Hip Adductors and Low Back Pain
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Category: Strength & Rehabilitation
Hip Adductors and Low Back Pain
The hip adductors, consisting of the gracilis, adductor magnus, adductor longus, adductor brevis and pectineus, are a series of muscles that assist in performing movements such as crossing one leg over the other or kicking a soccer ball. The adductors originate proximally at the pubis and attach distally at the linea aspera of the femur or the pes anserinus of the tibia. They are responsible for proper tracking of the knee, generating force with athletic movements and balancing the pelvis during standing and walking. If these muscles are tight or weak, normal body alignment can be affected leading to possible low back or knee pain or a groin strain.
The pectineus, adductor longus and adductor brevis are responsible for adducting as well as flexing the hip. These muscles are not considered the primary hip flexors however, if tight, these muscles can cause the pelvis to be pulled into an anterior pelvic tilt creating an increase in lordosis of the lower back. Studies have demonstrated that the average person experiences from 20-45 degrees of lumbar lordosis. An increase in this curvature can lead to low back pain due to abnormal stress being placed on normal tissues and joints. Often, one will also experience tight lumbar extensors and weak abdominals and hamstrings as a result. This condition is more popular in those who tend to sit for prolonged periods of time. The hip flexors are shortened creating an anterior pull on the pelvis as a result.
The adductor magnus is a hip adductor that serves as a hip flexor and internal rotator anteriorly and a hip extensor posteriorly. If the posterior fibers are tight this can cause the pelvis to be pulled into a posterior pelvic tilt. This creates a decrease in lumbar lordosis which can lead to possible low back, hip and knee pain due to the increased pressure placed on the lumbar joints and discs. Often this condition is associated with tight abdominals and weak hip flexors and lumbar extensors. Typically, one’s posture also changes from slight lumbar lordosis to a decrease in lumbar lordosis and an increase in thoracic kyphosis and cervical flexion. Over time the knee joint can become effected leading to hyperextension. This condition is more popular in gym goers who tend to focus more on strengthening their posterior chain muscles such as the hamstrings and gluteus maximus. These muscles become tight, pulling the pelvis into a posterior pelvic tilt as a result.
The hip adductors are located medially on the thigh. Due to their attachment point at the linea aspera of the femur or pes anserinus at the tibia, tight hip adductors can affect patella alignment. If the adductors are tight the patella can be pulled medially leading to an increased stress on the medial aspect of the knee joint. One may experience medial knee pain that can be relieved through soft tissue massage or stretching of the hip adductors. Alignment of the patella can also be corrected through different taping methods but, typically this is only a temporary resolution. The patella can also be pulled medially due to a decrease in hip abductor strength. The hip abductors assist in balancing the pelvis and keeping the pelvis level when walking. These muscles are often weak in runners or those who perform frontal plane movements only. The hip abductors can be strengthened to assist in correcting normal knee alignment. If the knee joint is effected, the kinetic chain can be effected leading to hip and low back pain as well. To correct these muscle imbalances, it is important to properly stretch the muscles that are tight and strengthen the muscles that are weak.
Methods to Decrease Adductor Tightness-
The adductors are located on your medial thigh and can be loosened through stretching, foam rolling or soft tissue massage.
One way to stretch the adductors is through static stretching. Static stretching should be performed after exercise or a light warm up in order to avoid injury.
1. To begin this stretch, sit on the floor with both legs out in front of
you and sit up straight.
2. Bring the soles of your feet together so that your knees are bent. Make sure that you are sitting up straight.
3. Bring your heels as close to your body as you can and bring your feet towards your pelvis.
4. Lean forward but keep your back in proper alignment to decrease the risk of low back pain.
5. Hold the stretch for 30 seconds and perform 3 times.
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.
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.
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.
1. Position yourself so that one leg is out of the way and the foam roller is under the inner thigh of the leg being rolled.
2. Using your upper body, as well as the opposite foot, roll from your groin to above the knee 15x.
3. Switch legs and perform on the opposite leg as well.
Half Kneeling Adductor Mobilization
1. Begin in quadruped positioning with one leg straight out to the side with toes pointed forward and the other leg flexed behind you.
2. Slowly rock forward and backwards stretching the adductors.
3. Perform for 3 sets of 15.
Side-Lying Hip Adductor Strengthening
1. Lying on your side, cross the leg on top over the bottom leg.
2. Use your upper arm and top leg to prevent your body from rolling forward or backward.
3. Keep your bottom leg straight and elevate your bottom leg about 6 inches from the ground
4. Repeat for 3 sets of 15.
a. If this exercise becomes too easy, a cuff weight can be added. The further the cuff weight is placed on the leg closest to the foot, the more difficult the exercise will be.
1. AmeeL, says AS, says SB. Posterior Pelvic Tilt: Causes and Treatments You Can Do Right Now. Healing Back Pain: Solutions. http://backpainsolutionsonline.com/announcements-and-releases/back-pain-exercise/posterior-pelvic-tilt-causes-and-treatments. Published September 16, 2017. Accessed March 11, 2018.
2. Giandonato J. Adding Up to Lower Back Pain. elitefts. https://www.elitefts.com/education/training/powerlifting/adding-up-to-lower-back-pain/. Accessed March 11, 2018.
3. 5 Exercises To Fix Tight Adductors. Movement Enhanced. https://www.movementenhanced.com.au/blog/5-exercises-to-fix-tight-adductors/. Accessed March 11, 2018.
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