When talking about low back and/or hip pain, a structure that often comes up is the hip flexors. These muscles are deep inside your core, and are responsible for- you guessed it!- flexing the hips, or bringing your knee towards your chest. In particular, the psoas and iliacus muscles form the iliopsoas complex, and are a major contributor to hip dysfunction and low back pain.
The psoas portion originates from the frontal aspect of your spine, in behind your stomach and intestines, and is joined by the iliacus portion as it passes the iliac bones of your pelvis. Together, they attach to a bony lump on the inside of your upper femur (called the lesser trochanter). These muscles cross the hip joint, which is where they have their primary function (hip flexion).
Why Hip Flexors May Cause Low Back & Hip Pain?
Problems arise when these muscles become hypertonic, or when they carry too much tension passively. When this happens it changes the resting position of your hips and low back when resting or in a weight bearing position.
The psoas attaches, as I said, to the front aspect of your spine. It arises from the main bodies and transverse processes of several vertebrae in your lumbar spine. When they are in a lengthened position (when your hips are extended straight out), that extra tension is going to add strain on the joints between the vertebrae of the low back, basically pulling them forward and increasing the curve in your lumbar spine. This causes jamming between the facet joints, irregular pressure on the intervertebral discs (IVDs), and changes the way your pelvis and hips orient themselves, leading to muscular compensation, altered biomechanics, and often pain or discomfort. If it happens on one side, it can also lead to spinal torsion, making it easier to injure the ligaments in your lumbar spine.
What is Often Involved In An Assessment?
There are several ways to assess hip flexor dysfunction. Muscle strength and length testing, or how powerful the contraction of a muscle and how far it can stretch, are the primary way to isolate these muscles, but your practitioner may also perform a postural and/or gait assessment.
How Are These Muscles Treated?
Treating them can be difficult, due to their deep position in the body, but generally involvesaccessing the belly of the muscle by pushing into the abdomen between the navel and hip. It's not the most pleasant thing to experience, but it makes a huge impact on theresting tension in these muscles.
What Can You Do For Rehabilitation?
There are also things you can do at home to help lengthen and treat these muscles. Stretching is important, though sometimes this area can be hard to target. Deep lunges are great, and another option is to lie on your back on the very edge of your bed and let your outer leg hang off it. To intensify either stretch, you can raise the arm on the same side of the body above your head. It's important to hold stretches for longer than 30 seconds, and make sure they feel good! Stretching shouldn't hurt.
Another thing that will greatly improve things is (unfortunately, because everyone hates it)strengthening your core and glutes. These muscles counteract the lumbar hyperextension and forward tilt of your pelvis by pulling up on the front of the pubis (the abdominal muscles), and pulling down on the posterior ilia (gluteal muscles). An assessment of your body mechanics by a certified practitioner may reveal weaknesses in the hip and abdominal region. Once these specific muscle weaknesses are diagnosed, a corrective and specific exercise regimen can be provided for your individualized case and needs.
To learn more or to book an appointment with one of our physiotherapists, chiropractors or massage therapists, call Choice Health Centre at 902-404-3668 or an book an assessment online.