They probably don't need it.
Do you feel constant tightness in the front of your hips? Especially when you run, squat, or stand up from sitting all day at work? This article is going to break down what may be causing it, how to test for it, and some exercises to (hopefully) abolish it for good.
If I had a nickel for every time that I heard somebody complain about their tight hip flexors… I would have an annoying amount of nickels (anybody else HATE pocket change?). These people typically have spent an enormous amount of time stretching out their hip flexors, foam rolling, massage gunning, and all sorts of other things without any consistent relief. But why is that? If it feels tight, we need to stretch it out, right? Well… no. Tightness is just a feeling. It doesn’t really tell you much about what is actually going on in those areas of your body. Just because you feel tight, doesn’t mean that you are ACTUALLY tight in those areas. Most of the people that complain of hip flexor tightness, have never actually had the length of their hip flexors tested. Assess, don’t guess.
So, what causes hip flexor tightness?
There are 3 main reasons why your hip flexors may always feel tight.
Weakness: if your hip flexors are on the weaker side, they will stay constantly tight in order to protect themselves from possible injury. Increasing the strength is the obvious fix here.
They are helping another muscle group do their job (aka they are overworked): one of your true hip flexors (psoas major) attaches from your leg bone all the way up to your spine in your low back. These attachment points mean that your body can also use your hip flexors as a core stabilizer. This commonly happens due to weakness in the core, or because of poor motor control (that just means coordination and being in control of what muscles are used when). So if your hip flexors are helping the stabilize your spine a lot, they may be tight due to trying to do more than they should have to do.
Actual tightness: yes, after all of this, your hip flexors may ACTUALLY just be tight. So why hasn’t all that stretching helped? Because only stretching won’t do anything for you if you don’t teach your body how to use the new range of motion that you just gained. Stretching is fine if you actually have shortened hip flexors, but you need to follow it up with strengthening in the new range of motion that you just gained. This teaches your body how to actually use and maintain the new ranges you are gaining from stretching. So….it again comes back to strengthening.
The Thomas Test
The Thomas Test (video below) is a very simple test that can give you a lot of information:
Here is what the different findings on this test may mean (all for the down leg), with your low back staying on the table:
a.) Knee stays bent to 90* (or more), back of thigh touches surface you are lying on, and your knee doesnt move to the outside of your body = no muscle length issues.
b.) Knee straightens out to greater than 90* of bend = rectus femoris tightness. This muscle goes from the front of your hip to below your knee cap, so plays a role in both joints’ motions.
c.) knee moves to outside of your hip = this may mean tightness of the tensor fascia latae muscles on the front/outside part of your hip. Commonly overactive in people with hip and low back pain.
d.) back of thigh doesn’t touch the surface you are on = tightness of hip flexors (psoas and iliacus).
End Range Hip Flexion Hold
How much control do you have over your hip flexors? That can be tested using this simple end range flexion hold (video below).
Pull your leg up as far as you can, then try to hold it there when you let go. Any loss of height, rounding of your back, hyperextension of your back, or any other weird motions that happen means that you may be lacking some end range strength in your hip flexors, or that your body simply isn’t very good at controlling motion through your hip without getting your back involved.
Hollow Hold
You can test whether or not your hip flexors are being recruited as a spinal stabilizer by looking at the hollow hold (video below).
Ideally I’d like to see this be held for 30-60 seconds. It should be a smooth banana shape, no hard angles at the hips. If you do notice that your back arches right away, or you are unable to keep a smooth shape (i.e. you bend at your hips as opposed to curl up), that likely means that you need to work on core strength and control. Being able to hold a good hollow position translates over into a lot of the gymnastics and higher-skill movements seen in CrossFit, so this isn’t all about your hip flexors, it’s also about improving your performance in the gym!
The solution
Here are my go-to exercises for those people dealing with tight hip flexors. They are a combination of eccentrics (i.e. controlled stretching + strength), strengthening, and motor control exercises for both the core and the hip flexors.
Eccentric Dead Bugs Off Bench
This exercise (video below) is focused on teaching your body how to control your hip flexors through their full range of motion. When your brain starts to recognize that you DO have control over those hip flexors in a stretched out position, it will stop being so worried about them and may reduce that protective tone.
Keep your back flat against whatever you are laying on. Holding a light weight above your head helps keep your core active during this. Keep knee bent to 90* as you slowly lower your leg off the side of the bed/table. If you start to feel yourself cheating at all (back lifting, shifting to the side) or you just get into a really strong stretch, pause there for 2-3 seconds, then return back to the start position. You can easily progress this by putting your foot through the handle of a light kettlebell, or by having somebody lightly push your leg down, so you have to control with motion against a little more force.
Psoas March
This is focused on strength of the hip flexors to RESIST motion, as well as make sure your core can take over as the primary stabilizer of your trunk when you need to move your leg. It’s just coordination people, and it’s severely overlooked.
Have a band looped around your feet, keep your back flat on the floor the whole exercise. Yes, you will feel your core working throughout this exercise. This is teaching your core and your hip flexors how to do their separate jobs. Keep one leg perfectly still as your other leg kicks out into the band. The farther you kick, the harder it is for the up leg. Move slowly and controlled.
Single Leg Hip Lift
If your hip flexors have been tight over a long period of time, that likely means that your hip extensors may not be working to their full potential either. This is because your body will limit the ability of a muscle to produce force, when its exact opposite is turned on. Example: when doing a bicep curl, you wouldn’t want your triceps (the back side of your arm) turned on fully as well, because that would stop your bicep from lifting the weight up. The goal of this exercises is to get those glutes working hard, as well as let your hip
Lying on your back with legs bent up, pull one knee to your chest. You will hold this leg close to your chest throughout the exercise in order to prevent any cheating via arching your low back, and force your gutes to actually do their job. Press the down leg down into the ground, squeeze that glute and drive your hips towards the ceiling. You are trying to create a straight line from your knee to your shoulder.
I hope this helps those of you that deal with chronically tight hip flexors. Remember that these are just the beginning. These are not intended to be medical advice or to cure all issues that involve the hip flexors, but hopefully they give you a solid starting point!
Please feel free to reach out with any questions. If you are looking for more in-depth help, I am currently taking online clients for anybody dealing with pain or performance issues. I have online visits as well as monthly exercise plans available. Send me a message if you would like more information, or check out our services page for more information about our online offerings.
Thank you for reading, Jacob Erbes PT, DPT, CMFA, CF-L1