If your hip flexors often feel sore and tight, and you’re wondering what might be causing that, and what you could do to make it feel better, you’re not alone.
Anterior hip pain is something many athletes and active people might be familiar with.
In order to address the possible causes and discuss solutions, we must first consider that the hip flexor muscles might be sore because of other underlying causes. When a patient comes in to see me for an evaluation of their hip, I take a thorough history and then conduct a physical exam to gather data. By the end of the evaluation I can rule out certain diagnoses and leave others to consider further. In this Q&A format I can’t gather data, so I’ll explain one of many possible causes of anterior hip pain.
Anatomy Of The Hip
The hip is a ball-and-socket joint. The “ball” is formed by the head of the femur, and the “socket” is the acetabulum of the pelvis. The muscles in the front of the hip are collectively referred to as the hip flexors. The hip flexors are listed here in order of greatest contribution to smallest contribution:
- Psoas major and Iliacus (often referred to as Iliopsoas)
- Rectus Femoris
- Tensor Fascia Latae (TFL)
- Adductor Longus
- Adductor Brevis
The muscles in the back of the hip are referred to as the hip extensors. They are:
- Gluteus Maximus
- Biceps Femoris, Semitendinosis, and Semimembranosis (the hamstrings)
As you can see from the illustrations, the gluteus maximus is a one-joint muscle (acting only on the hip joint), while the hamstrings are two-joint muscles (acting on both the knee and the hip joints). This is important because the glutes and the hamstrings need to co-contract and work together to keep the ball centralized in the socket during movement of the lower extremities.
Some athletes have dominant hamstrings, which extend the entire leg with little control over the movement of the femoral head (ball). This causes the femoral head to migrate forward in the joint during hip extension, and is called Femoral Anterior Glide Syndrome. The force of the femoral head moving forward in the socket can irritate the anterior joint capsule (the envelope-like tissue surrounding the joint).
When gluteal dominance is present, the glutes keep the femoral head closer to the back of the socket, preventing anterior glide. Ideally, the co-contraction of the hamstrings and glutes keep the femoral head centralized in the socket. If the hamstrings are overactive and the glutes are weak, the athlete may struggle with Femoral Anterior Glide Syndrome, chronic hamstring strains, adductor magnus (groin) strains, and low back pain. Additionally, the resulting irritation in the anterior joint capsule may lead to a sense of tightness in the front of the hip.
This is important. Many athletes who believe they have “tight hip flexors” embark on an aggressive hip flexor stretching program, only to find that the hip pain worsens. This is because they are continually stressing and irritating the anterior joint capsule!
So, what’s the best next step?
First and foremost, refrain from aggressively stretching the hip flexors. Include glute activation work in your training program instead.
Strengthening your posterior chain will keep the glutes strong and keep the femoral head centralized in the socket. Appropriate exercises may include glute bridges, deadlifts, Kettlebell Swings, and mini band work. Eric Cressey wrote a fantastic article on this issue that you may find helpful, and his Assess and Correct program offers ideas for corrective exercises.
Again, this is only one possible cause of anterior hip pain in athletes and physically active individuals. Other causes may be related to the hip joint itself, such as arthritis, or femoroacetabular impingement (FAI), the labrum (the cartilage surrounding the joint), or other muscular issues.
If you’re experiencing hip “tightness” or soreness, you may benefit from consulting with a physical therapist to identify the true cause, and develop a treatment plan to address the issue. Physical therapists are highly educated in the assessment and treatment of musculoskeletal injuries. Early access to physical therapy leads to better long-term outcomes, and physical therapists are happy to work with your coach or personal trainer to provide input on appropriate exercises for hip pain. You can visit the American Physical Therapist Association website to find a physical therapist near you.