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Remember the song “Dem Bones” from when we were kids? It goes something like, “the backbone’s connected to the hip bone, the hip bone’s connected to the thigh bone, the thigh bone’s connected to the knee bone, the knee bone’s connected to the shin bone…”

While we may associate this song with primary school, there is actually some truth to it (even with the questionable bone-naming).

From our spine all the way down to our ankles, our bones and muscles work together to propel our movements each day. That’s why, if we are experiencing knee pain, it could be associated with an ankle injury or even a tight hip flexor muscle: They’re all interconnected.

When we think about how our body works, especially our lower extremities, we often overlook how interconnected our feet, ankles, knees, hips, and lower back are. But, if your ankle is damaged, it almost always leads to knee and hip pain down the line.

Having ongoing lower back and hip pain can be a symptom or cause of other complications, and can even lead to additional surgeries if left untreated. Understanding how joints and muscles interact as a unit can help you manage your pain following lower back, knee, or foot surgery.

Why do I have pain after surgery?

Surgery is seen as a threat to the body, no matter what kind of surgery. Undergoing surgery takes a significant toll on your overall health, and your muscle-joint interactions as well.

Threats like surgery or injury often cause your muscles to tighten, as an instinctive protective mechanism. During your recovery, your body is likely more stationary than usual as you heal. Your normal walking movements will be altered or assisted, and your muscles won’t engage as readily or in the same fashion as usual, especially if you are experiencing pain. Add-in sleep challenges and increased pain, and it’s natural for your body to want to tighten the iliopsoas muscle and protect the pelvis.

You may have heard of the iliopsoas muscles under a different name: your hip flexors. The iliopsoas muscle is made up of two muscles, the iliacus and the psoas, which work together to perform important movements like walking, sitting, and standing.

The iliacus crosses over your hip joint and attaches to the pelvis, whereas the psoas crosses both the hip joint and pelvis to the spine. If these muscles tighten, they can pull the region off balance by creating a tilt or twist, which can affect your whole lower body and cause lower back and hip pain.

With all the stress your body is going through after surgery, your iliopsoas muscles may tighten to try to support and protect the injured area. Unfortunately, the lower back and hip pain that often accompanies this protective act can be confusing and frustrating when it adds extra pain to your recovery.

But if you had a knee or foot surgery…why are you experiencing lower back and hip pain instead of knee or foot pain? Let’s take a look at how it all connects.

The connection between the lower back and hip pain

Your body is an intricately connected, well-oiled machine. When one piece stops working properly, it affects just about everything. You need your bones for support, your joints to connect them, and all your muscles, tendons, and ligaments to move in the wonderful ways you do.

When one part of the body is injured, weak, loose, or too tight, it impacts how the rest of your body works. That’s why even when you have knee surgery, it can create lower back and hip pain.

The lower back and your hip pain are especially interconnected because of the iliopsoas muscle and the piriformis muscle. If one is too tight, it will add tension to the other, and if one part of your low back or hip is weak, both muscle groups will overcompensate and tighten to protect it.

Since the psoas connects to the spine and works hard to stabilize the back, and the iliacus connects to the pelvis to help stabilize the hip and sacroiliac joint, they’re a primary foundation for both your back and hips.

After surgery, especially hip or knee surgery, your iliopsoas is at a very high risk of tightening and causing an anterior pull. That tug on your pelvic bone strains the connection between your pelvis and tailbone, particularly where the two bones meet.

That junction is known as the sacroiliac or SI joint, and when added tension is put in that area, it gets twisted and irritated, causing lower back and hip pain. If you’re not feeling pain in the SI joint area, then the next most commonly affected joint junction is the hip joint.

The hip socket (acetabulum) cradles your femur (thigh bone) to allow a perfect fit and comfortable movements. When an anterior rotation begins with your pelvis, the thigh bone no longer sits well into the hip socket, and can cause friction or even pull the hip joint out of place.

With or without anterior or internal pelvic rotation, your psoas could also be tightening along with your iliacus. Since the psoas muscle attaches to the front of the thigh bone and the spine at the lower back, it has a similar chain reaction effect as the iliacus muscle as it tightens.

If you have a tight psoas, you are likely to feel a reaction down the leg and up to the spine, but the majority of the tension and pain will be on the spine itself.

A tight psoas muscle pulls your spine into an arched position. This compresses and bends the spine to the side that is being pulled by the psoas. All of the tension and tugging of that part of your spine can easily cause lower back and hip pain.

Leg pain after lower body surgery

Just as with the lower back and hip pain connection, pain from hip to knee is a common issue. An unhealthy iliopsoas, and more specifically an unhealthy iliacus, has a profound effect on pain from hip to knee – as well as the rest of the body overall.

Because a tight iliacus muscle twists the hip and thigh bone, it anatomically changes how your leg connects to your upper body. When the tension in your iliacus muscle is released, your leg and hip alignment will work as designed, but you are far more susceptible to pain when it is tight.

Although the direct connection between pain from hip to knee appears to be with a tight iliacus, that doesn’t mean that the psoas muscle should be ignored completely. After all, together, they form the iliopsoas, so if one is tight, the other is directly affected.

When strain is put on your iliopsoas, it can create a pelvic rotation as the muscle pulls and tightens. This can be either an anterior or internal rotation. Your pelvis’s internal rotation is what could potentially connect hip to knee pain and knee to foot pain.

You can also experience an internal rotation that puts a strain on your knee. An internal rotation of your pelvis affects the way your leg works from the hip down and doesn’t allow the kneecap to track correctly. This internal rotation can also cause the foot to flatten (or pronate), which changes how your foot and toes are aligned.

As you can see, when one area of your body is affected, it can cause a chain reaction of negative effects throughout your body. And, in the case of your lower body, the culprit for lower back and hip pain and imbalance is often an overactive iliopsoas.

So now that we have found the likely culprit for your lower back and hip pain, or your pain from hip to knee, what is there to do about it?

Addressing lower back and hip pain from tight hip flexors

Because of the likelihood of a chain reaction of lower back and hip pain from tight iliopsoas muscles, it is important to address and release them. There are multiple ways you can do this, including gentle strengthening exercises and stretches, and targeted physical therapy.

Strength training for lower back and hip pain

A big part of targeted physical therapy is balancing and strengthening your muscles to recover from – or prevent – future injury. Something you must remember when you exercise in any capacity is that you need equal strength in all of your muscles.

For instance, if you only exercise your front abdominal muscles and neglect your back core muscles, you are far more likely to injure your back or start to develop back pain from a consistent pull from the front of your abdomen.

The same is true for your legs and hips. Finding ways to work all of your muscles to build strength equally can help your body maintain alignment and balance and prevent lower back and hip pain.

Stretching

Stretching and yoga can be a wonderful way to relieve stress, but it can also help as you recover from surgery. After any type of surgery, you will be slightly more stationary than usual, and that can cause your muscles to tense and tighten more than normal.

When it comes to your iliopsoas muscles in particular, stretching can be beneficial. However, you can have too much of a good thing, and if you stretch too much or too deeply, it can cause more harm than good to your iliopsoas.

If you are stretching too much, your muscles will lengthen during the stretching period. Then, once you’re finished stretching, your muscles will begin to tighten again. Additionally, too much stretching can make your muscles too loose, and your muscles will not fully support your joints.

You may wish to consult a physical therapist or other medical practitioner to help decide which stretches will be most beneficial to your lower back and hip pain.

Muscle relaxation for lower back and hip pain

Taking time to relax is imperative to muscle health. Many of us often only find time to relax at night as we are falling asleep, but if our muscles are engaged throughout the entire day and only have one instance of relaxation, it’s not going to be enough to prevent tension from building.

One of the best ways to relax your iliopsoas is to elevate your legs on a couch or ottoman while laying on the floor. This is a traditional restorative yoga practice and can be done for 15-20 minutes at a time.

Consult your doctor about this exercise if you’ve just had hip surgery, as (depending on the entry angle for your surgery) having your hip at a 90-degree angle is not advised for about 6 months.

Another very accessible way to achieve muscle relaxation is to get a professional therapeutic massage. Deep tissue massages can be great for relieving muscle tightness, but they tend to be more invasive and too intense immediately post-surgery. Opt for a soothing Swedish instead!

Muscle release for lower back and hip pain

Releasing muscle tension can help you resolve your lower back and hip pain, and if you are aware of it before you go into surgery, you could even prevent it altogether.

If you visit a physical therapist, they will likely be aware of the complications associated with a tight iliopsoas muscle. A physical therapist can release some muscle tension during physical therapy appointments by putting pressure on specific muscle connection areas with their hands.

However, that is only helpful if you can attend appointments on a regular basis.

Because I don’t want you to have to wait for a physical therapist to help you every single time, I invented the Hip Hook and Hip Release Ball. These tools allow you to release the iliacus and psoas muscle tension you’re experiencing any time you need from the comfort of home.

The Hip Hook’s unique design gives you the ability to apply precise and angular pressure on the hard-to-reach iliacus muscle. The Hip Flexor Release Ball is the perfect size and density to target and help release the psoas muscle.

You can even learn more about realigning your body and treating unresolved pain in my book, Tight Hip Twisted Core.

As you expand your knowledge of how interconnected your joints and muscles truly are, you can easily prevent and treat lower back and hip pain – as well as unresolved pain throughout your body.

FAQs about lower back and hip pain after surgery:

Why do I have lower back or hip pain after surgery?

Along with periods of immobility following surgery, and changes in movement, your body is protecting itself from the trauma of surgery by tightening your core muscles.

But I had hip surgery; why does my knee hurt?

Your core muscles affect the alignment of your entire lower body. If the psoas and iliacus muscles are tight, they will tug on the entire interconnected line from your back, through your legs, and down to your toes. But you can often trace the source back to tension in those core muscles, even though you’re feeling it in your toe.

Why do my hip flexors hurt?

Your iliopsoas muscles may have tightened to try to support and protect the injured area. They work in opposition to the piriformis muscle (deep in your glutes), and when one muscle is tight they begin tugging on each other.

 

Christine was recently featured as a guest on the Dr. Bri Talks Lady Bits podcast, discussing the effect that the iliacus muscle has on digestion and pelvic health. See below for the show notes, YouTube video, and a full transcript of the podcast.

Show Notes:

In this interview with Christine Koth, MPT, you’ll learn all about the iliopsoas muscle group, and in particular, the iliacus muscle… A small muscle that has a BIG IMPACT on digestion and pelvic health. Christine Koth is the author of “Tight Hi, Twisted Core.” Discover how to identify and release the iliacus for less pain and better health!

Watch on YouTube.

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Full Transcript:

Brianne Grogan 0:00

I have Christine Koth with me and she has a book that I have with me right here. I know this is going to be on my podcast, if I share it on YouTube, they will see the book. I’m holding it up. But it’s called “Tight Hip, Twisted Core – The Key To Unresolved Pain.” And I got turned on to this book a couple of months ago, I guess. And when it arrived, I literally devoured it, not only because I am an anatomy nerd — I love anatomy — as a physical therapist, of course, I am fascinated by it. But Christine has written the book in such a fun way that it’s really just easy to digest and fun for anybody to read and understand. There’s fun illustrations. It’s a great guide. So the focus of the book is on the iliacus, one of the hip flexor muscles. We’re going to be talking about that today in relation specifically to the iliacus and digestion and pelvic health. So Christine, do you want to say hi, and maybe briefly share why you became so fascinated with the iliacus? And the Iliopsoas muscle group?

Christine Koth 1:08

Yes, absolutely. I’m also a physical therapist. I’ve been practicing for over 20 years and in my practice, I kept seeing this pattern evolve where, you know, as I’m looking at examining people’s bodies, I was noticing that there was tension in this muscle called the iliacus. And that everyone who came into my practice hadn’t really had that addressed. They didn’t even know they had an iliacus muscle. And what I started noticing was that this pattern of tension in this muscle contributing to various conditions. So, today we’re going to be focusing a lot on the pelvic floor, but people were coming in with maybe hip arthritis pain, and they were having tension in their iliacus. Maybe they were coming in with SI joint pain or low back pain, or pelvic floor pain and dysfunction. And then what I was noticing was that this tension was also impacting the mechanics of their body. So, you know, it could be a runner who was having knee pain, and they were focusing on treating their knee, but really, it was coming up from their pelvis and tension in this muscle. So when I started discovering this and started treating it, I kind of developed my own technique of treating the iliacus muscle by putting prolonged pressure on it to try to get it to relax and doing some various physical therapy techniques. And I noticed that oftentimes, for people, this was a missing link. Maybe they had seen 20 or 30 different practitioners, but hadn’t really gotten the relief that they were hoping for. And that once the iliacus was released, it was like the missing piece that wasn’t addressed previously. It was waiting to be addressed and once it was addressed, it really helped them move forward on their healing trajectory. So over time as I continued to realize that this was an area of the body that people weren’t addressing, I kind of took it upon myself to say, “Okay, I guess this is my thing. This is part of what I’m here on this planet to do — is to share information with people about iliacus.” And hence, the development of the book.

Brianne Grogan 3:27

Yeah, and the Hip Hook, which I want to talk about that too. It’s a device specifically designed by Christine to release this muscle yourself. And, I’ve been doing it with my fingers, but I’m really excited to get my Hip Hook because I know it’s going to be a lot easier to release with the tool. And I want to just briefly say that even as a physical therapist who studied anatomy fully — I mean, I know my anatomy, but I will say the iliopsoas is a very challenging muscle group to understand because of the way it hooks into the body. It crosses over so many joints and the way it starts in the back (for the psoas major) and then it goes over the front of the pelvis. Your book really helped outline all of that. Maybe you could give kind of a brief anatomy of where this muscle even is in the body?

Christine Koth 4:22

Yeah, sure. And I’ll share for the video folks a little. This the model as I explain it. It is an interesting muscle because it does cross so many different joints and it goes in a three dimensional way through the body. It’s not very linear. It does attach to the spine. As you can see this is the psoas. The psoas attaches to the spine. It goes through your abdomen — from the spine all the way through your abdomen to the front of your hip and attaches to the front of your leg bone (or your femur). And similarly, the iliacus attaches to the inside surface of your pelvis bone. So, when you put your hands on the front of your hips and you feel that bony part that sticks out, right at the front of your hip — right inside of that is where the iliacus lives. And I have a ton of pictures and stuff up on my website and Instagram and everything, so you guys can examine this yourself.

Brianne Grogan 5:15

And just so everyone knows, if you’re listening to the podcast, I will put links in the show notes to Christine’s pertinent information — website, the Hip Hook, that kind of thing.

Christine Koth 5:26

Awesome. Yeah, so this muscle crosses the spine, the SI joint, the hip joint. And so, it works in a three dimensional way. So it is something that is a little bit mysterious. And the other thing that I will mention too is a lot of people oftentimes group the iliacus and psoas together as if they’re one muscle. They’re actually two separate muscles. They’re innervated by two different nerves. And I think that’s part of the reason why the iliacus might not be addressed as much because people feel like “Well, I’m addressing the psoas so I’m probably also addressing…it’s all the same. And it’s actually not. They’re in two different locations, as you can see. And, they do behave differently and have different effects on the body.

Brianne Grogan 6:13

Oh, my gosh, I have so many questions. But let’s go ahead and dive in. With the connection between these muscles. Well, let’s focus on the iliacus since that’s really what we’re talking about today. But the iliacus on the pelvic floor, because I’ve heard you talk about this before. I read about it in your book. But a lot of the women who listen to my podcast and watch my YouTube have conditions such as prolapse, bladder leakage, and/or issues with pelvic pain and tension. So I know that iliacus concerns can affect all of those issues. But maybe you could tell us a little bit more about the connection between the iliacus and pelvic health?

Christine Koth 6:50

Yes, absolutely. So there’s a couple of different layers to that, if you look at the anatomy, the iliacus is on the inside surface of the pelvis. And in terms of its connection to other muscles, and the fascial connection, it absolutely just connects with the pelvic floor, right? I mean, it’s on the inside of the pelvis and then continues on with the pelvic floor muscles at the bottom of the pelvis and works its way up the other side with the other iliacus.

Brianne Grogan 7:18

So if anyone is listening right now to the podcast and can’t see Christine’s hand, she just described it so beautifully because she’s showing a full bowl effect. Like the wings of the pelvis — the inside of those wings have the iliacus muscle, so those are like the sides of the bowl. And then the base of the bowl is the pelvic floor. So you’re saying that because of the fascial connections, it’s really all connected like this big beautiful bowl, correct?

Christine Koth 7:43

Yep, exactly. If you have any muscle in that bowl that is holding tension, it’s going to affect all the other muscles that are around it. Now the iliacus in particular tends to get tight very easily because its job is to help stabilize your pelvis. So it’s helping stabilize your tailbone to your pelvic bones, as well as helping really to stabilize your hip joint. So I talk about this in the book, there’s many reasons why there could be tension that can develop. It could be from sitting too long. It could be from driving a lot, commuting. It can be from stress — there’s a lot of times we hold stress in our pelvic floor. It’s very common, I’m sure you talked about that. It can also be from certain sports and activities. Like for example, running is very common. Cycling, kicking sports and the like. Also, when you’re hyper mobile. For a lot of women, there’s a good population of us that are hypermobile or overly flexible. And when you have that type of body when you born that way, this muscle tends to kind of hold on for dear life to stabilize you.

Brianne Grogan 8:52

See, that’s a big question that a lot of people have had. So if you have anything else to say about hypermobility, I know people will be interested in that too. Like, well, you know, how come I have these issues when I’m already super loose? Like I don’t need to stretch anything. I know I’m super stretchy so how could I have a hip flexor issue? Or, hip flexor or iliacus tension? So let’s keep talking about the pelvic floor, but if that comes up at all for you, please elaborate.

Christine Koth 9:19

Yeah, we should definitely talk about that. You know what, let’s just talk about that now so we don’t forget because I think it’s very, very important. And then we’ll go back to how the iliacus impacts the pelvic floor. So when people use the word tight, right, and that that word means a lot of different things to a lot of people. I also talk about this in my book — it’s one of my pet peeves. “Tight” can mean one of two things. It can mean either that you can’t lengthen the muscle very well. For example, if you can’t touch your toes means your hamstring isn’t fully lengthening. That is one version of “tight,” meaning the muscle won’t fully lengthen, to allow your joints to move. So when you do a stretch, for example, you are using your own joints to help kind of teach that muscle how to elongate or become longer. There’s another version of “tight” which is holding tension. So you know, this would be an example of like, in your shoulder, your upper trapezius muscle on top of your shoulder — if you touch that, and it’s hard, and it’s not relaxed, that is another thing that people describe as tight, right? So it’s when your muscle is holding tension. Now you can have a muscle that’s holding tension that will completely elongate. But then when you go back to rest, it is still holding tension. And I use the example of, like, if you’re lying down on the ground, and you’re not doing anything, you know, you’re just lying there — you have nothing to do nowhere to go. Theoretically, every muscle in your body should be relaxed. So if you were to touch every muscle in your body, it should be nice and squishy and soft. If you put your hand on the inside of your pelvic bone, and you touch it, it should be just like butter. And if it’s not, then you’re holding tension. So you can be actually very, very flexible. You could go into the deepest yoga pose and not feel a thing but your body could be holding tension in that muscle you could consider as being tight. And the reason that’s important is because if you’re holding tension, and you’re going about your day, that is going to be not only changing the mechanics of your body, you know, muscles should be contracting and relaxing, not just holding tension constantly. And it’s also affecting all the muscles around that. So it is important to discern when you are very flexible, and you can stretch and you feel like “I don’t need to stretch because I’m already really mobile,” you may actually be holding more tension than you think in muscles. It’s a different phenomenon. And that’s where the prolonged pressure comes into play. A lot of times when your muscles are holding tension, you can stretch them and that does help to some degree. It helps increase circulation and helps to get the muscle to be a little bit more healthy. However, it doesn’t necessarily do enough to actually release that tension. And that’s where we use tools like the Hip Hook and balls and rollers and things like that to help your body, learn — your brain basically — learn how to release that tension. So that’s an important distinction.

Brianne Grogan 12:36

You’re talking about that tension and that difference between flexibility and then just the holding tension. It reminds me so much of the pelvic floor and how many people just hold chronic tension in the pelvic floor muscles themselves. And so is that one relation right there, potentially, to the tension that’s chronically held in the iliacus?

Christine Koth 12:58

Yes, absolutely. Like I was mentioning, in this area of the body we hold a lot of our essential organs and a lot of our survival, you know, our procreation is in the pelvic floor. So it’s a very common space for the brain to choose to hold tension in because it’s a protective mechanism. And another common place is at the base of the skull. Protecting our brain, also very important.

Brianne Grogan 13:27

And the reproductive organs, it makes sense.

Christine Koth 13:35

Yeah. So, we don’t even realize that we’re holding tension in that area of the body. You can be sitting at your desk holding tension in that it’s oftentimes related to stress, or even trauma in that area. And we’ve all experienced that on the emotional or physical levels. So that definitely is a big component to that. And the iliacus fits right into that group and that tightness party. Tension party.

Brianne Grogan 14:05

For sure. And so what about prolapse specifically? Do you have any information on that and with relation to the iliacus?

Christine Koth 14:14

Yeah. In a general sense, like we were talking about how, you know, there’s tension in the iliacus, there can be tension in the pelvic floor, or vice versa. It’s like the chicken or the egg? When there’s tension in the muscle, not only does that area not function mechanically, but it also does not function well neurologically. There’s all kinds of nerves in that area of our body that are going to different organs or that are going to muscles. There are nerves that can produce pain, like the pudendal nerve for example. And when nerves are tugged on, or compressed, they are not happy. Nerves do not like to be pulled on and do not like to be pushed on. So in that scenario and that phenomenon, if you have tension in a particular area of the pelvic floor, it can absolutely pull on a nerve and even in just a subtle way. And that tension can make it so that that particular part of your body is not functioning well. For example, if part of the job of your muscles are to hold your organs in place, and you have a nerve or you have muscle tension that is kind of pulling them out of whack, that can definitely impact the function of that particular part of the body. Another thing that’s important too, is that when muscles are tight, they actually become weak, which seems kind of counterintuitive. You think if they’re tight, they’ll be strong, you know, they’re holding tension. But if you’re holding tension for a very long period of time, you can imagine how that muscle would be exhausted. Muscles are the healthiest and most able to produce the force that are required of them, when they can relax and contract and also when they’re in the right length. They’re not being tugged on or pulled out of alignment. So you can see how this is like a complex ecosystem, right? And our pelvic area and pelvic floor — there’s just so much going on in there and really one thing can affect another. You end up with this set of symptoms that you don’t even know how this even started. That’s all it was — I was doing a lot of running and then all of a sudden, my pelvis started hurting, and then all of a sudden I am having incontinence and then the trajectory just goes on and on.

Brianne Grogan 16:27

Well, absolutely. And I want to just briefly share quickly a little bit about my story. I have right sided tension, which is very common. I know that from your book that that’s the most common, correct? And I am right handed and, of course, I drive with my right foot on the brake and the gas, etc. Looking at this condition, now, connecting the dots backward, I was always a runner in college, and in high school. And especially in college, after a few years of driving under my belt, long trips back and forth from college to where my parents lived and that kind of thing. I noticed that I started getting terrible shin splints when I was running. And it turns out, I was horribly over pronating on my right side. So my right arch was collapsing inward for anyone who doesn’t know what that is. And that contributed to shin splints. And so when I got arch supports and better footwear, it definitely helped. But connecting the dots back with my very, very, rotated pelvis on my right side, because of my tight hip muscles, my tight iliacus. That was causing this chain reaction down the road of my leg to actually contribute to that overpronation of that right foot when I was running, and step after step, causing those shin splints. And in addition, tying into digestion, I learned from you this fascinating thing. And who knows, I think it’s connected, that my right sided tension is definitely there. And I’m working on it now. But I have a long standing history of gut issues and one of them is SIBO. And when you said at some point that, because of the placement of the iliacus and the placement of the ileocecal valve, can you go into digestion a bit and the iliacus and particularly SIBO — small intestinal bacterial overgrowth?

Christine Koth 18:27

Yes, absolutely. This is a discovery that I happened to have the opportunity to work side by side a wonderful group of naturopathic doctors in my career. And as you may know, one of the things that people tend to go to naturopathic doctors for is digestive issues.

Brianne Grogan 18:47

Oh yes. I’ve spent many dollars and many, many hours in naturopathic doctors’ offices.

Christine Koth 18:53

Yeah, exactly. So, I started just discovering this correlation. And often the great thing is that these doctors that we’re working with, were super smart. And they were also like, “I wonder if the iliacus is impacting what’s going on here” digestively. So I was seeing people that were having issues with their ileocecal valve not closing properly. And also various digestive issues that can be result of that, but also just other things that are going on. And there is this really interesting correlation. So, again — it’s chicken or the egg — if you have a lot of inflammation in your digestive system, or things are not functioning well, your body’s tendency is going to want to kind of protect that area, right? And so that’s one reason why you could develop tension there. Say you just ate some bad food at a restaurant and your digestion is off for like a day. Your muscles can choose to protect that area because you’re in pain and you’re not feeling well, or something like that, and then that tension can decide to stay there. So then it creates this long term effect where it’s pulling on the nerves and the digestive system is pulled out of whack and all of that. On the flip side, if you have developed muscle tension, which might be like in your situation, you’re talking about being a runner. You know, you develop tension in this area of your body. That tension was pulling on the digestive system itself because of its connection to the fascia because again, the nervous systems connection, and that could have set you up for maybe like a subtle like — maybe your ileocecal valve just wasn’t quite closing well. And then over time, a little bit of the bacteria wasn’t quite flowing in the way that it was supposed to. And then over time, here you are 20 years later with these issues that have developed, just as a result of something being non optimal for a very long period of time. So there’s this definite connection. And what we were seeing in the clinic was that when I would release the tension and the iliacus with my hands, that those patients who are also doing things with their diet, and this supplementation and other things, were actually making much better progress. And symptomatically, whether it was like they were having pain, or they were having issues with their bowel movements, they would notice a direct connection with changes and improvement in that. On those days, when they would work on their iliacus, they’d come back to my office and be like, “Oh my gosh! I actually had a bowel movement and I haven’t had one in like a week.” as a result of that tension. So I think there’s a lot more to explore with that, but there’s a definite there’s a definite connection there.

Brianne Grogan 21:48

I couldn’t agree more. I’m completely obsessed with digestive health. And this has been a long standing issue for me. I think I had it fro

Here’s what to consider when choosing a psoas release tool.

Do you think your psoas is the cause of your problems or perhaps you know for a fact? In this blog, you will learn about each product’s pros and cons so that you can make the best decision for yourself!

Hip Hook benefits

We will start alphabetically with the Hip Hook.

The Hip Hook was designed by a physical therapist to release tension the iliopsoas (iliacus + psoas). By lying on the Hip Hook, you initially put pressure on the psoas muscle. Once the hook has sunk in and you have relaxed into it, it’s time for the magic. Utilizing angular pressure, pushing down on the lever, results in the Hip Hook pivoting up into the iliacus muscle, effectively releasing both hip flexor muscles.

Think about it this way: if you have tight hip flexors that only tighten up when you stretch them, you require pressure. But you need to apply pressure to both the psoas and the iliacus muscle to release the entire iliopsoas muscle.

Only releasing the psoas and ignoring the iliacus would be like only moving your front tires off the railroad tracks for an oncoming train; you might survive, but it’s not the best decision. There are two parts to the iliopsoas, and the Hip Hook has been designed to use angular pressure and leverage to effectively release both in the same way a physical therapist or massage therapist could do.

For the chart people:

Hip Hook vs Pso-Rite comparison

The Hip Hook is about precision, no different than a sniper rifle. The Pso-Rite is a shotgun. It covers the spread. You can use the Pso-Rite on the glutes, hamstrings, calves, shoulder, pec, biceps etc. This will be perpendicular pressure (straight up and down), and you will not be able to effectively release the psoas and iliacus. Like any problem, you need the correct tool for the job.

Renowned Tri-Athlete Matt Hanson shows us the differences in his ‘Ask the Pro(f)‘ breakdown.

Bobby & David briefly describe the differences between the two products.

Pso-Rite vs Hip Hook review

The makers of the Pso-Rite brought psoas release into the mainstream, and we are so thankful for that. If you purchase the Pso-Rite and it provides you relief, that makes us so happy, as that fits with our mission of ridding the world of unnecessary pain.

The hip flexor complex is, well, complex. What may work for you may not work for others. That is why we genuinely want you to find the best tool for you! The Pso-Rite may work on your psoas, but it can’t reach the iliacus effectively because it wasn’t designed to do so.

If you have general hip or quad tightness and it’s not causing you pain or getting in the way of your life, the Pso-Rite may be a good starting point as it allows for use elsewhere in the body.

Now, if the Pso-Rite didn’t work for you, or if your hip flexors are causing pain in the hip, back, down into the knee or even up into the ribs, shoulder or neck, then you NEED a precision tool to get at the muscle effectively to relieve that long-standing tension.

We only hope to provide the correct information so that you make the most informed decision. Please do not hesitate to contact us with your questions via our Instagram or contact us directly info@alethahealth.com to see if the Hip Hook is right for you!

You can get The Hip Hook alone or bundle all of our products together in the #FixYourHipKit, which comes with the book, Tight Hip Twisted Core (the guide to solving your pain), the Hip Release Ball (a massage ball that can help you release the low back, glutes, and other muscles of the body), as well as the Hip Resistance Band (a loop band to help strengthen your glutes and outer hip muscles).

Happy Hip Healing!

Frequently asked questions about the Hip Hook

How does the Hip Hook work?

The Hip Hook is a psoas release tool and iliacus release tools designed by physical therapist to specifically address muscle tension and tightness in your hip flexors. Using your own body weight to apply pressure to your muscles, you will first lay yourself over the tool with the platform of the Hip Hook flat on the ground to address the psoas. Then, by reaching back with your arm to press down on the handle of the Hip Hook, the tool will rotate and be pressing on the iliacus.

How does the Hip Hook compare to other hip flexor release tools?

The Hip Hook is different because it is designed to release BOTH the iliacus and psoas muscles – the 2 muscles that make up your body’s main hip flexor, the iliopsoas. Other hip flexor release tools or balls primarily address the psoas muscle without giving the proper attention to the iliacus. Releasing both of these muscles may lead to better and longer-lasting results compared to releasing the psoas alone.

How does the Hip Hook compare to a massage therapy ball?

Due to its rounded shape, a massage therapy ball can apply broad pressure to the psoas muscle and may have difficulty accessing the iliacus muscle on the inside surface of the pelvic bone (or ilium). The Hip Hook has a tip that can apply more precise pressure to the psoas muscle and also has the ability to rotate and access the iliacus muscle at an angle.

 

People are asking for a Hip Hook promo code, so we’re making a special little spot on the internet for you to check out the current deals on the Hip Hook, Hip Release Ball, and the bestselling book: Tight Hip, Twisted Core. You deserve the best deal we can offer, and we fully support an investment in your health.

We’ve replaced a Hip Hook promo code with special package deals just for you.

Here are Aletha’s current Hip Hook promo deals:

The #FixYourHipKit – a bundle of all three products for maximum pain reduction, PLUS the tools to prevent future tension and injuries.

Just want the Hip Hook ? Lucky you: for a limited time, you’ll get a discount off the regular price.

Both deals include free ground shipping in the United States.

Now is a good time to fix your hips

This year has not been kind to our hip flexors: from additional stress to less-than-comfortable work from home situations. Our hips and backs need some much-needed attention. That is why we are offering all of Aletha’s products bundled into the #FixYourHipKit at a discount as a Hip Hook Best Deal.

What’s going on with my tight hip? Why can’t I figure out this lower back pain?

Based on decades of study and clinical practice, Tight Hip, Twisted Core gives you the 3 Simple Steps to live a pain-free life without surgeries, medications, or thousands of dollars. This book explains the major causes and patterns that lead to hip and back pain, along with the exercises and adjustments to relieve tension and prevent future issues. It’s an owner’s manual for your core muscles and a complete guide to using the Hip Hook and Hip Release Ball.

The Hip Release Ball, included in the #FixYourHipKit Hip Hook Deal, is the perfect size and density to provide effective release of the general area around the iliacus and psoas muscles, and the perfect warm-up for the Hip Hook. The ball can also be used to help relieve tight muscles at the back of the hip, glutes, piriformis, hamstrings, and low back muscles. If you are super-tight, the ball is going to allow you to comfortably access all the nooks and crannies of your hip and glute muscles with broad pressure.

Benefits of Rreleasing the psoas and iliacus muscles

The Hip Hook is the world’s first tool designed to specifically release tension in the iliacus muscle and address the root cause of the problem. These are muscles that can only be reached through specific, angled pressure.

• Precise height to allow the perfect amount of pressure
• Tip can pivot to provide pressure to the iliacus where it attaches to the pelvic bone
• Weighted with a gripped bottom for precise placement
• Rubber angled tip to be effective but comfortable

It eliminates tightness at the core of the hip flexor and quickly reduces strain in the legs, hips, and lower back.

The psoas and iliacus have been labeled as the most vital muscles in your body, and these tools can reduce iliacus and psoas injuries for runners and reverse the damage done by prolonged periods of sitting.

Take advantage of the Hip Hook Promo Codes (follow the link to the best Hip Hook deal!) and let’s get you back to running, playing, living, and laughing again.

 

Hypermobility is encouraged in yoga, dance, and gymnastics. But if you’re naturally flexible and are someone that has no problem reaching – or reaching past – your toes, you may be just as susceptible to a hip pain as someone who regularly experiences hip flexor tension and/or lives a sedentary lifestyle.

In fact, you can actually be too flexible. And, yes, your stretching may be causing hip pain.

Let me explain.

You have two large muscles that are central to the movements you do every day. Your psoas muscle and iliacus muscle sit side by side and run from your spine to your pelvis to your thigh. Together, they are called the iliopsoas muscles, and they allow you to sit upright in your chair, drive a car, go for a morning jog, balance on a high beam, do a forward fold, learn a new four-count, and more.

The iliopsoas is in a compressed position when you bend forward, sit down or pull your knees up. And, for many people with tight hips or hip flexor pain, it’s a result of keeping these muscles in that shortened position for too long. It causes your iliopsoas to hold that position – sometimes even after you straighten your legs or stand up.

If you’ve ever felt stiff in your hips after a long day at your desk, this is what’s happening. Parts of your iliopsoas have not effectively relaxed after use, and they continue to pull on your pelvic bone and spine.

This whole idea of opening up the hips and creating more space in the hips is an idea that is useful for people who have a lot of tightness. Some of us tend to be really stiff and tight and need more flexibility, and yoga is a great form of exercise for those kinds of bodies.

In contrast, those who are already really mobile and can easily get into a deep lunge or fold forward with their hands to the ground already have a very flexible hip and do not need their hips opened more.

In fact, hips are designed to be stable and when they become too loose, your muscles tighten up to try to keep you from falling apart. It seems counterintuitive, but in this situation, a tight iliopsoas muscle is the result of your body trying to stabilize itself after overuse or too much mobility.

Let’s take a closer look at what’s happening in your hips as a very flexible person.

What causes hip injuries in yoga, dance, and gymnastics?

People who are naturally inclined to be more flexible may find themselves drawn to sports and activities that let them highlight that strength and continue to strive for a deeper stretch. If you’re a dancer, gymnast, or yogi, you probably have those “goal postures” you are working toward, like the splits, a deep pigeon pose, a flatter forward fold, or kicking your legs up to your nose.

And, when that’s the goal, more flexibility is revered.

However, these extreme motions are well past a normal range of motion for your body. They bring the lower back, hips, and pelvis into positions that are outside of what these joints are really designed to do. And, though they may be accessible to you, repetitive motions, swift movements (such as when dancing), stretching unevenly from side to side (if you favor one side over the other for the deeper postures), and continuing to move into these deep stretches day after day can and do strain your joints and the tissue that holds those joints together.

Even when you take out the swift extension and compression of your muscles, such as in gymnastics or a dance routine, you can still stretch too far. People sustain some of the most common yoga injuries because they are pushing past hip tension. What feels like a sense of accomplishment and that oh-so-sweet depth is setting the stage for problems early on.

This is why most people end up with yoga injuries after about 5 years of practice. Too much mobility has been developed.

With too much mobility, long-standing tension in the iliopsoas muscle develops. It is tightening its grip around your pelvic bone, hip joint, and spine in order to stabilize your core during a stretch or movement.

You see, your iliopsoas muscles are designed to protect your tendons and joints in this region, this is their primary job, so when you’ve created an unstable area to protect, they rise to the occasion.

Your iliacus muscle crosses over the hip joint, attaches directly to the pelvis, and affects the SI joint. The psoas crosses over both the hip joint and the pelvis all the way to the spine. Normally, your iliacus and psoas are responsible for moving these bones – I like to think of them as “puppets.”

But when your muscles become fatigued and are faced with the job of keeping this area from falling apart, they choose to contract and develop knots and tension that stays there not just during your yoga practice, but throughout your life.

This constant tension results in this part of the body taking on more stress and friction than it was designed for.

Furthermore, constant tension in the iliacus and psoas pulls on the pelvic bone and spine, changing the alignment of the hip, SI, and spinal joints and that mechanical change works its way down to the feet and up to the head. Because these muscles are at the core of your body, they affect everything else around them, even creating tension in other muscles in the glutes, hips, and spine that end up playing tug of war with them.

Therefore, that hip flexor pain or tension you feel is really a signal from your iliopsoas that you’ve gone too far. If you push past what your joints are meant to do, you may be inviting a dance, gymnastics, or yoga injury.

Three common hip problems due to hypermobility

There are various injuries or disorders that can cause a dancer, gymnast, or yogi to experience hip pain. I chose to focus on the three most prevalent problems I’ve seen happen in stretching sports.

Hip impingement

Hip impingement, or femoroacetabular impingement (FAI), occurs when the hip joint movement becomes restricted by the abnormal contact between the ball and socket bones.

A hip socket (acetabulum) is usually quite deep, stabilizing the ball of your femur during movement. This ball and socket joint is reinforced and protected by a lining and ring of fibrocartilage.

When there is a change in shape (such as with a bony growth or genetic malformation), a misalignment from the bones being pulled on by the iliopsoas muscles, or excessive use of the hip joint (such as in ballet) it causes unnatural friction. Movements can become extremely painful and piercing, which eventually restricts movement.

Hip dysplasia

To maintain a high intensity of hip mobility during dance, gymnastics, or yoga, many female participants actually have very shallow hip sockets. This could prevent them from ever experiencing hip impingement, but it could cause hip dysplasia instead.

Whereas a deep hip socket adds structural integrity to your movements, a shallow hip socket can create instability and put added stress on your hip flexor muscles. Athletes with hip dysplasia rely very heavily on the labrum (fibrocartilage) and soft tissues around the hip during movements like flexion. Because of this inherent instability in the joint, the muscles around the hip often present with excess tension to compensate.

Most dancers or gymnasts that have hip dysplasia may indeed be very flexible, but they are also more likely to experience a labral tear, hip flexor tendonitis, and cartilage damage as well as the host of issues that come with a chronically tight hip flexor.

Osteoarthritis

We often associate arthritis with old age, but early-onset osteoarthritis has increasingly become an issue among young gymnasts, dancers, and avid yogis. There is evidence to suggest that young, athletic people develop it due to consistent stress and overuse of their hip joints.

For example, a grand plié in dance or a malasana (garland pose) in yoga are both movements that require an extensive range of motion within the hip region. Other movements similar to this can further increase the severity of hip impingement or another hip injury (i.e., labrum tear), leading to osteoarthritis at an early age.

Hip impingement is such a big player in osteoarthritis development because osteoarthritis occurs due to the wear of cartilage tissue in your joints. As cartilage is damaged, and additional friction is applied, osteoarthritis develops and worsens with time.

If you are experiencing early symptoms of these hip injuries – or have already been diagnosed – it’s time to gain more stability before returning to those deep postures and swift movements.

Seeking stability and balance for your iliopsoas muscles

The idea of balance, both mind and body, is well-touted in yoga, dance, and gymnastics. However, we often forget what that looks like in regards to our iliopsoas muscles.

As a very flexible person, the solution may be the opposite of others experiencing hip pain.

The mainstream thought is that, if you are experiencing hip tension, a nice hip opener or yoga for tight hips may help. And hip flexor stretches are very valuable for someone who isn’t experiencing or using their full range of motion yet.

Ironically though, a very flexible person may only experience more hip tightness as they continue stretching.

That’s because those who are already really mobile and can easily get into a deep lunge or fold forward with their hands to the ground do not need their hips opened more. What you need is stability and strength in and around your psoas and iliacus muscles.

Now, you may have just learned what your psoas and iliacus muscles are. However, if you regularly partake in a sport that requires deep stretching and hypermobility, you can seek balance by slowing down, listening to your body, introducing stability exercises and learning how to release your hip flexor muscles.

Four yoga injury prevention tips to help you avoid hip flexor pain and tension from overstretching

The good news is, most hip-related gymnastic, dance, and yoga injuries are preventable, or at the very least manageable.

But it can be challenging to navigate the sensations you are feeling in your hip flexors – and to know whether you need more or less stretching. Here are some general tips and practices to abide by in order to enjoy your next gymnastic competition, dance practice, or yoga flow pain-free.

1. Perfect your technique, form, and feel

Many dancers and gymnasts start at a very young age. This can be both good and bad for technique. If you had a competent teacher during that time, they would have corrected your technique.

However, that is not always the case.

I have seen clients doing a stretch incorrectly for years, even causing damage, because they didn’t clearly know what they were supposed to feel. Many people who begin stretching or want to become more flexible view tension and slight pain as a sign that their efforts are paying off or they are working new muscle groups.

You know, “no pain, no gain.” But when it comes to your hip flexors, that could not be further from the truth.

If you are feeling pain or tension in your postures and movements, it’s time to re-evaluate your form and become aware of any bad habits you’ve picked up. Understanding what kind of sensation you should be feeling with a certain motion and where will help you evaluate if you are feeling something you shouldn’t.

For example, if you are in a deep hip flexor lunge stretch and you feel a stretch in the muscle in the front of your thigh and front of your hip, that’s an appropriate sensation for that motion. In contrast, if you feel a sensation in the back of the hip or your spine, that’s not good. Similarly, a deep, dull pull in your hip joint could indicate that you are stretching your joint capsule and not a muscle. Joint capsules are not supposed to be stretched.

This may mean enlisting the help of a new coach or teacher. And it may also mean backing off deeper stretches and advanced motions until your body can re-learn what the correct feeling is.

Slowing down to identify and correct improper technique or form will be only a temporary setback that wields long term success and may even prevent an injury.

2. Listen to your body

All of us have a different composition of collagen (the connective ‘stiff’ part of your tendons and muscles) and elastin (the ‘stretchy’ counterpart of collagen) in our bodies, as well as a unique ball and socket shape in our hip.

That means that a leap, hip flexor stretch in yoga, or plié will look a little different from person to person.

Chip up, buttercup, that’s perfectly okay and natural!

When you hold a yoga pose or perform a dance routine, your body will sometimes communicate with you. These messages of slight pain or a sudden loss of strength are not to be ignored.

For example, if you are in pigeon pose or performing a deep hip flexor stretch during yoga, and you begin to feel pain, do not just breathe through it and hope for the best. That is your iliopsoas or joint speaking up and telling you that your body is not ready to be stretched that deeply in that moment.

You may simply need to take it easy that day or invest more time in your warm-up routine. But, if ignored, stretching too intensely can easily cause a muscle strain, tear, or increased hypermobility of the hip muscles.

3. Balance your strength training

Ah, that word balance again.

It’s so important to make sure you are stretching and strengthening your muscles in equal and opposite ways. For example, if you favor one leg when going into a cartwheel, make sure you are also strengthening your other leg. And, when you do a forward fold, balance the movement with a sphinx pose or similar movement that stretches the front of your body.

Your psoas and iliacus muscles are quite capable of holding you and propelling you through poses and dance moves. But, that doesn’t mean they should bear the brunt of the force alone. Stronger glutes, thighs, and abdominals will help stabilize your core even more.

Keeping these muscles evenly conditioned with cross-training will help your body spread out the impact of explosive dance moves and deep stretches.

4. Know when massage isn’t enough

Massaging and tending to sore or tight muscles is important for rest and recovery. It can help break up scar tissue from prior injuries, increase muscle circulation, and relax your mind after a difficult workout.

As an athlete, you’re probably no stranger to professional sports massages as well as self-massage techniques such as foam rollers, balls, and other tools that move or vibrate. However, if a tight iliopsoas has already caused a trigger point or muscle knot, massaging that part of your muscle will likely activate and aggravate it further.

This can actually worsen your hip pain from stretching.

If you’ve reached this point, only a full release will help you get the relief you are looking for.

To do this successfully on your own, you will need a tool like the Hip Hook – or a skilled practitioner – to locate the exact spot where your iliacus muscle connects to your pelvic bone. That’s because your hip flexor muscles are considered inner muscles, and can be very difficult to locate with your own hand. Additionally, a full release requires a precise amount of pressure at a particular angle that you can’t achieve by just lying on a particular tool.

The Hip Hook replicates the motion of a skilled physical therapist, using only your body weight and a lever to apply pressure to and encourage a release of the psoas and iliacus muscle.

This tool and technique is crucial to not only the health of the psoas and iliacus, but for happy hips, SI joints, pelvises and lower backs. Keeping the hip flexor muscles relaxed as you continue with these hypermobile activities, can prevent or help heal injuries in these areas as well as issues up or down the kinetic chain, head to toe.

In addition, happy hip flexors, the Hip Hook

My clients that are cyclists often report persistent – sometimes even debilitating – hip flexor pain before, during, and after cycling. And, while riding a bike may have a lower impact on your lower leg, it can lead to back, hip, and knee pain.

Hip flexor pain with pedal clips while cycling

When you’re cycling and using pedal clips, your hip flexors are staying continually engaged with every revolution of the pedal. While one leg is pushing down, the other is pulling up, all the while asking for posture and stability in the core. This keeps the hip flexors (iliacus and psoas) working very hard in a shortened position. Muscles don’t like to be in a short position, they cannot generate the same amount of force and they tend to shorten and tighten over time.

This is felt the most at the groin where the hip flexors attach to the inner thigh. It can also translate into glute pain, sciatica, pelvic floor pain, back pain, SI (sacroiliac) pain, or knee and foot issues. Cycling is a very similar movement as pulling your knees up to run or holding a boat pose when doing ab workouts, activating the same muscle group in your lower abdomen.

During this entire time, your hip and core muscles are also remaining contracted to hold your position on the bicycle, balancing you from left to right, forward and backward.

So, that’s why your lower abs probably hurt a lot more than you expected when you first started cycling – and why you may be feeling hip flexor pain when cycling now.

So, if you’re a cyclist, what can you do about the pain – and how can you prevent it from turning into a larger injury?

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Getting to the root of hip pain from cycling

To manage hip pain from cycling, it helps to understand what causes it in the first place.

Endurance sports like running, swimming, and cycling all have a relatively high risk of injury due to the fact that you are requiring your muscles, ligaments, and joints to be in constant motion during extended periods of time. When you’re biking for miles on end, even if you maintain ideal form, the repetitive motions can put enormous strain on your muscles and joints.

Keeping this in mind, there are usually three main culprits for hip pain caused by cycling: overuse, muscle imbalance, and improper bike fit.

And, as you’ll see below, all three of these often cause the same result: tension and tightness in your iliopsoas muscles, which are a pair of muscles that sit side by side and run from your pelvis to your inner thigh. This overuse in a shortened position causes them to revolt with long-standing tension.

This tension is often the cause of not only hip pain, but pain in this region from cycling.

Tight iliopsoas for cyclists

One of the most common causes of hip pain for cyclists is overuse. Each time you pedal, you are engaging your iliopsoas muscles in opposite directions, either stretching them to extend the pedals or contracting them to pull up on the pedals and propel the bike forward.

While your iliopsoas muscles were made to extend and contract, they were not designed for doing this motion continuously for hours at a time and in a shortened position. Muscles don’t function well when they are too short or too long, they are strongest in their optimal length. In addition, the hip flexors work to stabilize your pelvis and spine in a somewhat stable position while your legs move underneath you, requiring even more from this cramped duo.

Without muscular endurance, your hip muscles will not be able to properly support your hip, back, and pelvic ligaments and joints. And, if you are quickly adding miles day after day with little to no recovery time in between, your fatigued hip muscles may be inviting pain and injury to the surrounding tendons, ligaments, and joints they are supposed to be supporting.

Muscular imbalance in the pelvis and psoas

Any time you are extending and contracting your iliopsoas muscles in opposition – such as when one leg is pushing the pedal forward and the other is pulling up from behind – there is an opportunity for an imbalance to form.

This is very common – and not just with cyclists. Most people have one thigh or glute that is dominant or one hip flexor that is tighter than the other.

You may not even notice yourself using one more than the other when walking or sitting in a chair. But, when you are cycling, you could be unknowingly putting more stress on your dominant leg. Your body may try to correct the imbalance after you get off your bike. However, this often results in one leg feeling excessively tight the next day.

The tightness likely began near the top of your pelvis, where your iliopsoas muscles connect to your hip joints. If they are pulling too tightly on your pelvis bone, it will affect the entire mechanics of your spine, pelvis, and hip. The muscles in your thigh may even feel sore and it may even be pulling on your knee joints, causing knee stiffness, and pain.

Improper bike fit and iliopsoas tension

Even if you have great muscular strength and balance in your legs, glutes, and hips, you may still suffer from hip flexor pain. One of the most common causes of hip pain during cycling – and sometimes the cause of muscular imbalance and overuse – is an improper bicycle fit.

When your bike isn’t professionally fitted to your body, it pushes your posture and body angles into unnatural positions.

Your muscles will try to overcompensate for the abnormal positioning. But, this can lead to one or both iliopsoas muscles being contracted too much or being used unevenly.

For example, think about the position of your pedals.

As a general rule, a 90-degree angle is a good range of motion for your hips and knees. So, if you are too compressed on your bike and bringing your knees up past your hip joint, you are overexerting your iliopsoas muscles, again, asking them to work hard for you in a compromised position.

Conversely, having your seat post too high can cause you to reach too far for the pedals, resulting in excessive motion and strain in the pelvis and spine while riding.

So now you know what causes hip pain while cycling, here are a few tell-tale signs your iliopsoas muscles are being overworked.

Common hip flexor issues for cyclists

The four most common hip flexor issues for cyclists include:

1. Snapping hip syndrome in cyclists

Also known as hip flexor tendinopathy, snapping hip syndrome causes a painful clicking in the hips. This “clicking” will usually be accompanied by a feeling of your tendons pinging. Most often, the click will be both a painful feeling and an audible noise, but it can manifest in just an audible form.

This pain is commonly the result of someone who is not naturally flexible overusing their hip flexors – or someone who is naturally flexible pushing their muscles too far. The snapping sensation and sound can be a result of a taut muscle, usually, the iliacus, psoas, or TFL, clicking over a part of the bone that sticks out nearby. This snap can also happen inside the hip joint itself. When there is hip flexor tension, the alignment of how the ball of the hip fits into the socket is off, making the joint click.

2. Hip bursitis in cyclists

Trochanteric bursitis is a common hip ailment that impacts many athletes, not just cyclists. It is a type of chronic pain that is caused by friction and inflammation of the bursae along the outside of your hips.

Each of your hips has two major bursae, which are small fluid-filled sacs designed to help reduce friction in and around your joints. They are there to protect the tissues from wearing down with motion and rubbing. But, when your muscles are imbalanced or overused during exercise, the bursa areas experience uneven strain and excessive friction, which causes inflammation.

If you notice pain on the outside section of your hip that extends to the upper thigh area, you may have hip bursitis.

The pain may begin as a very sharp, intense pain, but over time it could fade into a dull, wide-spread ache. You may even notice some swelling, warmth, or redness in the hip area.

3. Piriformis syndrome in cyclists

Piriformis syndrome impacts the buttock’s piriformis muscle, a muscle that sits directly opposite your hip flexors and iliopsoas muscles. So, when your hip muscles are pulling your pelvic bone forward, the piriformis muscle may contract in an effort to balance the strain. It’s a mean version of tug-of-war.

This then irritates the sciatic nerve, often causing pain to manifest in your hip area. Sciatic pain can be very insidious, starting as numbness or sharp pain in the buttocks, slowly creeping into your hips, lower legs, and even your feet.

4. Hip impingement syndrome in cyclists

Femoroacetabular impingement is one type of hip impingement syndrome. Impingement pinches the tendons, joint capsule, and labrum in the hip joints, usually due to the unique shape of your ball and socket in the hip. This creates a pinch during movement.

This happens often in cyclists because the hip joint is in the flexed position for extended periods of time – and that’s the exact position that pinches.

Repetitive motions like cycling tighten your iliopsoas muscles, causing the joint to be compressed and out of alignment, pinching the joints. This extra stress and inflammation are often all that’s needed for hip impingement to occur.

Hip impingement is noticeable as it can inhibit your range of motion and cause a distinct pain in the front of your groin. At first, the pain in the hip flexor and groin area may feel dull and achy. But, as it worsens, the pain will occur with more subtle movements and can be sharp as well.

How to improve hip health while cycling

Having a doctor or physical therapist diagnose your hip pain is the first step in working towards hip health, and hopefully, pain-free cycling.

While anti-inflammatory and pain medications can help ease some symptoms early on, becoming dependent on medications will usually only treat the symptoms, not the root cause.

I’m much more inclined to help my clients get to the root of the problem and find long-lasting results. Especially because releasing your iliopsoas muscles and keeping them in a happy state while cycling doesn’t have to be difficult.

7 ways to alleviate your cycling hip pain

Here are some tips for regaining pain-free cycling sessions.

1. Use bike gears properly

Knowing how to ride your bike is one of the most basic yet influential aspects of avoiding hip pain while cycling. If you are misusing your gears, you will exert more effort and put more strain on your hips than necessary.

2. Get a bike that fits

Professionally-fitted bikes drastically improve your posture while riding. Knowing how to fit your bike is difficult, so I recommend getting a professional opinion. They will be able to take photos of you sitting on your bike and can explain what the position for optimal riding comfort, performance, and efficiency feels like.

3. Warm-up before cycling

Your leg and hip muscles have a lot to do with your cycling ability and performance. You are pedaling with them, after all.

Just as with other forms of exercise, a proper warm-up prepares your muscles for the hard work ahead. It gets the blood flow going to your joints and ensures that your muscles won’t be as susceptible to tears or twists.

You want to try low-impact exercises that engage your legs, glutes, and core muscles before you ride. Yoga can be a great warm-up option for cycling, as well as lunges or planks.

4. Stretch often

Just as warming up before a ride is important to get your muscles and joints ready, stretching is an integral part of recovery. After any exercise, stretching highly-used muscle groups helps prevent muscle soreness and tension.

However, it’s very important to not mistake tension for a sign to go deeper into your stretch. Be gentle with your iliopsoas muscles and respect the range of motion that your body has.

And remember, there is no rule that you can only stretch after a bike ride. If you experience hip flexor tightness or pain, stretch as often as you want, whether that be before workouts, during workouts, after workouts, or on your off days.

5. Try the Hip Hook

Stretching is often not enough to change the tension holding patterns that may have developed over time. For a full and lasting iliopsoas release, you really need a tool such as the Hip Hook.

The Hip Hook helps you find the exact location of the psoas and iliacus where they connect to your pelvic bone and let you use the weight of your own body to apply the right amount of pressure at the exact angle needed for a release that only a skilled professional can reproduce.

This is an essential step when it comes to relieving pain and tension in the hip flexor region. Without this tool, it’s nearly impossible to release your own iliopsoas muscles, and you may need to seek out a good manual therapist or practitioner to help you.

6. Use a foam roller

With any muscle soreness, foam rollers come in handy. For large areas like your legs, foam rolling is an excellent way to add the benefits of massage to your cool down or stretching routine.

While a foam roller can’t effectively reach your hip flexors for a full release, you can focus on muscle release above your knees, and on the outside of your leg.

Although it’s tempting to roll out your IT band like everyone else, remember that the IT band is a piece of fascia that should not be rolled. It can’t be “tight,” only the muscles that attach to it can be tight. Instead, focus on the glutes and TFL muscles to fix IT band pain. Tightness in these muscles that attach to the ITB can worsen symptoms of bursitis and cause additional hip pain from cycling.

7. Balance your muscles