Hip Flexors – the Front of the Back

Having chronic or recurring back pain? Your answer may not be in your back, but in your front.

People who sit much of the day or do a lot forward bending, squatting, or flexion exercises (sit-ups, leg lifts, bench presses) that “scrunch” the front of the body together, may develop back pain that never goes away, no matter how much the back is treated.

The reason? The hip flexors and quadriceps (front of hips and thighs) may have become overly tight and shortened, pitching the pelvis forward and making the back arch too much. They create stiffness, particularly when rising from a chair or after prolonged standing. What’s more, recurring mid-back pain, neck pain, and headaches can be a consequence, due to changes in posture.

Hip flexors are very powerful – the quadriceps are second only to gluteals in size – and exert tremendous force on the spine. And if they are unbalanced – tighter on one side than the other – they can dramatically twist your pelvis and spine, giving you a temporary curvature. Bending and lifting with your body twisted in an unfamiliar way can put your discs at risk.

Yet hip flexors are sneaky – people seldom feel their pain in front, or they ignore the vague ache or tension located there.

So how do we treat this problem?

1. Work the tightness out of these muscles. Deep tissue work and stretching are particularly effective. Your chiropractor, therapist, or trainer can help with this. The quads in particular are very tough, and the usual standing stretch (grab the ankle and pull to the buttock) is seldom enough. Plus if they are tight enough quadriceps can also cause knee pain, which limits stretching. Best to get the trigger points worked out of the muscles, followed by stretches on the floor or a chair. You may also need extension adjustments of the sacroiliac region.

2. Walk more. Walking and cross-country skiing are about the only exercises that truly extend the hips. Too many of our exercises are done sitting, which keeps the hips flexed, shortening those hip flexors.

3. Limit sitting. Prolonged sitting is unhealthy anyway. Get up often and find ways to work in other positions. Perch on a chair with back straight and knees down whenever possible.

4. If you do have an incident with sudden back pain after bending, particularly if you have trouble straightening up, hip flexors are likely to have gone into spasm. The answer is to straighten up anyway, even if uncomfortable. Do not go sit down somewhere! Even if you have hurt a disc, straightening up, even arching backward, is the best thing for it. Then put ice on the back at 15 minute intervals and follow-up with your chiropractor or other physician.

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