9 to 5 Back Pain Part 3: Unlocking Your Hip Flexors

In part 3 of 9 to 5 Back Pain, we will discuss the effects sitting has on the hip flexors and the ramifications it has on your back. The biggest ramification of sitting on the hip flexors is shortening of the muscles which can create postural abnormalities that put undue stress on the lumbar spine. Luckily with some mobilization and stretching we can allow the bottom to assume a proper posture.

The hip flexors are a group of muscles with the primary responsibility of creating flexion at the hip. Often times the psoas major and iliacus are grouped together to be named the iliopsoas because of their close proximity to each other. Psoas Major has origin points from T12 vertebrae all the way through L5 vertebrae and inserts on the inside of the femur. It’s primary action is hip flexion with glue max being its biggest antagonist. What separates iliacus from psoas major is that it acts solely on hip motion. Because psoas crosses multiple bony aspects, it can create hip flexion as well as pelvic/trunk motion. Rectus femoris(apart of the quadricep group of muscles) is considered to be one of the weaker hip flexors as it also extends the knee and can be put in position that do not allow for great strength in hip flexion.

Sitting, much like squatting, requires the hip to taken into hip flexion and often times people remain in this position from 8 to 9 hours a day. Placing a muscle in a shorten position for an extended period of time can often times lead to a shortening of the muscle or a contracture. You see this in the elbow after it has been immobilized(casted) when a Bicep contracture occurs and the person is not able to extend their elbow. After having sat for 8 to 9 hours a day the hip flexor muscle group will be very resistant to lengthening, making full hip extension difficult. Repeated, long days of sitting can lead to chronic shortening of the muscle therefore robbing you of the full hip extension needed for optimal performance

As stated earlier, shortening of the hip flexors make it difficult to fully extend the hip. The primary culprit of dysfunction is the psoas majors. If the hip is not able to fully extend during high power movements like sprinting or power cleans, the body will compensate with extension in the lumbar spine. The extensors of the lumbar spine are not made to create high forces and this often leads to strains of low back. Tight hip flexors can also lead to increased anterior tilt, or the position many girls try to achieve when trying to make their backside look big, which can lead to issues at the l5-S1 discs.

Example of anterior pelvic tilt and a terrible plank
Example of anterior pelvic tilt and a terrible plank

Just like the glutes, there is hope in having better hip flexors. The biggest issue you must address is mobility/flexibility of the hip flexors, primarily the psoas major. Self-myofascial release is helpful here as well as with stretching. The biggest issues with the Iliopsoas is it’s location. It is very deep in the abdominal area and can be very uncomfortable because a lot of force is needed to affect the tissue. Tools used for the release shown below, can be a lacrosse ball or as shown in picture a Kettlebell handle.

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1. Lie down over KB, positioning between belly button and hip bone
2. Find a stiff spot, take a deep breath in for a few seconds and then exhale and allow yourself to relax into KB
3. Can flex knee or roll your body to the side to create a pressure wave effect across the tissue

The Rectus Femoris is much easier to treat with a release. My favorite tool here is the foam roller. I’ve also used a massage stick or you could also use your house hold rolling pint to do some self-massage.

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After you have worked on releasing the bound up tissue, stretching will help further elongate the tissue. The biggest fault I see with people stretching their hip flexors is that they add lumbar extension to give the vision of greater hip extension. The couch stretch is a great hip flexor stretch with the regular lunging hip flexor stretch is an effective regression if you can not handle the couch stretch.

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Me attempting the couch stretch. Notice I do not push the ROM and maintain a neutral spine
Me attempting the couch stretch. Notice I do not push the ROM and maintain a neutral spine
Properly maintaining my spinal position during lunge stretch
Properly maintaining my spinal position during lunge stretch
An example of what not to do. Notice the lumbar extension.
An example of what not to do. Notice the lumbar extension.

With regular mobilization and stretching of the hip flexor, you can help reverse the effects of sitting. Restoring full range hip extension will help optimize performance and allow an athlete to fully express their strength and power. In Part 4, I will discuss how you can structure your workouts to help include the mobilization and activation techniques. Also, I will give some weak points that you can focus on in your strength programs.