Back Pain? It's the Hip Flexors!
August 13 2012 – Gary Epler
There are two big muscles that you’ve never heard about until you develop excruciating, throbbing, and wicked low back pain. They let you know about their existence immediately. They’re called the hip flexors. They’re two big muscle groups located deep behind the lower abdomen. The top of the muscles are attached to the lumbar spine and the bottom of the muscles are attached all the way to the femur below the hip. They’re huge muscles. Their sole purpose is to support your back and keep you upright. As we evolved from four-legged crawling creatures to two-legged human beings, the hip flexors became the muscles of choice to keep us upright.
The problem is that we sit all day in front of a desk doing computer work or watching TV or whatever, and the hip flexors become tight and contracted. So when we bend over to pick something up or twist in the wrong way, we develop sudden onset pain in the lower back shooting down the leg and sometimes all the way to the big toe. We can’t get up and can’t sit down, but surprisingly we can walk standing straight and tall. It’s not the spine or the lumbar vertebra – they’re solid. It’s those pesky hip flexors. They were tight and suddenly became tight to the extreme by going into uncontrolled spasm. And, they don’t let up. They cause all types of collateral damage – firing peripheral muscle groups, and worse, pulling and inflaming nearby spinal nerves causing the local back pain and the referred lower leg pain. Stretching, deep muscle therapy, and physical therapy can help by gradually relieving the muscle spasm. You must be patient as there are many muscles and nerves involved so it will take several days. And it will recur again because sitting all day will result in the tight hip flexors that go into spasmodic contraction at the smallest hint of stress. Prevention is the ultimate answer. Keep the back straight. Keep those hip flexors loose and strong. This is done by taking standing and walking breaks and a ceiling stretch at least once an hour or preferable every half hour.
There are several hip flexor body core exercises that you can do, and it can be part of your routine daily work out. Manage those hip flexors properly, and you can banish low back pain from your life.
Best selling author of Fuel for Live: Level-10 Energy
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Dear Dr. Gary,
I have extensive foraminal arthritis bilaterally, throughout my whole lower back. I had an episode where my femoral nerve was pinched. I was unable to lift my leg, for three days. After being on prednisone and 8 weeks of PT, I regained my strength in my leg. Now I am experiencing severe pain in my left hip flexor, same leg that had problem before, when I walk up a slight incline. It was so bad that it affected how I walked. After resting it was relieved, only to happen again, when I went for a short walk up a slight hill. Any help?? Thank you.
Dear Dr. Gary,
I have extensive foraminal arthritis bilaterally, throughout my whole lower back. I had an episode where my femoral nerve was pinched. I was unable to lift my leg, for three days. After being on prednisone and 8 weeks of PT, I regained my strength in my leg. Now I am experiencing severe pain in my left hip flexor, same leg that had problem before, when I walk up a slight incline. It was so bad that it affected how I walked. After resting it was relieved, only to happen again, when I went for a short walk up a slight hill. Any help?? Thank you.
Hi Terry – pleased to hear you are an avid runner – it’s the best!
Hip flexors can be an issue for runners as the running gait doesn’t result in full flexion and contraction of these muscles. Almost all runners periodically have had low back pain from hip flexor weakness.
The right physical therapy exercise program can often solve the hip flexor issue – it takes a ton of work and time, but can be beneficial. In addition, there a very specific PT exercise that may be able to relive the L2 & L3 pinching of the femoral nerve root – try it.
I wish you good health and with lots of work, maybe you will be able to return to your running or at least LSRs (Long slow runs).
Gary R. Epler, M.D.
Boston
I WAS AN AVID RUNNER AND STARTED EXPERIENCING WEAKNESS IN MY RIGHT HIP FLEXOR. THEN I HAD A SPASM IN MY RIGHT HIP THAT WENT DOWN INTO THE FRONT OF MY THIGH. IT DIDN’T LET UP FOR ALMOST A WEEK. IT RESOLVED BUT THEN HAPPENED AGAIN ABOUT 2 MONTH LATER. THEN I WAS DIAGNOSED WITH DDD AT L2 & L3 PINCHING A FEMORAL NERVE ROOT. WITHOUT GETTING A SIGNIFICANT RELIEF FROM A CHIROPRACTOR I AM BACK IN PT AND THEY ARE SAYING NOW I HAVE A SI JOINT PROBLEM WITH TIGHT HIP FLEXORS. I AM GETTING FRUSTRATED. EVERYONE HAS ADVISED TO QUIT RUNNING DUE TO THE DEGENERATIVE DISC.