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Published: September 5, 2023

Do tight hip flexors cause back pain?

What is a hip flexor?

Hip 'flexion' is a movement we're all designed to do.

If you're standing, then raise one knee in front of you, that is 'flexion' of the hip.

The main muscles that make this movement happen -- the hip flexors (psoas and iliacus) -- routinely get accused of causing low back pain and other problems. But I don't think they deserve that blame.

Why don't I care about hip flexors? Because I ignore them, and patients get better anyway. Which suggests they weren't that big of a deal in the first place.

Hip flexors attach to each of your lumbar vertebra, then run down the inside of the pelvic "bowl", attaching near the groin. When they contract, they raise your knee.

And because of their location (attaching to the low back), that often makes chiropractors and physical therapists suspicious that they may be contributing to lower back pain.

I disagree. And we see literally thousands of patients with low back pain get better -- even though we've ignored their hip flexors. Which suggests the problems causing their pain were elsewhere.

Have you ever tried hip flexor stretches or massage?

You'll find thousands of videos on social media recommending these stretches, and special tools that are supposed to "massage" or "release" the hip flexors.

But if you've ever tried the stretches, they're super awkward to do, it's hard to tell if you're doing them right, and sometimes (if your back is already hurting) you just may not be able to do them period -- because the position is too painful.

And, if you've ever had a massage therapist "work" on your hip flexors, it's often extremely painful -- digging deep into your belly muscles, trying to reach them.

But research shows that we can't even *touch* the hip flexor from the outside of you -- let alone massage its whole length. Imagine a 10-inch muscle, and we may be able to *barely touch* the last half inch of it.

How much good could that possibly do? Not much.

So if the hip flexor stretches are too difficult and awkward to do, and you can't tell a difference from doing the stretches...and the massage is painful and ineffective...why should we care about hip flexors at all?

Personally, I don't.

And as long as we're seeing steady improvement in your back pain from addressing the other, REAL causes -- it means we made the right decision to ignore them.

But what if I have pain in the front of my hip?

Doesn't that mean my hip flexors may be causing it?

This would make sense, right? But here's the thing.

Pain is famous for happening where the problem ISN'T.

Meaning, just because you may have pain in a certain area, it doesn't automatically mean the pain is CAUSED by that area. In fact, it's my experience that almost ALL low back pain isn't a low back problem at all -- it's caused by tight glutes and legs.

I'll explain this in more detail in another post, but the takeaway here is that pain in the front of your hip doesn't automatically mean you have tight hip flexors, or that they're a problem in any way.

So, what IS causing my low back pain?

If it's not my hip flexors, what is it?

The short answer? I find that it's tight glutes & legs.

"Stiff" hips -- meaning, muscles that aren't elastic enough to allow normal, safe movement of the hips -- can force you to move in a less safe way, that can overwork your lower back, and cause pain.

I'll go into more detail on this idea in a future post, but it's important to know you can safely ignore your hip flexors, and forego those awkward stretches & painful massage. They're almost certainly not going to give you a full, speedy recovery.

So you can save some money, save some time, and avoid some unnecessary pain by skipping them altogether

And if you're willing to invest a little time and effort to get rid of your back pain, come see us. We're famous for our super short treatment plans, and we have thousands of happy patients to back that up.

Give us a call when you're ready to stop hurting!