If I had a dollar for every time an athlete in my treatment room has reported “tight hip flexors”, I might not have to work anymore (but why would I do that? I love my job!). Oftentimes this is followed up with the plea for a better hip flexor stretch, the best office chair, or simply WHY is this happening to me!?
Oftentimes, tightness in the front of the hip is not as simple as “tight hip flexors”, and therefore more stretching is not always the answer. To better understand this phenomenon, let’s look at the anatomy of the anterior hip and all of the factors that contribute to tightness here.
From a muscular perspective, we have a group of three muscles that contribute to hip flexion (and are therefore called “hip flexors”): Rectus femoris, iliopsoas, and pectineus. The Rectus Femoris is a member of the quadriceps group, and has attachments on both the hip and knee joint. The iliopsoas originates on the vertebrae of the lumbar spine. The pectineus is technically part of the adductor group, but it is located high and anterior enough in the thigh and groin area that sometimes it can create a similar sensation of tightness. The overarching theme here is that the “hip flexor” is actually a dynamic group of muscles that all have other roles as well as flexing the hip.
The hip joint itself is quite variable in individuals as well. The fit of the head of the femur into the acetabulum heavily influences available range of motion, and certain “fits” and/or tightness within the joint itself can limit movement.
Finally, the femoral nerve passes through this area as well. The femoral nerve originates from the L2-4 segments of the lumbar spine and follows the path of the iliopsoas through the front of the hip. Our nerves carry both motor (muscle movement) and sensory (touch, tension, stretch, etc) information like telephone wires through the body. If the nerve is constricted anywhere along its path, it can send faulty information back to the brain, such as a muscle being “tight” even though it may not be. This is called "neural tension" and in order to improve the tension, we have to perform specific exercises called nerve glides, instead of stretches. I've written about this previously and you can check that out at the link above.
It can be really difficult to figure out for yourself what components of your anatomy are contributing to your hip tightness, so it is beneficial to have a Physical Therapist on your healthcare “team” to help do some investigation for you. However, you can do a few tests on your own:
Femoral nerve test:
Start in a half-kneeling position, like you’re going to do a hip flexor stretch. Rotate your pelvis so that your hips are not tilted or backward. Note if you feel any sensation or tension in the front of your kneeling thigh. Then, tuck your chin and bring your chin toward your chest. Note if the sensation changes at all with the head movement. If it does, neural tension of the femoral nerve may be influencing the tightness of your hip.
Joint mobility test:
Start on all fours (hands and knees), and keep your back straight as you “rock” your hips back toward your heels. Go slowly so that you can feel any restriction in movement. If you feel a “block” in front of your hip prior to your hips progressing over your knees, or if you feel a “pinching” sensation, then you might have some joint tightness.
The final component of "hip flexor tightness" is a possible weakness or over-utilization of the hip flexors. Weak muscles often feel "tight" because they shorten over time when we ask them to do too much. Weakness of the deep core and abdominals can also cause overwork of the hip flexors. The core muscles maintain stability of the pelvis, allowing the limbs (for our purposes, the legs) to have a stable base to operate from. Think about the difference between climbing a rope ladder vs. a regular ladder. The rope ladder is more taxing because it constantly moves and requires more muscular work to move forward.
I hope you have a better understanding of why you feel like you have two steel rods in the front of your hip, and what to do about it. As always, we here at Precision are here to help!
Keep going, you got this!
Kacy Seynders, PT, DPT, OCS