Is Your Lower Back Pain Caused by a Tight Hip Flexor?

The iliopsoas muscle, commonly referred to as the hip flexor, can often be a significant reason for lower back pain. I recall numerous patients with lower back pain who had tightness in these muscles. These muscles connect to your lower back and pelvis, then extend downward to attach to the upper portion of your thigh bone.

The muscle, as its name suggests, flexes the hip or raises the leg. It also affects the pelvis and lower back, causing the pelvis to tilt forward, known as an anterior tilt, and bending the spine to the side. Tightness in the hip flexor can lead to a forward tilt of the pelvis and excessive lordosis, or an exaggerated arch in the lower spine. This misalignment causes instability and abnormal pressure on the spine, which can stress the facet joints and lead to degeneration and potentially nerve compression, known as stenosis.

Extended periods of sitting are the primary reason for tight hip flexors, highlighting one of the many ways that a sedentary lifestyle can negatively impact your spine and overall health.

Regularly stretching the hip flexor is beneficial to avoid tightness. Additionally, strengthening the gluteus maximus, which counteracts the hip flexor, is highly advantageous. Many people often experience tight hip flexors and weak glutes. According to a study by Matthew Mills and colleagues, published in the International Journal of Sports Physical Therapy, individuals with limited hip flexor muscle length showed reduced activation of the gluteus maximus.

The gluteus maximus plays a crucial role in stabilizing the hip, pelvis, and spine. Numerous studies have linked lower back pain to weakness in this muscle. A study published in Plos One by Amy Amabille and colleagues found that the average normalized cross-sectional area of the gluteus maximus was notably smaller in individuals with lower back pain compared to those in the control group. This indicates that the gluteal muscle was weaker and smaller in those suffering from lower back pain, particularly in individuals with chronic lower back pain.

How to assess your hip flexor flexibility:

Raise one leg while allowing the other to drop. If the thigh isn't parallel to the floor, it indicates a tight hip flexor; in this image, the tight hip flexor is on his right side.

Here is a good way to stretch and lengthen your hip flexor:

Begin in a half-kneeling position, shifting your weight forward onto your front leg while keeping the back knee on the ground. Engage the gluteus maximus and attempt to extend your hip backward. For an additional stretch, lean to the opposite side. Maintain this position for 20-30 seconds and repeat three times.

Here is an exercise to isolate the gluteus maximus:

This exercise is known as a donkey kick. Begin on your hands and knees, ensuring your hands are directly under your shoulders and your knees are directly under your hips. Keep your back stable and neutral. Engage your gluteus maximus and raise your leg upward as if pushing your heel toward the ceiling. Perform this exercise slowly and with control, holding your leg up for a second or two with each repetition. Aim for 10 repetitions and 2-3 sets daily.

We hope these exercises assist you in achieving a healthier back! Feel free to contact us if you require further consultation about your back. We provide a variety of personalized exercises tailored to your specific needs and also offer deep tissue massage to target and release the hip flexor.

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