Category: Pain

If you’re a runner, you’re probably no stranger to tight hips or maybe even hip pain after running.

That’s because running requires your hip flexors to constantly be working, stretching, and contracting to pull your leg forward or extend it backward each time you take a step. And, for my long-distance runners, you’re asking your hips to keep doing that work for extended periods of time.

But, even if you are doing everything right when it comes to stretching, maintaining good form, and ensuring you never miss your cool-down routine, it’s not uncommon to still feel lingering tightness or soreness around your hips.

What causes hip pain after running?

The culprit behind your discomfort – whether a dull ache or a debilitating pain – could be your iliopsoas muscle.

If you aren’t familiar with this one, don’t worry.

You see, when most people talk about tight hip flexors, they are usually referring to what’s known as the iliopsoas muscle. This is a name for two muscles that live side by side, the iliacus and the psoas muscles.

These muscles act a bit like rubber bands, expanding and contracting to propel you forward while you’re running. But, when you are mid-stride, with one leg forward and the other extended backward, you are causing your iliopsoas muscles to work double time. They need to have the flexibility to move your leg behind you and contract to bring your leg in front of you, while, at the same time, stabilizing your pelvis and core.

As you can imagine, this is a very taxing job. Your iliopsoas can become fatigued and may tense up – causing knots, hip tightness, and/or hip pain while running.

Additionally, if there is an asymmetry somewhere along the chain, it’s unlikely that each iliopsoas muscle is exerting the exact same amount of energy, which leaves room for one to pull a little more on your pelvis or thigh bones than the other side.

This is what I refer to as Tight Hips, Twisted Core (which is the name I used for my book to describe this extremely common phenomenon). In my practice, I’ve seen clients’ whose iliopsoas muscles are pulling so tightly that they’ve developed an unnatural curvature in their back or cannot fully extend their legs when lying down.

It’s not surprising then, that a tight iliopsoas can lead to a whole plethora of other issues.

The most common injuries for runners

Unfortunately, most runners will experience an injury. From minor tendinitis to serious tears that require surgery, an estimated 79% of runners will sustain at least one injury. That’s almost 8 out of 10!

And this isn’t limited to serious athletes or fitness fanatics. Honestly, many of the people that I have treated were non-competitive runners suffering from such bad hip flexor pain, knee pain, or foot pain, that it stopped them from enjoying one of their favorite activities. When running is your go-to activity for stress management and exercise, this can be a significant bummer for most.

Many of the most common injuries have nothing to do with the hip – or so it seems. Here are some of the most common injuries for runners:

• Plantar fasciitis
• Sore ankles
• Shin splints or fractures
• Runner’s knee
• Achilles tendinitis
• Outer hip pain
• Pulled hamstrings
• Iliotibial (IT) band syndrome
• Back pain

But research shows that there is a very strong correlation between hip strength and running injuries. And, once injured, your abductor and hip flexor muscles are much more likely to be weakened, making them more susceptible to subsequent injuries. Also, hip tightness development, common in runners, affects the mechanics of the entire leg as it hits the ground, setting the stage for injury from the back to the tips of the toes.

So, hip strength and – because your iliopsoas connects at your core – core strength may help mitigate future injuries and hip pain while running. Similarly, a relaxed hip flexor allows for proper alignment of the pelvis/hip area and therefore, allows the rest of the leg to be efficient and aligned. Joints don’t like to be out of place, then they rub the wrong way and protest with pain.

The point is, getting your hip muscles to release their tense grip on your body will not only allow for the rest of your leg to be in alignment and the joints not irritated, but the muscles around the hip, leg, and core will work more effectively.

How to release your tight iliopsoas muscles

Some strength-building exercises may only strain already-fatigued muscles even more. So, it’s really important to get your hip flexors to relax before moving forward with training.

As I mentioned, the iliopsoas is made up of two smaller muscles. Your psoas muscles are a bit easier to work and massage with your hands. But, due to their location on your body, your iliacus muscles are much more difficult to reach. And, when people come to me with mysterious pain, it’s the iliacus that is often at the root of the problem.

There are three potential ways to release this muscle: with your fingers and the right applied pressure, a trained professional, or the Hip Hook, which is a tool created to locate the point where your iliacus attaches to your core with extreme precision.

The truth is, it’s very difficult to find the right angle and be able to apply enough pressure with your own hands. And a good physical therapist may not always be an option – or easy to find. The Hip Hook helps make hip pain after running a thing of the past, helping you effectively release your iliacus at home.

After doing so a couple of times a week for a few weeks, it will be time to build that strength back up. The muscles will actually start to work more efficiently automatically when the hip flexor is relaxed and your pelvis is in alignment, you’ll be amazed. And you can prevent hip tightness from becoming hip pain in the future.

How to strengthen your hips for running

Once you have happy hip flexors again, you can follow these tips to help strengthen your core and prevent future injuries:

Do functional workouts for your entire core

You don’t need to start lifting weights at the gym or do tons of sit-ups. In fact, you probably shouldn’t. Instead, opt for workouts that strengthen your core and hips and are low-impact, such as the classic plank or a banded squat.

Don’t rush into a lot of new mileage

Build up to your running goals slowly. Pushing your body to do more miles than it’s ready for will do more harm than good.

Review your running form

Never lose sight of proper running form – or how you are distributing your weight as you take strides. It’s extremely common for runners to have one leg that’s slightly shorter than the other and/or to have a strong leg. You can still overcome these imbalances by being intentional with your form, but even more effective is making sure your pelvis is aligned and you don’t have tightness around the hip that is pulling you out of place. Then your form will naturally improve.

Train for your specific type of run

Sprinting and endurance running are going to put two very different types of strain on your body and iliopsoas muscles. It’s important to follow a training routine that is made for the specific type of run you are training for, including the surface you’ll be running on.

Dynamic stretching for your hips

Warm-up your hip flexors and help reduce hip pain after running by doing active stretches specifically targeted toward that area, such as lunge stretches. Adding in a side bend to the opposite side you are stretching is magic.

Never forget a cooldown after running

Just as you’d never start a run cold, you should always take the time to let your muscles relax afterward. Stretching and self-myofascial release (foam rolling) are great ways to ease the tension that may build up during a run.

Practice slow yoga poses

Yoga poses such as bridge, fire hydrant, and downward dog can help build core strength stability when you really focus on slowing down and holding proper form. You may be surprised at how hard these “simple” poses can be!

Strengthening your hips and core is all about giving your body more stability – especially if you’ve already suffered from an injury. Being strong, relaxed, and aligned in your hips is the golden ticket to running long-term. While you can never fully relieve your iliopsoas muscles of the constant stress that is running, you should be able to enjoy running without hip pain or injuries.

To learn more about how I helped runners reduce their back, knee, and hip pain with iliacus release, you can read my book Tight Hip, Twisted Core. Want to experience the world’s first tool designed specifically to release the iliacus? Get the Hip Hook!

Frequently asked questions about hip pain after running

How do I relieve hip pain from running?

To help improve your hip pain while running, it is perhaps most important to consider how you take care of your body when you are NOT running. When running, the hip flexors are used consistently and may become overworked and painful over time. If you also sit a lot, this may end up adding to the issue of tightness.

Helping the hip flexors recover by adding in exercises to stretch and release tension in these muscles can help assist with recovery. Additionally, strengthening some of the opposing muscles (like the glutes and hamstrings) can help support a healthy muscle balance and keep the hips feeling strong and healthy before, during, and after running.

Can you still run with hip flexor pain?

Pain is a signal from your body telling you that something is wrong and needs to be improved. If you are experiencing hip flexor pain when running, continuing to run through the pain likely is not going to make it better. It might even make it worse or lead to a more significant injury.

What muscles cause hip pain when running?

Muscles that may cause pain when running include the hip flexors, tensor fascia latae (or TFL, which attaches to the IT band), and the piriformis. These muscles tend to have a relationship with each other on the front and back sides of the hip, where if one of these muscles becomes tight then the others can as well. This tightness can compress the hip joint, restrict its full range of motion, and cause pain.

 

If you’ve ever gone on a long road trip, you probably know the simple pleasure that is stopping to stretch your legs. You feel restless, your body is a bit stiff – and maybe you’ve even developed a muscle cramp or pain from falling asleep in a weird position. Some fresh air and a nice walk around a parking lot feels great.

But an exit sign for a truck stop is not just a welcome break for you. Your psoas and iliacus muscles are about to be a whole lot happier, too.

These are the two muscles that have been quietly holding you up in your seat during that long drive. Or, if you’re the driver, the two muscles that have been allowing you to step on the gas pedal or brake at a red light. Together, they are called your iliopsoas and help make up the network of hip muscles – or “hip flexors” – that connect your thigh bones to your pelvis.

If you’re like most people, you probably aren’t thinking about your psoas and iliacus muscles throughout the day. That is, until you start to experience hip tightness, hip pain, sciatica, low back pain, or any other aches that don’t feel quite right.

So, what does that have to do with your road trip?

Well, prolonged sitting – like you do in your car – is one of the common culprits and causes of hip, back, and tailbone pain.

But, it’s not just relevant for those times when you know you have a long trip ahead of you. Most of us are clocking way more time in our cars than we realize. And we have developed tight hips as a result.

The relationship between driving and hip pain

Did you know that 95% of American households own at least one car?

This stat comes from the US Department of State. Though the introduction of ridesharing and a green push toward walking or riding bikes has decreased the number in recent years, it’s still accurate to say that most of us find ourselves sitting behind the wheel on a regular basis.

In fact, for a large majority of us, long commutes and rush hour traffic are just normal parts of a busy morning. According to another report from the National Household Travel Survey, we’re spending an average of one hour a day on the road.

Depending on where you live, that number may even feel low.

But if you add that up, it equals more than 10 full days each year that we are sitting in our cars.

And, though sitting in your car may feel like a passive activity, you are actually overworking your muscles. Ask anyone who needs to drive for a living, and they’ll probably be able to speak to the toll that it can take on your feet, hips, lower back, and neck.

Your hip flexors are at the core of that.

You see, when you sit down, your psoas and iliacus muscles contract to stabilize your pelvis and spine. Just like the hip pain you might experience from sitting, those same muscles can “freeze up” and form painful knots when you’re in the car. Unlike sitting in a normal chair, though, you’re engaging your psoas and iliacus muscles even more when you’re driving, especially so with your driving leg and even more so with a manual transmission.

When we’re sitting behind the wheel, we are using our hip flexors to hold us upright. We’re also engaging our psoas and iliacus muscles to move our foot on and off the pedals or release pressure of the pedal. In fact, that pedal foot has a constantly contracted hip flexor because that leg needs to be ready to move on a dime. Add in stressful driving conditions which is a common cause of tension in the pelvic region, and you have a triple whammy.

Left unchecked, this can become a disaster for your hips.

How to reduce hip pain while driving during daily commutes

Unlike sitting in your chair at work, or even on long road trips when you can take regular breaks to gently stretch your hip flexors, daily driving makes it much harder to give our muscles some relief from their contracted position.

So, what can you do to prevent hip pain while driving?

For starters, try to find a healthy sitting position. No more slouching with the windows down and one hand on the wheel – your hips will thank you for it!

Spend some time sitting in the driver’s seat of your car moving the seat around. Most have automatic controls that let you move the seat up or down, from front to back, change the angle of the seatback, and even control the tilt of your seat.

Ideally, you want to find a position where your knees are at just over a 90-degree angle, your feet can rest comfortably on the floor, you can reach the pedals without completely straightening your leg and the steering wheel is in front of your chest. A slight tilt forward, bringing your hips above your knees, will help take some of the stress off your hip flexors, too.

After you feel comfortable in the driver’s seat, you can prepare your iliopsoas muscles for a morning commute with a gentle stretch.

This doesn’t need to be a big production.

Doing hip circles or a quick hip flexor stretch for 30 seconds before you hop in the car may help your psoas and iliacus muscles relax a little.

And, after any drive, it’s always a good idea to take a short walk or stretch out your iliopsoas muscles again. Even if it’s simply parking at the back of the lot to add a bit of a walk to the store or taking one flight of stairs at your office.

Any of these will encourage tight hip flexors to release their hold after driving.

Keeping your hips pain-free when you aren’t driving

The reality is that it’s probably not possible for most people to give up their car – or stop every 30 minutes for a hip flexor stretch.

So, when it comes to hip pain from driving, you can probably do more to take care of these muscles that are oh so tight from driving.

That’s when a tool like the Hip Hook could make a huge impact on your day-to-day comfort. Especially if you’ve already started experiencing pain from driving. This simple tool helps you target the source of your hip pain and apply gentle, continuous pressure to your psoas and iliacus muscles. Incorporating a simple stretching exercise into your morning and nighttime routines is a great habit to start.

If you’re just beginning your journey toward understanding your hip pain, keep in mind that there probably is no one cause. While driving alone can overstress your psoas and iliacus muscles, there are probably other activities that you do each day to compound the problem. Sitting, overstretching, working out, driving – these are all very normal (and even healthy) activities that can add up to some chronic hip tightness and pain over time.

So, the next time you get ready to hop in your car, remember your hip flexors!

Take just a few seconds to let them stretch out before you get in the driver’s seat and check your seat position once you do. It just may help you prevent more serious hip, tailbone, and back pain while driving.

Frequently asked questions about hip pain while driving

Can driving cause hip pain?

Driving, along with excessive sitting elsewhere, can be a contributing factor to hip pain. Being in a seated position for many hours each day may lead the hip flexors and other muscles around the hips to tighten up, which can create compression, decrease range of motion, and cause pain in/around the hips.

Is driving bad for the hip flexors?

When driving, the hip flexors are placed into a shortened position (just like sitting at your desk or on the couch) where they can tighten up and become weaker. This can later lead to experiencing hip pain if the hip flexors are never able to truly relax and fully lengthen. You may consider adding in some exercises to stretch and release tension in the hip flexors to reduce the likelihood of developing hip pain while driving.

How do I stop my hips from hurting when I drive?

When sitting down and driving for longer periods of time, the muscles surrounding your hips are not being used and may have the tendency to tighten up and cause pain. If you experience hip pain while driving, it can be a good idea to stop and take a break every so often to stretch and move around. You may also find it helpful to release the tight muscles in your hip flexors and your glutes, as well as performing supporting strength and mobility exercises.

 

After you’ve released the front of the hip using the Hip Hook or Hip Release Ball, as well as using the ball to release the back of the hip, the last step is this realignment exercise. This step is extremely important to realign your pelvis, but is also the most forgotten.

The goal of the exercise is to use your own muscles to put your pelvis into alignment. Now that the hip flexor has been relaxed, it shouldn’t be locking your hips in a twisted position and by activating the correct muscles you should feel alignment and ultimately relief.

As mentioned in the video lie on your back. You want to do this only on the side that you have released, whichever hip is tight. You’re going to put your hands behind the knee of the tight leg. Now pushing into your hand with a moderate amount of force thinking about putting your foot back down to the ground, but don’t let it move. You should be feeling the hamstring and glute muscles working. This will tilt the pelvis back into position. Be sure you’re not pushing really hard, just the amount of force needed to fire the muscles. Push for two seconds isometrically, then relax for 2 seconds, then go again doing about 10 reps or so of this. Think of it like getting a drawer unstuck, you kind of have to push and pull and wiggle it to get it moving and sliding the right way. The contracting and relaxing is the pushing and pulling of the drawer.

The iliacus and the psoas make up what is commonly called your “hip flexor.” These 2 muscles have an important job, to connect the upper part of your body to the lower half! Although these muscles are also responsible for flexing your hip (bringing it forward), their main job is to help hold your spine, pelvis, and hip together. The iliacus and psoas are called the iliopsoas together. They often time contract and stay knotted up when the body is either too mobile or if those muscles are overused. Because we need them to stabilize us, activities like sitting, running, biking, kicking, and weight lifting are common causes of tightness along with too much stretching like yoga and dance.

As you can see, there are lots of reasons these muscles tighten and this tightness can cause pain in all kinds of places in the body.

I uncover these patterns in my bestselling book, Tight Hip Twisted Core – The Key to Unresolved Pain!

This is also why I designed the world’s first tool designed specifically to release the iliacus muscle – The Hip Hook

 

The Hip Hook is designed to put pressure on the psoas and iliacus muscle. These muscles are located right inside the pelvic bones. Using the diagram as a guide, find these spots on yourself. Feeling the soft spot adjacent to the front of your pelvic bones will help you locate the iliacus. The iliacus runs the whole length of the inside surface of the pelvic bone. The psoas can be safely accessed in this area as well as it crosses over the iliacus here. The Hip Hook should be placed as close to the inside surface of your pelvis as possible. That way you will be able to safely access both the psoas and the iliacus. The psoas will be pressed upon when you first lie upon the Hip Hook. The iliacus will be pressed upon when the handle is used to pivot the Hip Hook. Treating both muscles is essential. Accessing only one without the other is often ineffective, giving temporary results.

Starting position – Lie on your side on a firm and non-slip surface like a yoga mat or carpet. Surfaces like beds and treatment tables are too soft and bare floors are too slippery.

Find the access point for the iliacus – Referencing the images of your iliacus and psoas, place your hands on the front of your pelvic bone and slide your fingers right inside that bone. That’s the sweet spot.

Although it may feel sore closer to the fold where your hip meets your leg, that is not the correct location for this tool. If you place it on this fold, you will be pressing on blood vessels and nerves.

TIP – Tip your body onto the Hip Hook. Make sure the flat part of the Hip Hook is flat on the floor as you position your body on it. Feel free to adjust the position of the tip as needed. In this first position, you are pressing on the psoas and releasing its longstanding tension.

Melt into the psoas – Let your body melt into the tool. At first, the pressure might be intense, especially if you have never done this before, but over time it will decrease. Happy muscles don’t hurt. You can place a sheet or towel over the tip of the tool the first few times to lessen the pressure if you’d like.

Pivot for the iliacus, the moment you’ve been waiting for – After the initial pressure has lessened and the psoas has had a chance to relax, use your hand to place gentle downward pressure on the handle. This will allow for that expertly designed tip to precisely press towards the pelvic bone to where the iliacus attaches, gently squeezing the muscle between the tip and your bone. You are helping the iliacus relax by holding prolonged, steady pressure in this position for thirty to ninety seconds.

Be symmetrical, slow, and consistent – Check both sides. You only need to do this once a day or even once every other day. The first time, it will be sore, but you should not feel any numbness or tingling down your leg. If you do, reposition. This muscle has likely never been touched before and it’s been tight for ages. It will get better over time. Take it slow. It’s common to have bruise-like soreness after use. If you get sore, take a break for a day or two. If it feels painful and doesn’t get better, stop and consult your healthcare practitioner.

Enhance your release – After you have become comfortable with the Hip Hook, try pressing up onto your elbows or hands, squeezing your glutes together, bending your knee and swinging the foot side to side, bringing your opposite leg out to the side, bending and straightening your knee, and lifting your leg off the floor.

Video tutorials of these advanced techniques (and more!) can be found on the Aletha YouTube channel.

Complete the program – Now that you have the Hip Hook, learn the importance of this muscle, the value in prolonged pressure, and other activities and exercises to support your healing by reading Tight Hip, Twisted Core – The Key to Unresolved Pain. Key additions to releasing the iliacus and psoas including releasing the back of the hip and realigning the pelvis can significantly enhance the effectiveness of the Hip Hook. Learning how to fix what has gotten your iliacus and psoas tight in the first place is key.

Get a free first chapter of the book and exclusive discounts here.

 

For those of you that love to get deep into the details, you will love this section. As an anatomy geek myself, I can’t help but get excited about this topic, especially when digging into arguably the most important muscle group in the body. You may want to also explore these topics:

• What Causes Tight Hip Flexors?
• What are the Common Symptoms of Tight Hip Flexors?
• What’s the Best Way to Strengthen the Iliacus and Psoas?
• How Do You Stretch the Hip Flexors?
• How Do You Release Tension in the Psoas and Iliacus?

What is the origin, insertion, and nerve supply of the iliopsoas?

The origin of a muscle is the location where the muscle attaches closest to the center of the body. The insertion is the attachment point furthest away from the center of the body. The origin of the iliacus is the inside surface of the pelvic bone (the iliac crest and iliac fossa on the ilium) and the top edge of the tailbone (the ala of the sacrum). The insertion of the iliacus muscle, along with the psoas, is located at the inside of the femur near the groin (the lesser trochanter on the femur). The origin of the psoas is the front (anterior) surface of the lower vertebrae (T12-L5) and the bottom of the transverse processes of those same lower vertebrae. The insertion of the psoas is the same as the iliacus, on the lesser trochanter.

The iliacus and psoas blend together to form the iliopsoas tendon where they both attach at the lesser trochanter. The iliopsoas tendon translates the force produced by the muscle belly of the iliacus and psoas themselves, moving the femur bone relative to the pelvis and low back. As you can see, the iliacus crosses 2 joints (the sacroiliac joint and the hip joint) and the psoas crosses 3 joints (lumbar vertebrae, sacroiliac joint, and hip joint). Often times the iliopsoas is only considered a 2 joint muscle because the sacroiliac joint is not counted, no respect for the SI.

Nerves coming off the spinal cord create a complex network that shares information with the muscles, skin, and other tissues in the area. Special nerves head straight for the iliacus by exiting the spine at L2-L4, joining to form the femoral nerve, and innervating the iliacus. Nerves exiting the spine at L1-L3 join to form the Ventral Primary Rami and innervate the psoas. Interestingly, the signals from the brain to these two muscles are distinctly different, showing they are acting independently of each other and should not be considered one muscle. Because they are often called the “hip flexor” or iliopsoas, the iliacus and psoas are often considered one in the same when they are each distinctly different in their action, purpose, and location.

Summary FAQs:

Q: What is the origin and insertion of the iliacus?

Origin – iliac crest and iliac fossa on the ilium bone

Insertion – lesser trochanter on femur

Q: What is the innervation (nerve supply) of the iliacus?

Femoral Nerve (L2-L4)

Q: What is the origin and insertion of the psoas?

Origin – anterior surface and transverse processes of T12-L5 vertebrae

Insertion – lesser trochanter on femur

Q: What is the innervation (nerve supply) of the psoas?

Ventral Primary Rami (L1-L3)

Q: Where does the iliopsoas tendon attach?

It wraps around the inner thigh and attaches at the lesser trochanter of the femur

Q: Is the iliopsoas a 2 joint muscle?

Technically the iliacus is a 2 joint muscle and the psoas is a 3 joint muscle, but often the SI (sacroiliac) joint is not counted, making the combined “iliopsoas” a commonly called 2 joint muscle.

What else is connected to the psoas and iliacus?

Because everything in the body is tied together by connective tissue like fascia, ligaments, tendons, and joint capsules, the iliacus and psoas are connected to the tissues around them. This includes the digestive system, nerves, urinary system, lymph system, and reproductive system.

The iliacus and its intimate connection to the pelvic floor

Fascia is a specialized connective tissue that is continuous from head to toe. The purpose of fascia is to hold everything in place. If we didn’t have fascia our organs would end up in the wrong place and our muscles would be sagging off of our bones! Not very attractive. The fascia that is connected to the iliacus and psoas is also directly connected to the pelvic floor and diaphragm. This gives a “C” shape of connective tissue that wraps along the pelvic floor, follows the iliacus and psoas up the back of the abdomen, and then curls under the ribs along the diaphragm. Because of this connection, tightness in the psoas or iliacus will pull on the diaphragm and pelvic floor muscles, nerves, and organs.

The iliacus is of particular interest to the pelvic floor itself. Issues with urination, sexual function, and pelvic pain are commonly associated with tightness in the iliacus. You can see how intimately connected these structures are in location and with their fascial connection. Similarly, when the iliacus is tight, it rotates the pelvic bones which directly affects the strain of the nerves and muscles in the pelvic floor and hip regions, often manifesting in chronic tension and nerve pain.

Summary FAQs:

Q: Does the psoas attach to the diaphragm?

The psoas and iliacus are connected to the diaphragm and the pelvic floor by the fascia connection.

Q: Does the iliacus and psoas attach to the organs?

The fascia in the body is continuous from head to toe and creates a connection between the iliopsoas and the digestive system, nerves, urinary system, lymph system, and reproductive system.

What do the iliacus and psoas muscles do?

The function of the iliopsoas varies depending on the position and activity of the body. Although these muscles are often referred to together as the hip flexor or iliopsoas, their action and function are different. This is an underappreciated and very important point. They both contribute to hip flexion motion but their primary job is to hold together the hip, pelvis, and lower back area.

What does the iliacus muscle do?

Primarily, the iliacus stabilizes the hip joint and the SI (sacroiliac) joint. Because it is relatively short and strong and crosses the two joints of the hip and the sacroiliac joint, it acts as more of a stabilizer, keeping those two joints aligned and strong regardless if the body is stationary or moving. Long muscles have good lever arms for moving bones well. A good example of this is the quadricep that goes from the hip to below the knee. Short muscles are built to hold parts in place. This is what the iliacus was born to do, stabilize the hip and SI joint. Any situation that challenges these 2 joints will lead to a challenge to the iliacus muscle and possibly the development of chronic tightness.

Why does my leg rotate out when I lay down? Why do I need a pillow under my knees when sleeping?

A tight hip twists the leg. The action of the iliacus when it moves the femur bone is flexion and external rotation of the hip. Because of this, when you have a tight iliacus and your pelvis is stationary like when you are lying down, your leg will rotate outward. Tightness here may also put your hip into a little bit of flexion when you lay down, making it hard to lie on your back without a pillow under your knees. These are two signs that you have chronic holding patterns in this muscle. If a muscle is tight laying down, it’s tight all the time, during everything you do. It doesn’t take much imagination to see how that can cause issues with performance and pain.

Why is my pelvis rotated? Why does my hip go out?

A tight hip twists the core. When the leg is fixed instead of the pelvis, like in standing for example, the pull of the iliacus can cause a rotation of the pelvic bone forward, changing the alignment of the pelvis, hip joint, femur, and the rest of the leg. This is called an anterior rotation and this pulling motion works its way up to the spine as well. This is a very common sign of a tight iliacus and can get stuck that way and affect your alignment of the entire body, leading to pain and poor muscle strength

Does the iliacus move the spine? Is the iliacus attached to the spine?

When the leg is stationary, the iliacus will help bend the spine to the same side (ipsilateral side bending) and rotates the pelvis forward when you go from laying down to long sitting, contributing to spinal flexion in this situation. Although the iliacus does not directly attach to the spine, its connection to the pelvis and how it moves that bone affects the motion of the spine.

What does the psoas muscle do?

Similar to the iliacus, the psoas stabilizes the hip joint and SI joint but, due to its connection to the lumbar spine, is involved much more than the iliacus in stabilizing the lower back. Its close connection to the lumbar vertebrae and its attachment to the front and back of each vertebra give it the perfect advantage to help hold that lumbar spine in place. When there is any issue in the low back, the psoas grabs on for dear life to hold it all together, easily developing into chronic tightness. Its complex attachments at the lumbar spine also contribute to motion of the spine such as rotation, side bending, flexion and extension, but primarily, its job at the lumbar spine is to stabilize.

Why does my lower back arch so much?

Some people experience what is called excessive lumbar lordosis where their lower back arches too much. Because of the long length of the psoas, attaching at the top of the lumbar spine and running all the way to the inside of the femur, it does a good job of extending the low back and creating an anterior pelvic tilt. This motion is best seen when sitting when you create extension in your spine to sit with a lumbar curve. Slouching in your chair relaxes the psoas, sitting in good posture activates the psoas (and iliacus). People who have psoas tension tend to have an excessive arch in their spine when they stand or lay down as well.

Does the psoas move the hip joint?

Like the iliacus, the psoas creates flexion and hip external rotation at the hip joint. This can also contribute to one leg rotating outward when standing or laying down, a tight psoas or iliacus could be the culprit along with the bony structure of your hip and pelvis.

Summary FAQs:

Q: What is the function of the iliopsoas?

Primarily the iliacus and psoas are hip flexors but they also have different jobs due their location, nerve supply, and shape.

Q: What is the function of the iliacus?

The iliacus primarily stabilizes the hip and sacroiliac (SI) joint but when it does help with movement, it flexes and externally rotates the hip. It often causes an anterior rotation of the pelvis when the leg is stationary and can contribute to movements of the spine indirectly.

Q: What is the function of the psoas?

The psoas does most of its work stabilizing the spine (and to a lesser degree helps to stabilize the sacrum and hip). It also helps with hip flexion and hip external rotation as well as lumbar extension and other low back motions.

Q: Why does my leg rotate out when lying down?

The psoas and iliacus are hip external rotators and, when they are tight, they will make the leg rotate out to the side. When you release that tension and align the pelvis, the leg will not rotate out as much. The bony structure of the hip and pelvis can affect this too, but usually does so on both sides equally.

Q: Why does my back arch when I lay down?

A chronically tight psoas will pull the spine into extension (arch) at rest. A tight iliacus will rotate the pelvis forward, indirectly contributing to an arch in the back as well.

Q: Why does my hip go out? Why is my pelvis rotated?

One of the most common causes of a pelvic rotation is a tight iliacus. Sometimes a tight psoas contributes as well.

June 16, 2020

Do you get hip pain when sitting at a desk or computer for a long time? When you get up do you feel a pull along the front side of your body, like your mobility has been robbed from you while you were working? Does hip tightness and/or back pain seem to creep up every time you sit down – even if it’s only a slight ache?

You aren’t alone.

The average American adult sits for more 6.5 hours a day, according to a new study from the US Centers for Disease Control and Prevention. Many people also report digestive issues and pain in their low back, neck, leg, and knees after prolonged sitting. These may even show up before you notice pain or tightness in your hip – but the location of the pain may not be the primary cause of your discomfort. Oftentimes, the real cause of pain that develops as a result of sitting is hidden in the hip.

How your hip flexors work while sitting

It’s time to dig below the surface and cast a light on the seemingly innocuous duo in this tale: the psoas and the iliacus muscles.

Don’t know what I’m talking about? You probably know them by a more common name – hip flexors.

‍

“Hip flexors” is a general term to describe the group of your hip muscles that connect to the bones in your thigh, pelvis, and spine that help to bring your leg forward. They’re the reason we are able to walk, run, step up a ladder and – yes – sit in your chair every day. When most people talk about hip flexor pain or tightness, they are specifically referring to (even if unknowingly) a more precise part of their hip flexors – the iliopsoas muscle, which is your psoas and iliacus muscles combined.

When working in perfect harmony, your iliopsoas muscle supports your whole body, stretching out and shortening to move your legs and help you run after energetic kids or do your favorite post-work yoga class.

But, like the supportive friend that we get used to having around, we tend to take our iliopsoas muscle for granted. After years of being there for you while you work long hours at your desk, commute in your car, and navigate the daily stresses of modern life, it can start to scream out for attention. Literally.

You see, when you sit down, you’re shortening – or contracting – the iliopsoas muscle and essentially asking it to stay “on” the entire time you’re in your chair. Its job is to hold you in place while sitting. So, basically, the psoas and the iliacus are keeping you from falling out of your seat.

The problem is, they aren’t meant to be in this position for a long time. Eventually, your iliopsoas muscle gets cramped and starts to develop painful muscle knots. And these concentrated parts of your muscle stay contracted even after the rest of your muscle has relaxed.

Ouch.

That’s when that insidious hip pain creeps in from sitting or when you begin slouching. Your body slouches as a natural response to gravity and an unconscious way to take a little stress off a fatigued iliopsoas.

Even after you stand up and begin to go about your day, your psoas and iliacus might feel like they’re still “frozen” in the contracted position they were in while you were sitting down. Doing this day after day is what causes constantly tight hip flexors and chronic hip pain while sitting.

Why stretching isn’t always the answer to tight hips

A common misconception is that, after a long day of sitting, tight hip flexors simply need a nice stretch, gentle massage or short walk around the block to release their grip on your core and back. But if your muscles have been contracting long enough to form knots and hip pain when sitting, stretching isn’t going to cut it.

Think of your psoas and iliacus muscles as rubber bands. When they are taken care of, they can stretch and contract, moving back and forth with ease. Now, imaging removing all the pressure from the rubber band and putting it in the freezer. The next time you go to stretch it out, it will resist you. If you stretch it too far it may even crack or break.

Your iliopsoas muscle is very strong – so it will take more than a few minutes of sitting down for it to become “frozen” and start causing you hip pain. That being said, it can happen faster than you think. Fortunately, there are a few simple things you can do to reduce the chances of your iliopsoas muscle causing you pain while sitting.

4 simple ways to prevent hip pain from sitting

Preventing tight hips is always better – and a lot less painful – than treating them! When it comes to your iliopsoas muscle and sitting down, the most important things to remember are form and frequent breaks.

1. Create a healthy workspace

For people who work at a computer all day, the easiest way to do that is set your desk and chair up to be as ergonomic as possible.

But if you are already having hip pain while sitting, I’d take this even one step further and look for a sit/stand desk. This will give you the option to change your body position throughout the day to make sure you’re not standing or sitting too much.

2. Check your form

Yes, seriously! You may have been “practicing” the art of sitting since you were a toddler, but if you have hip pain from sitting, you’re probably not doing it right.

Let’s compare how you are right now with the ideal sitting position.

Are your shoulders relaxed and over your hips, your neck neutral, and your feet on the floor with your chair high enough that your hips are slightly higher than your knees? A 90-degree angle is OK, but not optimal. Try sitting on a pillow to put your pelvis at a slight incline. Or, if one side of your iliopsoas muscle hurts more than the other, try tucking that foot underneath the chair – without crossing your legs!

Finally, your sternum should be up and your abs should be engaged so that there’s a very slight curve in your back. Slight is the magic word here. Not too much arch or your iliopsoas will work overtime.

This will take some of the pressure off your psoas and iliacus muscles and encourage a stronger core in the process!

3. Give your psoas and iliacus a break

One of the most important things to keep in mind to prevent hip pain while sitting: frequent breaks.

Every 30 minutes is ideal.

Only a 15-second break is enough to be a game-changer for your health and comfort. Get up, move your hips and spine from side to side, walk over to the window to take in the view, or go refill your coffee. A quick (but gentle) hip flexor stretch in place is perfect! The important thing is that you give your iliopsoas muscle a break from being contracted.

4. Teach your psoas and iliacus to relax

If you are reading this article, you’ve probably already developed a tight iliacus and psoas from sitting too much. Implementing the recommendations above may help the issue from worsening – and could even prevent hip flexor pain in the first place.

But, your already tight hip flexor will also need to learn how to relax. As I mentioned above, stretching is often not enough. The muscle has already decided to stay tight and contracted.

So, what do you do?

Muscle knots and tension respond to prolonged pressure by relaxing. This happens when the brain gets a message to finally release the tension it has been holding. But because of the location of the iliacus and psoas, it’s hard to reach with your hands or common tools.

This is where employing the help of the Hip Hook or a trusted practitioner is the key to getting this tension to release. After using the Hip Hook to successfully target the source of the hip pain you feel from sitting, you can then change your other daily habits with the recommendations above.

You’ll be well on your way to keeping your iliopsoas happy and healthy moving forward. And your reward for implementing these four easy steps will be huge relief from tight hip flexors and pain while sitting.

Your pain – whether you feel it in your hips, knees, feet, or back – could be a result of tight hip flexors and sitting too much. This could be one of the most simple changes to your life that could lead to the most profound transformations in your health and wellness.

Plunking down in your chair in the morning and staying glued to one spot all day is a disaster waiting to happen – but these are four small shifts you can make in your day that could have radical outcomes. And the best part is – they are easy to do!

If this has piqued your interest about your psoas and iliacus muscles, I really recommend that you keep learning more about the stretches and activities you can do to keep your muscles happy and healthy. I talk all about this subject in my bestselling book, Tight Hip, Twisted Core – The Key to Unresolved Pain.

The truth is, if you have a tight hip flexor – especially if it’s a result of years of poor sitting posture – you’re probably going to need some prolonged pressure to release it. The Hip Hook could be your new best friend.

If you want to dive deeper into how your hip flexors affect the rest of your body, check out this post.

Frequently asked questions about hip pain from sitting

Can sitting too long cause hip pain?

Sitting too much can be a contributing factor to hip pain. Being in a seated position for many hours each day may lead the hip flexors and other muscles around the hips to tighten up, which can create compression, decrease range of motion, and cause pain in/around the hips.

What helps hip pain from sitting?

When sitting down for longer periods of time, the muscles surrounding your hips are not being used and may have the tendency to tighten up and cause pain. If you experience hip pain while sitting, it can be a good idea to stop and take a break every so often to stretch and move around. You may also find it helpful to release the tight muscles in your hip flexors and your glutes, as well as performing supporting strength and mobility exercises.

Is sitting bad for the hip flexors?

When sitting, the hip flexors are placed into a shortened position where they can tighten up and become weaker. This may later lead to experiencing hip pain if the hip flexors are never able to truly relax and fully lengthen. To help, consider adding in some exercises to stretch and release tension in the hip flexors to reduce the likelihood of experiencing hip pain while sitting.

Can sitting too long cause buttock pain?

Sitting too much can be a contributing factor to buttock pain. Being in a seated position places the hip flexors into a shortened position, where they can become tight and pull the pelvis forward into an anterior tilt. The muscles on the back side of the body (like the glutes and hamstrings) may tighten up in response to try to maintain balance and prevent the pelvis from rotating forward even more. As these muscles tighten up, you may experience pain and tightness in the buttocks.

 

Hidden in our pelvis lies a dynamic duo of muscles that are arguably the most important muscles in our entire body. These hip flexor muscles, the psoas and iliacus, are experiencing an increasingly challenging existence in our modern lives full of too much sitting, driving, working, and stress. Add in too much stretching or too much exercise and our world full of “too much” is the perfect opportunity for the hip flexors to be tight and painful. This is highlighted in the International Journal of Sports Physical Therapy where they suggest that iliopsoas syndrome may develop as a result of overuse.

A tight hip flexor does not go unnoticed. It silently wreaks havoc on the alignment of the pelvis, hip, and spine, ultimately creating pain in many parts of the body. As the American Osteopathic Association confirms, a tight iliopsoas may manifest in many different ways. For example, your plantar fasciitis, bunions, knee pain, IT (iliotibial) band syndrome, piriformis syndrome, back pain, SI (sacroiliac) joint pain, scoliosis, even your neck pain, could all start from a tight iliacus or psoas.

Many of us don’t even know we have a tight hip flexor, let alone where our iliacus or psoas is located, what it does, and why it would be tight. This series of articles will shed light on all the aspects of this area of the body so that you can be the master of this part of you and understand how this muscle is impacting your entire body.

What is the hip flexor muscle?

You may have heard of the hip flexor, a more commonly known term. Hip flexion is technically describing a type of motion. This motion moves the whole leg forward at the hip, as in walking or marching. Any muscle that helps do this motion is called a “hip flexor.” There are actually many muscles that could be considered hip flexors. However, when a layperson uses the words “hip flexor” they are typically referring to the two largest hip flexors in the body, the iliacus (pronounced “illy ak us”) and the psoas major (pronounced “so as”). When grouped together they can also be called iliopsoas (pronounced “illy o so as”). Although commonly called the hip flexor, we will use iliopsoas throughout this article to more accurately describe these two muscles when referred to together. There is another muscle in this area called the psoas minor that only exists in about 40% of all humans. Although it does not produce the motion of hip flexion, it shares a name with psoas major and does its small job of mainly stabilizing the lower spine.[CK1]

An in-depth examination of the iliacus and psoas including origin and insertion, nerve supply, and the actions and primary function of the iliopsoas can be found in the article, “Deep Dive into the Anatomy of the Hip Flexor”

What other muscles are hip flexors?

There are a few other muscles that also produce the motion of hip flexion, bringing the leg forward at the hip like in walking or marching. Because they have a similar job as the iliopsoas, they not only work together, but they can also become injured together. Although these muscles help create the motion of hip flexion, they are not commonly part of the lay term “hip flexors” used by many to refer to the iliacus and psoas only.

Pectineus (peck-ti-knee-us) is in the inner thigh. Rectus femoris is part of our quadriceps, the big muscle on the front of the thigh. Tensor fasciae latae (ten-sir fash-ha lot-a), one of my all-time favorite names for a muscle, attaches to the IT (iliotibial) band on the outside of your leg. Part of the gluteus medius, located on the outside of the hip, is also involved in hip flexion. Many of the adductor muscle group located in the inner thigh (sartorius, adductor magnus, adductor brevis, adductor longus, and gracilis) are involved in the motion of hip flexion to some degree.

All of these muscles are hip flexors and support the iliacus and psoas in bringing the hip forward, working in different ways. The shorter muscles, like pectineus and iliacus, have less leverage and tend to focus on stabilizing the hip. The longer muscles like the psoas and rectus femoris are better at moving the leg bone forward into hip flexion with actual force.

Other major muscles that create hip flexion along with the iliopsoas (gluteus medius, sartorius, gracilis, and adductor group not shown)

Summary FAQs:

Are the iliacus and psoas the only hip flexors?

Even though the iliopsoas is what is often referred to as the “hip flexor,” there are other muscles that produce this motion as well

What other muscles are hip flexors? Is the gluteus medius a hip flexor?

Muscles that contribute to the motion of hip flexion include:

• Iliacus
• Psoas
• Rectus Femoris
• Tensor Fasciae Latae
• Pectineus
• Sartorius
• Adductor Brevis
• Adductor Longus
• Adductor Magnus
• Gracilis
• Part of the gluteus medius
• Building Blocks of the Body

Each part of our body has a role. The bones support your body and the joints are where the bones connect. Joints allow the body to move but the bones wouldn’t move at all if it weren’t for the muscles. Muscles are attached to the bones by tendons so that they can contract and move those bones around, so you can do your thing. If it weren’t for the ligaments and joint capsules holding the joints together, those movable connections of one bone to another would fall apart as soon as the muscle tried to move them. Then there is the fascia, which runs continuously from head to toe. Fascia holds the muscles, cells, organs, nerves, all parts of the body, in place. If you didn’t have fascia, your muscles would be hanging off the bone.

When one part of the body is too tight or too loose or broken or weak, it affects the way the rest of the body works. Since each bone is connected to the next by this network of ligaments, tendons, and muscles, when part of the system is not working well, it impacts the rest of the body. We see this when a broken toe leads to back pain or when knee surgery creates a hip problem.

The chain reaction

An unhealthy psoas and iliacus have profound effects on the rest of the body. Due to the location and strength of the iliacus and how it connects to both the pelvis and the thigh bone, it is involved in issues with the low back, tailbone, hip, leg, knee, foot, toe, upper body, and neck. Because its tightness twists the core and changes the way the leg is connected to the upper body, all of these areas are affected. When the iliacus is relaxed and happy, these areas have a chance to work as they have been designed to work—with ease, aligned and strong. When the iliacus is tight, all of these areas are susceptible to pain and injury.

Tightness in the iliacus and psoas (iliopsoas) is caused by either overuse (sitting too long or certain athletic endeavors) or by a too flexible body (where the muscles have to hold on for dear life to keep the body from falling apart). Injuries and stress contribute as well. Once this tightness sets in, it can persist for years, pulling on the pelvis and creating a faulty movement pattern in the leg to the toe and the spine to the head. That strain starts to wear away at the body, usually at your weakest link, and eventually leads to the one thing that no one wants and everyone wants to get rid of: pain. The “hip flexor” is commonly the root cause of a chain of events that leads to pain; therefore, if we keep our iliopsoas healthy and happy, we can simply avoid so much suffering.

Become a part of this movement by intimately knowing your iliacus and how to take care of it. Get on the iliacus train to your own wellness and evolve into a better functioning you. Soon you will be an expert on how to care for this muscle, and your newfound knowledge will help to create a world where everyone knows they have a psoas and iliacus that makes up their “hip flexor”, its importance, how to care for it, and how to live pain-free.

In this article series you will discover:

Deep Dive into the Anatomy of the Hip Flexor (also known as iliopsoas or psoas and iliacus). What is the origin and insertion, nerve supply, and the actions and primary function of the iliopsoas? What muscles oppose the iliopsoas?

How do I find the iliacus and psoas on myself? Can I palpate it?

What causes tight hip flexors?

• Sitting
• Driving
• Running
• Lunging Sports (Tennis, Skating, Cycling)
• Kicking (Soccer, Football, Martial Arts, Kickboxing)
• Heavy Lifting (Crossfit, Squats)
• Golf
• Stretching Sports (Yoga, Dance, Gymnastics)
• Hypermobility Syndrome (Ehlers-Danlos Syndrome, Marfan Syndrome, Down Syndrome)
• Hip Dysplasia
• Pregnancy
• Hip Arthritis
• Hip Replacement
• Hip Labrum Tears
• Hip Impingement Syndrome
• Hip Surgery
• Pelvic Pain
• Lower Back Pain
• Sacroiliac (SI) Joint Pain
• Lower Back, Knee, Foot Surgery
• Abdominal Issues (Digestive, Uterus, Urinary, Prostate, Ovary, Colon)
• Stress, Trauma, and Emotions

What issues can a tight hip flexor cause?

• Lower Back Pain
• Facet Joint Pain
• Herniated Discs
• Nerve Pain
• Back Muscle Spasm and Pain
• Scoliosis
• Sacroiliac (SI Joint) Pain
• Tailbone Pain
• Pelvic Pain
• Bowel, Bladder, and Reproductive Issues
• Constipation
• Abdominal Pain
• Weak Abdominals
• Hernia
• Hip Arthritis
• Hip Labrum
• Groin Pain
• Psoas Tightness
• Hip Flexor (Iliopsoas) Tendonitis
• Hip Flexor (Iliopsoas) Bursitis
• Hip Flexor (Iliopsoas) Strain
• Psoas syndrome
• Piriformis Tightness
• Glute Tightness
• Weak Glutes
• Hip Bursitis
• Adductor Muscle Pain
• Pain Getting Up From Sitting
• Pain with Marching
• Pinch in Hip When Bringing Knee to Chest
• Hip Pop When Lowering the Leg
• Snapping Hip
• IT (Iliotibial Band) Syndrome
• Nerve Pain
• Sciatica
• Hamstring Issues
• Quadricep (Rectus Femoris) Pain
• Leg Length Differences
• MCL Strain
• Knee Arthritis
• Meniscus Tear
• Kneecap (Patellofemoral) Pain
• Ankle Pinch
• Achilles Strain
• June 16, 2020