Recovery Series: Correcting Tight Hips

Did you just kill leg day? Are you a rucker or a runner? Does your job require you to sit most of the time? Chances are high that for any of these reasons (along with any number of others), you've found your range of motion lacking in your hips. You may even feel how tight they are in your movements, or found that your low back is suffering due to the pull from your consistently static position (sitting) or through constant activation (training). One thing is for sure: I see the consequences of tight hips day in and day out with fellow athletes as well as clients. I make recommendations consistently on what should be done to ameliorate the problem, but felt it best to share everything in a full-on recovery series covering different areas of the body starting with this very prominent issue. Let's get started.

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HIP MUSCLE ANATOMY

Before we get into the nitty gritty about what you can do to loosen up and strengthen your hips, let's get a visual about what the muscles are so we can pinpoint trouble areas.

The iliopsoas (that is, the iliacus and psoas together which share a common insertion point in the hip complex) is very commonly the region that is most often the "tight" hip flexor. This grouping attaches to the top of the hip and to the spine and is a common trigger of low back pain. Because the psoas attaches to the spine, this muscle also plays an integral role in lumbar spine stabilization.

The tensor faciae latae (TFL) inserts onto the IT band, so if you have had tight IT band problems you also need to take care of this area of the hips as it's also going to be terribly tight.

If you've ever had sciatic pain, you may have impingement from a tight piriformis as the sciatic nerve passes through this muscle. The piriformis stabilizes the hip join and lifts/rotates the thigh away from the body. It allows us to walk, shift weight from one foot to the other, and maintain balance.

The gluteus maximus is one of the strongest muscles in the human body and is one of the primary movers in running. The gluteus medius is a dynamic pelvic stabilizer, meaning it holds the pelvis in a neutral place during strides -- this muscle gets tight particularly in female athletes. The gluteus minimus assists the piriformis in external rotation of flexed thighs, assisting in balance.

The adductors are fan-like muscles in the upper thigh that pull the legs together when they contract and help stabilize the hip joint. They are part of the grouping generally called the groin muscles: adductor magnus, adductor longus, adductor brevis, pectineus and gracilis. Men in particular often have chronically tight groin musculature.

An additional hip flexor which is often forgotten is the rectus femoris, which is one of the anterior quad muscles. Its origin point is attached to the pelvis, making it a hip flexor which must be addressed in any treatment of tight hips.

Each of the many muscles in the lumbo-pelvic hip complex has a slightly different function which you may or may not be able to pinpoint in your daily movements. Together they allow the flexion of the hip joint, the rotation of the pelvis and the extension of the lumbar spine and are an important part of injury prevention and daily activity, regardless of whether you are an athlete.

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TESTING YOUR RANGE OF MOTION

Let's assess the flexibility of your lumbo-pelvic hip complex. The Thomas Test is quick and easy.

1. Begin on the edge of a bench, box or treatment table.
2. Lie back holding one knee toward your chest (but not pulled all the way to your chest). Your low back needs to press against the surface you are lying on.
   1. Does the thigh reach full extension? If there is a gap between this thigh and the surface you are lying on, then your thigh is NOT at full extension. This indicates hip flexor tightness.
   2. Is the knee able to bend to 90 degrees without the thigh raising? If the knee CANNOT flex to 90 degrees without the thigh rising, the rectus femoris is tight. If the knee can flex to 90 degrees without the thigh rising BUT the thigh still doesn't reach full extension, the illiopsoas is tight.
   3. Does the thigh migrate laterally? If so, the TFL and illiotibial band is tight.
3. Repeat with the opposite leg, as you may have more flexibility in one or the other limb.

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RELEASE TENSION

Your first task once you've identified what's tight is to release the tension locked up in those areas. You may not be able to perform all of these initially, so start with the movement you can execute with the best form. As you progress with daily work on the same areas, your flexibility and range of motion will increase and you can progress to more challenging stretches.

KNEELING HIP FLEXOR STRETCH

• Begin by stepping forward into a lunge on a mat or foam pad. Continue until your knee is resting on the mat or pad, making sure that your front leg is at a 90-degree angle with the knee tracking directly over your foot.
• Reach your arms overhead and clasp them.
• Drive your hip forward and your knee into the mat or pad.

LUNGE WITH OVERHEAD REACH

• ​Begin by stepping forward into a lunge. Your forward leg should be bent at a 90-degree angle to the ground with your knee tracking directly over your foot.
• Reach your arms overhead and clasp them.
• Drive your hip forward and your back knee downward. This variation allows for a potentially deeper range of motion.

LIZARD POSE (UTTHAN PRISTHASANA)

• ​From downward-facing dog (adho mukha svanasana), exhale and step your right foot forward between your hand, aligning the knee over the heel.
• ​Lower your left knee to the floor.
• Sink your weight down into your hips, keeping the weight distributed evenly. If you feel comfortable, lower down onto both forearms. Keep your chin lifted and your chest open.
• To sink deeper into this pose, curl your left toes under and press up into the ball of your foot. Actively lift the inner left thigh and press the left heel back while reaching the chest forward.
• Repeat on the other side.

LOW LUNGE (ANJANEYASANA)

• From downward-facing dog (adho mukha svanasana), exhale and step your right foot forward between your hand, aligning the knee over the heel.
• Lower your left knee to the floor.
• While keeping the right knee fixed in place , slide the left back until you feel a comfortable stretch in the left front thigh and groin. 
• Turn the top of your left foot to the floor.
• Lift your torso upright and bring your arms up overhead, perpendicular to the floor. Draw the tailbone down toward the floor and lift your pubic bone toward your navel. Lift your chest.
• Repeat on the other side.

PIGEON POSE (EKA PADA RAJAKAPOTASANA)

• Begin on all fours on a mat. Bring your right knee forward and place it behind your right wrist. Place your ankle in front of your left hip. The more parallel your lower leg is with the front of the mat, the more intense the stretch.
• Slide your left leg back, straighten the knee and point the toes. Make sure your leg is behind your body (rather than moving outward) and your heel is pointing up toward the ceiling.
• Draw your legs in toward one another to keep your hips square.
• Lower yourself down slowly, using support under your right buttock if needed in order to keep your hips level.
• Draw your navel in, tailbone down, and open your chest. Hold for several breaths.
• Repeat on the other side.

RECLINING PIGEON POSE (FIGURE 4 STRETCH)

• Begin by lying on your back with your feet hip-distance apart on the mat. Lift your right leg, bend your knee, and flex your ankle.
• Cross your right ankle over your left knee, creating the shape of a figure-4 with your legs.
• Clasp your hands around the back of your left thigh and lift your left knee toward your chest.
• Press your right knee away from your body.
• Hold for 1 minute, then repeat on the other side.

STANDING FIGURE 4 STRETCH

• Begin by standing with your feet hip- distance apart. Lift your right leg, bend your knee, and flex your ankle.
• Cross your right ankle over your left knee, creating the shape of a figure-4 with your legs.
• Squat down as far as you can, leaning forward slightly to counterbalance, making sure that your left knee tracks over your left foot and that it does not extend over your toes.
• Press your right knee away from your body.
• Hold for 1 minute, then repeat on the other side.

PIRIFORMIS STRETCH

• Begin by lying down on your mat with knees bent. Cross your right leg fully over the left so that your right knee is crossed over the left thigh.
• Pull your right knee toward  your left shoulder as far as is comfortable and hold.
• Repeat on the opposite side.

STANDING PIRIFORMIS STRETCH

• This variation of the above offers a larger range of potential motion, and therefore a deeper stretch. Begin by finding a stable surface a little lower than hip height that you can lay your left leg on such as a table, stool, box or bench. Your right leg remains flat on the ground, toes pointing forward.
• Adjust your left leg so that it is parallel to the edge of the surface it is resting on.
• Extend both arms overhead and lean forward over your leg until you feel a good stretch in your glutes.
• Hold for several breaths and then stand up straight again. Perform several times before switching legs.

BOUND ANGLE POSE (BADDHA KONASANA)/BUTTERFLY STRETCH

• Begin by sitting on your mat with your feet hip-distance apart, knees bent.
• Relax your knees toward the  outer edges of your mat as you draw the soles of your feet toward your body until they touch each other.
• Slide your heels as close toward your body that you are comfortably able to, relaxing your arms.
• To deepen this stretch, lean your upper body forward as far as you are able.
• Hold for up to 2 minutes.

RECLINING BOUND ANGLE POSE (SUPTA BADDHA KONASANA)/RECLINING BUTTERFLY STRETCH

• Begin by lying on your back with your feet hip-distance apart on the mat.
• Relax your knees toward the  outer edges of your mat as you draw the soles of your feet toward your body until they touch each other.
• Slide your heels as close toward your body that you are comfortably able to, relaxing your arms.
• Hold for up to 2 minutes.

YOGI SQUAT (MALASANA)

• Begin by standing with your feet at least as wide as your mat with your toes turned out in plié.
• Bend your knees and drop your hips as low as you can, keeping your knees stacked over your ankles.
• Relax the weight of your hips toward the floor.
• Hold for up to 1 minute.

SIDE LUNGE (SKANDASANA)

• Face the long edge of your mat and assume a wide-legged stance with your feet as far apart as is comfortable with your toes turned out into plié.
• Keep your left leg straight and bend deeply into your right knee, leaning your weight to the right, placing your hands on the floor for balance. Be sure that your right knee is tracking directly over your foot.
• Flex your left foot with your toes pointing toward the ceiling. Keep your chest up.
• For a balance challenge, draw your palms in to meet at chest level.
• Hold for 1 minute and then switch to the other side.

FIRE LOG POSE (AGNISTAMBHASANA)

• Begin by sitting on the edge of a thickly-folded blanket or mat with your legs extended in front of you. Shrug your shoulders up and back as if tucking them into your back pockets, pressing the bottom tips of your shoulder blades into your back. Bend your knees and bring them in to your chest.
• Slide your left foot under your right leg to the outside of your right hip and lay the outer leg on the floor. Stack your right leg on top of the left. Be sure that the right ankle is outside the left knee (sole perpendicular to the floor). If this is too difficult, sit with your shins crossed in easy pose (sukhasana). 
• Hold for 1 minute and then switch.

FIRE LOG POSE, PIGEON VARIATION

• Begin by sitting on the edge of a thickly-folded blanket or mat with your legs extended in front of you. Shrug your shoulders up and back as if tucking them into your back pockets, pressing the bottom tips of your shoulder blades into your back. Bend your knees and bring them into your chest.
• Position your left leg so that your thigh is straight out from your hip and your knee and hip are in alignment. Position your shin at a 90-degree angle. Stack your right leg on top of the left in the same 90-degree angled position.
• Hold for 1 minute and then switch.

FROG POSE (MANDUKASANA)

• Begin on all fours. Keep your hips in line with your knees as you slowly slide your knees apart from each other as far as is comfortable.
• Turn your toes toward the exterior of your mat with your arches resting on the mat.
• Keeping your core engaged, relax the weight of your hips toward the floor.
• If comfortable, lower your forearms to either yoga blocks or to the floor.
• Hold for up to 1 minute.

STRAIGHT-LEG SUPPORTED BRIDGE (SETU BANDHASANA VAR.)

• Begin by lying on your back with your feet flat on the floor about hip-distance apart.
• Press down against the mat with your shoulders and feet to lift your hips off the floor. 
• Slide a rolled-up mat, yoga block or other soft prop under your sacrum (about where your waistband is) and rest the weight of your hips on the block.
• Extend your legs either one at a time or together simultaneously and hold for 1 minute.

SQUATTING INTERNAL ROTATIONS

• Begin in a deep squat position. Rotate one knee inward and downward toward the ground.
• Hold for a couple of seconds and switch sides. Perform 10 reps per side.
• This dynamic stretch can also be performed on a small stool or yoga block if you cannot squat comfortably.

CURTSY STRETCH

• ​Begin by standing with your feet hip width apart, toes pointing straight ahead. Cross your left leg over your right at the ankles, so that the soles of both feet are able to bear weight.
• Reach overhead with your right arm and push your right hip away from your body. Your upper torso will bend toward the left.
• Be sure that your shoulders and hips are still squared and facing forward -- that they are not curling over. Imagine that you are trying to fit your body between two panes of glass.
• Hold the stretch for a few breaths and then release. Perform several times before switching sides. You should feel the stretch along the side of your hip. This works the IT band and abductors.
• If it is difficult for you to balance, use a doorway or a thin pole for support.

FLAMINGO STRETCH

• Begin by standing with feet hip width apart. Bring your left foot backward, grabbing and holding your ankle with your left arm.
• Bring your knees as close together as you are able, squaring your hips and straightening your stance.
• Pull your left leg in toward your left buttock as far as you are comfortable able and hold for several breaths before returning to starting position.
• Repeat several times on the left side before switching to the right.
• If it is difficult for you to balance, extend your right arm out to counterbalance or find a stable object to hold on to (wall, table, etc).

KICKSTAND STRETCH

• Begin by standing with feet hip width apart. Bring your left foot forward with your foot flexed, so that the heel is resting on the ground and your toes are pointed toward the ceiling.
• Bend your right knee as needed and lean forward over your left leg as far as you are comfortably able. 
• Hold for several breaths and return to starting position. Repeat several times before switching legs.

SUMO SQUAT HOLD

• Begin with feet slightly wider than shoulder width apart, toes pointed at a diagonal away from your body at an angle that is comfortable for you.
• Keeping your back flat and chest proud, lower your body down with your knees tracking over your feet. Imagine that you are trying to sit down but are sideways in a narrow passageway -- your butt should not be sitting back but moving straight down.
• Press the backs of your hands into your knees as firmly as you are able. You will feel a stretch in your hip flexors.
  
• Hold for several breaths before returning to starting position. Repeat several times.

SMR: HIP FLEXORS

• Begin by lying face down on your mat. Place a foam roller or lacrosse ball in the crease of your hip.
• Apply a tolerable amount of pressure on the left hip and move slowly forward and back to roll the device. When you find a point of tension, remain still on that spot for at least 30 seconds to release the muscle adhesion (sometimes this can take up to a minute).
• For additional release, slowly slide left and right to glide the tense spot over the roller or lacrosse ball. 
• Once you have released the tension on the left hip, proceed to the right hip.

SMR: PIRIFORMIS

• Begin by sitting on a foam roller or lacrosse ball with your knees bent. If using a lacrosse ball, position it under your right buttock. Cross your right leg over your left so that your right ankle is atop your left knee.
• Lean onto your right buttock and slowly glide forward and backward until you find a point of tension. Remain still on that spot for at least 30 seconds to a minute.
• For additional release, slowly slide left and right to glide the tense spot over the roller or lacrosse ball. 
• Repeat on the left side.

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STRENGTHEN AGAINST INJURY

Once you've gotten the knots worked out of your muscles and upped your flexibility, you'll need to strengthen your muscles in order to prevent future injury. 

GLUTE BRIDGES & SINGLE-LEG GLUTE BRIDGES

• Begin by lying down on your mat with your knees bent. Bring your heels as close as you can toward your posterior. Keep your hands to your sides. 
• Lift your hips off the ground until your knees, hips and shoulders form a straight line. Squeeze your glutes and tuck your navel toward your spine.
• Hold for a couple of seconds and then ease back down.
• To perform a single-leg bridge, simply raise one leg and perform the same movement with all of your weight on the other leg. Perform all reps on one side before switching.

THOMAS BRIDGES

This glute bridge variation makes you work hard to achieve full hip flexion. You'll find you have much more glute activation.

• Begin with your back flat against the mat and your knees bent. Keep your heels as close as you can to your butt.
• Raise one knee toward your chest and hold.
• Lift your butt off the mat into full extension, as high as you can, pausing for a moment at the apex of the motion before dropping back down.
• Perform all reps on one side before switching to the other knee. 

CLAMSHELLS WITH RESISTANCE BAND

• Begin by lying on your side with legs stacked and knees bent at a 45-degree angle. Place a resistance band around both legs, just above the knee.
• Rest your head against your lower arm and use your top arm to steady your balance. Be sure that your hipbones are stacked on top of one another and are not tilted.
• Draw your navel toward your spine to engage your core. 
• Keeping your feet touching, raise your upper knee as high as you can without shifting your hips or pelvis. Don't move your lower leg off the floor.
• Pause, then return your upper leg to the starting position. Perform all reps on one side before switching.
• If this is too difficult, remove the resistance band.

SIDE SHUFFLES WITH RESISTANCE BAND

• Begin by placing your resistance band around your ankles, or just above your knees (wherever you find tolerable resistance), feet hip width apart.
• Step out to the side with your right foot, keeping your hips and toes pointing forward. Sit your butt back and keep your chest up.
• Step your left foot in, and at the same time step your right foot out again so that you travel laterally. Once you run out of space to move right, shuffle to the left while facing the same direction.
• If this is too difficult with the resistance band, perform the movement without it.

SUPINE KNEE LIFTS WITH RESISTANCE BAND

This movement activates the psoas. It is crucial that you keep your spine flat against the ground when you perform this movement.

• Begin by lying flat on your mat with a resistance band loop around both feet. Keep your spine flat against the mat at all times.
• Slowly bring one leg up as high as you can, pausing at the apex of the movement before lowering your leg back down again.
• Optimal muscle work is achieved by working one side at a time; perform all reps with one leg before switching to work the other.

hip ups

• Begin by standing with the arch of your right foot alongside the edge of a step, yoga block, box etc. with your left foot hanging off the side.
• Without moving your standing knee or rotating your hips, bring your left hip directly up toward the ceiling as high as you can, holding for a moment at the apex of the movement before releasing back down to starting position.
• Perform all reps on one side before switching to the other.

STRAIGHT LEG RAISES

• Begin by sitting in a chair, on a bench, etc, with your back straight, knees at a 90-degree angle with feet flat against the floor. Your hands should be straight along your sides, palms flat against the seat of the chair or bench.
• Extend your left leg until it is straight and your foot is flexed, toes pointing up toward the ceiling.
• Raise your left leg as high as you are able and hold for a few seconds before releasing back down.
• Perform all reps on your left side before switching to your right.

SIDELYING ISOMETRIC LEG RAISES WITH RESISTANCE BAND

• Begin by lying on your side with legs stacked and straight. Place a resistance band around both ankles.
• Rest your head against your lower arm and use your top arm to steady your balance. Be sure that your hipbones are stacked on top of one another and are not tilted.
• Draw your navel toward your spine to engage your core. 
• Raise your upper leg as high as you can without shifting your hips or pelvis. Don't move your lower leg off the floor.
• Pause, then return your upper leg to the starting position. Perform all reps on one side before switching.
• If this is too difficult, remove the resistance band.

PELVIC TILTS

• ​​Begin by lying on your back with your knees bent and the soles of your feet flat on the floor. 
• On an exhale, gently rock your hips toward your face. Your butt will not actually leave the floor but you will feel your low back press into the floor.
• Hold for a few seconds, inhale and return to starting position.

LATERAL LUNGES WITH SAME-SIDE ROTATION

• ​Begin with feet hip width apart and arms extended in front of you at shoulder height. Lunge to the right, keeping your feet parallel and your left leg straight.
• Twist your torso and left arm to the right, making sure that your hips still face forward.
• Perform all reps on one side and then switch to the other.

ROTATING PIVOT LUNGES

• Begin by standing with feet hip-width apart. Rotate to your left and take a step with your left foot approximately 45 degrees behind you. You will land in a plié squat position.
• Place your left foot next to your right foot about 12" apart from each other with the toes pointed in. Your knees will fall in slightly.
• Step back out into the plié squat position.
• ​Perform all reps on one side and then switch to the other.

SINGLE-LEG PIVOTS

• Begin by standing with feet hip-width apart. Shift your weight to your right foot and lift your left foot a few inches off the ground.
• Tap your left foot forward and then backward.
• Perform all reps on one side and then switch to the other.

DEEP AB BREATHING

• Begin by lying with your back against the floor and your feet flat against a wall, your knees stacked over your hips and bent at a 90-degree angle.
• Place a rolled up towel under your tailbone (not your back) and a book or rolled up towel under your head. Relax all of your muscles, your head, shoulders and neck, back, hips and legs. Do a quick check by touching these areas if you are in doubt. If needed, place a pillow between your knees to help your legs and hips relax.
• Place your fingertips on your low belly, a couple of inches below your navel. Inhale a deep breath, and then slowly exhale for as long as you can, emptying all of the air out of your lungs. You should feel your low belly muscles tighten at the end of this breath.
• Breathe in slowly and fully so that your belly is completely expanded, and then exhale all of your air again in this same fashion.
• This movement works your deep ab muscles which aid in breath but also assist in strengthening and releasing your hips.

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TIGHT HIP MYTHS

I couldn't finish out this article without addressing some common misconceptions about tight hips. Let's go over what they are.

MYTH #1: TIGHT HIPS ARE ALWAYS BAD

Although the hips are often the source of many pains and injuries to the low back and legs, and although I frequently recommend the above stretches and exercises to clients and fellow athletes to assist in correcting these pains, a certain degree of stiffness is required for specific forms of movement. Runners, for example, require a degree of tightness in the hips coupled with leg mobility to propel themselves forward economically. For them, although some stretching is good to prevent excessive tightness, the strengthening exercises are more important to stabilize the hips. 

MYTH #2: STRONG BUTT MEANS STABLE HIPS

One does not necessarily equal the other. The muscle that is most prominent in the glute complex is the gluteus maximus, but it's the gluteus medius that provides stability.

MYTH #3: I NEED TO OPEN UP MY HIPS

The hip joint's primary purpose is stabilization, however many types of athletes require a good range of motion as well. For weightlifters, if their hips are too tight they can't sink into a deep squat. For runners, overly tight hips shorten stride length and can slow up their pace. As with all things, finding a happy medium is the key.

MYTH #4: TIGHT HIPS ARE STRONG HIPS

Muscles can become tight from overuse and repeated contraction, but also from being under-utilized and weak. Both a long-distance runner and an office worker with sedentary lifestyle may suffer equally from excessively tight hips. 

MYTH #5: TIGHT HIPS ARE THE ROOT OF ALL MALADIES

Actually, quad dominance is more often an issue for weightlifters, runners and cyclists. When there is a discrepancy in quad vs glute strength the quads take on the task of stabilizing the hips in place of the glutes. Over time this pulls the pelvis out of alignment, strains the hamstrings and IT band and can lead to any number of issues in the low back and knees that wreak havoc on performance. Weightlifters, runners and cyclists: work on the above strengthening exercises and on releasing the tension in those quads! I'll be covering legs in another installment of this recovery series. ​