Category: Pain

The Hip Hook was just featured on Family Education’s guide as a tool that helps with Hip and Back pain during pregnancy!

Check out the article here!

Designed by Christine Koth, a holistic physical therapist, the Hip Hook is a muscle release tool designed to address your hip flexor muscles, specifically your psoas and iliacus. When tight, these muscles can contribute to pain experienced in the lower back, hips, and knees.

Using the tool for just a few minutes per day can make a big difference in how your body feels.

Learn more about the Hip Hook here.

 

Slowly, but surely, the importance of the iliacus muscle is making its way out into the world.

When the iliacus becomes tight and holds tension, this lesser-known hip flexor muscle can cause misalignment of your hips and pelvis, ultimately leading to aches and pains developing in your lower back, hips, knees, and more.

Dr. Kelly Starrett from The Ready State agrees, and considers the iliacus to be a part of what he refers to as “The Four Horsemen of the Spine” along with the rectus femoris, the psoas, and the quadratus lumborum. Keeping these muscles happy and healthy can make a big difference in the way that your body moves and feels day after day.

In that article, Dr. Starrett acknowledges that the iliacus muscle is one of the most challenging muscles to reach due to its location deeper within the pelvic bowl, and he recommends using the Hip Hook as an awesome mobility tool for people to try to access and mobilize this area.

The Hip Hook also appeared as part of the TRS Holiday Gift Guide along with some other great products recommended by Dr. Starrett.

 

You’re finally ready to hit the hay, but your hip pain won’t let you sleep. You can approach this problem from a couple of new angles: comfortably positioning your body in bed, and understanding the root cause of the problem to address the root cause of the pain.

In this article, I will detail a little known reason you may be experiencing hip pain when sleeping (or rather a little known muscle that may be the culprit), a few ways to alleviate your hip pain at night, and how you can begin to address the root cause of your hip pain.

Although this article is filled with helpful resources and information, it is not meant to diagnose the cause of your specific hip pain. Consulting a physical therapist or medical practitioner is the best way to get a full picture of your situation, understand your treatment options, and establish a supervised treatment plan.

Let’s help you get some ZZZZs!

What causes hip pain when sleeping?

Numerous ailments can affect your hips and cause you pain. Many people who experience hip pain when sleeping may not have much pain during other activities – or even during other parts of their day.

In the evening, when your body has had a chance to rest and relax a little, your pain may be triggered by inflammation due to lack of movement. Or, you may just finally have had the time to notice your pain.

For athletes, sore muscles may cause hip pain while sleeping or even a more chronic pain like tendonitis or bursitis. As you age, hip pain may be caused by arthritis or osteoarthritis. Even certain cancers, injuries, or pregnancy can all contribute to hip pain.

One of the most common (yet often overlooked) reasons why so many of my patients have hip pain when sleeping is tight hip flexor muscles. That is: their hip flexor muscles are so tight that they are pulling their hips out of alignment (which can be the cause of pain for hip bursitis or SI joint pain). And this is only exacerbated by sleeping positions that cause an unnatural curvature in your neck and back for prolonged periods of time.

But what are your hip flexor muscles, and why do they hold so much sway over your hip pain while sleeping? I mean, you’re just laying there!

Tight iliacus muscles and tight psoas muscles can create hip pain while sleeping

Your hip flexor muscles are also known as the iliopsoas muscles. The iliopsoas are made up of two separate muscles: the iliacus and psoas.

These two muscles are essential to everyday movements like sitting, walking up stairs, running, jumping, and rotating your hips.

Because of the extensive overuse of your iliopsoas muscles in the various movements you make during your day, they tighten over time. This is especially true for athletes that tend to engage their iliopsoas muscles more and put additional strain on them during training.

Not surprisingly though, tight hip flexor muscles are equally common in people who tend to sit for most of their day.

These muscles like balance. So, both inactivity/under-stretching and overactivity/over-stretching can cause pain and tightness.

What’s more, the location of the iliopsoas muscles on the inside of your pelvis bone makes them hard to access and easy to overlook. In fact, many of my patients had never even heard of the iliacus before! So, unlike your hamstrings or calf muscles, you can’t easily use a massage roller to relieve your muscle tension after a workout or a long day on your feet.

The iliacus muscle attaches to the inside of your pelvis and comes down the front of the hip, where it connects to the front of your thigh bone. The iliacus muscle, in particular, is very close to the hip joint.

The psoas muscle blends with your diaphragm via connective tissue and attaches to the lower spine. As you move down the psoas muscle, it attaches to the same spot on the front of the hip as your iliacus muscle.

While there is a myriad of reasons while your hips could hurt, tight iliopsoas muscles are often a major culprit in hip pain when sleeping. So, it’s important to not only know about the issue of tight iliopsoas muscles, but how to prevent it.  

Best sleeping positions for hip pain

If you have hip pain while sleeping, it is extremely helpful to understand the root cause. Still, once you’ve determined what is causing your pain, it will take some time to treat, even if your issue is simply tight iliopsoas muscles.

That’s why I’ve compiled a list of some of the best sleeping positions for hip pain. These positions will help you lower your pain while you are working to get to the source of that pesky symptom.

Try a few of these out and see how they work. Finding comfortable sleeping positions may help you alleviate hip pain while sleeping and allow you to finally get a good night’s rest.

If you have hip pain when sleeping on your side

Many of us enjoy sleeping on one side, and in fact, you may even favor one side over the other.

If you have outer hip pain, such as hip bursitis, you may feel pain either on the hip you’re laying on, or the hip you’re not laying on.

If you have pain in the hip you’re laying on, pain caused by direct pressure on the joint, then pay attention to your mattress surface. You may find relief by adding a memory foam pad or mattress topper to your mattress to help distribute your weight more evenly and provide extra cushion for that hip joint.

If you have pain on the hip you’re not laying on, try sleeping with a pillow between your knees and ankles. It may take some time to find a position that works with your pillow, and you may even have to try out pillows of different densities. The goal is to have your legs rest parallel to each other, so your knee is not lower than your hip. This can be accomplished by using a fat pillow, resting lengthwise from knees to ankles.

Sleeping with a pillow between your knees and ankles is a good way to relieve SI joint pain while sleeping on your side, as it reduces the strain on muscles attaching to the top of the thigh bone (greater trochanter). This strain on the hip is directly related to a tight iliacus muscle, which causes an anterior rotation on the pelvis, and pulls on the lower back and hip joint.

Whatever the pillow position you choose, the main purpose of sleeping with the pillow is to alleviate the pull on your hip’s soft tissues and keep your pelvis in a natural alignment.

When you allow your leg to rest naturally while lying down, there is a slight dip that enables your legs to connect and rest. When this happens, your leg’s natural pull adds more pressure to the muscles around your hip joint, which can then cause hip pain when sleeping.

If you have hip pain when sleeping on your back

If you have hip pain when sleeping on your back, it can make almost any other sleeping position uncomfortable. This pain is often caused by tension in the hip flexors which then tug on your lower back, hips, and legs.

For alleviating your hip pain when sleeping on your back, try placing a pillow or rolled-up blanket under your knees. Depending on the degree of muscular tension, you may need two pillows positioned under your knees. This places your hip flexors in a relaxed state, easing tension on your lower back and hips.

If you feel a pinch on your groin while laying in this position, allow your legs to spread and rotate outward. You can even use pillows on the outside of your knees to keep them comfortable and supported in this position.

If you have hip pain while sleeping on your stomach

Although sleeping on your back is likely the best sleeping position for someone with hip pain, there are those of us who prefer sleeping on our stomachs. If that is the case for you, and you want to prevent hip pain when sleeping, then grab a pillow and try this sleeping position out tonight.

When sleeping on your stomach, you might bend one leg out to the side. If you do, you should place a pillow under your knee to elevate it slightly. This will relieve some of the pressure on your hip.

If this is too dramatic of a position for you, then try a folded blanket or a thinner pillow that makes you more comfortable.

Iliacus release: Discover the root cause of your hip pain for a better night’s sleep

While getting enough sleep is crucial for your physical, mental, and emotional wellbeing, the ultimate answer is not extra pillows and smooshy mattresses, but addressing the root cause of the problem.

All of these issues tie back into tension in the iliacus muscle, one of your primary hip flexors. This tension in your core is likely putting strain on your lower back and hip joints.

Stretching may help some, but if tight muscles are the true cause of your hip pain when sleeping, then you’ll need to fully release those muscles to alleviate the pain for good.

The iliopsoas muscles (comprised of the psoas and iliacus) are very interconnected to the structure of your hip, and because of their positioning on the inside of your pelvis bone, they are difficult to access. Repeated sessions to a physical therapist or other practitioner who specializes in releasing the hip flexors may not be possible.

This is why I invented the Hip Hook: after decades of clinical practice and seeing this pattern of tight hip flexors creating hip pain, back pain, and even knee pain, I looked around to find any tool that could mimic the angled pressure I apply with my hands in therapy sessions. When I discovered that no psoas and iliacus release tool existed, I got to work inventing one!

If you want to address the root causes of hip pain at night, I highly recommend the Hip Hook. The Hip Hook is still the only muscle release tool designed for targeted pressure on the hard-to-reach iliacus muscle.

With just a few minutes added to your bedtime routine each night, or even once every few nights, the Hip Hook can help you be on your way to a life free from hip pain when sleeping.

3 simple steps to realign your pelvis before bed

Release your hip flexors as a part of your bedtime routine. Taking ten minutes and following these 3 simple steps can realign your body and stop your muscles from pulling on your joints, so you’ll never need an article like this again!

Step 1: Release the front of your hip using the Hip Hook or the Hip Release Ball. You can also add to a bedtime routine a slow, soothing yoga flow, or a few hip flexor stretches for tight hips.

If you have sciatica pain while sleeping, these self-massage techniques for sciatica can be helpful.

Step 2: Use a massage ball to release the muscles in the back of your hip.

Step 3: Realign your rotated pelvis with this simple 2-minute exercise.

Other ways to manage hip pain when sleeping

I’ve already given you a few good options, but there are even more ways that you can ease your hip pain while sleeping, and some of them happen before you go to bed.

Get the right mattress

First, make sure you have a decent mattress. In general, a firmer mattress is ideal for preventing hip pain when sleeping. If the mattress is too soft, your body will not be aligned properly and your hips, in particular, will not be given the support they need.  

A mattress can also be too firm and will be equally poor when it comes to giving your body the support it needs.

That is why it can help talk to an orthopedic specialist when choosing a mattress that’s right for your body.

You can also add a foam pad or mattress topper to your mattress to help distribute your weight more evenly and add more support, especially if you’re a side sleeper who experiences pain in the hip you lay on. Try not to get a mattress with inner metal springs, especially if you sleep on your side. A memory foam mattress is better for weight distribution and support.

Follow a bedtime routine

Although this may seem like a strange addition to the list, if you are already losing some sleep to hip pain, you need to try and get as much good sleep as you can.

One of the best ways to optimize your sleep is to put your body into a natural rhythm. To do this, you need good morning and evening routines (ideally including hip flexor release!).

Going to bed and waking up at the same time each day is ideal, especially if you can get 7-9 hours of sleep each night.

It also helps to eliminate distractions and to keep your bedroom clutter-free and reserved for sleep only. Create a peaceful environment so your mind and body can relax each night.

Before deciding to do hip flexor stretches, it is helpful to know the root cause of your hip pain. Although some stretching can be great, overstretching is possible and can cause more harm than good.

It’s important to visit a physical therapist to determine the cause of your hip pain when sleeping once and for all. Then, and only then, will you gain the tools to get rid of your hip pain.

FAQs about hip pain when sleeping

How do I stop my hip from hurting when I sleep?

One way is by using pillows to adjust the positioning of your body, allowing for more natural alignment. However, addressing any underlying muscle tension during the day may address the root cause of hip pain at night and lead to longer lasting results.

What can cause hip pain at night?

Common causes of hip pain at night include:

• Tendonitis
• Bursitis
• Arthritis
• Injury
• Tight hip flexors
• Pregnancy

What causes hip pain when lying on your side?

If your hip touching the mattress is hurting, it could be from the compression on that joint from a variety of causes, from bursitis to arthritis. If your top hip is hurting, it could be muscular tension from the angled weight of your top leg tugging the muscles around your hip joint.

 

Is there anything better than a cozy night cuddling with your sweetheart? Or anything worse than when you can’t find the right cuddling or sleeping positions for hip pain?

For many of us, cuddling is one of the ways we show affection to our partners and enjoy quality time together. So, what happens when your hip pain starts to interfere with that sacred time?

Whether your hip pain starts to act up just when you’re starting to snuggle in, or is interfering with your ability to sleep at night, you’ll need to know how to manage it.

No matter what the root cause of your hip pain is, knowing the best snuggling and sleeping positions for hip pain is a good starting point in your hip pain management.

That being said, implementing the best sleeping positions for hip pain is only the first step. Your body positioning is merely a reaction to a deeper issue. If you don’t find out what is causing your hip pain in the first place, then you are only putting a bandaid on the problem. And I’m a big fan of addressing the root cause of the problem.

That’s why I’ll help you understand some common reasons your hip may be hurting when cuddling or sleeping, a few of the best sleeping positions for hip pain, and how to prevent hip pain altogether.

What causes hip pain when cuddling?

Hip pain can persist throughout the day, but many people actually experience the worst of it when they’re resting or trying to sleep. So, it’s no wonder the pain can pop up when you are cuddling with your partner or relaxing at the end of the day.

There are a variety of reasons why you may have hip pain, but some of the most common causes of hip pain include:

• Arthritis and osteoarthritis
• Bursitis
• Tight iliopsoas muscles
• Tendonitis

This is certainly not an exhaustive list. There are other reasons you may be having hip pain, including a hip fracture or a labral tear.

Because hip pain is so different for many individuals, if you are experiencing discomfort or any sensation that is interfering with daily activities like sleeping, cuddling, walking, driving, etc., it is important to get an opinion from a medical professional.

This article isn’t meant to diagnose or treat hip pain. It is here merely to help you understand your hip pain better, learn a little bit about the anatomy of your hip flexors and find the best sleep positions for hip pain so you can rest easy.

Although there are quite a few relatively common reasons for hip pain, the one I want to focus on today is overly tight iliopsoas muscles (also known as your hip flexor muscles).

Tight iliopsoas muscles are a frequently overlooked factor when it comes to hip pain, but this tightness is also one of the most prevalent reasons so many people have persistent pain in their hip – sometimes spreading to their back, legs, knees and further downward.  

How tight hip flexor muscles cause hip pain

Your hip flexor muscles are one of the most used muscles in your body. During the majority of your daily activities – including sitting, walking, stepping up, lunging, squatting, kicking, running, and anything else that involves leg or trunk movement – these muscles are engaged.

The over-engagement of the iliopsoas muscles can eventually lead them to tighten.

The two separate muscles that make up the hip flexors are the iliacus and the psoas muscles. The iliacus and psoas overlap and connect, the psoas starting at your low-mid spine, and the iliacus starting inside your pelvic bone, and both inserting at the top of your thigh bone. These muscles go diagonally through your core and have the very important job of connecting your upper and lower body.

If the iliacus and psoas muscles are allowed to get too tight, they begin to pull on the structures around them. The excessive tension in the iliopsoas can pull your hip out of alignment and eventually cause pain in your hip or lower back.

The iliopsoas muscles and other surrounding pelvic muscles have the ability to create a domino effect. If one of the muscles is too tight, or a bone is misaligned, it will impact the surrounding areas. Tight iliopsoas muscles can interfere with your other muscles, interfere with your posture (all the way down your feet!), and keep creating more and more issues if the tension continues.

That’s a pretty big effect from such small muscles!

So now that you have a better understanding of your hip structure, and know at least one possible source of your hip pain, it’s time to learn how to manage that pain in the evening so you can actually relax.

Here are the best sleeping positions for hip pain that I recommend to my patients.

The 4 best cuddling & sleeping positions for hip pain

Cuddling is a great way to relieve stress, enjoy time with your partner, enjoy a strong cocktail of your self-manufactured love chemical oxytocin, and even alleviate some chronic pain symptoms. Still, if you suffer from hip pain for any reason, you may struggle to cuddle comfortably or to get a good night’s sleep.

Most of these cuddling and sleeping positions for hip pain are going to be ones that you’re already familiar with, but they include some variations to help you get comfortable and ease hip pain while you cuddle or fall asleep.

1. Be the little spoon

Spooning is a very common cuddling position for many couples, especially when they’re falling asleep together. And, if you are one of the couples who enjoy spooning then you are in luck! Spooning is one of the best sleeping positions for hip pain.

If you have hip pain even while spooning with your partner, identify which hip you’re having pain in while you spoon. If your hip pain is isolated to one hip, be sure to flip over and lie down on the hip that is not causing you pain.

If you prefer being the little spoon, put a pillow between your legs (from knee to ankle) while lying on your side. Elevating your top knee and keeping your top leg parallel to your bottom leg with the pillow, helps to change your top thigh’s angle and prevents it from dropping and tugging on the muscles surrounding your hip.

If you don’t prop your leg up with a pillow and it drops, it can impact the soft tissues (such as your muscles) around your hip and pelvis. This can trigger pain. By separating the top and bottom leg, even just slightly, you can take away some of the stress on those muscles.

If you don’t have an extra pillow to use, or you find sleeping that way uncomfortable, you can instead try angling ever so slightly onto your stomach so that your top knee rests in front of your bottom leg and your hip angle is altered.

2. Be the big spoon

If you are the big spoon through and through, there are some helpful sleeping positions for hip pain for you too. In fact, as the big spoon, you won’t need a pillow at all – you can substitute your partner for one!

While being the big spoon, simply rest your upper leg on top of your partner’s leg. Make sure you are actually relaxing while doing this. This position will help to relieve some of the tension in your leg and will ease your hip pain as well.

3. Try half-spooning

The half spoon is another one of the best sleeping positions for hip pain. If you aren’t sure what I am referring to, don’t worry. I’m here to explain it!

One partner will be lying on their back to perform this cuddling position, and the other one will be on their side facing their partner, similar to a traditional spooning position.

The partner lying on their side will rest their head on the crook of the other partner’s arm, and can rest their own arm on their partner’s chest.

The partner lying on their back can wrap their arm around their partner and lie in whatever position is comfortable for them.

If lying on your side doesn’t work, even with modifications, then choose to be the partner lying on their back.

If you still have hip pain on your back, then try putting a pillow or two under the back of your knees to lift your legs slightly and release some tension on the hip flexor muscles.

If you are the partner that is lying on your side, then just make sure you are lying on the hip that does not cause you pain. Then, drape your top leg across your partner’s body. Just like in the examples above, this will elevate your upper leg enough to relieve some of the pull on the soft tissues in your hip.

4. Rest your head on your partner’s chest

Resting your head on your partner’s chest while they are lying on their back is one of the most comfortable cuddling or sleeping positions for hip pain. Much like in the half-spoon cuddling position, one partner will lie on their side and the other will lie on their back.

The partner on their back can choose a position that works well for them, and if you struggle with hip pain when lying on your side, it will work best for you to be in this position.

The partner lying with their head on their partner’s chest will essentially be in the half-spoon position, but will be slightly lower so that their head rests on their partner’s chest instead of their partner’s arm.

This position allows you to also elevate your top leg by laying your leg across the top of your partner’s legs.

So there you have it! You can be the big spoon, little spoon, or a combination of the two (a human spork?) – and still find a comfortable sleeping position for hip pain.

As I mentioned before, however, simply managing your hip pain at night or while cuddling will not correct the cause of your hip pain in the first place.

Don’t just react to hip pain – prevent it

Chronic hip pain doesn’t have to last forever. While finding the best cuddling and sleeping positions for hip pain can help relieve your pain (or at least make you comfortable enough to fall asleep and enjoy cuddling with your partner) it is only a temporary solution.

One of the most effective ways to address hip pain when cuddling or sleeping is to find the cause of that pain and manage it. Often, there is a common root cause to hip, back and knee pain: tight hip flexor muscles. Fortunately, if that’s the case, there are several easy things that you can do to address the issue.

First, you should get an evaluation from a medical professional, like a physical therapist, to help come up with a treatment plan that fits your needs. Within that treatment plan, they may recommend that you begin to implement some hip flexor stretches to target tight iliopsoas muscles as well as muscle release techniques.

Some stretching techniques can be beneficial to tight hip flexor muscles, but the best way to release your iliacus or psoas muscles is to use targeted muscle release, involving direct, prolonged pressure. Unfortunately, the iliacus and psoas are hard muscles to reach.

While your physical therapist can reach your iliacus and psoas muscles to apply pressure to them during a session, your muscles need more attention between appointments if you want to see results.

Most standard massage or muscle release tools can’t access the iliacus or psoas muscles. That’s why I invented the Hip Hook – a psoas release and iliacus release tool.

Paying careful attention to the tightness of your hip flexor muscles is one of the best preventative measures anyone can take to ensure that they can enjoy cuddling and sleeping without hip pain. Because relaxing with another human really is the good stuff.

Keeping your hip flexors muscles healthy and happy is a long-term journey, and it’s completely worth it. If you need some relief in the meantime, my list of the best sleeping positions for hip pain should help you find it.

FAQs about hip pain when sleeping

Can a body pillow help with hip pain?

It can, and a human body pillow works just as well! If you’re a side sleeper, spooning another human (or a body pillow) allows you to keep your top leg elevated, reducing muscle tension on your top hip joint and compression on your bottom hip joint. But at some point, you may want to address the root cause of that hip pain and look at what you’re with your body during waking, non-cuddling hours.

How do I stop my hip from hurting when I sleep on my side?

One way is by using pillows to adjust the positioning of your body, allowing for more natural alignment. However, addressing any underlying muscle tension during the day may address the root cause of hip pain at night and lead to longer-lasting results.

 

Those stubborn quads. You’ve rolled them, stretched them, and massaged them but they’re still tight and/or sensitive to pressure. It’s time for a new angle: let’s look up the chain to find out where that tension is coming from.

There’s no doubt that your quads are working hard, and it’s true they may be holding tension. But they’re also part of a much larger team of muscles that works synergistically while you’re running and even while you’re sitting.

Just because the pain is in your quads doesn’t mean the problem is in your quads

I’m going to bring your attention up the chain to your iliopsoas muscle, an important member of the hip flexor family.

The iliopsoas is actually two muscles: the iliacus and the psoas. Many runners mistakenly refer to these muscles interchangeably, or believe when they’re releasing the psoas they’re also releasing the iliacus. But these two muscles each have distinctive locations and roles, and they both need to be addressed.

One part of this muscle – the psoas– travels from your lower back, across the front of your pelvis, and attaches to the femur (thigh bone). This muscle crosses diagonally through your body in a direction we rarely think about.

The other part of this muscle – the iliacus – travels from the iliac fossa (the pelvic bone) and crosses over the hip joint and also attaches to the femur.

Functionally, these muscles attach your upper body to your lower body, and have the extremely important job of both stabilizing your pelvis and lifting your leg.

Nearly all runners have a tight iliopsoas. Running utilizes the iliopsoas to swing the leg forward in a running pattern while simultaneously stabilizing the spine and hips. The leg strides forward using the iliopsoas and when the leg extends behind the body, that muscle is stretching. Any time you have one leg forward and the other leg behind while using this muscle, there is a good chance for one of the iliopsoas muscles to develop tightness because they have to shorten and lengthen all while stabilizing your spine and hip area. And when this tightness is chronic, this muscle can form something called a trigger point.

What is a trigger point?

A trigger point is a muscle knot that refers pain to a completely different place than where it’s pressed (hence the name; it triggers pain elsewhere). For example, if you have a knot of the trigger point type in the top of your shoulder and you press on it, it might hurt right where you’re pressing, but it could also refer trigger point pain into your neck or head, resulting in a headache.

Trigger points are important to understand because often we have pain in certain areas of the body that are actually coming from a different location.

So back to those stubborn thighs…

An iliacus trigger point can refer pain to the thigh

If you have an iliacus trigger point, you may experience referred pain to the top of the thigh. This may feel achy or tight. If you have a psoas trigger point, you may also experience referred pain that specifically runs vertically along your lumbar spine: this is the trigger point pattern for the psoas and iliacus.

While trigger points often show up in iliospoas muscles on both sides, they are typically more active in one side over the other. But for you special cases out there, it is possible to have them equally active on both sides.

Because the nerves from the lumbar spine are lodged within the psoas muscle, trigger points in either the psoas or iliacus muscle can also entrap nerves, creating symptoms of weakness in the leg and/or sensations of numbness, tingling, or pain.

Tension in these muscles not only affects the nerves and the pain patterns, but they cause a twist in the core resulting in issues from the spine down to the mechanics of the toe. It’s a pretty big deal. I wrote a whole book about it: Tight Hip, Twisted Core: The Key to Unresolved Pain.

What causes trigger points

Iliopsoas trigger points can form from overexertion on an unconditioned muscle, a sudden overload (as in, falling and catching yourself), or regularly sleeping in a fetal position (with your knees drawn up to your chest).

Trigger points can also be aggravated when a muscle is in a contracted position for an extended amount of time (hello, desk chair and long drives), especially in positions where your knees and higher than your hips. Even more so if you are leaning forward at the same time.

Keep in mind that any posture or activity that activates a trigger point, if not corrected, can also perpetuate it.

Foam rolling is not the (only) answer

A trigger point can remain inactive, existing as a knot in the muscle tissue, but not causing any other issues. However, if you go to town rubbing on the trigger point or stretching it, it can become active. Once activated, this “active” trigger point can cause referred pain without being pressed. (Spoiler alert: you don’t want that.)

Foam rolling and stretching your quads can be part of the solution: increasing circulation, releasing tension and softening those muscles absolutely helps. However, when the rectus femoris muscle (that big one on the front of your thigh) is shortened, the iliopsoas muscle also becomes shortened, making it more susceptible to forming and perpetuating iliopsoas trigger points. So even if the origin of your quadriceps tension was actually in your thigh, it is now tugging on the entire chain.

In my experience, many runners with tight iliopsoas muscles have resolved their pain in other parts of the body such as the glute, knee, foot, and toe, by releasing the tension in the core, the iliacus muscle itself.

Trigger points release best with direct, prolonged (90 second) pressure

You need to access this muscle directly to release the trigger point. If the trigger point was in your shoulder, you could easily release it with a tennis ball, a partner, or a well-placed doorframe. The psoas and iliacus muscles are a bit trickier because they are located up against the pelvic bone and you need more angled tools to reach them.

Your first option is to see a physical therapist who can manually release these muscles with their hands. Your second option is to use a tool to release your iliopsoas at home. Some runners have been known to use a kettlebell handle or a massage ball. But there are a couple of tools on the market that address the psoas and only one that addresses both the psoas and the iliacus.

One psoas release tool is the Pso-Rite. It has two arches that curve upwards and you lay over them. For some runners, they are able to get the angle they need for psoas release using this tool, but be aware that it’s a one-size-fits-all tool. Your body needs to be a certain width for those spots to match up with your psoas muscles and the pressure point is non-specific.

Another other psoas release tool is the Hip Hook, which first releases the psoas, then angles inward to perform an iliacus release. For trigger point release specifically, you want hands or a tool that can access the specific nooks and crannies of that muscle and provides pinpoint pressure like only a therapist’s thumb could do otherwise.

Sometimes a trigger point may be right in the belly of the muscle, but sometimes it may be further towards the origin or insertion point. Engage your patience and curiosity: you may need to do some exploration to find the right spot: that’s where a skillful practitioner or specific tool comes in handy.

Iliopsoas trigger points pull on other places, too

Because the iliopsoas muscles are part of a larger functional unit, it is likely you also have trigger points or tightness on the back of your hips and legs due to trigger points in the iliopsoas. So don’t ignore your backside. The antagonists (muscles designed to work opposite the iliopsoas) are also likely to develop trigger points: especially the gluteus maximus (your largest butt muscle), hamstrings (backs of your legs), and adductor magnus (tippy-top of the inner thigh to your inner knee).

This best practice of direct, prolonged pressure applies to these muscles as well. For your gluteus maximus, lay on your back with your knees bent and place a lacrosse ball, tennis ball, hip flexor release ball, or solid dog toy under your hip to release these muscles. Trust me: you will know the spots when you reach them. Breathe and imagine your muscle melting over the ball for 30-90 seconds and you’ll feel that muscle releasing. You can also let your knee fall out to the side to achieve deeper pressure. Then roll the ball a couple inches in any direction and find the next spot. Use this same technique with a foam roller or ball for your hamstrings and adductors.

How to prevent iliopsoas trigger points

Sometimes the best way to take care of your runner’s body is to pay attention to what you’re doing in the other moments of your life. Avoid sitting in positions that keep your iliopsoas flexed for long periods of time, and learn to release your iliopsoas regularly as part of your stretching routine. (And if you haven’t already: develop a stretching routine). Your muscles form movement habits that affect everyday functioning. And like every habit, for better or for worse, regularity matters. Think of releasing your iliopsoas like flossing for your core: it doesn’t take long, you have to remember to do it, and your body will thank you for it in the long run.

 

Now that you’ve learned the top reasons to strengthen your hip flexors, you’re probably chomping at the bit to try some exercises. In this article, we’ll share with you the best hip flexor strengthening exercises you can do to gain those benefits.

Try these exercises to strengthen your hip flexors

For the most effective results with any of the following hip flexor exercises, we recommend that you work within a range of motion, resistance level, rep range, and speed at which you are sufficiently challenged yet can control with good technique. This is super important!

Hip Flexor March (Supine or Standing)

A hip flexor march strengthens the iliopsoas (formed by the iliacus and psoas muscles). So it is a psoas strengthening exercise and an iliacus strengthening exercise. Depending on your ability to balance on one leg, you may choose to perform this exercise while laying on your back (supine) or you can place your hand against the wall for some light assistance when standing.

Removing balance from the equation may make this exercise even more effective because you are able to place more focus and energy towards engaging and strengthening your hip flexors. We recommend that you try those variations first before challenging yourself by adding balance back into the mix.

Here’s how to do each exercise!

Supine Hip Flexor March

To perform a supine hip flexor march:

1. Lay down on the ground on your back and have a resistance band (optional) around the middle of your feet. Keep your legs straight.
2. Keep the core engaged around a neutral pelvic position, where you could really only slide one finger between your lower back and the floor if you tried.
3. Bring one knee as close to your chest as possible, while squeezing the glute and quad on the other leg to keep it straight. Hold this position for 3-5 seconds and make sure the core stays engaged.
4. Return to the starting position slowly and with control, repeating the same thing on the opposite side. Continue to alternate sides with each rep in the set.

To challenge the core and upper body during this psoas strengthening exercise, you can also add movement of the arms to perform a more advanced variation of this exercise that is commonly called a dead bug.

Standing Hip Flexor March

To perform a standing hip flexor march:

1. Stand up tall and have a resistance band (optional) around the middle of your feet.
2. Keep the core engaged around a neutral pelvic position (not too arched and not too rounded in the lower back).
3. Raise one knee towards your chest, while keeping your pelvis as level as possible. Squeeze the glute and quad on the other leg to keep it straight. Hold this position for 3-5 seconds and make sure the core stays engaged.
4. Return to the starting position slowly and with control, repeating the same thing on the opposite side. Continue to alternate sides with each rep in the set.

Taking a Different Angle

By changing the angle at which you orient your hip when holding the end position, you can begin to target the tensor fascia latae (TFL) and pectineus muscles — both of which are also hip flexors — and strengthen them too.

By placing your hip into internal rotation, you will activate the TFL muscle. As you do this, you can also move your leg further away from the center of your body (hip abduction) to challenge the TFL even more, while also recruiting the gluteus medius.

By placing your hip into external rotation, you will activate the pectineus muscle. As you do this, you can also move your leg closer to the center of your body (hip adduction) to challenge the pectineus even more, while also recruiting the other adductor muscles.

Note that you can also use these variations to change the angle of your hip flexor strengthening when performing the supine hip flexor marches shown earlier.

Mountain Climbers to strengthen hip flexors (using sliders)

Mountain climbers are a fantastic way to challenge your core and upper body while keeping the primary focus on strengthening the hip flexors. It is our preference to perform this exercise using sliders underneath the feet (wearing socks on a smooth surface also works great) to add some additional resistance due to friction and also to prevent “cheating” the purpose of the exercise by bouncing out of each rep.

Standard Mountain Climber

To perform a standard mountain climber:

1. Start in a high plank position with your arms directly underneath your shoulders. Keep the core engaged around a neutral pelvic position and with the hips around shoulder height.
2. Drive one knee forward towards the elbow while the other leg remains straight, keeping the core engaged and staying in contact with the slider or the floor.
3. Straighten that leg out while you simultaneously drive the opposite leg forward towards the other elbow, again keeping the core engaged and staying in contact with the slider or the floor.
4. Repeat this alternating pattern for the remainder of the reps or duration in the set.

For a very advanced version of mountain climbers, you can add a resistance band around the middle of your feet. Feel the burn!

Crossover Mountain Climber

To perform a crossover mountain climber:

1. Start in a high plank position with your arms directly underneath your shoulders. Keep the core engaged around a neutral pelvic position and with the hips around shoulder height.
2. Drive one knee forward towards the opposite elbow while the other leg remains straight, keeping the core engaged and staying in contact with the slider or the floor.
3. Return that leg to its starting position while you simultaneously drive the other leg forward towards the opposite elbow, again keeping the core engaged and staying in contact with the slider or the floor.
4. Repeat this alternating pattern for the remainder of the reps or duration in the set.

This version will be much more of a challenge for the hip flexors and there will likely be the tendency to want to round the lower back and twist the pelvis to help the knee get closer to the opposite elbow. Resist the urge to do so as best as you can to keep the focus on the hip muscle working.

Paused Squats to strengthen hip flexors (or Tempo Squats)

You might not think of these exercises as something that trains your hip flexors, but they sure do! The functions of the iliopsoas include flexing the hip and stabilizing the lower back, pelvis, and hip. When performing a paused squat or a tempo squat, you will find yourself engaging your hip flexors (as well as many other muscles that make up your core) as you control your body throughout the movement.

There are many different tempos and lengths of pauses that you can experiment with. When written out, you will often see the tempo as 3 numbers. For example, a 3:2:1 tempo means a 3-second eccentric component as you lower yourself down into the squat, a 2-second isometric hold (or pause) at the bottom of the squat, and a 1-second concentric component as you stand back up.

Here are some helpful cues!

To perform a pause squat (or tempo squat):

1. Start by standing nice and tall in the squat variation you’ve chosen. Keep your core engaged around a neutral pelvic position.
2. Send the hips back slightly as you also begin to bend your knees. Slowly lower yourself down into the bottom of your squat position in accordance with the tempo you selected.
3. At the bottom of the squat, hold this position and continue to engage your core (which includes your hip flexors) to maintain a strong, stable position.
4. Drive out of the bottom position of your squat and return to the starting position with a strong squeeze of the glutes and legs as you stand back up.
5. Take a breath and rest in between reps, as needed.

There are many different squat positions that you can practice these exercises — bodyweight squat, goblet squat, front squat, back squat, overhead squat, and more. The ones listed here are in an order of relative difficulty. Choose a squat variation that is appropriate for you and, if you choose to add weight, select a resistance that you can control with good technique.

Want to deepen your knowledge of your hip flexors?

Learn more about the hip flexors and how they affect the functioning of your entire body in the book “Tight Hip, Twisted Core – The Key To Unresolved Pain” by Christine Koth, MPT.

Frequently asked questions about hip flexor exercises

What are the benefits of strong hip flexors?

Having strong hip flexors can help you maintain good posture and core stability, reverse the effects of sitting, improve the symptoms of weak hip flexors, decrease the likelihood of pain and injury, and increase athletic performance.

How do you strengthen your hip flexors?

Strengthening the hip flexors can be done using isolation or compound exercises that train these muscles through their full range of motion. Using added resistance and changing the tempo during the eccentric, isometric, and concentric portion of an exercise are all variables that can be changed to achieve the desired effect.

What causes weak hip flexors?

Your hip flexors spend a lot of time each day in a shortened position when sitting, where they can become easily fatigued. This contributes to the hip flexors becoming weaker and tighter, especially as you sit for longer periods of time day after day without letting the muscles recover.

How long does it take to strengthen your hip flexors?

If you are someone who does not do any direct hip flexor strength training work on a regular basis, then you may start to see some noticeable improvement in a relatively short period of time by incorporating these hip flexor strengthening exercises more consistently into your routine.

If you are a more experienced athlete or are someone who trains their hip flexors already, then it may take longer for you to make significant strength improvements. Working with a trainer or other exercise professional to determine a more appropriate routine that mixes in more exercises, different loads and resistance, varying rep ranges, and larger ranges of motion can help accelerate your hip flexor strength gains.

If my hip flexors are tight, should I still strengthen them?

A tight hip flexor is likely to be a weak hip flexor. To strengthen tight hip flexors, you may find it helpful to first get those muscles to relax. Using a hip flexor release tool in combination with other hip flexor stretches can help the muscles to recover before you perform hip flexor strengthening exercises.

 

That’s right — we said strengthen your hip flexors.

With tight hip flexors being such a common problem, people are always asking for the best hip flexor exercises to stretch these muscles. Perhaps they’ve never considered also adding hip flexor strengthening exercises into their routine.

Whether you’re an athlete or a NARP (non-athletic regular person), we’ll share from our perspective on why strengthening the hip flexors is important and lay out the best approach for doing so (since they’re probably tight to begin with).

Five reasons to strengthen your hip flexors

Strengthening your hip flexors can help you maintain good posture and core stability, reverse the effects of sitting, improve the symptoms of weak hip flexors, decrease the likelihood of pain and injury, and increase athletic performance.

1. Strong hip flexors help maintain good posture and core stability

The iliopsoas muscles, your main hip flexors, play an important role in helping you maintain good posture and core stability. They each connect to the lumbar spine, travel through the pelvis, and attach to the inside of the femur near the hip joint. As a result, the iliopsoas are the only muscles that connect your upper and lower halves of the body!

Whether you are sitting, standing, walking, running, or moving around some other way, the iliopsoas is responsible for providing stability for your lower back, pelvis, and hips — all of which make up the “core” of your body. It’s important for these areas to be strong and supported!

2. Reverse the effects of sitting

As you’ve likely heard before, sitting places the hip flexors into a shortened position where they are asked to perform a lot of work to help us sit up straight for hours and hours each day. Over time, these muscles fatigue, tighten up, and actually become weaker.

Adding some exercises for your hip flexors can help build the strength back up in these important muscles, increase blood flow to the area, and help the muscles lengthen out more effectively later on when you do some hip flexor stretches.

3. Improve the symptoms of weak hip flexors

If you know what it feels like to have tight hip flexors, then you know what it feels like to have weak hip flexors, as these often go hand-in-hand. Common symptoms of weak hip flexors include (but are not limited to):

• Tightness at the front of the hip and/or the lower back
• Reduced range of motion in the hips
• Stride length when walking or running feels “off”
• Clicking, popping, or clunking sensation felt in the hips when moving in certain ranges of motion
• Difficulty activating posterior chain muscles (e.g. glutes and hamstrings), which may also feel tight
• Experiencing lower back and/or hip pain and discomfort after standing, sitting, or walking for longer periods of time

4. Reduce the likelihood of pain and injury due to weak hip flexors

When the hip flexors are weak, muscle imbalances can begin to develop in the surrounding areas of the body. This affects the alignment of the pelvis, restricts movement of the hips, and reduces stability around the lumbar spine. Ultimately, there is a chain reaction seen throughout the entire body.

The mechanics of your body change and compensatory movement patterns develop. The pre-existing muscle imbalances become “stronger” and continue to hold your bones out of their natural alignment. Over time, this creates wear and tear on the structures of your body and leads to pain.

5. Strengthen hip flexors to improve athletic performance

Having strong muscles around your hips (like your hip flexors, glutes, etc.) allows the hip joints to work in each of their ranges of motion — flexion, extension, abduction, adduction, internal rotation, and external rotation — and do so efficiently.

Whether your sport involves running, jumping, squatting, throwing, hitting, skating, or changing directions, strong and mobile hips support the body’s ability to produce force, power, and speed to increase athletic performance across the board.

3 tips for strengthening your hip flexors

When strengthening your hip flexors — or any other muscle, really — it’s generally best to have a solid approach to achieve the goal in mind. Here are our best tips for you to consider as you create a routine that works best for your body.

1. Relax your hip flexors before strengthening them

Learning to relax your hip flexor muscles is an important first step before you strengthen them. With the amount of sitting that we do on a regular basis, these muscles are likely to be exhausted and may already be holding tension. Contracting the iliopsoas without letting the muscles recover won’t do you any good.

Think about it — what sitting does to the hip flexors is what squeezing your biceps for 10+ hours each day would do to your arms. As the hours pass by, the muscles get tired, the contraction of your biceps becomes weaker, and it gets harder to straighten your arms because the muscle is tight and holding tension.

Trying to squeeze the bicep even more after having it flexed for 10+ hours doesn’t let the muscle recover and it won’t actually get stronger. By first letting the bicep muscles relax, they will be able to produce a stronger contraction the next time you train them, leading to actual strength gains. This same concept applies to your hip flexors.

To relax the hip flexor muscles, consider adding in various hip flexor stretches to your routine. However, understand that stretching alone may not be enough to get the muscles to truly relax if they are holding tension. Using a hip flexor release tool that applies pressure to BOTH the psoas and the iliacus muscles (like the Hip Hook, pictured below) can help release that tension and improve the effectiveness of your stretches. This sets you up for better success with your hip flexor strengthening exercises because your psoas and iliacus will have recovered and be more relaxed. Hip flexor strengthening exercises are also psoas strengthening exercises because you are working the entire iliopsoas.

2. The best hip flexor exercises are adapted to your body’s needs

The hip flexors are just like any other muscle in your body — they need an appropriate amount of functional strength to perform the daily activities that you do each day. As such, you should be training your hip flexor muscles in accordance with these demands.

We’ll use 3 different kinds of people — a weightlifter, a marathoner, and a desk jockey — as an example to help illustrate this concept of functional strength in the hip flexors. Each of them need strong hip flexors in a slightly different way.

Strengthening hip flexors for weightlifters

A weightlifter needs to have very strong hip flexors to help support and stabilize their lumbar spine, pelvis, and hips in a strong position when performing exercises (such as squats or deadlifts) with very heavy loads. A way in which they may train for this could involve using paused reps or a slow tempo during the descent of the movement (like a squat) to exhibit strength and control throughout their entire range of motion.

Strengthening hip flexors for marathon runners

A marathoner needs to have the strength and endurance in the psoas and iliacus muscles to be able to lift the weight of their leg (which is actually quite heavy!) stride after stride over the course of the race that lasts several hours. They might train for this with a more dynamic exercise that simulates running, such as a knee drive, with added resistance (using a band or a cable) and perform this for higher reps to build up their endurance.

Strengthening hip flexors for sitting at a desk

Someone who sits all day long can benefit from having strong hip flexors, too, as these muscles help you sit upright in a good posture. However, we also know that sitting too long can actually fatigue these muscles and weaken them. To train for this, they might consider doing hip flexor marches from a standing position or knee raises while seated. Also important is to get up to move around and take frequent breaks from sitting, giving the hip flexors a chance to recover to stay strong and relaxed.

3. Establish a routine to help with hip flexor recovery

We’ve already talked about what happens to the hip flexors when they don’t have the chance to recover — they become overworked, tight, and weak. Creating a balanced routine that involves a combination of releasing, stretching, and mobility alongside the hip flexor strengthening exercises can keep your hips feeling strong and relaxed while helping your body feel at it best. Click here for the best hip flexor strengthening exercises.

Want to learn more about your hip flexors?

Deepen your knowledge about your hip flexors and discover how tightness, weakness, and imbalances in these muscles impact the way your entire body functions by reading the book “Tight Hip, Twisted Core – The Key To Unresolved Pain” by Christine Koth, MPT.

Frequently asked questions about the hip flexors

How do I know if my hip flexors are weak?

If you are someone that spends a lot of time sitting down or doesn’t get enough movement and exercise on a regular basis, your hip flexors are likely to be weak. Here’s a simple hip flexor strength test to find out if you have weak hip flexors.

Standing on one leg, raise the knee on your other leg towards your chest. Make sure that the knee raises up higher than your hip to better target your hip flexors. Maintain a neutral pelvic position and ensure that you are not hiking your hip up on the working side to compensate for a weak hip flexor. Hold this position for at least 30 seconds and then switch sides, noticing any imbalances side to side.

If you’ve continuously stretched your hip flexors but the tightness keeps coming back, or if you failed the test outlined above, that may be an indication that you’d benefit from getting some strength into these muscles.

How do I know if my hip flexors are tight?

Tight hip flexors do not fully lengthen to their full range of motion. Tight hip flexors also hold tension when at rest. There are a few ways to test whether this is true on your body. First, use the Thomas Test to see if your hip flexors can reach full extension.

You can perform the Thomas Test on yourself at home. If your hip cannot reach extension, then you’ve “failed” the test and may have tight hip flexors. However, it is important to note that you can “pass” the Thomas Test yet still have tight hip flexors.

The next definition of a tight hip flexor is one that holds tension even when at rest. This happens when a portion of the muscle remains contracted (like having a muscle knot or trigger point). This impacts the ability of the muscle to perform its full function, causing it to tighten up as a form of protection to create stability around the hip joint.

Perhaps the best and most effective way to test for this form of tightness is to press on these muscles. If your psoas and iliacus muscles are tender or painful to the touch, then it may be an indication that these muscles are holding tension and are, in fact, truly tight.

What causes weak hip flexors?

Your hip flexors spend a lot of time each day in a shortened position when sitting, where they can become easily fatigued. This contributes to the hip flexors becoming weaker and tighter, especially as you sit for longer periods of time day after day without letting the muscles recover.

What are the benefits of strong hip flexors?

Having strong hip flexors can help you maintain good posture and core stability, reverse the effects of sitting, improve the symptoms of weak hip flexors, decrease the likelihood of pain and injury, and increase athletic performance.

How do you strengthen the hip flexors if they are already tight?

To strengthen tight hip flexors, you may find it helpful to first get those muscles to relax. Using a hip flexor release tool in combination with other hip flexor stretches can help the muscles to recover before you perform hip flexor strengthening exercises.

 

We don’t talk enough about the portability of the Hip Hook. That ache in your low back and hips from traveling? That’s what we’re here for.

The Hip Hook helps you straighten up after long hours of sitting. Because it doesn’t just give you a temporary feel-good stretch; it targets the root of muscle tension for long-term relief.

Thankfully, Travel & Leisure Magazine figured that out immediately and highlighted us in their Intelligent Traveller article: Take Wellness With You. They even pointed out the value of applying sustained pressure on stubborn muscle knots (that’s what we’re all about!)

Whether you’re trying to social distance in economy airline seats, taking that long-anticipated road trip, or sitting glued to your desk, your hip flexors are taking the brunt of it. And we’d like them to be able to take a vacation, too!

Plus, the Hip Hook is an easy fit in your travel bag. And, yes, plenty of our customers have taken it through airport security without a problem.

‍

 

Many people think sciatica is just something you have to live with. It’s time for a new angle. Often, relief from sciatica pain occurs by releasing tension in the muscles surrounding the sciatic nerve pathway. If you are one of the many people whose sciatica pain is caused or exacerbated by tight muscles, self massage with muscle release tools and learning sciatica trigger points can offer dramatic relief.

Sciatica pain relief exercises

Sciatica pain relief exercises are less about “exercise” and more about applying pressure to specific muscle groups that help relieve tension and remove impingements along the sciatic nerve pathway. You’ll be learning which muscles to target and how to best use muscle release tools to apply direct, prolonged pressure for 90 seconds (while taking nice, deep breaths).

What is sciatica?

Sciatica is often considered to be a type of back pain; however, it is actually nerve pain. The word “sciatica” describes a kind of pain that someone experiences when their sciatic nerve (which begins in the lower back) becomes compressed, inflamed, and irritated. It is estimated that sciatic pain affects as much as 40% of people over the course of their lifetime.

What is the sciatic nerve?

The sciatic nerve is both the largest and longest nerve in the body – it starts in the spinal canal at the L4 vertebra, goes down to the sacrum through S3, travels out towards the buttocks where it passes underneath (or sometimes through) the piriformis muscle, before traveling down the back of the leg all the way to the feet and toes.

What are common symptoms of sciatica?

Common symptoms of sciatica include radiating pain in the lower back that may travel into the glute and down the leg towards the feet. Some describe the pain as a dull ache along the pathway of the sciatic nerve, while others experience more of an electric jolt or burning sensation down their leg. Additional feelings of numbness, tingling, or weakness may also be present on the affected leg. While the pain is typically felt on one side of the body, it is possible to experience sciatica on both sides.

What are common causes of sciatica?

Common causes of sciatica include bulging or herniated discs, a narrowing of the spinal canal (called spinal stenosis), piriformis syndrome, as well as other spinal conditions that impact the natural alignment of the vertebrae and intervertebral discs in the lumbar spine. It is possible for other conditions to seem as if you are experiencing sciatic pain down the leg, such as SI joint dysfunction and IT band syndrome. In most of these scenarios, the piriformis muscle, deep in your glute, plays a major role in sciatica pain.

Because of the many different possibilities, it is important to consult with your healthcare provider to determine the true root cause of your pain so that you can create an appropriate treatment plan and corrective exercise routine to make long-term improvements and get relief from sciatic pain.

How can I prevent sciatica pain?

While some causes of sciatica may be linked back to genetics, the way that you live your life and take care of your body can also have a really big impact on the likelihood of developing sciatic nerve pain. Keeping your body strong and aligned in good posture allows the muscles, bones, joints, discs, and nerves to function properly and reduce the risk of pain or injury.

The connection between our muscles, body alignment, and sciatic pain

Being in good alignment helps your body function at its best and reduces the chances of experiencing pain, like sciatica. Your muscles are what hold your bones, joints, and spine in good posture as you go about your life – whether you are sitting down, out for a run, picking up your kid, working out, and more.

As we move through our lives, muscle imbalances may develop – perhaps from past injuries, accidents, sitting too much, single-sided habits, sporting activities, you name it – and this changes how our body is aligned. Misalignments can lead to gradual wear and tear setting in and may eventually result in pain.

Focusing specifically in the lumbopelvic region where the sciatic nerve originates, muscle imbalances can hold the pelvis in a twisted position, where they may:

• Affect the alignment of the vertebrae in the lumbar spine
• Change the distribution of pressure across the intervertebral discs
• Reduce space in the spinal canal for the nerves to travel
• Make the lumbar facet joints and/or SI joints unhappy
• Cause the muscles surrounding the lower back and pelvis to tighten up (especially one specific troublemaker: the piriformis. We’ll be focusing heavily on that one)

Each of these things can lead to injuries and/or added compression being placed on the sciatic nerves to cause pain – but we don’t want that!

If you are currently experiencing symptoms that resemble sciatica, I’ll share some of my favorite sciatic pain relief self massage exercises that you can try to see how it may help you out along your healing journey.

What are sciatica trigger points?

A “trigger point” is a contracted piece of muscle tissue (commonly known as a muscle “knot”) that exists even when a muscle is at rest. Pressing on this area will trigger a pain response locally in that area and may also cause pain elsewhere in the body, which are known as referral patterns or referral pain.

When describing a trigger point, it is more common to see it be described as within a certain muscle (e.g. piriformis trigger point). When the term “sciatica” is used to describe a trigger point, what someone likely means is actually the pain referral pattern mimics that of sciatica. Due to the proximity of the piriformis muscle to the sciatic nerve, what is actually a “piriformis trigger point” may also be referred to as a “sciatica trigger point.”

How to do self massage for sciatica pain relief

I recommend exploring the following muscles with self massage techniques using a ball or massage tool to help release muscle tension, improve your body’s alignment, decrease compression around the sciatic nerve, and reduce your pain.

For each of these releases, you will likely need to explore along the length of each muscle to find those tighter spots on your body, with a ball or massage tool. Once you find a tight spot, rest in that place (with pressure on that spot) for somewhere between 90 seconds (based on your comfort level). Focus on breathing and relaxing that muscle.

After releasing that spot, you may decide to move the ball or tool to a different area of the same muscle, or move to another area and repeat the same process: direct and prolonged pressure with deep breaths for 90 seconds.

While self massage for sciatica pain relief may hurt, it should be more of a “hurts so good” kind of feeling during and after the release. The pain should start decreasing after 30 seconds; if it doesn’t move the tool to a different spot. If at any point you feel a large increase in pain that lingers after the release, you may want to reduce the intensity of the pressure and/or explore a different spot along the muscle. If that increased pain does not go away, please stop and consult your healthcare practitioner.

Self massage for sciatica on the piriformis

The piriformis is a small, yet very important, muscle to address for sciatica pain relief. This is because the sciatic nerve actually passes underneath this muscle deep within the glute area before it travels down the leg. If the piriformis muscle becomes too tight, it may compress the nerve and cause sciatica-like pain; this is one of the reasons these spots on the piriformis muscle are sometimes referred to as sciatica trigger points.

While the piriformis lies underneath the larger gluteus maximus, it is still relatively close to the surface of the body. This helps make the muscle easier to access by using something like a foam roller, lacrosse ball, or a massage therapy ball.

Self massage for sciatica on the iliopsoas

The iliopsoas muscles are our body’s main hip flexors and also play a large role in supporting the alignment of the lower back and pelvis. Due to its connection points in the lumbar spine, tightness in this muscle can create downward compression on both the joints and discs in the lower back. If left unaddressed for a longer period of time, this may begin to affect the health of these structures and contribute to sciatica due to a disc injury or pinching of the nerve.

Another reason to release the iliopsoas is due to the effect that a tight hip flexor has on the piriformis muscle. The body wants to be in balance, so tension in the front of the hip can cause the muscles on the back side of the hip to tighten up, playing a game of tug-of-war with each other. We already know that a tight piriformis can compress the sciatic nerve and cause pain. When the iliopsoas is also tight, we have a double whammy for potential sciatic pain.

Self massaging the iliopsoas is more challenging than you might think. Unlike the other muscles discussed in this article that are closer to the surface of the body, the iliopsoas is deeper within the core of the body. Because of this, a lacrosse ball is likely too small to even reach this muscle. Using a larger hip flexor release ball can be a little better to reach the general area; however, the most effective way to self massage the iliopsoas is with an iliopsoas release tool designed specifically for that area of the body.

Take a look inside the body to see how the Hip Hook – a psoas release and iliacus release tool – is able to access and release these deeper psoas and iliacus muscles.

Self massage for sciatica on the gluteus medius, gluteus minimus, and tensor fascia latae

This group of muscles – responsible for moving the hips in many different ways and providing stability to the pelvis – tend to be tighter on people who are experiencing pain from sciatica. When these muscles hold tension and do not function properly, it causes other areas of the body to compensate. This becomes the perfect opportunity for the development of muscle imbalances, misalignment of the spine and pelvis, and the potential for sciatic pain over time.

Located on the outside surface of the pelvis, each of these muscles are easily accessible using a lacrosse ball (or similar). You’ll start off laying on your side with a massage therapy ball of your choice underneath you, where you can then angle your torso forward or backward to target the tensor fascia latae (or TFL), gluteus medius, and gluteus minimus muscles.

These trigger point pain referral patterns can mimic the sciatic pain even though the nerve may not be involved, because the muscle knot refers pain to a different spot.

Self massage for sciatica on the spinal erectors and quadratus lumborum

The spinal erectors and quadratus lumborum muscles make up the backside of your “core” and are responsible for moving, stabilizing, and protecting the lumbar spine. Tightness and weakness in these muscles affects a person’s ability to align their pelvis in a safe position when performing their daily activities, increasing the risk of injury and sciatic pain.

For those already experiencing sciatic pain, these muscles like to tighten up to protect the area. However, this can create more compression in the lower back, prevent natural movement of the spine and pelvis, and may increase pain.

The lower back spinal erectors connect to the sacrum and iliac crest and run up each side of the spine along the spinous and transverse processes before inserting into the ribs. The quadratus lumborum are deeper muscles underneath the erector spinae that attaches to the top of the pelvic bone (or ilium), the bottom of the 12th rib, as well as the outside of the transverse processes of the L1-L4 lumbar vertebrae.

While a lacrosse ball may be large enough to reach the spinal erectors, it may be necessary to use a slightly larger massage therapy ball to reach the quadratus lumborum, using pressure in the spots marked with an “x” in the image.

Frequently asked questions about sciatica pain relief

What triggers sciatica?

Sciatica is a type of nerve pain that is triggered when the sciatic nerve becomes compressed, inflamed, and irritated. This is typically caused by conditions such as tight muscles, a herniated disc, degenerative spinal conditions, or misalignments of the vertebrae and discs of the lumbar spine, among other potential causes.

How do I get relief from sciatica pain?

To relieve and improve sciatic pain, you must relieve the pressure that is being placed on the sciatic nerve. One way this can be achieved is through releasing tension in the hip, glute, and lower back muscles.

However, it is important to understand the actual root cause of the issue, which may be closely related to the alignment of the lumbar spine. When the spine is out of alignment, injuries and pain are more likely to occur.

When the spine is in alignment, the bones, joints, discs, nerves, and muscles all work better together. Improving spinal alignment can be achieved through corrective exercises (including muscle release, strengthening, stretching, and mobility).

How do I massage sciatica trigger points?

Applying direct, prolonged pressure to trigger points in the piriformis, as well as trigger points in other related muscles (such as the iliopsoas, gluteus medius, tensor fascia latae, and quadratus lumborum) may help to relieve tension and ease restriction around the sciatic nerve. Pressure is better than rubbing in this cae: rubbing can actually irritate the area and increase pain.

Massaging a tight piriformis muscle may create a sciatica-type pain. This is because the sciatic nerve actually passes underneath this muscle deep within the glute area before it travels down the leg towards the feet.

 

Why do my hip flexors hurt after squatting?

Can lifting weights cause hip pain?

Many of my clients who are frequent gym-goers, CrossFit enthusiasts, or weight lifters come to me with these questions. Hip pain when squatting is more common than you might think, and it isn’t something you just have to live with.

Squatting is such a functional and effective exercise, no matter your fitness level. So, having hip pain after exercising or lifting weights not only impacts your gym progress, but your day-to-day quality of life as well.

There are a variety of reasons why hip pain from weight lifting occurs, but once you can determine the cause, it becomes much easier to treat and even eliminate.

Understanding how your hip functions

Before I jump straight into the reasons why your hips hurt, it helps to understand how your hips move when you exercise. Our hips have a powerful connection to our entire body. They are the center of our kinetic chain that is being used while you squat, connecting the upper body to the lower.

The hip is a large ball-and-socket joint that is reinforced with four ligaments and supported by multiple muscles. Two of these muscles are the iliacus and psoas muscles, which connect your spine and pelvic bone to your thigh bone. Together, they are known as your iliopsoas muscles, and they play a very important role when it comes to both flexibility and stability.

One important thing to keep in mind: although medical professionals generalize the way the hip joint is structured, not everyone will have hips that fit the “textbook” anatomical definition.

We all have different bone structures. The length of the femur (the leg bone), the angle of the head of the femur (where the ball comes off the bone), and the depth and angle of the socket (that the ball fits into), are all examples of bone structure that can vary widely from person to person.

All of these factors, in addition to the structure of the pelvic bone, correlate to the hip’s ability to rotate, flex, and stabilize. These determine if your leg rotates out when you squat or if your toes can point straight forward. This also impacts how stable or unstable your hip may be during activity. A deep hip socket, for example, is more stable than a shallow one.

There are also less-visible factors at play, such as how much collagen or elastin your body naturally has. This ratio of collagen to elastin affects the strength and stretch of the ligaments, joint capsules, tendons, and fascia in the body.

Those with more elastin are likely to be more flexible and have a larger range of motion when doing exercises like squatting. But too much elastin can make the hip unstable when it’s being asked to do challenging tasks. This instability will cause your hip flexors to become tighter in response, as the muscles will take over the work of holding you together if your connective tissue isn’t stable.

Those with less collagen have more joint support while exercising. On the downside, you may not have the mobility to get into the deepest version of that squat.

It’s all about balancing stability and mobility in the body. Your body is happiest when you are in balance, a concept that stretches into all aspects of life.

Common causes of hip pain when squatting

Squatting is an explosive and powerful exercise that puts an enormous amount of pressure and stress on our hip joints and iliopsoas muscles, yet is highly effective in strength building and athletic performance.

Although the main muscles that work to move your body during a squat are your glutes, quads, calves, and back muscles, the iliopsoas is behind the scenes, holding it all together. These two muscles stabilize the hip, pelvis and lumbar spine.

When tremendous and repetitive stress is placed on this area of the body, the iliopsoas contracts with intensity to hold your back from going out, keep your hips in the socket, and keep your tailbone connected to your pelvic bones. It’s a big job!

It’s no surprise that several different hip problems can arise from heavy lifting.

If and when you decide to seek treatment for hip pain from weight lifting, you will need to go over the symptoms you are experiencing with your doctor. Instead of including an exhaustive list of hip pain scenarios, I have listed the three most common reasons people experience hip pain when squatting.

Hip pain while squatting due to muscle strain

You are likely familiar with some form of muscle strain or pull. When a muscle is used beyond its capability, microtears or even major tears can occur. And it’s the most likely culprit of hip pain when squatting or exercising.

Pulled muscles are uncomfortable and can take a long time to heal. When it comes to your hips, a strain or pull can occur in those big mover muscles (the glute, back, or quad), but can also occur in either the iliacus or psoas muscle – and can be especially painful.

The iliacus and psoas major muscles (also known as your iliopsoas) work together to stabilize your core while you squat. And the rectus femoris (a part of your quadriceps muscle) is closely associated with the iliopsoas in location and helps you to stand up. Because the rectus femoris part of the quad crosses the hip joint as well, this part of the quad is especially sensitive to injury with challenging squats. It attaches to the front point of your knee cap and travels all the way up to the pelvic bone.

When you’re experiencing a hip flexor strain, you might feel pain in the front of your hip, leading from the outside of your hip down into your groin area. You may even feel mid-to-low back pain where the psoas attaches. Muscles that are strained hurt when used or stretched. They also tend to hold tension to protect themselves. Injured and tight muscles become weak because the brain is trying to tell you to stop moving so much so it can heal! If you ask an injured muscle to work hard, it’s not going to be happy about it.

Unlike delayed onset muscle soreness that lasts a few days, muscle strains last weeks or months.

More specific symptoms of a hip flexor strain include:

• Muscle spasms in your hip or thigh
• Pain that comes on suddenly
• Increased pain when stretching hip muscles
• Increased pain when actively lifting your thigh towards your chest or raising your knee
• Pain or tenderness when touching the front of your hip
• Swelling on the hip area
• Pain when walking, especially up the stairs

Other muscles that are strained will feel similar sensations just in different locations.

Something to note about the hip flexors is that strain creates tension because an injured muscle wants to protect itself by encouraging you not to move. A strained muscle also becomes weaker for this same reason.

When the hip flexor complex is tight or holding tension due to injury, or even from having to work too hard for other reasons, that tension is pulling on the bones of the hip, spine, and pelvis. This also changes the length of the other muscles that attach to these bones. These other muscles like the hamstring, glute, and quad become weaker as a result. Shortened or lengthened muscles lose some of their strength, resulting in increased susceptibility for strains themselves. Furthermore, tension in the hip flexors will change the mechanics of the entire leg, spine, and tailbone, making you more susceptible to further injury somewhere else.

Very few people realize that working out with tight muscles makes you more susceptible to strains in this way.

Hip impingement when squatting

One type of bony issue that causes impingement is known as femoroacetabular impingement (FAI). This common issue causes you to feel pain and stiffness in your groin and hip flexor area. With movement, you may even feel a catch or clicking feeling on your inner hip. You may also feel discomfort when sitting for extended periods.

FAI occurs when the bones of your hip joint have a suboptimal fit, causing your bones to pinch or rub too close to surrounding tissues. These rubbing or pinching movements create unnecessary friction between the various bones and tissues, causing deterioration and pain.

To break it down further, the hip is designed so that the femoral head, which is the ball of the hip joint, sits on the femoral neck. You can envision this as you would a scoop of ice cream sitting in an ice cream cone.

So, when the hip joint – either the femoral head and the socket – does not fit together as they were designed, they will rub against each other, creating friction. This prolonged rubbing in the hip socket (such as in avid gym-goers) is one of the causes of hip pain when squatting. This bone structure can also pinch muscles and tendons nearby.

One thing worth mentioning: this pain often has very little to do with how much weight you are lifting. The weight may speed up your symptoms or increase your discomfort, but easing off on your gym visits or weights won’t fix the problem.

Often, I find that even though the bones have set the stage for pinching, when the iliopsoas muscles have been unnaturally pulling on your hip joints, it causes even more pinching to occur. A tight hip flexor twists the core and further impinges the hip joint in flexion. Deep flexion, where your knee goes up towards your chest as in a deep squat, is the motion that is limited when you have an anterior pelvic rotation due to a tight hip flexor. It’s also the motion that is irritated with an impingement issue.

Once they’re able to release the iliopsoas muscles – particularly the iliacus – my clients have noticed their symptoms either go away or are remarkably improved, allowing that joint to have more space to move before it is pinched!

Hip bursitis causing hip pain when squatting

Lateral hip pain when squatting can be caused by bursitis.

Bursa are small, fluid-filled sacs that sit in various places around your hips. They are positioned between the bone and the soft tissue of the joint to cushion those structures when you move. When your bursa gets inflamed, it causes bursitis.

There are two bursa sacs located around your hip joints, and they can become inflamed for several reasons:

• Improper posture when sitting, standing, or squatting
• Laying on the side of your hips for extended periods
• A hip injury of some kind
• Overuse of hips from running, jumping, squatting, etc.
• Tightness in the hip flexor complex which in turn causes unnatural tension in the muscles that are nearby the bursa

Once a bursa is irritated, it will no longer be able to properly protect the tissues near the hip joint. There is a major bursa on the outside of the hip that helps cushion many muscle attachments on the greater trochanter, a part of the femur that sticks out on the outside of the hip. When this bursa is irritated, it is called trochanteric bursitis. The iliopsoas attachment also has a commonly irritated bursa that gets irritated in the inner groin.

Some other common symptoms of bursitis include:

• Redness surrounding the outer hip and upper thigh (for trochanteric bursitis)
• Noticeable swelling of the hip area
• Limited joint movement
• Pain in the hips while walking, sitting, or lying down, especially when lying on the outside of the hip
• Warmth in the hip area

Pain from hip bursitis may not always be consistent or noticeable. It can come and go in flare-ups after activities such as CrossFit, running, or weight lifting.

You may not even notice the hip pain when squatting or lifting, but once you are home and resting, pain may arise.

Four ways to prevent hip flexor pain when squatting

1. Focus on form

When performing a squat of any kind, but especially while weight lifting, your form is the best defense against any type of injury. If you are using poor form, you can accentuate your hip pain in CrossFit or other weight lifting activities.  

So, take a step back from your weights next time you’re in the gym – or even do this little exercise at home. Break down each movement to ensure that you are not putting a strain on one part of your body over another.

To perform a basic bodyweight squat, follow these steps:

1. Stand with feet hip-distance apart, toes turned slightly out. The position of your toes will vary depending on your bony anatomy. Allow yourself to have a natural stance for your hips
2. Stabilize your stance by tightening your core and turning your chest upward
3. While doing this, begin to shift your weight back into your heels and push your hips behind you as you squat down
4. Continue to slowly lower yourself until your thighs are almost parallel to the floor
5. During this movement, your feet should remain flat on the floor, and your knees should stay over your second toe
6. Keep your chest lifted and gaze either forward or slightly up

There are other variations of a squat, such as a jump squat, sumo squat, and barbell squat, which all require slightly different positioning to be performed correctly. For loaded or barbell squats, for example, you could move below a parallel position with your thighs.

If you are not properly distributing the weight throughout your body, more pressure is put on your hips to compensate for changes in posture and positioning.

When squatting, most clients say they focus on their legs or keeping their knees in the proper position. While these are vital aspects to squat form, focusing on our hip positioning is equally important.

If it’s not possible for your thighs to become parallel to the floor when you squat, it is likely that you lack strength and mobility in your iliopsoas muscle or other areas of the body. Leaning too far forward as you squat will put added stress on your back and quadriceps while also shortening and tightening your iliopsoas.

If you are feeling wobbly or off-balance when you slow down, that may be an indicator that your iliopsoas muscles have been weakened from overuse or poor form. Remember, these muscles are supposed to help you stabilize.

When your hip flexor muscles have proper mobility and strength, they assist you to pull your squat deeper while still maintaining form in your back and keeping the center of gravity over your feet. Your best bet with form is to work with a skilled trainer or practitioner who can watch you move and help tweak your motion.

2. Flexibility and mobility

During your warm-up or cool down, consider adding in some hip mobility exercises along with stretches, especially if you have hip pain when squatting.

You don’t have to limit it to those times either. Any time during your workout, between sets, or even at home before bed is a good time for stretching. If you improve your flexibility, you will simultaneously be able to increase your mobility.

If you’re already experiencing some pain or tightness in your iliopsoas, it should be addressed before you turn to strengthening exercises