Hip Hip Hurray

One of the curious and frustrating muscoloskeletal complaints to resolve is the beast of the persistently tight hip flexors. The psoas muscle runs down the front of the spine from T12 (about the level of the bottom of the rib cage) and attaches on the leg just below the hip. Its partner in crime is the iliacus muscle which is a flat fellow who lines the inside shell of the pelvis and joins the psoas muscle as one tendon (commonly we refer to them collectively as the iliopsoas). Because of where the muscle attaches, it is a powerful “hip flexor” muscle. When we are sitting, this muscle is in its shortened position and therefore is quite often tight in those who are chained to a desk all day. It is also a culprit in low back pain, as technically this is also a spinal muscle and when it’s tight, it squeezes and compresses the spine together and can cause pain or further irritate already irritated tissues. 

There are all sorts of biomechanical and physical reasons why these muscles are tight in so many people. Sitting, low back pain (both as a cause and an effect), weak gluteal muscles, lack of stretching, and many more. It is often said in the rehab world that the psoas muscles aren’t going to turn off (aka relax) until the gluteal muscles learn to turn on. While I believe there is good merit to all of these explanations, still I have found many people who don’t seem to respond to addressing any of these avenues. It doesn’t seem to matter what amount of glute rehab, core strengthening, reduction of sitting, stretching or manual therapy is done, they still stay tight. This led me to search for other explanations and outside the box avenues that may be playing a role in these stubborn cases. 

I came back to the nervous system, how many people have higher sympathetic activity and stress these days, and what sort of impact our emotions and past traumas could have on this muscle in particular. You’ll recall our sympathetic nervous system is the “fight or flight” one. The posture that our body must assume to get ready for either of these actions is to flex. We must bend forward a little bit to be stable enough to take off running or to have a strong base to fight off that tiger chasing us. So if we are constantly in sympathetic mode, we must always keep these muscles tight and at the ready - just in case. If we have had some traumas in the past, our body likely feels a bit vulnerable. When we are feeling vulnerable, the rudimentary position we often go to is the fetal position, as this feels safe. I’m not saying we all curl up in a ball on the floor, but we certainly have the tendency to bring our limbs in, sit slouched, or lie on our sides. We are not likely to stand erect and proud, limbs outstretched to the sides as if celebrating in victory at the finish line or the top of a mountain. I have often  suggested patients work with counsellors or therapists who are well trained in techniques that help people process past trauma and be aware of the physical sensations in their body when working through these memories. Sometimes, following a counselling session with one of them, people report there to be more of a release and relaxation of the psoas and adductor muscles than with an hour of massage, IMS, or aggressive active myofascial release therapy. 

So if you’ve got tight hips and feel like you’ve tried it all, it might just be worth considering the role of your nervous system, emotions, and past experiences. Your body might just be stuck in a mode of trying to protect you - having not got the message that you’re actually ok now and it can let down its guard. It’s up to you to do the work to convince it of that and that can take time and patience with yourself. I’d suggest not delving into past traumas or digging through too many emotions without a professional on board to guide you through it as that can be tough work. For homework though to get started, you may want to spend a bit of time lying on your back with your legs extended out (this is corpse pose in yoga), doing some deep breathing into the area of your hips, and trying some meditation to help your body relax and reset. Best case scenario, adding this into the mix of your stretching and rehab unlocks these tight muscles a bit more for you. Worst case scenario - you’re working on relaxing your nervous system by using a body position that helps you do that, relaxing your mind, and bringing yourself closer to a mindset and a physiology primed for self-healing and repair.

Risk -benefit ratio look ok to you?