together. Flexing my hip forward, when standing, feels mostly normal, but it’s when I flex my hip and externally rotate it that I get the catching/sticking of the ligaments/tendons. Also, when I am in a standing position and contract my abductors bringing my leg outside laterally then swinging it across my body and over my right leg in a “pendulum” motion, I hear a pronounced “Pop.” Lastly, when I’m in everyday situations (Standing, laying on my back, sitting with my left leg crossed over my right leg sort of like the number 4) it seems like my legs are always slightly externally rotated. I have tried different foam roller routines, but it feels like I’m running in circles. I don’t know if this is snapping hip syndrome (I don’t think it is) and I don’t know if it is my psoas, adductor magnus, piriformis or other muscles causing this because it seems as though many sites contradict each other. Any insight on my problem would be very much appreciated. – Ben
reddyb
January 26, 2015
Give these a read. I think they’ll be useful:
Think about what happens when you have a broken foot and can’t push off as much while you’re looking at this one: http://b-reddy.org/2013/06/13/relieving-hip-pain-while-walking/
I would take a look at your hip structure as well: http://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
Lastly, don’t stretch the crap out of anything! Be gentle to your young hips. You may need to even things out sort of speak and work yourself (gently) back into some hip flexion. (May also be worth looking at: 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/ .) Such as the quadruped rocking. But start with the first two links above.
Anton
January 31, 2015
Hello Brian! Very good article! I was thinking you might be able to help me out a little bit with my hip.
I’m 21 years old and have been weightlifting for about a year. Squatting almost twice a week since the beginning. In the very start i had horrible form, meaning i hyperextended my back, putting my hips faaaar back. As you can imagen this puts my hips in an extremley bad position. Also caving my knees inwards, as soon as i was applying force, going upwards. Nowadays my squat form is good with solid spine position and, still trying, keeping my knees out. Note that it’s not a problem without weight and when i do this i feel nothing. It’s not like my knees cave in without it being heavy.
Recently i’ve been experiencing some kind of pinching pain in the hip flexor region (upper quad) when applying force to the up motion in the squat, still only with weight on my back. And i don’t really know how to fix this. I try to do glute activation drills however it still hurts in the hip region when applying pressure trough my heels. I also get a pain when lifting my leg up towards my chest, however only when i keep my leg straight ahead of me, if i let it drift out a little bit i still feel it but it doesnt pinch as bad. I also “suffer” from that knee behind hip posture thing, so when i stretch my hip flexor, holy shit, it gets even worse.. After some squat sessions ive also become really stiff in my low back and i have no idea if this has to do with the psoas as i understand it attaches to the spine?
Well, yes thats my story and since its not super bad i still want to fix this before it gets even worse, so what would you suggest? I’ve read alot of your posts however im not really that into the anstomy and names of everything so would be great to get some kind of drills or what so ever that you think could help me. I know glute activation is key but still as i apply pressure hard through my heels contracting my ass in the hole of the squat i still feel this pinching feeling. Any stretches or what so ever? Btw my inne thighs a really stiff and also the “tear drop” part of my quad hurts extremly much when foam rolling. I forgot to mention that when i had the back pain/strain i just did a regular stand up quad stretch and it went away.
I forgot to mention that i don’t get that strain in my low back anymore, but instead i get this hip pain
Thanks for the great posts, not alot of people seems to know what they are talking about when it comes to the hips!
reddyb
February 1, 2015
Hey Anton,
-There are exercises in this post -Prone Leg Raise, Hip Rocking- as well as a lot of discussion regarding exercises in the comments, with more links. I’d look at those.
-I discuss foam rolling a ton in the comments as well. I wouldn’t be doing it.
-There are other things to look out for when squatting. Such as hip shifting -hips moving to the side rather than staying square (facing ahead).
I’m not trying to be brief, it’s just the comments have a lot of this already in there.
Arjun
February 4, 2015
Hi, your article(s) are superb. In fact, have helped me more than any of my previous physiotherapists have managed to do. I have always believed my hip flexors have been chronically tight and following the advice of my physiotherapist, have been stretching them like crazy for the best part of 2 years, with zero success in terms of getting them feeling better.
My issue is that my right leg feels a bit longer than my left. When standing up straight I feel a lot more pressure exerting into the ground through my right leg, which makes standing extremely uncomfortable, and forces me to shift over to my left just to be able to stand for any period of time.
I have been to chiropractors and had myself x-rayed and apparently my legs are the same length but the pelvis is slightly tilted . I have had several chiropractor sessions and they have basically done all they are able to do and said that I am straight enough, however I still get a lot of impingement/cramping/pain in my psoas (very annoying whilst driving) and I am constantly having to consciously contract my quads/glutes just in order to stand straight.
Would you say this is an issue of weak psoas? I do believe I have a slight anterior pelvic tilt which would mean that my psoas is constantly over stretched. I have also been following some of your recommended exercises such as backwards rocking stretch and toddler squats which have definitely helped but I was curious as to whether you knew about anything specific I should be doing with a problem like mine.
Many, Many Thanks
reddyb
February 8, 2015
Hey Arjun,
Thank you for the nice words.
-If you feel more pressure on one leg while standing, you may simply be standing on that one leg more. Such as this picture: https://breddydotorg.files.wordpress.com/2013/09/standing-on-one-leg-lateral-pelvic-tilt.png
-You need to look at more than the hips in order to get a feel for what may be going on with the psoas. More info 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/
In my experience though, cramping deep in the hip, especially with significant hip flexion (usually knee above hip), is a sign the psoas isn’t working as it should be. For instance, when I see people cramping in this exercise:
-X-Rays aren’t necessary to figure out if one leg is longer than the other. In fact, based on how the X-Ray is done, you can come up with false information. More here: http://b-reddy.org/2012/12/14/properly-assessing-leg-length-discrepancies/
-I wouldn’t be consciously contracting your quads or glutes while standing.
-In terms of making specific recommendations for you, you’d have to take a look at these types of things:
http://b-reddy.org/2013/06/20/the-remote-client-process/
http://b-reddy.org/2014/08/04/phone-video-consultations/
Yves
March 3, 2015
Hello Brian i really like this article.
I would appreciate to have some help, i’m bit lost with all i thought i knew.
I’m not sure if I have an anterior femoral glide or if only my anterior hip capsule is tight.
I don’t really have hip pain when I do a full squat (without weight) but when I walk I feel a tighness in the front of my hip.
I’m pretty sure that I’m hamstring dominant so it seen logic that I have an anterior femoral glide but what i’m not sure to understand, is if a take a static pose with my left foot in front and my right foot back and I push my hip a little bit forward I feel that tightness in my right hip.
If i contract my butt in that stance and I push my hip forward it seen to be even worse. Is there a reason because my hamstring does not seem to work at all in that static position.
I’m sorry to add more variable in my question but i also know that my high right medius gluteus seem to be overactive and when i walk after 10 minutes i feel some pain also in my lower back / high butt.
I hope that my question is understandable. (I’m not so good to write in english)
thank a lot for your work.
reddyb
March 5, 2015
Hey Yves,
-Just because it feels tight, doesn’t mean it is: http://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/
-Squeezing the glute, especially at terminal extension, or towards terminal extension, is a common way to exacerbate hip pain of this sort. That’s why squeezing the hell out of the glutes doesn’t get the job done. Timing is what matters most; not how hard you squeeze.
-Hip issues and lower back issues often go together.
Lisa
May 20, 2015
Hi Brian,
I’ve had a constant throbbing pain on the top of my knee (where my quad muscle connects) for years. I’ve never had a specific injury or broken anything. I kind of just chalk it up to “overuse.” I cycle, dance, run, and swim. Usually I can manage my knee pain, but now the pain has progressed into my glut, IT band, and hip flexor. I’ve always thought my pain came from my tight hamstrings, but I’ve also noticed that when I pull my left leg into my chest, I get a pretty sharp pain deep in my hip. Even if I’m resting, my glut and quad have an aching pain that doesn’t go away. Do you have suggestions on what is the real issue here? I’ve seen many people and they just say I have sciatica. I’m 26. I don’t think I have sciatica. 🙂
Thanks so much!
Lisa
reddyb
May 21, 2015
Hey Lisa,
Sounds like some anterior glide of the femur (pain with hip flexion), and some sciatic issues. Barring maybe 15 years and younger, age is fairly irrelevant here. (In terms of whether you’d get symptoms or not.) Any pain that radiates around the hip / leg like that is usually coming from the lower back. Particularly when the back of the hip is involved, like the butt. That doesn’t mean you only work on the lower back, but it does mean it needs to be significantly addressed.
Edited “heavily addressed” for “significantly addressed.” Want to be sure heavily is not interpreted as strength training.
Joe D
May 22, 2015
Lisa,
Could a torn labrum in your hip as well. The pain from AFG and the labrum can be similar (I’ve had/have both) 🙂
Best,
Joe D
Lisa
May 22, 2015
Thank you Brian and Joe! I took a yoga class yesterday for the first time in a while, and balancing was a disaster. Putting a pillow between my legs while sleeping relieved any pain I was having (back, butt, and leg) so I definitely think my issues are stemming from my lower back. I’ve been addressing my IT band, quad, and other muscles, which has relieved the pain temporarily, but I think it keeps coming back because I’ve never addressed the lower back before. Thank you SO much!
Lisa
Joe D
May 22, 2015
I got one more reply for you – to add to what Brian said about the lower back, I also have an L5/S1 degenerative disc issue which can certainly cause sciatica, but in some cases other types of nerve pain (like for whatever reason I have nerve pain issues down the lateral side of my leg, into my shin). If perchance you are in NYC, I can recommend some decent PT’s.
Lisa
May 22, 2015
Nope! NC. Thank you though!
reddyb
May 24, 2015
Down the lateral shin can still be sciatica esque, with the fibular nerve. Lateral thigh is more femoral.
I tend to put any radiating nerve stuff down the leg into the sciatic category though, as the source is often the same: lower back. I’m not sure I’ve come across any utility in focusing on differentiating between femoral and sciatic nerve, for instance. And most people know “sciatica,” opposed to mentioning the femoral nerve.
One potential exception is if a person has something unusual, like a surgery history, where a particular nerve may have been cut.
Tangent: Another rare but still needs to be considered exception here is someone whose nerve symptoms are only from the knee down. When someone tells me they never have issues from the back to the knee, then I start to pry more. Often, one of the symptoms a person will mention is numbness, in which case it’s never a bad idea to make sure clotting or something diabetes related isn’t at play. Especially considering the likelihood the person is overweight.
reddyb
May 24, 2015
That’s often a good indication excessive twisting at the lower back is what you want to be focusing on. Placing a pillow between the legs can help prevent the lower back from rotating, or being in a rotated position. I cover this a ton in my sleep manual, just FYI.