Updated: May 23
"My hips feel constantly sore! How do I fix this?"
"Will stretching help my tight hip flexors? I've already been stretching them so much. It only lasts a couple hours and then the tightness comes right back."
"Is it normal for my hip muscles to ache this much?"
Cranky hip flexors and tight hip joints got you down?
Maybe you even splurged and got a massage gun…which helps temporarily.
Maybe you were even so desperate you ordered a hip hook off of Amazon. (yikes!)
Or maybe you lay on your belly with a lacrosse ball in your hip crease for hours?
I've heard a lot of things over the years as a physical therapist and runner. And I've seen a lot of runners with stubbornly, tight hips.
The ONE thing in common with EVERY runner?
You've already tried stretching your hip flexors
Multiple different ways
Multiple different times.
Ready to try something NEW? Something that I use in the clinic on the regular with my patient that works?
Let's dive in.
STUFF YOU TRIED THAT FAILED YOU:
1/2 kneeling hip stretch
1/2 kneeling hip stretch with the back leg propped up on an ottoman
Regular standing quad
Figure four piriformis stretch
I could keep going..
But the point is: you've already tried those.
And your results have been…lackluster.
The BIGGER QUESTIONS:
Why don’t they work?
Why didn't your results "stick"?
Was it you, the stretch, or both?
Research has the answer.
WHY YOUR HIP FLEXOR STRETCHES DON'T WORK
"restricted hip flexor muscle length is theorized to decrease neural drive to the hip extensor musculature. Specifically, reciprocal inhibition of the gluteus maximus, secondary to “overactivity” of the hip flexor muscle group…
Reciprocal inhibition is theorized to lead to an increased reliance on the secondary hip extensor muscles, such as the hamstrings and hip adductors…,clinically referred to as 'synergistic dominance'.
Dependency on secondary hip extensors may provoke greater tissue stress in the hamstring and hip adductor musculature, thus resulting in a higher risk of soft tissue injury.
However there is a dearth of literature that validates clinical theory of restricted hip flexor muscle length as an underlying factor inciting altered lower extremity neuromuscular control."
Our muscles work in antagonistic pairs.
do a bicep curl; and your tricep MUST relax.
Try to extend your arm overhead to grab a plate from the top shelf, your bicep MUST relax.
This type of relationship exists ALL OVER our bodies, and the hip flexors and glutes…you guessed it…are one mighty pair.
So what happens when one partner won't chill out?
You end up with "overactivity", sometimes tightness, in your hip flexor and inhibition, or inability to activate, in your glutes. The Ying is not allowing yang.
This is a problem and your body is determined to find another solution.
And it does, by recruiting other muscles with a similar job to the muscle that is inhibited.
But because those second-stringers aren't meant to be the starting player, over time if this "synergistic dominance" pattern continues, you end up with a soft tissue injury
(like I did! I have a history of a "hard to activate right glute" and that resulted in a right groin strain during one cross country season…not fun.)
Your hip is might be tight and is staying tight because:
Your body decided that the hip flexor was the powerhouse muscle of the lower body and not glute…
Probably because of some funky compensations that got picked up over the years
And your hip is staying tight now to protect you because it's getting messages from your glute that it can't let go because the glute can't activate to 100% (but it can't actually activate to 100% because the hip flexor won't relax)
Confusing? I know…
This will help:
"The primary hypothesis of this study was that individuals with restricted (think 'tight') hip flexor length would exhibit less hip extension strength (think 'glute strength')… compared to individuals with normal hip flexor length during the descent phase of a double‐leg squat (DLS)"
"I wonder if runners with tight hip flexors have weaker glutes compared to runners who don't have tight hip flexors?
Let's test this in a double leg squat, but the going down part."
My two pennies:
I think it's cool they picked the descent phase. It's this type of muscle strength runners require to run FASTER because we need to get better at decelerating! Producing power and speed isn't our problem; being able to handle the flip side of our own speed is. What would have made this test even better was if it was a single leg squat...
WHAT YOUR TIGHT HIP FLEXORS *actually* NEED AS A RUNNER
New solution presented by research:
"The current findings revealed that muscle activation amplitude of the gluteus maximus was significantly less in the restricted (hip flexor) group compared to the normal group…"
...These findings support the hypothesis that gluteus maximus activation is affected by hip flexor muscle length. Furthermore, these findings implicate that individuals with restricted hip flexor length may use less muscle activation of the gluteus maximus and greater relative activation of the hamstrings to achieve the same net hip extension moment profile as those with normal hip flexor muscle length."
If that's clear as mud, let this stat do the talking:
"The restricted (tight hip flexor) group had a relative difference of 60% less gluteus maximus activation compared to the normal group during the descending phase of the squat."
THAT'S A HUGE DIFFERENCE!
If your hip flexors have been chronically tight, you're "missing" over HALF your glute!
This is how POWERFUL that ying-yang relationship is between your muscles.
One relaxes so the other can contract, and vice versa.
Give and Take.
But there's a VERY IMPORTANT distinction that needs to be made.
"Hip extension strength did not differ between the restricted (tight hip flexor) and normal groups."
But you JUST said, I'm missing half my butt!
There's a difference between muscle ACTIVATION vs. muscle STRENGTH.
And that's what this quote is referring to.
Despite having tight hip flexors, you might have VERY STRONG GLUTES! But your body doesn't know how to access this powerhouse muscle.
So on your way to building stronger glutes, you first need to unlock their potential (aka activate them).
HOW DO I LOOSEN MY TIGHT HIP FLEXORS?
Easy answer: By daring to train differently.
You strength train like a runner for STRONGER GLUTES, which means
You first restore hip joint mobility in order to…
activate them FULLY with appropriate warm up exercises follow up with…
Running specific strength exercises.
The reason for this order?
Does it make sense to put frosting on top of a birthday candle and call it a birthday cake? (please say no).
But this is what it can be like if we jump right into a strength exercises without doing the recommending prep work.
You first need to make and bake the cake = have good hip mobility.
Then you can frost the cake = activate your glutes
And finally add the birthday candle = get into the stronger glutes exercises.
It's all about building on top of a solid foundation of restored mobility/range of motion and neuromuscular engagement (aka glute activation and "turning the volume up to 10").
Let's wrap up with this:
SIDE EFFECTS OF TIGHT HIP FLEXORS AND WEAK GLUTES FOR RUNNERS
"However, the observed muscle activation strategy in individuals with limited hip flexor muscle length suggests that these individuals exhibit relatively greater reliance on hamstrings musculature versus gluteus maximus to eccentrically control hip flexion during a controlled functional movement.
The requirement for greater hamstrings muscle co‐activation may impart greater stress on the hamstrings, thus clinicians should be aware of a potential for increased risk of a hamstring muscle strain injury in those with hip flexor muscle tightness, characteristic of biomechanical overload of muscle tissue. In addition, greater hamstring muscle co‐activation may make those with hip flexor muscle tightness more susceptible to hamstring muscle fatigue during sport."
Remember how we discussed the ying-yang relationship of hip flexors to glute muscles but there's some additional teammates that can be recruited?
Meet your hamstrings.
They have a similar job to your glutes where they provide the yang to the hip flexor-ying.
And if we put the puzzle pieces together…
Hip flexor remains locked down because of poor movement patterns.
The glute remains relatively inactivated despite it being strong.
So somebody else needs to be the heavy mover, and that becomes the hamstring.
The hamstring is now doing it's job ONTOP of trying to take up glute's slack.
Makes sense then that a runner could end up with BOTH :
Tight hip flexors
Tight hamstrings…potentially resulting in a hamstring strain down the road.
Talk about getting into high-level stuff here…but let's wrap this up.
You're take away is to ask yourself these questions.
If you have tight hip flexors, ask yourself:
how long as this been going on?
Does it only happen after specific workouts or runs?
Or is this something that's been lingering for months….or years?
Do you ALSO have tight hamstrings?
This doesn't mean you have to be able to palm the floor…
But can you at least make it to your mid shin?
If not, do you do regular strength work?
If you're struggling through these questions, Grab my NEW FREE STRENGTH GUIDE for RUNNERS!
It has exercises to get you started in the right direction…and, I have a secret buried in there about what I've been working on that just might solve all your tight hip flexor issues ;)
Grab your FREE STRENGTH GUIDE HERE!
And until next time, running fit fam….
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
P.S. Looking for some new running specific strength exercises to try? Then you'll love the NEW STRENGTH GUIDE too ;)
Mills M, Frank B, Goto S, Blackburn T, Cates S, Clark M, Aguilar A, Fava N, Padua D. EFFECT OF RESTRICTED HIP FLEXOR MUSCLE LENGTH ON HIP EXTENSOR MUSCLE ACTIVITY AND LOWER EXTREMITY BIOMECHANICS IN COLLEGE-AGED FEMALE SOCCER PLAYERS. Int J Sports Phys Ther. 2015 Dec;10(7):946-54. PMID: 26673683; PMCID: PMC4675195.