Lower back pain affects almost all of us at some point in our lives and it isn’t just a slight twinge that goes away within a few hours. Lower back pain is often an ongoing, debilitating pain affecting function, social relationships and the ability to work and go about your normal daily routine. To give you some idea of how profound this issue is, the NHS estimate that it currently costs them £4.2 billion each year due to the volume of patients who are suffering and the rate of reoccurrence.
There are many possible reasons behind why a person suffers from lower back pain including nerve damage/trapped nerves, a specific impact injury, poor posture, muscular imbalances and muscular weakness. There is one cause of back pain that I would like to discuss further during this article. It is a group of muscles that are often neglected mostly due to the fact that they are not superficial (so people tend not to focus training them) and that the majority of people spend a great deal of their day sitting down (which shortens the muscles and decreases range of motion). Those muscles are the hip flexors.
It’s surprising to learn that these overlooked muscles can wreak havoc on the human body when they are short or stiff, altering body alignment and placing a great deal of pressure on other joints and muscle groups. Few people are even aware that back pain can be caused by lack of care for the hip flexors and so the issue is never really rectified.
The hip flexor muscles are located on the front of your body (predominantly), spanning from the abdomen, across your hips and down the front of your legs. They act to bring your legs up towards your torso. Hip flexion occurs whenever you take a step, walk up a flight of stairs, run..you get the idea. The hip flexors are extremely important because of what can happen when they are not able to function normally.
Below I have outlined what the hip flexors are, why they are important, the consequences of poor hip flexor muscles and the steps you can take to reduce or prevent lower back pain as a result of tight hip flexors.
Anatomy of Hip Flexors
A brief human biology lesson for you... (If you are not a fan of biology, I would recommend you skip straight to the next section!)
The hip flexor is a group of muscles that attach your femur (thigh bone) to your pelvis and lumbar spine. The hip flexor muscle group encompasses a number of individual muscles as well as some other major muscle groups. These muscles and muscle groups include:
- The Iliopsoas (or muscles of the inner hip) which are made up of the psoas major, psoas minor and the illiacus muscle.
- The thigh muscles: Rectus femoris and Sartorius
- The gluteal muscle tensor fasciae latae
- The muscles of the inner thigh: adductor longus and brevis, pectineus and gracilis.
There are many muscles which contribute to the flexing of the torso and hips, however, to delve in deeper I will focus on the psoas major, illiacus and rectus femoris muscles. If what I have said so far is just a bunch of strange sounding words, there is a diagram below to help you out .
FRONT OF BODY:
The Illiacus muscle originates in the iliac fossa and travels down to the lesser trochanter.
The psoas major originates on the transverse processes of the lumbar spine from L1-L5 and inserts into the lesser trochanter. You can begin to see now that the link between the hip flexors and lower back is highly important.
The rectus femoris originates on the anterior inferior iliac spine and ilium above the acetabulum and inserts onto the tibial tuberosity via the patella tendon.
This is a brief anatomy of the hip flexors, however, what we are most interested in is their function.
Function of Hip Flexors
To sum up very briefly, the function of the hip flexors is to flex the hip and the torso. Allowing you to move your leg up towards you torso or bend your torso over towards your legs. They also allow you to externally rotate your hips to allow for a wider range of motion through various planes as opposed to simply moving your legs backwards and forwards. The hip flexors are also responsible for keeping your hips and lower back properly aligned so it is vital that they are strong and flexible in order to perform this function optimally.
Consequence of Poor Hip Flexors
Unfortunately, poor hip flexor functionality is common. One of the major reasons that these muscles become tight and dysfunctional is the fact that we spend a great deal of time sitting from an early age and this continues into our adult lives at work, at home and even when we go out (cinemas, theatres, bars etc). Spending so much time in a flexed position means that the muscles of the hip flexor spend a great deal of time in a contracted and shortened position. Over time, this reduces the flexibility of the muscles and shortens their length, restricting movement when we are no longer sitting.
One of the other major reasons that the hip flexors can become chronically shortened is due to the fact that they have to take on the role of stabilising the pelvis and spine, which creates excessive tightening in the muscle fibres to hold the joints steady. Functionally speaking, it is not the job of the hip flexors to stabilise the pelvic complex on their own, but the muscles which are supposed to be responsible for this function are notoriously weak which places more pressure on our hip flexors.
The chronic shortening of these muscles results in the pelvis being tipped forward as seen below.
This alteration to our anatomy changes our posture and places a great deal of pressure on the lumbar spine causing reduced flexibility, muscle tightening, trapped nerves and in most cases, an excessive amount of pain. It can also affect the function of the glutes which reduces stability of the pelvis even further, reduces functional strength of the body and leads to more back pain and injury.
Another muscle groups affected by the tipping of the pelvis is those all important abdominals! The tipping leads to a lengthening of the abdominals which creates muscle weakness due to a poor length-tension relationship.
If your hip flexors are tight, short or overdeveloped you may suffer from the following:
- Lower back pain and hip pain
- Trapped nerves which affect both your upper and lower body
- Poor balance
- Postural problems
- Issues with running gait and subsequent injuries
Correction and Prevention
If you suspect that tight hip flexors may be causing you an issue, there are strategies that can help you to correct this problem. The first thing on the agenda is releasing the muscles which have become chronically shortened and stiff. You can perform myofascial release (soft tissue release) using a foam roller or a tennis ball to apply pressure to the tight muscle tissue and release and lengthen the muscle fibres.
You also need to strengthen the muscles that give the spine stability so that your hip flexors are no longer picking up the slack for weakened muscles in the lower back. A balanced strength and conditioning program which ensures that you target core strength and incorporate exercises which engage the hip flexors such as leg raises, the plank and lunges/weighted lunges is vital. This will help to strengthen and elongate the muscles and promote optimal stability.
You will also need to incorporate stretches into your daily routine to keep the hip flexors flexible and functioning optimally through a good range of motion. Yoga and pilates are great for increasing overall flexibility and encouraging stability, good posture and reducing the risk of injury. Low lunges (where the knee of your rear leg is on the floor) are the perfect stretch for hip flexors. The knee of your front leg should be in line with the toes of your front foot and you should allow your hips to sink into the stretch.
A few quick tips:
- As you already know by now, sitting is not good for you. Try to get up and move around every 30 minutes, even if you just stand up and have a quick stretch or take a short walk to the coffee machine, you will be giving your hip flexors a break.
- Stretch while watching TV. Buy yourself an exercise ball and do bridges over the ball so that your back is fully supported while you stretch out your hip flexors!
- Lengthen your body whenever you get the chance! Hang from the pull up bar in the gym, reach for the ceiling when you stand up or stretch out while you are in bed.
- Try to avoid sleeping with your legs curled up in a foetal position. It is one of the chances during your daily routine that you get to lengthen your body, so try not to spend it in a ‘seated’ and flexed position.
- Use your foam roller and self massage as often as possible.
- Keep an eye on your posture and try to correct yourself if you notice that you are leaning to one side or in a slumped position. Imagine a piece of string from the top of your head pulling you towards the ceiling.
PLEASE NOTE: If you have ongoing chronic back pain you should consult your doctor as there may be an underlying medical issue which needs to be addressed.