Back Pain: Home Managements #6 - Stretching Exercises – Hip Flexor Muscles

The major hip flexors are the Psoas Major and the Iliacus. The Pectineus Muscle and the Rectus Femoris Muscle assist the major flexors in carrying out the flexion movement of the hip. The Sartorius Muscle also helps in hip flexion when both the hips and knees are flexed simultaneously.

The tightness of the hip flexor muscles exerts an adverse effect on the pelvis and the lumbosacral spine. This is because the major hip flexor muscles, the Psoas Major and the Iliacus, take origin from the anterior aspect of the Ilia and get inserted to the anterior aspect of the femorae. Hence the tightness of the hip flexor muscles can increase the lordosis of the lumbosacral region. As we know, the activities of daily living demands the frequent changing of the lumbosacral lordosis to khyphosis and vice versa. This frequent change from lordosis to khyphosis and vice versa is essential to relieve excessive strain on the low back. The tightness of the hip flexor muscles prevents this changing over from lordosis to khyphosis and vice versa and hence causes extreme strain to the low back.

The tightness of the hip flexor muscles must be ascertained during the early stages of evaluation and examination. If need be, hip flexor muscle stretching exercises may also be incorporated in the exercise programme for low back pain along with other exercises.

The patient lies supine(lying with the face upwards) on the edge of a firm bed in such a way that both the legs hang down the edge of the bed. With the contracted leg(the leg with tight hip flexor muscle) hanging down, the opposite leg is flexed at the hip(keeping the knee flexed) and brought towards the chest and held in that position using both hands. This manoeuvre protects the low back, as it reduces the lordosis . The leg which is to be stretched (leg which is hanging down) is held in that position by placing a heavy object on the anterior aspect of the thigh, or by tying the thigh down to the bed by a strap. It can also be held in that position by an assistant. This exercise causes the hip flexor muscles to get stretched as the opposite leg is slowly, gradually and gently brought towards the chest. Quick and bouncing movements must be avoided at any cost. It is held in a position as close to the chest as possible for 10 seconds. This manoeuvre (of the opposite leg) stretches the hip flexor muscles of the contracted (“held down”) leg. This exercise repeated for 10 times. This exercise can be done the other way round, so that the hip flexor muscles of the opposite leg may also be stretched, if need be.

The patient lies supine (lying with the face upwards) on the edge of a firm bed, so that both the legs hang down the edge of the bed at the knees. With the contracted leg (the leg with tight hip flexor muscle) hanging down, the opposite leg is flexed at the hip(keeping the knee flexed) and brought towards the chest. This leg is held in a position as close to the chest as possible and strapped to the chest with the help of a tight hip flexor strap. It can also be held in that position with the help of an assistant. When the opposite leg is strapped to the chest, it is likely that the contracted leg may flex a little more at the hip. A heavy weight is placed on the anterior aspect of the thigh of the contracted leg which is hanging down. This leg is allowed to flex further, slowly and gently, along with the weight that is placed on the thigh. After a few degrees of flexion is attained at the hip, the contracted leg is allowed to descend down along with the weight. This manoeuvre stretches the hip flexor muscles of the contracted leg. This leg is held in the maximum stretched position for 10 seconds. This is repeated 10 times. The same exercise can be done the other way round so that the hip flexor muscles of the opposite leg may also be stretched, if there is need.

The second exercise for stretching the hip flexor muscles is just reverse of the first exercise. In the first exercise stretching is carried out by stabilising the contracted leg and then manoeuvre is being done by the opposite leg. In the second exercise stretching is carried out by stabilising the opposite leg and then manoeuvre is being done by the contracted leg itself.

The patient maintains a kneeling position, keeping the knees directly under the hips and the hands directly under the shoulders. Keep the abdomen firm so that the spine is in a neutral position (not arched or sagged). Keep the neck relaxed in its natural curve position. Now extend one leg straight out and hold it parallel to the bed. Hold it in this position for 10 seconds. Now reverse back. This manoeuvre stretches the hip flexor muscles of the leg which is stretched out. Repeat the exercise for 10 times. Same exercise can be done the other way round so that the hip flexors of the other leg may also be stretched. Care should be taken that the pelvic tilt may be maintained throughout the exercise. This exercise is also suitable for strengthening the gluteal muscles.

The patient stands erect with the feet kept little apart, the body weight evenly distributed. Maintain the pelvic tilt by “tucking in” the low back and thus decreasing the lordosis. One leg is swung backwards at the hip and is held in the maximum extended position. The other leg held straight takes the whole body weight. Hold it in this position for 5-6 seconds. Repeat the exercise 10 times. The same exercise can be done the other way round so that the hip flexor muscles of the opposite leg may also be stretched.

The patient lies prone (lying with the face downwards) with the flexed arms under the head. The legs of both sides are kept extended at the hips and the knees. One extended leg is lifted upwards and is held in the maximum extended position, keeping the other leg flat on the bed. The lifted leg is held in the maximum stretched position for 5-6 seconds. Repeat the exercise 10 times. The same exercise can be done the other way round, so that the hip flexor muscles of the opposite leg may also be stretched.

The patient lies on his side with the face facing sideways. The hip and knee of the leg which is kept below is kept flexed, so as to stabilise the pelvis by decreasing the lordosis of the low back. The leg above is kept straight at the hip and the knee and is brought backwards till the maximum stretched position is attained at the hip. This is held in this position for 5-6 seconds. Repeat the exercise 10 times. The whole exercise procedure may be done the other way round so that the hip flexor muscles of the opposite leg may also be stretched.

Many activities of daily living require a person to be seated which maintains the hips and the knees flexed bilaterally. Hence there are chances of the flexor muscles of the hips and knees getting “adaptive shortening”. This can be avoided by having the patient stand briefly and frequently at regular intervals in between during the day. Standing with the low back “tucked-in” decreases the lordosis of the low back. Holding the low back”tucked-in” and then leaning backwards simultaneously may minimise the adaptive shortening of the hip flexor muscles. The Pelvic Tilt Exercises (discussed earlier), if done regularly, may decrease the lordosis of the lumbosacral spine which in turn prevents, to some extent, the “adaptive shortening” of the hip flexor muscles.