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Protecting The Lower Back: The Effects of Tight Hip Flexors

EnFuse Staff
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Category: Strength & Rehabilitation

Protecting The Lower Back:  The Effects of Tight Hip Flexors

As mentioned in the previous article (Protect Your Lower Back: Exercises & Considerations), there are a series of hip flexor muscles that when tight can cause increased pain to various areas of the body. This article will focus specifically on the effects of a tight iliopsoas muscle on low back pain. The iliopsoas is a hip flexor, as well as a back extensor that allows us to bend at the hips rather than bending at the lumbar spine.1 The iliopsoas consists of both the iliacus and the psoas muscles. The psoas muscle originates at the lumbar spine and joins the iliacus muscle to attach at the lesser trochanter of the hip. The iliopsoas muscle is often tight in those who sit for prolonged periods of time, runners and cyclists. The muscle becomes shortened in this position which as a result can lead to an increased risk for low back pain with activities such as standing or walking.1

Due to the origination of the psoas muscle on the lumbar spine, this muscle pulls the lumbar vertebrae forward and downward creating slight extension in the lumbar spine.1 This natural curvature allows for us to comfortably stand upright and transfer our body weight when walking.2 If the psoas muscle is tight, the vertebrae are pulled forward and downward even more than usual creating increased lumbar extension which is also known as an anterior pelvic tilt. The irregular positioning creates increased stress on the lumbar extensor muscles which as a result can cause increased compression on the lumbar vertebrae and discs. The abdominals and glutes are put on stretch and are often weak in those with tight hip flexors. These muscles are not functioning as well as they should be and compensatory actions may occur as a result.2

Signs and Symptoms

Those with a tight iliopsoas often experience low back pain as a result of the excessive anterior tilt that occurs due to the muscle being shortened.2 Typically, these types of people prefer sitting over standing and walking because sitting puts the psoas muscle on slack creating decreased tension on the muscle. When standing, the already tight muscle is put on stretch causing increased compression, as well as load in the lumbar spine. If the iliopsoas muscle remains tight, one is at more of a risk for a disc injury. Throughout the course of time one may experience nerve symptoms such as numbness and tingling or pain that travels down the leg. Therefore, those experiencing a tight iliopsoas also prefer to stand in a slightly flexed position rather than standing upright. This position slackens the iliopsoas as well as opens the segments in the lumbar spine creating decreased compression on the nerves and discs.2

How Do You Know If You Have a Tight Iliopsoas Muscle?

Self Thomas Test

  1. First, find something such as a bed or a massage table that you can lie on.
  2. Sitting on the edge of the table, bring both knees to your chest as you lie back onto the table or bed.
  3. Keeping the knees at your chest, make sure that you can feel your back flat against the table. This is important because if your back is not flat against the table your results can be skewed.
  4. Lower one leg and relax it. Other leg should still be at chest and back should remain flat on table.
  5. If iliopsoas on lowered leg is tight, the hip will be elevated from the table in slight hip flexion. Normally, if your iliopsoas is not tight, it will be flat on the table and measure 0 degrees of hip flexion.


Self Treatment

There are several ways to avoid the onset of low back pain by stretching your iliopsoas muscle, strengthening your core and glutes, and including range of motion exercises for the hips.

Hip Flexor Stretch

This stretch can be performed and modified in several ways depending on the person performing the stretch. The stretch should be felt in the anterior thigh/groin area.

Standing

  1. To begin, the leg being stretch will be on the ground and the opposite leg will be placed on a step.
  2. The leg being stretched is rotated so that the foot is pointed inward and the hip in being internally rotated.
  3. Your bum is tucked under performing a posterior pelvic tilt, and squeezed.
  4. If the stretch is not felt, lean forward at the hips, not the spine.
  5. This stretch should be performed 3 for 30 seconds, 2-3 times per day.

Half Kneeling

  1. Start kneeling and bring one leg into half kneeling. The leg being stretched in the one on the floor.
  2. Bring shin and foot outward so that hip being stretched is internally rotated.
  3. Tuck bum under and squeeze.
  4. Lean forward at hips if stretch is not felt
  5. Perform 2-3 times per day for 3x30 seconds.

Soft Tissue Massage/Foam Roller to Extensor muscles

The muscles of the back are often tight due to the excessive anterior tilt caused by a tight iliopsoas muscle. To decrease the tension of the muscles in the back one can have a friend perform soft tissue massage or one can use a foam roll to perform self soft tissue massage.

  1. The foam roller is placed around bra line in the back.
  2. Lumbar spine is flattened, posterior pelvic tilt is performed.
  3. Foam roll is rolled from bra line to scapula.
  4. Head and neck are supported. To increase pressure bring elbows closer to head.
  5. Roll back and forth for 15 rolls. This can be performed 2-3 times per day.

Knees to chest

Performed to stretch lumbar extensors and hip extensors.

  1. Patient lies on back and brings knees to chest.5
  2. Holds for 15-20 seconds then slowly lowers legs back onto table surface keeping knees bent.5

Hip/Glute Strengthening

Clamshells

  1. Clamshells are performed side lying, with knees bent.
  2. The ankles are “glued” together and the top leg is elevated about a foot above the lower leg.
  3. It is important to avoid rocking back and forth of your body because this works other muscles instead.1
  4. Perform for 3x15 bilaterally. To increase intensity a resistance band can be added.

Glute Bridges

Double leg glute bridges.

  1. Patient is lying on back performing posterior pelvic tilt and drawing in core.
  2. Drives through heels to lift glutes off of table.
  3. Hold for 3 seconds at end of range, squeezing glutes and lowers body back to table.
  4. Performed for 3x15.

There are several exercises and stretches that can be performed in order to strengthen the glutes and hip muscles to avoid compensation as a result of a tight iliopsoas. There are other methods of stretching the iliopsoas which completely depend on the person performing the stretch. It is import to stretch the iliopsoas muscle in order to decrease the risk of low back pain.

If you would like help and or guidance developing a hand-tailored fitness program that considers your own unique needs, please contact our team- support@EnFuseFitness.com

We hope that you find this article helpful!

In Health,
Team EnFuse

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References:

  1. https://www.kenhub.com/en/library/anatomy/iliopsoas-muscle
  2. https://www.spine-health.com/blog/essential-role-psoas-muscle

Images:

  1. https://thumbor.kenhub.com/gQWYMbM_ST9Kek3aTzI0K5vSoy0=/fit-in/800x800/filters:watermark(/images/logo_url.png,-10,-10,0)/images/library/79/Iliopsoas_Muscle_Neutral.png
  2. http://www.verticaljumpdevelopment.com/wp-content/uploads/2016/07/tight_flexors_difference-225x300.jpg
  3. http://www.runtothefinish.com/wp-content/uploads/2014/05/hipflexors_thumb71.png
  4. https://i.ytimg.com/vi/Q0XiUq9TJ2w/maxresdefault.jpg
  5. http://www.pt-helper.com/images/hip%20flexor%20stretch%20on%20step%202_300.jpg?crc=3768820091

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