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.
-> 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.
Anonymous
July 6, 2016
Hi Brian, I’m sorry for the late response but it looks like you still might be answering people (hopefully?) I hope you don’t mind reading my background – it’s long. I have a diagnosis but can’t find the correct treatment.
I am 35 years old female, 3 years post-op hip arthroscopy (2013) and still in a lot of pain. Pain is mostly with sitting/standing & walking, turning my leg in, pulling my knee to chest, and squatting (mostly inner thigh area.) I sit on a 1.5″ wedge cushion and feet on the ground crossed at the ankle for most of the work day. It hurts to sit with my leg straight up so it’s usually turned out a little bit. I also would like to point out this is new pain that I didn’t feel before the operation.
I have had post-op MRI and x-rays which ruled out a re-tear or another visible problem. After seeing 4 PT’s and going back to my surgeon, after three years, in May 2016, I was finally diagnosed with adductor tendinitis and iliopsoas tendinitis. I have instructions to avoid anterior hip flexor stretching due to “joint laxity” which is allowing my tendons to overstretch.
At this point I believe my muscles are extremely weak, after dealing with pain since 2010 (when I was diagnosed) and then post-op pain since 2013. The tendinitis was exacerbated by pigeon pose in yoga class in February 2016. I was under the false pretense that if my hips feel tight then I need to stretch them.
I’m writing to you because this is the only site I’ve seen that says that stretching the hip with these kinds of issues is bad, which is in agreement with my surgeon’s instructions. I have been searching for some kind of exercise that can build my strength up but every exercise for hip tendinitis that I see online seems to involve stretching the front hip. I think even my PTs are at their wit’s end.
In PT I tried all kinds of exercises, even dry needling but that didn’t help much. The best exercises I have found are – the star excursion; standing on a balance disk for several minutes; bridges; and planks with one foot off the ground. I’ve been doing about 15 mins of this per day, for about 3 months, since I was diagnosed with tendinitis.
I do these exercises and usually feel better, but the pain always comes back. There must be some muscle area that I’m missing. I don’t know if it’s inner thigh specifically since that’s where most of my pain is, but it’s very hard to work that area. Any ideas? Thank you for your time reading this.
reddyb
July 8, 2016
Hey there,
Have a good idea what could be done here, but this is much more fitting for a client process than a comment exchange. I’d recommend taking a look at this: https://b-reddy.org/2013/06/20/the-remote-client-process/
And stay away from yoga for now :).
Lisa Rue
July 22, 2016
So I have been doing the rocking exercise. I cannot feel anything strechoing anywhere. What am I doing wrong?
reddyb
July 24, 2016
1) Hard to comment on someone’s form when you haven’t seen it. You might not be doing anything wrong because
2) You don’t need to feel something to stretch something.
Edit: Added to 1).
Bárbara
July 22, 2016
Hi! I’ve been dealing with hip pain for about 6 months now, specially when squatting. Can’t squat at all now. The thing is, my hip hurts the most when I do the backward rocking position. As if I was squeezing something in between my legs and hip. :/ Any ideas that could help?
reddyb
July 24, 2016
Hey Barbara,
This would have to be its own article. Many things to consider. (Often, on the backward rocking, opening the knees helps (but keep the feet together), but that’s only one consideration.)
Might be interested in this: https://b-reddy.org/2016/07/22/an-example-of-improving-hip-pain-during-squatting/
Alex
August 10, 2016
hi – i’ve been dealing with ‘deep hip flexor’ pain for years now on my right side. I can’t sleep on that side because of the dull, aching pain. I’m an avid cyclist but even when I stop biking for weeks or even a month, the pain never goes away. It feels like a deep hip flexor pain that no stretch can get to. I’ve tried PT and even gotten an MRI. No issues found. It feels like a really deep dull pain that is only relieved when I flag my leg off to the side (basically bend at the hip). Note I’m a 27yo male.
sorry forgot to mention that if I flag my leg out to the side my hip snaps and sort of ‘reloads’ and i can snap it again in a minute or two after.
Thanks!
Alex
reddyb
August 11, 2016
Hey Alex,
With something bothering you for that long, tough to help much only in a comment.
I’d check out the remote client process for specific help- https://b-reddy.org/2013/06/20/the-remote-client-process/
Sleeping would be a top priority for me. If you’re able to sleep well just in different positions, then great. If you’re having trouble no matter what, a guide to helping- https://b-reddy.org/2012/08/06/sleep-with-less-pain-tonight/
If you mean opening your leg to the side, you may want to check this out too- https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
Andrew
August 28, 2016
Hello,
I’m a 36 year old male that started lifting weights about a year or so ago and noticed after about 4 months that squats started causing pretty serious pain in the front of hip, especially on the left side. Sometimes I noticed what I can only describe as a pinch at the bottom of my squat. I’ve had to give up squatting with a barbell and moved into more machine work, because of the pain and inflamed feeling.
When seated I notice the pain if I lift my knee in towards my abdomen – not a leg raise, these don’t bother me at all, more of a knee raise and only on the left side now.
Stretching, as you mentioned didn’t seem to help much. Another weightlifter suggested Bulgarian squats, but I’m not sure I notice improvement there either. Any advice would be much appreciated. I don’t feel any ‘aha’ moment from your back rock either.
reddyb
August 30, 2016
Hey Andrew,
If you search the page (Ctrl+F or Command+F on a Mac) you’ll see “squat” has been mentioned 52 times in the comments. Good deal to look at there.
If you’re noticing you have more pain when bringing the knee up and in rather than up and out, I’d check this out: https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
Which would also mean Bulgarian Split Squats wouldn’t be advisable. You’re not able to open the knee as much, and it tends to ask for more hip flexion relative to a barbell squat. I’d stay away from those right now.
If you don’t feel any issues in the hip rocking exercise, which is a horizontal squat, but you do while squatting, that gives valuable information. I’d have to see the two to get an idea, but the gist is what are you doing in the hip rocking that makes bringing your knees to your chest ok, that you’re not doing in a barbell squat?
(If you want some directed help, feel free to look at these
https://b-reddy.org/2014/08/04/phone-video-consultations/
https://b-reddy.org/2013/06/20/the-remote-client-process/ )
Isaac
September 8, 2016
Hello,
After using the hip abductor machine, the next day I had and still have a little discomfort in the front of my left hip and I think my lower back. It seems like it could be somewhere in the middle of my lower back and left glute. If I were to stand up straight and move my hips to the right, I feel the pain in my glute or lower back area. If I lie flat on the floor I feel it the most. I can lie flat and lift my legs straight of the floor with little to no pain. This has been going on for about two months. Yesterday, I noticed a click in the hip when I swing the leg forward and back. I use to have the same type of click in my left shoulder when coming down from pull-ups before pulling back up. What do you think is the problem?
-Thanks
reddyb
September 9, 2016
If I were assessing you, first thing I’d be looking closely at is your lower back and for femoral anterior glide.
https://b-reddy.org/2013/09/09/some-quick-notes-on-piriformis-syndrome/
https://b-reddy.org/?s=femoral+anterior+glide
https://b-reddy.org/2013/06/20/the-remote-client-process/
Bonnie
October 1, 2016
Is there a way to understand this without needing to learn all the pt lingo first?
I’m 59 years old and need a way to assess whether the PT they will prescribe for my labral tear with lots of pain, seizing up, catching so it takes five plus minutes to “line it up” so I can get out of a chair.
Sitting at the computer makes it worse and it seems like I have to take a course in anatomy online before I can even understand what to do to help myself. Hip flexor definition? Adduction, abduction and the rest… I couldn’t be the only one who doesn’t understand all these terms. Please help!
reddyb
October 2, 2016
In reference to those terms, it doesn’t take very long to learn them:
I’m not sure what your second paragraph is saying. You need a way to assess ?
If you want very to the point help: If you have trouble with how you sit, then you need to change how you sit.
If you’re hoping to come across something like “Your labrum is torn, just do this,” that’s not how this stuff works.
David
January 14, 2017
Very interesting article. My posture is nearly identical to Dan, probably because I spent over a decade sitting in from of the computer. Recently I started noticing pain in the hips, especially after squatting or jogging, sometimes it’s almost a shooting-pain when I place my thigh in external rotation (fire hydrant exercise triggers it the worst)
However, in the article, you’re telling us what not to do and showing us one stretch (that frankly I don’t really feel much)… Any other recommendations? My physio just told me to do hip flexor stretching……
reddyb
January 15, 2017
Hey David,
There are more recommendations and discussions on what to do in the comments. e.g. toddler squat exercise, psoas strengthening, glute strengthening, glute timing, etc. Along with the option of getting more directed help through this process: https://b-reddy.org/2013/06/20/the-remote-client-process/
Josh Clayton
January 24, 2017
Hi Brian,
You mentioned early on:
“1) The issue is actually from the back. This typically (but not always) manifests a bit more in the back of the hip / or nerve issues like sciatica. 2) The issue is truly at the hip. This manifests more in the front / side of the hip with things like snapping or pinching feelings.
This will deal with 2). Why does 2) happen?”
Do you have an article that deals with 1? I was assessed in a screen to have tight hip flexors and have been performing hip extension stretches as a result. I’ve also noticed an asymetrical pain in my right hip/lower back region as well as asymetrical movement of my two hips and can’t appear to correct this movement. So I was wondering if you expand on this connection between the hip and low back?
Thank you,
reddyb
January 27, 2017
Hey Josh,
Some other things I’ve written which hit on sciatica some-
https://b-reddy.org/2014/11/18/7-very-common-movement-issues-and-how-to-work-on-them/
https://b-reddy.org/2013/09/09/some-quick-notes-on-piriformis-syndrome/
https://b-reddy.org/2013/04/16/an-example-of-how-important-your-sleep-positioning-can-be/
In terms of the hip / lower back connection, it’s tough to move one without the other. So when there is an issue going on at one, there is often an issue going on at the other. For instance, if the hips rock back asymmetrically:
https://www.youtube.com/watch?v=3ADrLvF8Vio
Then the back did too. So while in the above video that person may have e.g. lower back pain, in order to correct the movement it may be best to focus on the hips. Because if you change how those hips move you’ll likely change how the spine moves.
Luis G. Zuñiga F.
February 17, 2017
Hi Brian, i’m 17 and i’ve been an avid athlete since i was a kid, i started playing football (soccer) when i was around 10 years old and i didn’t experience any sort of problem but until my late 15s, when i started to feel progressive pain in my groin, that intensified depending on how much activity i did, alongsides with that, the infamous ” pops” came by. i was pretty fool by that time so i just ignored the pain and tried to not do any “explosive” movements since those really agravated the pain, eventually, due to the annoying pain and other factors i stopped playing, and now, two years later the same problems persist, the pain whenever i play (soccer) is still there, building relying on how much i play (per day), but it always goes off with some days of rest, and the pops, are still there, i must mention that i spend considerable hours of the day sitting at my job/school. Anyways, i found your page and it’s freaking amazing! the backward rocking excercise really gives some relief contrary to some other stretching excercises i was doing, i must ask you, how can i fix my problem forever? or to at least be able to play football on a regular basis?
Thanks in advance Brian! I really aprecciate your work
reddyb
February 19, 2017
Hey Luis,
Thank you for the nice words.
The hip rocking and leg raise exercise are good places to start. I don’t have a dedicated manual for this right now, but there would be some more helpful things in this guide: https://b-reddy.org/2015/11/23/8-weeks-towards-correcting-your-anterior-pelvic-tilt/
Then, I would strongly consider how you get back into playing soccer too. More about that here: https://b-reddy.org/2016/10/24/the-variables-and-an-equation-to-consider-when-starting-a-physical-activity/
If you end up wanting more specific help, then you can also consider: https://b-reddy.org/2013/06/20/the-remote-client-process/
jenny
April 16, 2017
I am not an athlete, I am a 47 yr old Fibromyalgia sufferer. I was once a healthy fit person. Now I am heavy and in pain. However, in the last two years I have had hip flexor pain. I was given a gentle stretch which I do every day, but nothing has helped. I did have Trochiantaric bursitis in the same hip for 8 years. The pain of the hip flexor has slowed my movement so ironically the bursitis has eased up! The pain of the hip flexor echoes in the muscle attached to the outside of the knee. Very painful when I move, I limp, and is like toothache when I am still. I just want to cry.
reddyb
April 18, 2017
Hey Jenny,
Sorry to hear about your issues.
One way to get hip flexor pain to feel better while walking is to shorten someone’s stride. Go over this some in this post: https://b-reddy.org/2013/06/13/relieving-hip-pain-while-walking/
If you want more specific help, you may be interested in: https://b-reddy.org/2013/06/20/the-remote-client-process/
Valtssu
May 4, 2017
Much Love from Finland. For the first time in my life I have been able to deadlift comfortably. My RDL is even, and I gained 7 inches of ROM in it, all this from half an hour of hanging in the backward rocking stretch.
What do you think about alternating pulling yourself deeper with your hip flexors and pushing you back up with your glutes in the backwards rocking stretch?
reddyb
May 5, 2017
Thanks Valtssu! Glad to hear you’ve had some quick success. Doesn’t always happen that easily :).
I like the make the backwards rocking more of a relaxed exercise. Where the muscles around the hip are as quiet as possible. Find this feels best, particularly on irritated hip joints.
I do like to work areas like the hip flexors and glutes, but in other ways. The prone leg raise is one example for the glutes, and this is another (though sometimes too hard to start out with) for the psoas- https://www.youtube.com/watch?v=Icjmz7NWVk8