What are your thoughts when you're on the returning stretch of your long run and your hips start feeling achey and sore?
"I did my warm up stretches and everything before my run; why is this still happening?
Or what about this scenario…
What's your first instinct when you feel those hip flexors tighten up post run?
"I should probably stretch more and use my mobility tools…"
Hmmm, not so fast.
Science actually has a different opinion on the whole stretching situation. (Want to check that out? See the first blog post of this hip series HERE!)
But…I don't want to rain on your parade.
You're on the right track!
When muscles or joints feel tight, we want to restore mobility and range of motion.
But it doesn't end there.
This is a two part process.
But dr.whitt.fit, how am I supposed to fix my tight hip flexors if I'm don't stretch? Do I l use my mobility tools for hours?
Eeehhh, not quite.
Mobility tools have their time and place….they're just not the first tool I reach for when I work with runners like you.
Because frankly, you deserve a better answer than "just foam roll it away!".
(That's a lazy solution if you ask me. It doesn't help you become a better runner.)
So about together we discover that first step to truly loosening those tight hip flexors? And maybe even give you a sneak preview of what the second step is.
Let's unlock those tight hip flexors together.
Signs You Might Have Tight Hip Flexors and/or Not-Great Hip Mobility
Do you check any of these boxes?
Sore, achey, tight hips (but it's vague and you can't tell wear it's actually tight)
Hip flexors that stay tight
Achey and sore low back (almost always in the same spot, usually on both sides that comes on several miles in)
Knee pain or history of patellar tendonitis (aching in the tendon right below your knee cap)
....or patellofemoral pain syndrome (pain underneath your knee cap)
An unfortunately, returning history of ITB syndrome (that's starting to drive you mad and make you re-think your upcoming increase in mileage)
If you said "YES!" to any of those, then keep reading…
Because tight hip flexor muscles and not-so-great hip mobility can be a contributing factor to all those *amazing* (NOT) problems above.
How?
Well, real quickly…
Remember in the last blog post how we talked about some specific muscle complexes like the iliopsoas that actually starts at the same backbone of your LAST rib? Yea. It starts all the way up there and plugs into your femur (the top leg bone). (Full scoop HERE.)
So, based on how ginormous-ly long this muscle is and how much area it spans in your body, it makes sense that when it's "tight" or when it at least feels "tight", it can be awfully hard to point to a specific spot in your hip.
And when that entire muscle complex is shortened, it directly affects the joints around which it plugs into (in the case of the iliopsoas, is your back and hip joint).
Can you see where we're going with this?
Our body is rarely good at giving us specific messages saying:
"hey! I know our low back hurts, but it's not actually our back. It's actually this really large hip muscle that's also a big low back stabilizer and core muscle…and it's having to work overtime right now, because we've been really bad about our strength and core work recently…"
Wouldn't that text message be so much easier than that vague achey, tight hip feeling?
Regardless, hopefully you're starting to see that just because your hip flexor feels tight, doesn't mean it's the hip flexor's fault.
Or the hip joints fault.
Or even the low back's fault!
Something is off…and you're body is sending up warning flares.
Moving onto the seemingly unrelated cases of knee pain and ITB syndrome...
Yea, how the heck are these related to tight hip flexors?
The wheels may already be turning if you read last week's blog. Because we talked about the quadriceps muscles that start on your actual hip bone and plug into your tibia (a lower leg bone).
The quads are most definitely a hip flexor.
But they're also a knee extender.
And often, they have to do BOTH of these jobs at the same time, lengthening over one joint while remaining stable at a different joint just down the chain and then vice versa over and over and over with every stride…
Yaaeeaa….can you multitask that well? I don’t think I can.
So when it comes to knee pain and ITB syndrome, your hip flexors may be tight.
(Or maybe you notice the opposite where the hip flexors become tight and knee pain or ITBS follows…??)
Either way, if we follow the pattern, just because it's tight, doesn't mean the hip flexor is the actual culprit.
A glute issue could be the true trouble-maker:
"The hip theory suggests that decreased eccentric hip abductor and external rotator strength causes a relative femoral internal rotation and/or hip adduction moment. This causes increased compressive forces of the patella in the trochlear groove with dynamic movements such as running or squatting"
(but just for full disclosure, it wouldn't be science-y if in the same paper, the authors didn't mention competing, opposing theories. Because again, we don't know everything. It's a science and an art...)
But without diving deeper down the rabbit hole, hopefully you can start to appreciate how many moving, dynamic factors there are to consider.
There's a bit more to it than just google "hip flexor stretches".
But if it's so complicated, what am I supposed to do then?
I'm so glad you asked!
Exercises You've Probably Done that Don't Seem to Work Anymore
The "couch stretch"
Extra aggressive: full knee flexion.
Honestly, OUCH! (unless you're a dancer, gymnast, or other performing art athlete, I'm not sure you actually need a stretch like this.)
The hip hook AND/OR lying on a tennis ball to get a deep muscular-release
(I'm guessing your symptoms come right back? Maybe you've even bruised yourself?) the hip hook makes me squeamish...)
Why don’t these seem to help in the long run?
Let's look at a couple studies…
"After the stretching program, passive hip extension increased significantly (p < 0.001), whereas no improvements during running were reported for active hip extension, anterior pelvic tilt, or lumbar spine extension (p ≥ 0.05). In addition, no relationship was found between the change in passive hip extension with either the change in active hip extension, anterior pelvic tilt, or lumbar spine extension.
"The results suggest that passive hip joint flexibility may be of limited importance in determining the kinematics of the LPH complex during submaximal running. However, it is possible that an increase in the range of motion at the hip may be beneficial when running at or near maximal speeds."
And just to make things interesting, a different side to the story:
"results suggest that the lunge and reach stretch can be used to improve hip flexor length and gluteal power in a young, healthy population. "
What are all these studies saying?
They're demonstrating that while stretching *can* create an anatomical change such as lengthening hip flexor muscles, these changes don't always relate back to running.
In addition, those studies also found that while hip mobility objectively improved (they were able to measure an increased angle), there was no carry over of that increased range of motion during the actual act of running. The biomechanics of the runner did not change.
How come?
Well, that requires another study.
But we can start to understand that hip flexor stretching does NOT make up the entire picture!
Try These Hip Exercises Instead….
Shin boxes
Can you feel a difference R vs L?
Nerd Note: Encourages the runner to work into end range active hip internal and external rotation, helping the runner access the hip rotation that naturally occurs with each step
Nerd Note: this active mobility drill combine motion in the both the frontal + transverse plane
World's Greatest Stretch
Can you even feel a difference R vs L?
Nerd Note: This exercise requires upper body push stability + core activation + SL balance: all required while running. This movement requires core and lower extremity co-contraction to create stability that you can FEEL!
Nerd Note: This motion works into active hip flexion and contralateral hip extension within the sagittal plane
Crawl <>Squat sequence
Take your time here with this exercise; if you feel like a pretzel, don't be afraid to back off!
Nerd Note: This exercise continues to work into end range hip flexion and contralateral hip extension at the same time with active end range motion
Nerd Note: This movement is interesting because it starts within the sagittal plane and ends with a squat in the frontal plane (you could also argue there is some transverse plan motion happening because of the hip rotation, but now we're getting really nit-picky) Regardless, we're creating mobility + with hip girdle co -contraction for stability in all planes of motion!
What Makes These So Different?
By now, you can SEE and FEEL a difference between these two lists.
I see the first list of exercises we covered as being very passive.
Which isn't bad...
(but…we're runners. Do we do anything passively?? We tend to be over-achievers, go-getters, and very goal-driven people.)
Anywhoooo..
I'm partial to the second list because of how active they are.
You're an active participant in them.
And your muscles, namely your glutes and core muscles, contract together, creating stability and strength to encourage mobility.
Everything is working together and feeding into each other.
That's how our bodies work.
Rarely does one body part move or contract in isolation of another.
Ok, but the actual best part about the second list...
These exercises are SO DANG FAST.
And EASY!
They only take 5mins at the most! 5mins, fast and furious, for dynomite results?? Who wouldn't say yes to that?
And the research we've look at today backs this.
Remember, when passive mobility gains are made, they can be objectively proven.
But they do NOT translate into an increase active range of motion during running.
So where does that leave you?
With the hip mobility exercises above aannndd possibly considering dynamic warm ups. (I'll let you read about that HERE.)
Ok, let's say you are convinced and you're ready to take the next step and learn even more about how to fix those tight hip flexors for good.
You're in luck!
Grab my dyno-mite FREE running Guide HERE!
It's full of hip resources that will help you unlock up those hip flexors for good…aannndd give you a sneak preview into next week's blog.
Here's what one runner said about the hip guide. She absolutely made my day :)
"Hello Marie! Just wanted to drop you a quick message to thank for your free guide- after reading it I can honestly say it's exactly what I've been looking for. Just haven't been sure where to start when it comes to strength/mobility....its something that I neglect big time but your guide is perfect. Thank you so much! Your Instagram content is wonderful too - thanks for sharing your knowledge!"
First, we restore mobility. Then, we build stability.
I'll see you next week.
Until then, Dare to Train Differently, running fit fam.
Marie Whitt, PT, DPT // @dr.whitt.fit
References
Hiser, D., Ehresman, B., Wietharn, J., & Koster, L. (2020). Uncorking Gluteal Function through Hip Flexor Stretching. In 16th Annual Symposium on Graduate Research and Scholarly Projects. Whichita: Department of Physical Therapy, College of Health Professions.
Konrad, A., Močnik, R., Titze, S., Nakamura, M., & Tilp, M. (2021). The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis. International Journal Of Environmental Research And Public Health, 18(4), 1936. doi: 10.3390/ijerph18041936
Mellinger, S., & Neurohr, G. (2019). Evidence based treatment options for common knee injuries in runners. Annals Of Translational Medicine, 7(S7), S249-S249. doi: 10.21037/atm.2019.04.08
Mettler, J., Shapiro, R., & Pohl, M. (2019). Effects of a Hip Flexor Stretching Program on Running Kinematics in Individuals With Limited Passive Hip Extension. Journal Of Strength And Conditioning Research, 33(12), 3338-3344. doi: 10.1519/jsc.0000000000002586
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