Hip Flexors - To Stretch or To Strengthen?

For this blog, I wanted to write about hip flexors. This is an issue with ALL of my patients.  It is not just a matter of concern for those who are pregnant or postpartum even though hip flexors are an issue that most pregnant and postpartum women have.

People hear about it a lot and they know that it needs to be addressed. However, there is a tendency where people will dig into them or overstretch them. I wanted to describe where the hip flexors are, what constitutes them, and what people can do to address them depending on the circumstances and factors that affect them. Remember that addressing the issues with hip flexors vary from one person to another.

Where Are The Hip Flexors

Psoas is a deep hip flexor. It attaches from the front of our lumbar spine and goes underneath our abdominal organs to our legs. They are really important not only for hip flexion, but also for spinal stability because they attach to the spine. Another cool thing about the Psoas is it attaches near the diaphragm and has some fascial connection there.  Breathing and Psoas are intimately tied together.

Another hip flexor that is closely tied to the Psoas is the Iliacus. Imagine the Psoas attaching at the spine and then going to the leg, we also have Iliacus attaching from the Ilium to the legl. Actually, the Psoas and the Iliacus meet and attach at the same spot – the Iliopsoas tendon that attaches down on the leg bone. The Iliacus is a hip flexor, but does not help with spinal stability because it does not start on the spine like the Psoas does.  These two hip flexors have different roles. Iliacus focuses more on hip flexion while Psoas is more complex as it is tied with breathing and it does some spinal stability. We even noticed that when you stand on one leg and bend that one leg up to the chest, the opposite side of Psoas is firing at the same time to stabilize the spine while opposite Iliacus and Psoas are doing hip flexion.

The next hip flexor that people really get honed in on is the TFL (Tensor fascia latae), which is part of the IT band. People love to roll the heck out of the IT band (Iliotibial band). A lot of runners think they have an issue here and they beat it up with all sorts of myofascial release tools and sometimes that can actually be a little harmful.

The TFL is the small muscle that feeds into the IT band, which is just a name for the tendon of the TFL muscle, which is the hip flexor. The other muscle that feeds into the IT band is the glute max. The TFl and the glute come together into that IT band. It’s not as powerful of a hip flexor as the Psoas and the Iliacus.

The last hip flexor I will write about is part of your quad. The quad is in the front of the leg and it has four parts to it. Three of them don’t cross from the femur to the pelvis, but one does. The other three parts of the quad simply extend the knee but the last part of the quad crosses the joint and it helps with hip flexion. This is the rectus femoris. With the real intense stretch of the quad, you want to have the hip extended as well to get that rectus femoris involved in the stretch.

What We Do All Day That Affects Hip Flexors

Everyone is different and everyone has a different set of circumstances. Lots of people sit a majority of the day, either it's from your job because you have a desk job, if you are a driver, or if you are like me who is up and down a lot but I am often bent over people and is bent to the waist. This shortens the hip flexors for long periods of time.

This is where the tricky part comes in because I think people equate short and tight with just needing to stretch them, round them out, and dig in with foam folling. They usually forget that they could be weak. That can affect the centration of our hip joints. The centration of the hip is really important in maintaining the integrity of the joints and it allows it to move smoothly in there. If it is not lined up in that ball and socket area, you are going to get wear and tear, arthritis, tears, and those kinds of things. We want that centration of the joint to be nicely lined up and smoothly moving. Movement helps lubricate the joints so we want movement but we want it to be centered as much as possible.

What We Can Do With Our Hip Flexors

We have got this chronically shortened hip flexor area and lots of people who have sedentary jobs or school. So, what do we do about it?

Don’t overstretch.  The psoas hates to be yanked on and it irritates the nerves in it, I see people go to stretch their Psoas by taking a deep huge lunge with a big arch in their low back. Essentially, it tethers out that Psoas muscle and it takes quite a journey from underneath all of your abdominal organs to the leg and it can get very irritated. You can actually make your hip flexor pain worse by stretching it that way. You really don’t need a ton of extension of the hip to stretch that muscle. You simply need to tuck your tailbone under and that tethers it out. You will get that stretch in the Psoas. You can check this exercise I did before (SUPINE PSOAS STRETCH ) to safely stretch that area and focus in on it rather than wrenching your low back and flaring that up as well.

I’ve also seen all these things on the market to dig into your side to work on trigger points on your Psoas. Your Psoas is so deep and under so much stuff that you can’t possibly feel the trigger points in your Psoas. Whenever I work with a patient and I am working on that area, I am not palpating to feel the muscle itself. I am simply pushing in to assess tenderness, how stiff the tissue is, and trying to trap the Psoas along the border there. When people use these really hard and sharp things to get in there and loosen that up, I don’t think it’s very effective for the top side where it is attached into the spine. Remember, your spine is in the middle, so you are going to have to be in the center line and deep under all the layers of your abs and all your organs.

To mobilize that area, usually I go super soft and super gentle and use a coregeous ball, that air-filled ball I use in my videos. For people who have an issue there, I deflate it so that it looks almost like a pancake. The very light pressure from it will help mobilize things. A big thing for me when I am treating someone who I think has Psoas issues is making sure you have good lymph movement in your abdomen. This is because a stagnant lymph system is the first issue of having a lot of inflammation. If you have a poorly functioning lymph system, it is bathing your irritated muscle in an inflammatory environment.  You are not going to have optimal relief. I then work with breath exercises, I use the coregeous ball to keep the lymph system moving as well as possible because I want it to be as uninflamed as possible. Instead of using those hard, sharp implements I’ve seen around, I would try breathing exercises since the Psoas is directly linked to your diaphragm and use a coregeous ball.

When we go to the attachment on the leg, I like to tell people to use the tune-up balls, a peanut of some sort, or two tennis balls taped together to address that attachment. It is kind of an all-in-one attachment because we got the Iliacus, the Psoas, and the rectus femoris that all come up into this similar area. When you do this attachment side, you cater to all three hip flexors. You can check this video where I use the tune-up balls to cater to this attachment (QUAD QUENCH (AND PSOAS)  TENDON RELEASE).

For the TFL, it being so thin and so small, I would just use a coregeous ball to essentially get the fluid moving and get some nice fascial movement on that area. You can work your way down the TFL but do not beat the heck out of it.

Once you’ve warmed it up, I would do some stretches. I would go super gentle and really baby it to test how you can move your pelvis and how you can make those slight changes to make you feel more intensity. You move around the tissues gently through gentle stretches and then you will want to strengthen that since it has been short and weak for a long, long time. We need the hip flexors to centrate the joint well so you can do a variety of different things to engage your hip flexors and that could be anything by using a simple circle band or theraband around your feet and you can do knee to chest. I will work with whatever is within your reach by slowly loading and intensifying your exercises. 

People think that sitting at your desk is not a total strain in your body, but repetition cumulatively can be more problematic than a really extreme workout because you are doing it all day long. People underestimate the cumulative effect of an activity so that’s an easy way to address that throughout the day.

Conclusion

The takeaway here is that it is great that people are starting to take notice of their hip flexors and they want to make them better. But, do not forget to go easy on them when you are rolling them and stretching them. Further, do not forget to strengthen them. That is going to make a huge difference because we are typically weak in that area especially if we sit a lot.

If you have any questions, you can drop it in the comment section or you can send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

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