How to avoid back pain - keep your hip flexors and hamstrings healthy!

Updated: Jun 18


How they affect your quality of life Your hip flexors and hamstrings are among the most important groups of muscles in the body. They are necessary for the long term mobility and stability of your lower body. Healthy and well-conditioned hip flexors and hamstrings are key for the prevention of hip, knee and lower back issues. Acute or chronic pain in these areas can be a sign of a medical concern which should be addressed by your physician or health care professional. If the root of the pain is found to be muscular in nature, it is important for you to understand why it is occurring in the first place. When you have grasped this, you will be able to take the proper steps to correct the problem.

Not as well understood as other muscle groups Compared to some of the more prominent muscle groups, the hip flexors and hamstrings are not well understood by the general public.This is perhaps due to their lack of visibility, even when well conditioned. Their importance often comes to the forefront only when direct discomfort or pain is experienced in the area surrounding the hip joint.


Can tight or painful hip flexor or hamstring muscles affect each other? Yes, but pain in one does not necessarily lead to pain in the other. What they do both lead to issues in the lumbar region of the back. Initially, it is common to have isolated hip and/or hamstring pain due to muscle weakness and/or tightness in that area. With time however, as these areas become progressively weaker or tighter, the lower back is affected.


The hip flexor group consists of the iliopsoas, rectus femoris, sartorius, tensor fasciae latae, pectineus, gracilis, adductors and a gluteal muscles.



A case study - tight and painful left groin and left hamstring


M. is a 12 years old child. He goes to football training 2/3 times a week and has usually two games at the weekend. He presents with left groin pain and tightness in his left hamstring. When his football training is particularly intense he also experiences pain around his left heel, possibly plantar fasciitis.

On the first treatment he presented with a shorter left leg, which after assessment showed it was caused by a primary problem in his pelvis. I treated him for 5 sessions, working progressively towards releasing the gluts, the adductors, the paraspinals, the psoas and the hamstrings.


I believe the tight left hip flexors (mainly the psoas, adductors and inguinal ligaments) caused a tilt in his pelvis with consequent pull in the left hamstring, which over time started to also affect his plantar fascia.


Despite the legs length discrepancy resolved during the third and fourth treatment, it did then go back to asymmetry. On the 5th treatment I focused mainly on releasing the left hamstring. I checked M. a week after his last session and he had maintained symmetry. This to me shows that, aside the time it might take for a therapist to find the main area of dysfunction in the body (e.g. a drag in the fascial structure around a particular group of muscles) and work systematically through unfolding these different layers of dysfunction, sometimes it might also takes a few weeks for the connective tissues to be able to hold a new structural pattern. Regular maintenance treatments and targeted exercises are advised to help the body remember the more functional structural pattern and consolidate balance.


Aside an improvement in pelvic alignment and a decrease in discomfort levels around his groin and hamstring, M. also experienced a boost in his general wellbeing, with a reduction of hyperactivity, a calmer attitude and better sleep.


This leads me to consider how the psoas muscle, in particular, is directly involved in the regulation of our emotional and mental wellbeing. This particular aspect of psoas mobility and core awareness has been extensively studied over a period of 30 years by international somatic educator and author Liz Koch. Watch this space for some more juicy and experiental writings on the topic of core awareness and emotional wellbeing, with a guest article by Lee Bolton, Dance and Embodied Movement practitioner.



How hip flexor and hamstring issues contribute to lower back pain The health of your lumbar spine (specifically the L1-L5 vertebrae and discs) is directly affected by the action of the hip flexors and hamstrings. When there is an imbalance present in any number of these muscles, the lower back can easily be subject to strain and injury. It has been well established both in the literature and among health professionals that tight hamstrings are one of the primary contributors to chronic lumbar pain.


Hamstrings and pelvic tilt pain It is very rare to have chronically tight (or short) hamstring muscles and NOT suffer lumbar pain. The hamstring muscles are a group of very strong and large muscles which are often poorly maintained. It can be very challenging to keep them well conditioned, even under ideal situations. Tight hamstrings and hip flexors will often occur together. The strong pull of tight hip flexors can lead to an anterior pelvic tilt. Sometimes this happens asymmetrically, with only one side of the pelvis affected (e.g. anterior left tilt). This forward tilt of the pelvis causes an increased pull on the hamstrings which contributes to tightness of the muscle group. Another common contributor to this pelvic tilt and the related pain is the hip flexor muscle known as the Psoas (pronounced “so-as”) muscle. Unlike the hamstrings, which are not connected to the lumbar vertebrae, the Psoas is directly attached to each of the five lumbar vertebrae. The picture below shows the Iliopsoas complex, a group of muscles formed by the Iliacus and the Psoas. It is the iliopsoas muscle which has the strongest pull on our spine. It is attached to the L1-L5 and T1 vertebrae. A tight psoas can pull on the spine and compress the discs and vertebral joints associated.



The importance of a balanced pelvis

To maintain the normal and proper curvature of the spine, the muscles which are located in front and behind the pelvis must act and function in a balanced fashion throughout your daily activity. In doing this, they keep the pelvis in a neutral and safe position. This ’tilt’ is important in order to maintain evenly distributed pressure on the vertebral discs.

Bowen Technique Bristol can help with assessment and treatment of the hip flexors and hamstrings among other muscles groups involved. For a simple exercise on how to release tension in the hip flexors you can check the video in this article. Source: Active Physiotherapy and Wellness



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