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October 2, 2021

Is Your Hip Flexor Actually Tight?

Is Your Hip Flexor Actually Tight?

Sitting for long periods of time can have compound effects on our body including hip and low back pain.  Some careers require prolonged sitting for hours on end so it can be difficult to avoid some of these discomforts. Then add in the hours of Netflix multiple times per week after a long day and we are asking for a disaster. One particular area of discomfort that is often mentioned during patient visits is tightness into the front of the hip. Although there are a number of differential diagnoses that can be discussed with pain or tightness in the front of the hip, often it is tightness or dysfunction in the hip flexor or the iliopsoas

The iliopsoas is our main flexor of the hip joint. This muscle can be separated into two components, the iliacus and the psoas major. These muscles, often referred to as one muscle, participate in flexion and external rotation of the thigh at the hip joint, flexion of the trunk at the hip joint, and some lateral flexion of the trunk. The iliopsoas originates at the lower thoracic spine and upper lumbar spine and attaches to the femoral head of the femur.

When we stay in a static position for a prolonged period of time, our muscles tend to adapt to that position. When we sit for long periods of time our hip flexors will become shortened in length. This is why we often term our hip flexors “tight” when we do a lot of sitting. However, not all tightness is created equal. Hip flexors can feel “tight” even when they are not actually shortened in length. Have you ever stretched your hip flexor but don’t feel like you are getting much out of it or don’t get any relief of tightness? This is why the typical hip flexor stretch isn’t appropriate or applicable to everyone.

Sometimes our hip flexor can have a “perceived tightness”. This is where the hip flexor feels tight but isn’t actually shortened in length as mentioned above. This can be a sign of hypertonicity. A hypertonic muscle is, otherwise, an overactive muscle during contraction. When a muscle is overactive, this can lead to weakness into the musculature. When a muscle is overactive, or weak, we should be strengthening the muscle not stretching it. This is a common misconception when it comes to our hip flexors and how we are distinguishing “tightness” versus “perceived tightness”.

How do we know when to stretch  or strengthen our hip flexors? A simple, yet, effective assessment can differentiate between a tight or weak/overactive hip flexor. Utilizing the modified Thomas test can be an effective assessment to determine the length of your hip flexor.

The steps of the test are as followed:

  1. Lay down on your back on a taller table or bench.  Make sure your sit bones are at the edge of the table or bench.
  2. Bring one knee towards your chest and hold the knee with both hands. Let your opposite leg hang freely off the table or bench.
  3. Make sure your low back is flat, not extended,  and coming off the table. Relax the opposite hip as much as possible.
  4. The determination of tightness or weakness is the angle of your hip joint relative to the table or bench. If the hip remains in a flexed position, the test is positive. This is positive for a tight or shortened hip flexor. If the hip remains on the table or bench or extends off the table, the test is negative which is consistent with “perceived tightness”.

There are other factors or determinations that can be drawn from this test as well. If the knee remains extended, this can be a sign of tightness into the quadriceps musculature. When the hip is abducted, which is when the hip is in a position away from the midline of the body, this can mean tightness into the TFL (tensor fascia latae) or IT Band.

What can we do about tightness or perceived tightness into the hip flexor?  There are exercises that can address both.  The two main exercises utilized in our office are the half kneeling hip flexor stretch and banded hip flexor march.

Addressing a shortened hip flexor muscle: Half Kneeling Hip Flexor Stretch:

  1. Set up in a half kneeling position with one knee down and the other leg flexed.
  2. Sit up straight and start with a pelvic tilt by engaging your core and squeeze your glutes.
  3. Keeping tension into the front of the hip by squeezing the glute on the knee down side and maintaining the pelvic tilt, rock back and forth.
  4. Repeat on the other side.

Addressing a weak or overactive hip flexor muscle: Banded Hip Flexor March

  1. Lying on your back, place a mini band on your feet at the mid foot.
  2. Do a pelvic tilt and engage the core.
  3. Bring one knee towards your chest while maintaining tension into the core and pelvis.
  4. Slowly extend the hip and come back to the starting position.
  5. Repeat on the other side.

If you are experiencing “tightness” in your hips and you would like to be evaluated by one of our providers you can book an appointment online.  Please perform these tests and exercises with caution and if you are experiencing pain, please contact us or your nearest healthcare provider to determine if these exercises are right for you.

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