Think your pain is coming from your back? Read this first.
Hi! My name is Paul Jones. Today I would like to show you a couple of my favorite stretches I give to my patients with low back pain. These stretches target tight hip flexors which are located at the front of the pelvis and hips and have attachments from the lumbar spine all the way down to the knee.
How do the hip flexors influence back pain?
If you imagine someone standing upright, the pelvis balances on the femur. The pelvis uses the hip joint as a fulcrum. Muscles in the front and back of the hip act like guy-wires, holding the pelvis level. Now imagine if the muscles in the front of the hips are tight. This will tilt the pelvis forward and thus change the posture of the lumbar spine. As you walk around, your hips move from flexion to extension and absorb the movement of your legs all while keeping your pelvis and lower back in a neutral position. This new forward tilted position means that some of the movement that should be absorbed by the hip is now transferred to the sacroiliac joint and the lower lumbar spine. This can be very subtle, you may not be able to see it. To give you an idea of how important it is, imagine that you have a 5mm to 10 mm displacement of your pelvis. One step is not going to make that much difference, but when you consider that even a sedentary person takes nearly 2,000 steps a day, that small amount of displacement can add up to a lot of irritation in the SI joint or lumbar spine. Now imagine that going on for weeks or months and how painful that would become.
The truth is, a very large number of people who come to me with back pain have this problem and simply stretching out the hip flexors can provide a lot of relief. Even people with herniated discs, arthritis and facet joint problems are surprised at how effective these stretches are.
Why are hip flexors tight?
There are a lot of schools of thought here, but a simple explanation is that most of us sit too much either at work or when we are driving or relaxing at the end of a long day. We, also, do very little to counteract this flexed posture. Even those who exercise daily do not do enough stretching to mitigate the hours and hours they spend in a flexed position. So, over the years, our hip flexors tighten and we start having back pain. Most people attribute this pain to age and take a painkiller every now and again. Others may go have an x-ray. The x-ray shows some degenerative changes and these changes are assumed to be the cause of the pain. The truth is that it’s pretty normal for anybody over 30 years old to have some degenerative changes in their spine. The changes may have you thinking that what’s on your x ray is the cause of your pain, it may simply be the way you are moving that is the primary source of your pain.
Stretches to ease hip tightness
Supine Hip Flexor Stretch
For this stretch I have the patient lie on their back and simply hang their leg off the side of the bed. We are looking for a gentle stretch in front of the hip here and no arching of the back. If the stretch is uncomfortable, I will add some support under the foot. This primarily stretches the iliacus and psoas which attach to the pelvis and lumbar spine. This should be a gentle stretch. The reason for this is that one of the functions of muscles is to protect the joints they support. If you stretch a muscle too hard, it will pull back against the stretch and thus defeating the purpose. Instead we go for a gentle stretch, but for a longer period say 3 to 5 minutes. This allows the muscle to relax and stretch out.
Prone Hip Flexor Stretch
For this stretch the patient lies on their stomach and we flex the knee up. This stretches the iliacus and psoas, but additionally it stretches the rectus femoris which crosses the hip and knee joints, hence the knee bend. I like to take a strap and hand it to the patient so they can hold the leg in this position, that way they can relax into the stretch. Try to keep the hips flat and avoid the pelvis lifting up off the bed. If they are not feeling a stretch you can elevate the knee with a rolled-up towel or even a foam roller.
If you are having back pain, particularly in the lower lumbar area or around your tail bone or hips, try these stretches at home. They should not be uncomfortable but rather feel a little better at the end of each session. If that’s not the case or if there is something else that concerns you, or even if you just have questions, then you should come see us in person at one of our clinics. Call and ask to be scheduled for a free Discovery Visit, there’s no charge and no paperwork. You get to meet with one of our PTs, tell them what’s going on and find out if Physical Therapy is something that can help you.