Hip Flexors And Lower Back Pain: Everything You Need To Know
Can Hip Flexors Cause Lower Back Pain?
The hip flexors and lower back are very close structures, but what is the connection between hip flexors and lower back pain? And is it really possible that tight hip flexors can cause lower back pain?
The answer is yes. Hip flexor muscles can contribute to lower back pain. If the hip flexors happen to be tightened or shortened, the lower back can suffer consequences such as pain or discomfort. The main reason is the influence of the hip flexor on the position of the pelvis, which leads to the anterior pelvic tilt. Such pelvic position is unfavorable for the lower back and is usually the result of muscle dysfunction in the pelvic region.
What Are Hip Flexors?
Hip flexors are a group of muscles located on the front of the thigh. They are responsible for movements in the lower part of the body, such as lifting the legs, kicking, bending and more.
The following muscles in the hip are responsible for hip flexion:
- Psoas major
- Iliacus
- Rectus Femoris
- Sartorius
- Pectineus
The strongest hip flexor is the muscle psoas which connects the thigh to the lower back. That’s why the psoas has the most impact on the low back health of all hip flexors. Psoas is connected with the muscle iliacus, and they are forming the iliopsoas muscle.
How To Test The Function of Hip Flexors?
There are two tests you can do to confirm the negative effect of the hip flexor muscles on the lower back.
- Hip Flexion Range of Motion
- Hip Flexion Strength Test
Hip Flexion Range of Motion
To test hip flexion, you need to lie on your back and lift one leg. Then bend your leg at the knee and bring your knee closer to your chest.
The normal mobility of the hip in flexion is 120 degrees when the knee is bent. Don’t forget to test your hip mobility with the other leg as well. It often happens that the muscles on one leg are in better or worse shape than the other leg.
If you are experiencing reduced hip flexion, it does not mean that you will end up with lower back pain, but that negatively affects the health of the lower back.
The more specific test for flexibility for iliopsoas muscle is Thomas test.
Hip Flexion Strength Test
You can test the strength of hip flexors in two ways. In both ways, the starting position is the same. You will sit with the knees bent at 90 degrees.
The first way is to raise one knee and hold for 30s.
The second way is with the help of one person. When you raise your knee, the other person will try to lower your knee down and return it to its starting position. You need to resist and keep your knee in the air for 5s.
If these tests show muscle weakness or reduced hip mobility, then there is a good chance that the hip flexors will cause discomfort in the lower back.
The Connection Between Hip Flexors And Lower Back Pain
Tightened hip flexors lead to a vicious circle that negatively affects the health of the lower back. I will explain as simply as possible so you can understand connection between hip flexors and lower back pain.
Shortened hip flexors eventually lead to anterior pelvic tilt, lumbar spine hyperextension and gluteus muscle dysfunction (antagonists of hip flexors).
*Antagonist’s muscles are opposite muscles that are responsible for opposite movement. Opposite movement from hip flexion is hip extension, and the gluteus muscle group is the main hip extensors.
The anterior pelvic tilt is the position of the pelvis in forwarding rotation. The most common reasons for anterior pelvic tilt are shortening the hip flexors as well as weakness of the gluteal group muscles.
This position of the pelvis leads to increased pressure on the joints in the lumbar part of the spine, which causes the lumbar curvature to increase. Increased lumbar curvature is called lumbar spine hyperextension.
If the hip flexors become weak and overstretched, the pelvis can rotate backward. This position of the pelvis is called the posterior pelvic tilt. The curvature in the lower back is lost, and the back can become susceptible to injury. Active trigger points in the gluteal muscle group are common with overstretched hip flexors.
Due to the potential problems that can occur due to shortened hip flexors, you should pay attention to the function of the hip flexors.
Activities That Are Causing Tight Hip Flexors
I classify the activities that affect the tension in the hip flexors into two groups. Long-term sedentary activities are in one group, while in the second group are physically strenuous activities.
Prolonged sitting is one of the most common causes of weakness and/or shortening hip flexors. The reason is that when sitting, the hip flexors are both inactive and constantly bent. Hip flexors become weaker over time, while mobility in the hip becomes increasingly difficult in the direction of extension.
Activities such as cycling, running or jumping are great for the whole body. However, if these activities are overdone, the hip muscles will be the first to suffer the consequences. Hip flexors are active in most activities that involve leg movements, so they are difficult to rest if you are very active physically.
However, many exercises will positively affect the health of the hip flexors and thus the lower back. I will talk more about this below.
Hip Flexor Stretches For Back Pain
Here is a list of exercises that I find useful for reducing hip flexor tension, with an accent on the psoas muscle. I recommend doing these exercises every day. For best results, repeat hip flexor stretches several times a day.
Lying Posterior Pelvic Tilt
- Lay down on your back and bend your knees.
- Rotate your pelvis backward and hold for 10s.
- Contract your glutes.
That way you will relax the hip flexors even more.
Standing Hip Extension
- Stand up straight and extend one leg back.
- Try not to move your torso.
- Repeat 15x.
Side-lying Psoas Stretch
- Lay down on your side.
- The bottom leg is bent.
- Grab your top leg with one hand and pull backward.
- Reach the glutes with a heel.
Kneeling Lunge
- Start with kneeling lunge position.
- Lean your body forward.
- Stop when you feel the stretch in the front of the thigh.
Knees To Chest
- Lay down on your back.
- Grab your knees and pull them to your chest.
- Hold for 10s and repeat 15x times.
Stretching exercises are even more effective if the muscles are prepared for stretching beforehand. You can achieve that with five minutes massage, ie. using a tennis ball or foam roller on the thigh. To be even more precise, massage the front of the thigh.
How Long Does It Take To Release Tight Hip Flexors?
With regular stretching and massage routine, you can expect that tightness in your hip flexors is gone after four weeks. It is also important to avoid activities that make the hip flexors even tighter.
How To Prevent Hip Flexors Tightness
Varied Physical Activity
Practicing only one type of physical activity often leads to injuries in the sense of overexertion. The same applies to hip flexors, so the more diverse the activities, the better. Running, strength and endurance exercises, and stretching exercises for hip flexors are good examples of a variety of physical activities if you are primarily interested in running.
Focus On Strengthening The Gluteus
This is a muscle that works against the movement of the hip flexors. If the gluteus is weak or tight, then it will have a bad effect on the health of the hip flexors.
Avoid Sitting For Long Periods
If the job still requires you to sit for a few hours without getting up, it would be good to set aside half an hour a day where you will do strengthening and stretching exercises for the forehead. of course this includes muscles such as the hip flexors.
Avoid Classic Sit-ups
The reason is that the hip flexors are active as auxiliary muscles in classic abs, and are very easily overforced. That’s why I recommend that you don’t do classic sit-ups, and do exercises like plank or chop/lift.
More Information About Back Health
- Lower back pain after running – Learn the connection between lower back pain and running. I’ve covered common injuries from running and explained why they occurs. You can find a quick guide on how to deal with lower back pain from running also.
- Lower Back Pain After Deadlift – Learn the connection between lower back and deadlift exercises, what are the common back injuries after a deadlift, and what it takes to prevent and relieve the pain. You can read the simple and effective exercise program that helps to relieve muscle tension in the lower back. I apply the same exercises when I go too hard with training!
- Lower back spasm and loss of mobility – Read more about how you can react when dealing with painful spasms in the lower back and restricted mobility. Few exercises included.
- Back Pain After Squats – How can squats cause issue in the lower back and how to treat it.
- Tight gluteus and back pain – Learn more about influence of the glutes on lower back health and how to prevent tight and weak glutes.
- Back Pain From Improper Lifting – Having a proper lifting form is key to saving your back muscles, ligaments and joints from being hurt. Improve your lifting technique today.
- Anterior Vs Posterior Pelvic Tilt – Everything you need to know about anterior and posterior pelvic tilt.
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