Patrick Gilbert PT, DPT, ATC, CSCS
Over the years, I have seen entirely too many people butcher the hip flexor stretch. While there are plenty of other stretches I’ve seen that are even more wild, I wanted to take the time to dispel a couple myths and set the record straight on how to properly stretch the hip flexor muscles (psoas major, iliacus and rectus femoris). At its very core, stretching must elongate the muscle or muscle group you are targeting. In order to do that, you need to know the attachment points and action(s) of that particular muscle.
At the end of the day, every movement we make depends on anatomy. If you have a thorough understanding of key anatomy principles – bony anatomy and orientation, where muscles originate and insert, ligament attachments, nerve and vessel placement and orientation and all the rest of the complexity that make up the human body – you have a foundation for everything else.
There are three individual muscles that make up the group of muscles known as the “hip flexors”: the psoas major, iliacus and rectus femoris. It is important to note that the psoas major and iliacus have two, distinct proximal attachments, but blend together at their distal tendon attachment, so they are commonly referred to as the “iliopsoas”.
Since the proximal attachments of the psoas and iliacus are at the lumbar spine and pelvis, respectively, you realize that solely extending the hip will have no true change in muscle length at the proximal attachments of these muscles. In order to get a true stretch of these muscles, you need to affect change at the attachment points of the muscle and not simply reverse the action.
It is extremely important to note that the position of the pelvis and lumbar spine are directly tied to one another. Tilting the pelvis anteriorly will result in lumbar extension, while a posterior pelvic tilt is accompanied by lumbar flexion. I go into much more detail about this concept in my post about Cueing the Posterior Pelvic Tilt. This is important as we continue to explore pelvic and lumbar position and their contributions to this stretch.
The position of the pelvis and lumbar spine are directly tied to one anotherTweet
How NOT to Perform this Stretch
A lot of the time you will see people lean way forward in order to get what they feel is a “good stretch”. In reality, all you are doing in this instance is stretching the anterior hip capsule instead of stretching the hip flexors. If a muscle does not have adequate length, or a joint has limited mobility and you place that joint into extremes of motion, all you are doing is compensating elsewhere along the chain. Most of the time, this compensation comes in the form of lumbar extension. By extending the lumbar spine, you create more lordosis, which brings the lower and middle lumbar segments further anterior. Since we know the proximal attachment for the psoas is on the lateral sides of the lumbar vertebrae, we also know that bringing these segments further anterior will do the opposite of stretch this muscle, no matter how far you bring your thigh into extension.
In the same vein, another consequence of lumbar extension is an anterior pelvic tilt. We said earlier that the rectus femoris attaches to the anterior inferior iliac spine, which is located on the front of the pelvis. By tilting the pelvis forward, you are actually bringing that attachment point closer to the distal insertion, which again is not actually stretching the muscle.
The final piece that you often see during a hip flexor stretch is a contralateral sidebend with overhead reach away from the hip you are trying to stretch. In theory, this concept actually makes the most sense of these, since the attachment point for the psoas is on the lateral side of the vertebrae. By leaning away from the hip being stretched, you are actually moving the proximal origin of the muscle further from the distal insertion. That’s a good thing, right? The short answer: yes. The more complicated answer: if you are performing the other components of a proper hip flexor stretch affecting the spine and pelvis in the sagittal plane and you still aren’t feeling a stretch, the flexibility of your hip flexor probably isn’t limited enough to warrant stretching it in the first place. With this rationale, the contralateral sidebend probably isn’t warranted. However, if you find that no matter what you do, you are unable to figure out how the heck to “tilt your pelvis back”, you may need to employ this strategy.
There are three key factors in achieving proper form for this stretch. I like to do each one in sequence to make sure you put them all together correctly.
Position – The first is a good initial starting position. Get set up with one knee down, ideally on a pad of some sort to take the stress off the anterior knee, with that foot and/or heel pressed up against a wall (more on this later). This is the hip you will be stretching. Your other foot should be planted flat on the floor with that knee bent to about 90°. This is known as a half-kneeling position.
Pelvic Tilt – The second key is to rock your pelvis back to achieve a posterior pelvic tilt. This can be difficult for a lot of people who are not familiar with how to move their pelvis. If you are just learning how to do this, it is actually easiest to do in a hooklying position, lying on your back with knees bent. I find it best to start with a neutral pelvis, then rotate it back and forth, alternating between anterior and posterior pelvic tilts. I like to place my thumbs on the front of my pelvis, at the bony anterior superior iliac spine. Just practice rocking back and forth. An “anterior pelvic tilt” will result in an arched back, with your belly button raised up toward the sky. Conversely, a “posterior pelvic tilt” will result in your stomach drawing in and your back flattening against the surface you are lying on. Once you get the hang of this, you can do this in the half-kneeling position described in the first step. Rock your pelvis back so your lower back flattens, and the front of your pelvis is brought up towards your belly. This will create relative flexion of the lumbar spine, bringing the proximal origin of the psoas further from the distal insertion. By now, you should already be able to feel at least a small stretch in your hip flexor if it truly warrants stretching.
Activation – The final piece is active contraction of both the glutes and the abdominals. The easiest way to flex your glute from this half-kneeling position is to push that foot backwards into the wall or other object you’ve placed it against to isometrically activate your hip extensors. This glute activation actually serves two purposes. First, flexing your glutes will enhance the posterior pelvic tilt by pulling downward on the posterior portion of the pelvis. In addition, by contracting these muscles responsible for extension of the hip, you are also employing what is known as reciprocal inhibition of the hip flexors, making it easier to lengthen them. Contracting your abdominals is also relatively easy in this position, since you already need a good amount of it to tilt your pelvis back. If you want to strengthen the core activation, you can press your hands down on your other knee. This engages the lats and further recruits your rectus abdominis (the 6-pack muscle).
Duration, frequency and intensity are all major factors when it comes to most principles of exercise. Stretching is no different in this regard.
Stretching duration is an important parameter that must be addressed in a proper stretching protocol. The length of time that people hold a stretch vary greatly. Some people hold for 10 seconds, others hold for 30 seconds, and others hold for multiple minutes. Technically the duration can depend on your goals. However, if true collagen lengthening is your goal, the sweet spot is right around 40 seconds. Collagen can continue to lengthen for up to a 2 minute hold, but the “bang for your buck” decreases after 40 seconds. 40 seconds appears to be superior to 30 or less, but the difference between 40 and 120 seconds may not be worth holding for an additional 80 seconds. Also, I’m not sure the last time you tried to contract multiple muscles for 2 straight minutes, but you would probably wind up pretty fatigued by the end.
Depending on how restricted your muscles are, you may need to stretch anywhere from 3-4x/week to 2-3x/day. Someone on a maintenance program may only need to perform this stretch a few times a week to keep up with their flexibility. Another person who has active impairments from restricted hip flexors or who sits for long periods of time because of work or an inactive lifestyle may need multiple stretching sessions in a single day. Again, it all depends on your unique situation.
Last but not least is intensity. Although this is technically referred to as “passive stretching”, this stretch should be anything but passive. The true goal of stretching is to lengthen the collagen that makes up muscles and tendons. Collagen deforms in response to stress and stretch. With that said, if the tissues begin to lengthen during the duration of this stretch, you will need to move further into the restriction to continue to impart the same stress on the tissues. As you feel these muscles and tissues free up, you should continue to contract and push the limit of stretch, so you are always on the edge of tissue resistance. This will provide the stimulus for the most effective and efficient stretch possible.
So now you have the ingredients for an effective hip flexor stretch. Go forth and conquer those tight hip flexors!
About the Author – Patrick Gilbert PT, DPT, ATC, CSCS
Patrick is a physical therapist, athletic trainer and personal trainer. He runs Summit Performance and Therapy in Indianapolis, Indiana. He has been training clients of all backgrounds for years and has been a practicing physical therapist since 2016. His training philosophy combines his knowledge of rehabilitation as well as strength and conditioning in order to train clients to achieve great results and avoid injuries in the process. His physical therapy practice focuses on a three-dimensional view and treatment of the body and its many parts. Treatment emphasizes manual techniques and rehabilitative exercises to get patients back to previous activity levels without pain or dysfunction.
For more information about training or rehabilitating with Patrick, contact him at SummitPerformancePT@gmail.com or visit SummitPerformancePT.com