Have these words ever come out of your mouth before?
"Man, My hip flexors are so tight!
(..at least, I think it's my hip flexors.)
At this point, you probably hop on Google, search "hip flexor stretches", find a couple, and stretch away.
It feels pretty good and seems to the hit the spot.
So you continue on with your day.
The same tightness comes back tomorrow, next week, and then settles in to stay as you start a training program with more speed work and higher mileage.
Maybe at this point you've already added those hip flexors stretches into your warm up AND your cool down.
But something isn't sticking.
Because the tightness, soreness, aching keeps coming back.
And now, it's starting to creep into your longer runs.
You find your hips are feeling achy and tight mid workout.
What gives??
*knock, knock!*
This is usually a sign your body is trying to tell you something!
But are you listening?
I hear you all (and see you in the clinic) with this exact story.
Want to put an end to constantly tight hip flexors?
Are you ready to finally get some answers?
Stick around for this 3 week series on tight hip flexors and how to fix them…all by daring to train differently (duh).
You ready?
Let's dive in!
What are your hip flexors? And WHERE are they?
Quick facts:
Our bodies are deliberately made with redundancies, fail-safes.
There are 5 hip flexor muscles groups.
We're talking about 2 of the heaviest lifters.
Meet: Iliopsoas (a group of 3 individual muscles)
Quadriceps (a group of individual muscles)
The reasons for our focus on these 2 groups? Take a look at these pictures.
Left Image: liopsoas ( a complex of 3 muscles) // O: T12, L1-L5, iliac fossa // I: lesser trochanter of the femur. Right Image: Quadriceps // O: AIIS + anterior femur // I: tibial tuberosity via patellar ligament
Did you notice how the Iliopsoas actually starts at the back bone attached to your lowest rib? And, it plugs into your upper leg bone? That muscle group covers a LOT of ground and starts far back in your body and comes a little closer to the surface. But there are still a lot of organs sitting on top it.
And those quads, they start on your hip bones and plug in right below your knee cap.
Why do I bring all this up?
To attempt to demonstrate what your hip flexors actually are.
When we take the time to look at and understand the muscles and the anatomy, a lot of our answer are RIGHT THERE!
Like why when your hips are tight, your back might also start to feel sore and achy. (That iliopsoas complex might be tightening up and pulling on your back…but why?)
Or why there might be some popping or snapping with certain hip exercises. (this used to happen a lot for me on my left side; it's often just as a muscle tendon not gliding smoothly over a bone).
We need to have respect and understanding of our anatomy. When we do that, it allows us to make better corrective exercise decisions. And explains why your googled-hip flexor stretch isn't helping anymore. Because there's more to the story!
How do I know if my hip flexors are tight?
Steal a test from the PT world!
We call this the Thomas Test.
There are technically 2 ways to do it so check out the 2 different videos below so that you can decide which is a better option for you.
SHORT Answer Version
LONG Answer Version (more explanation, my personal favorite)
So how do you know if your hip flexors are "tight"? You'll feel that stretch; maybe even a difference left side compared to right. But more importantly...
You might decide you need a running buddy to help you out with the observation part of the hip flexor test.
Where and how though? Instead of fancy physical therapy mat like you see in the video, just use a picnic table at your local park. I mean, sure, you might look a little funny, but we're runners. We kinda sorta already look funny running for fun.
If it's easy, let it be easy.
The beauty of paying attention to how YOUR body feels doing either of these tests, is that you then have the ability to RE-TEST!
Yes!
Do the Test, do some of the exercises below (we'll get there) and then come back and do this test again.
Ta-da!
You just did an experiment to determine which exercises are most effective for YOU specifically as an individual runner. That kind of knowledge and power give you confidence!
Why are my hip flexors tight?
Honestly, I struggled here, running fit fam.
I couldn't find a whole lot of research that could explain the mechanism of how and why hip flexors become tight. And the research I did find, I just wasn't satisfied with.
I came across some general articles out in the wild west of the interwebs, but even there, no one had an answer.
Ok, a real answer.
It was answers like:
"your glutes aren't active"
"your hip flexors are never lengthening, only repeatedly shortening when your run".
Ummm, that last one: that's not how anatomy or biomechanics work, but alrighty there.
So this is one of those times where again, I have to say "the science doesn't know". But tight hips happen anyway. (But if you've heard something different, drop it in the comments below! I love learning something new.)
But if you've been around here long enough (or maybe you're new), we don't just shrug our shoulders here when the WHY becomes too hard.
We dare to train differently, so we dare to think differently.
Here are my answers based on my clinician practice as a physical therapist whose taken multiple functional movement courses.
From working with runner-patients, I've found that most of their chronic hip tightness is due to overload; the hip flexors are trying to pick up the slack and keep you running.
Peeling back the layers of strength deficits and movement compensations, we usually find their hip flexors are absorbing a different muscle's work load. (remember at the beginning when we talked about how our bodies are made with intentional redundancies and fail-safes? Yea, this ties into that…)
Overworked and tight hip flexors can result in:
A Lack of hip mobility
Continued poor core strength (think about that origin and insertion of the iliopsoas muscle)
Weak or poor glute neuromotor control
Where am I going with this?
Meet Sebastian.
A talented high school cross country and track athlete with a can-do attitude.
When we first started working together on his foot pain and shin splint pain, we started with runner-specific foot exercises (you can find those exact same exercises HERE!).
And they worked miracles taking away his foot pain, strengthening his feet, but he still had some lingering shin pain.
So we looked up the kinetic chain and assessed his hips.
Wow.
That kid has some real cruddy left hip mobility compared to his right.
But neither were great.
And despite all the hip mobility exercises, they didn't budge much.
So we changed tactics. We looked at building hip stability and core strength in conjuction with foot strength.
Over time, WITHOUT specific hip mobility stretched, that hip mobility naturally returned! His hip mobility was equal!
This goal of this story: to tell you you're body is smart!
And like Sebastian, it gets really good at protecting itself.
And sometimes that guarding looks and feels like tightness that can result in YOUR stiff, aching, tight hips and back.
How do we ultimately solve tight hip flexors?
By taking the time to listen and understand your body instead of punishing it.
And that's why I rarely stretch tight hip flexors.
(I do it occasionally, don't get me wrong…)
But I find the body cooperates better when we search for the reason of WHY the hip flexors are tight and what they're protecting.
It elucidates the specific case and leads us to treating the culprit, not punishing the tight hip flexor-victim.
What's the usual culprit then? Usually, like in Sebastian's case, it's a need for core and pelvic stability, maybe with a touch of hip mobility work. (but I'm saving all that for upcoming weeks!)
But if you're a die hard, and you're gonna stretch...here's what the evidence says to do.
Like I said, sometimes stretching is an answer, but it's not my first answer.
Here's why:
"In contrast to strength and stability training, although stretching has been considered as a good strategy to reduce running-related injuries, it has not been shown to be a beneficial effect on injury prevention in runners Nonetheless, joints’ range of motion values outside the normal range (i.e., low or high muscle extensibility) could be harmful." ALBERTO
But, true to science, we need to respect both sides of the argument and recognize this gem:
"In contrast to other muscle groups such as the plantar flexors, where 120 s of stretching likely decreases force production, it seems likely that isolated hip flexor stretching of up to 120 s has no effect or even a positive impact on performance-related parameters. This difference might be explained by the specific function of the hip flexor muscles for lumbar spine stability….A comparison of the effects on performance between the three defined stretch durations (30–90 s; 120 s; 270–480 s) revealed a significantly different change in performance between the lowest hip flexor stretch duration (30–90 s) and the highest hip flexor stretch duration (270–480s).
Moreover, meta-analysis reported a significant impairment (but with a trivial effect size only) in the highest hip flexor stretch duration (270–480 s), whilst no significant effect was reported in the lowest hip flexor stretch duration (30–90 s).
This additionally indicates a dose-response relationship in the hip flexor muscles. …..Based on our findings it can be recommended to stretch the hip flexor up to 120 s to improve performance, especially in sports where a high range of motion in the hip extension is required (e.g., dancing, gymnastics). " KONRAD
I know, that last quote is quite the doozy.
But, it does give you some pretty clear guidelines to follow and what you can hope to expect (or not). Because at the end of the day, our bodies are not perfect excel spreadsheets where you know the input and the guaranteed output. (It's definitely more a slot machine.)
So if you wanna stretch, you can.
Just know, it also needs to be supplemented, according to the science.
But supplement with what?
I'm so glad you asked!
Because if you want a head start on unlocking your tight hips, I've got a free running guide for you filled with my favorite hip mobility exercises.
…and a whole ton of other strength and running specific exercises that will help you keep the mobility you've just created!
You're going to want to get your hands on that and stick around the next 2 weeks.
Because we're going to keep de-bunking the hip flexor stretches you've probably tried before.
But over time, they didn’t cut it.
Let's find some other exercises that will.
So in the meantime, grab that free running guide and Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
References
Hiser, D., Ehresman, B., Wietharn, J., & Koster, L. (2020). Uncorking Gluteal Function through Hip Flexor Stretching. In 16th Annual Symposium on Graduate Research and Scholarly Projects. Whichita: Department of Physical Therapy, College of Health Professions.
Konrad, A., Močnik, R., Titze, S., Nakamura, M., & Tilp, M. (2021). The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis. International Journal Of Environmental Research And Public Health, 18(4), 1936. doi: 10.3390/ijerph18041936
Mellinger, S., & Neurohr, G. (2019). Evidence based treatment options for common knee injuries in runners. Annals Of Translational Medicine, 7(S7), S249-S249. doi: 10.21037/atm.2019.04.08
Mettler, J., Shapiro, R., & Pohl, M. (2019). Effects of a Hip Flexor Stretching Program on Running Kinematics in Individuals With Limited Passive Hip Extension. Journal Of Strength And Conditioning Research, 33(12), 3338-3344. doi: 10.1519/jsc.0000000000002586