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Corrective exercise helps personal trainers address postural and movement dysfunctions and prevent injury in clients, such as with the hip flexors. Too much hip flexion can lead to tight hips, which causes hip flexor problems in clients. This results in hindered exercise performance and increased risk of injury.
Many of these issues arise from muscle imbalances in the surrounding anatomy. Hip muscle action heavily influences muscles such as the glutes, hamstrings, and lumbar spine. With so many other muscle groups contributing to improper biomechanics, it is important to address the hip joint and the surrounding anatomy.
Let's dig into common hip flexor issues and causes, plus how you can use corrective exercise to prevent or address problems with these muscles.
These flexor muscles are located around the hip joint. As their name suggests, they aid in hip flexion. That makes them important for movements that involve lifting the knee, such as when walking or running. You also use your hip flexors when kicking or bending forward.
Another function of the flexor muscles is to support and stabilize both the pelvis and spine. This provides better postural control. It also keeps your back and pelvic area in better alignment.
When we talk about the hip flexors, we are referencing five different muscles:
Iliacus. This hip muscle is a prime mover in hip flexion movements. It is flat and triangular in shape and can be found in the curved surface of the ilium, which is the largest pelvic bone.
Psoas. Another prime mover, the psoas muscle runs from the lower spine, down through the pelvis, and attaches to the femur bone.
Rectus femoris. This muscle runs down the front of the thigh and is one of the quadriceps. The rectus femoris aids in hip flexion, also assisting with knee extension. That makes this hip flexor important for kicking movements.
Sartorius. The longest muscle in the body, the sartorius begins at the anterior superior iliac spine and crosses the hip and knee joints before attaching to the tibia bone. At the tibia, it joins the gracilis and semitendinosus muscles. Collectively, these three muscles are known as the pes anserinus.
Pectineus. This hip flexor muscle aids in hip adduction. It runs from the superior pubic ramus, located at the bottom of the pelvis, to the top of the femur bone.
Lots of factors play a role in hip pain. The most common hip flexor issues are strains, labral tears, and stress fractures. When a hip flexor experiences excessive tightness or stiffness a strain is more likely to occur. A tight hip can create an immense amount of hip pain and lead to more serious injuries.
The first step to successfully fixing hip flexor issues is to determine what the actual issue is. You will not be able to rehabilitate an injury unless you determine where disruption is in the kinetic chain. The next step is to design a program for the actual issue at hand. Then implement the stretches, exercises, and foam rolling into your client's current program.
The hip flexor muscle demonstrates its main function when a client bends at the waist or raises their knee upward. These types of hip flexion movement patterns occur in both athletes and sedentary clients.
Every athlete performs running motions, bringing their knee upward. Sedentary clients find themselves sitting a lot in a position where the body bends at the waist. When these movements occur, the hip flexor muscles shorten. The longer the hip flexors remain in a shortened or contracted position, the tighter they become.
When a client stretches a tight hip, it could cause a strain depending on the extent of the hip flexor tightness they have built up. This can lead to more serious hip issues and even knee injuries. Maintaining hip and knee strength, mobility, and flexibility will help clients avoid injury.
Hip issues usually contribute to knee injuries and vice versa. The body is a kinetic chain where everything connects and affects each anatomical part. Knowing this will help you quickly determine the issue at hand.
The more severe the injury, the higher the grade of tear.
Grade I: The client's hip still functions properly, but they experience a small amount of pain in the groin area.
Grade II: The hip does not function properly but can tolerate some weight; the hip gives out every so often.
Grade III: The client is unable to tolerate any weight at all; it is unlikely your client will be able to walk. These types of tears coincide with stress fractures and you should recommend your client to see an orthopedic doctor immediately.
Overuse of the hip also causes hip tendonitis. To differentiate between tendonitis and strains you need to discover the location of pain. If pain in the front of the hip worsens when the knee lifts towards the chest, it is most likely a strain. If pain occurs in the leg or even the back, it is most likely tendonitis.
Hip tendonitis slowly gets worse over time, whereas a strain or tear is usually immediate pain. Every client should be stretching on a routine basis to help prevent hip stiffness and to alleviate any pain that might occur in the hip joint.
The acetabulum, which is known as the hip socket, is where the femur sits in the pelvis. Labral tissue covers this socket and can become irritated through excess rubbing and overuse of the hip joint. If this tissue tears it is known as a labral tear. Clicking or popping often accompanies labral tears, which cause pain in the hip and groin area. The structure of a client can also influence these types of issues, but injury and overuse are the common cause of these complications.
Repetitive movement or overuse within the hip joint is a major aspect to hip flexor pain. Weak or tight hip flexors cause hip flexor injuries. It is important to understand what contributes to the weakness or tightness the hip flexors experience. If a client experiences direct damage to the hip it can cause a hip flexor injury, but overuse is the biggest reason for hip flexor tightness.
Hip flexor tightness can come from excessive sitting and bad posture. If your client is sitting a lot throughout the day, their hip flexors remain in a flexed position for an extended period. This creates tightness and leads to inactive hip flexor muscles. When muscles are inactive, they will atrophy and become weaker. Weak hip flexors will lead to more hip flexor strains.
Picture a client who sits all day long and suddenly stands up. The entire time they were sitting their hip flexors were in a flexed position. In this flexed position the hip flexor muscles contract and shorten. When your client stands up the hip flexor muscles stretch and elongate quickly, possibly even more than the muscle can withstand. As the hip flexor quickly extends beyond the muscles' threshold, it creates micro-tears in the muscles.
Stretching routinely will help prevent this, but you must know that any form of overstretching can also be detrimental to the hip flexor muscles. If your client stretches too much, they can create micro-tears in the muscles as well.
The piriformis is a common muscle responsible for a lot of hip issues. The piriformis muscle is the muscle in the body that sits underneath the gluteus maximus. It is a small muscle unable to withstand the same stress larger muscles can. Many clients have piriformis syndrome that amplifies hip flexor issues.
With excessive sitting the glutes become underactive and weak causing the piriformis to compensate. It is a strong, but small muscle that cannot undergo the same activities the glutes can. Therefore a client will experience pain in the hips, which can be alleviated through consistent hip flexor and piriformis flexibility exercises.
Several strengthening exercises target the hip flexors. Adding these to your exercise plan can help avoid the development of weak hip flexors.
Some of the best (and most effective) hip flexor exercises include:
Knee lifts. While standing, lift the right knee until the hip is at a 90-degree angle. Then, return this knee to the floor. Do the same movement with the left knee. Continue alternating the knees for 12 to 15 reps.
Front leg raises. Still standing upright, extend the right leg and lift it as high as you can. Keep your spine straight to avoid lower back pain. Try to get the right foot about hip height. Lower this leg, then do the same movement with the left leg. Again, try to get the left foot about hip height. Do 12 to 15 reps on each leg.
Hip circles. Balance your weight on your right leg. Lift your left leg off the ground slightly and move it in clockwise circles. After doing 15 circles, switch direction and move the leg counterclockwise. Return the left foot to the ground and go through the same steps with the right leg.
Sidesteps. Get into a squat position. Engage the hip flexors while taking 10 small steps to the right. Stop, then take 10 small steps to the left. Do three to five sets of this exercise.
Sumo squat. Stand with your feet wider than shoulder-width apart. The toes should be pointing slightly outward. Lower into a squat position, as if you’re going to sit back on an imaginary chair. Stop once your knees are at a 90-degree angle, then stand back up again. Do 12 to 15 reps of this hip flexor exercise.
Bulgarian split squat. Stand in front of a bench. Lift your right foot and place the top of that foot on the bench behind you. While balancing on the left leg, lower into a squat position. Return to standing. Do 12 to 15 reps before switching to the opposite leg. To make the upper thigh stronger, you can do this exercise while holding weights.
Jump squat. This squat variation involves doing a regular squat, then jumping up explosively. When landing back on the ground, lower back into a squat position. Do this exercise 12 to 15 times.
Reverse lunge. Instead of stepping forward and lowering into a lunge position (with your upper body upright), this flexor exercise involves stepping backward, then dropping into a lunge. Do 12 to 15 reps with each leg.
Lateral lunge. Also known as a side lunge, you do a lateral lunge by stepping out to the side, then dropping into a lunge position. Do 12 to 15 reps with your right leg to the side. Then do another 12 to 15 reps with your left leg to the side.
Single-leg Romanian deadlift. Stand with your feet shoulder-width apart. Bend your right knee slightly, lifting that foot off the ground. Hinge forward at the hips, stopping once your upper body is parallel to the ground. Your right leg is now extended behind you. Raise the torso back up, returning to the starting position. Do 12 to 15 reps, then switch to the other leg.
When strengthening the hip flexors, do these exercises twice per week. You don’t have to do them all either. Adding just three to five of these exercises to your training session can help boost hip flexor strength.
Implement the following corrective exercises into your client's program to help with hip flexor issues. Not only will these techniques and exercises help relieve pain, but they will repair and strengthen the hip region.
Have your client lie flat on their back, both feet on the ground, heels close to their glutes. Have them raise their hips off the ground, extending their hips towards the ceiling. Cue them to contract and squeeze their glute muscles, then lower the hips back down to the starting position. This is great for strengthening the gluteal muscles and getting their body used to hip extension movement patterns.
While in a kneeling lunge position have your client sit up straight, pushing their hips forward. They should feel a stretch in the hip flexor of the leg that is back. This is good for stretching the hip flexor muscles to get them used to elongating. It will relieve any extra tightness or stiffness in the area that could be causing pain.
In a pushup position have your client bring one knee at a time to reach the elbow of the same side. Rotate to the other side. These are important for strengthening the hip flexor muscles.
Full body self-myofascial release techniques will help get rid of muscle knots and alleviate tension throughout the kinetic chain that is affecting the hip flexors. Those who have back pain or knee pain might have tight hip flexors.
Hip flexor pain will disrupt a client's progress, which is why you need to focus on addressing it quickly and correcting it with effective exercises.
If a client experiences pain in the lumbar spine or glutes, you must consider tight hip flexors as the problem area. Implement corrective exercise into a client's program to help improve hip mobility and hip flexibility and to relieve pain in the hip joint.
To design an effective corrective exercise program to address hip flexor issues, start by dedicating the beginning movement prep of each workout to exercises that target these specific areas. Incorporate a combination of stretches, movement prep exercises, and foam rolling throughout the workout.
Some movement prep exercises to include before the main workout are glute bridges, bird dogs, single-leg squats, dead bugs, and mountain climbers. For the post-workout stretches, incorporate flex focus stretches like a lying hip flexor stretch. You want your clients to perform extension type stretches as well, like a quad stretch or kneeling hip flexor stretch.
Foam rolling the upper thigh and hip flexor region will serve as a self-massage and get rid of any muscle knots. Have your client foam roll all the surrounding muscle groups as well. Often the issue is the other tight muscle groups that pull on the hip flexors. It can also be inactive muscles that do not stimulate properly. If you help your client release these muscles through foam rolling, they will experience immediate relief.
Pelvic stabilization helps keep the hip muscles and hip joint in place to function properly. The pelvis is responsible for supporting the entire body and transferring weight from the upper body to the lower body. Numerous muscles attach to the pelvis making it able to perform many movements in the kinetic chain.
The psoas major is the strongest hip flexor muscle in the body and attaches the hip to the pelvis. With the Princeton University exercise list, the pelvis, hip, and glute muscle groups can be targeted effectively to help improve your client's hip mobility and stability.
If you are looking to learn more corrective exercises and how to program them best into a client's program, you must check out ISSA's Corrective Exercise Specialist course. You will learn corrective exercises that correspond with the most common movement dysfunctions. This will allow you to address hip flexor problems and many other common issues that will arise in your fitness career.
The ISSA's Corrective Exercise Course will help you learn how to identify and correct the most common movement dysfunctions that you are likely to see in a wide range of clients.
Nall, R. (2019, March 8). Hip flexor strain: Causes, symptoms, and treatment. Healthline. Retrieved October 12, 2022, from https://www.healthline.com/health/hip-flexor-strain
The Trustees of Princeton University. (n.d.). Welcome to University Health Services | University Health Services. Princeton University. Retrieved October 12, 2022, from https://uhs.princeton.edu/
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