WHY BASIC HIP FLEXOR
STRETCHES DON’T ALWAYS WORK

Do you do a daily stretching routine only to find that your muscles tighten back up throughout the day? Do you consistently stretch your hamstrings only to find they continue to feel tight? Many stretches focus on individual muscles, but we must remember, the body works as a unit. It’s the relationships between the various muscles and joints throughout the body that must be addressed if we want to create and maintain flexibility.

THE ILIO-PSOAS MUSCLE

One of the keys to good alignment, muscular integrity, and reducing tension throughout the body is restoring function to the primary hip flexor. The psoas is considered the fillet mignon of the human body. They often call this muscle the ilio-psoas, as the iliacus and psoas have such an integral relationship.

The psoas is the only muscle that connects the upper and lower body; therefore, it can have multiple effects on posture, stability, and function. As you can see in the diagram below, the psoas attaches to the lumbar (lower) spine and winds through the pelvis before attaching to the femur (the large thigh bone). Many people complain of tight hip flexors, but this is not a muscle that is easily stretched or realigned due to its attachments both on the front of the hip and at the lower back. It can be done effectively however, as I will explain later in this article.

So, why doesn’t stretching the hips release tightness in this muscle? As I mentioned, it’s tricky to stretch the front of the hip without also influencing the attachments on the posterior side of the body. Furthermore, the attachment of the psoas on the femur (your leg bone) is influenced by the position of your knees and feet. Think about it like this…. If your knees and feet turn out which we see quite frequently, how will this influence the hip flexor? Stretching won’t alleviate the tension until you change the “position†of these other joints as well. And let’s not forget the attachments at the lower back. How will this influence the rib cage and upper body musculature?

The Tower

One of the only exercises I’ve found that truly resets the primary hip flexor utilizes a device called The Tower. “The Tower” mainly addresses the ilio-psoas musculature, but in doing so, also affects all the muscles into the spine and shoulders as well as the legs and feet. 

This excerpt explains how the tower is influencing the entire kinetic chain, but don’t fret if you get lost in the technicality of this explanation. The video below gives a fantastic illustration.

In the tower, the 90-degree, dorsi-flexed, straight position of the foot impacts the position of the femur at the knee and hip. As the femur is forced back to its neutral position, the pelvis is then able to rotate over the femur as it’s intended to. Simultaneously, the mid-back and shoulders let go as a reaction to what’s happening in the lower body. Gravity promotes thoracic extension, as the floor prevents the upper body from going into flexion or rotating. As a result, the shoulder blades can return to a more functional position. This chain reaction influences the curves of the spine allowing the lower back to let go and the upper back to extend, while decreasing rotation and disparities in the pelvis, and re-educating the proper position of the hips. Furthermore, with one hip in extension and one in flexion, we are able to separate the function of the hips. This re-education of hip separation occurs without the ability for the upper body to compensate. It takes each hip individually from flexion to extension which is required for proper gait mechanics. The top levels of the tower mainly affect initial contact in the gait. Terminal stance is being impacted toward the bottom levels. Ultimately the tower will allow the hip to function as designed, in flexion and extension, rather than adduction or abduction, as the pelvis rotates back over the neutral femur and returns to its functional position.

Click HERE to watch a video of the inner workings of the body in the tower. This is a fantastic illustration of what the tower accomplishes.

THE ANTERIOR PELVIC TILT

with FEET THAT POINT OUT

Hopefully that video helped to clarify the body’s response to the tower, but to further demonstrate I’m going to give a specific example of how the tower may influence the common posture of the person who stands with their knees and feet turned out.

In a case like this we say the “femur” is externally rotated. People with this all-too common posture no longer walk with their primary hip flexors. Instead, they are forced to compensate for the lack of proper hip function by also recruiting secondary hip flexors (such as the adductors) due to the dysfunctional position of their knees and feet. They are basically walking with their inner thigh muscles, which are not primarily designed for forward motion. Furthermore, when the feet and knees turn out, this will affect the gluteal (butt) muscles. The glutes will consequently tighten up, as they are an external rotator. So, now we not only have tight hips, but also tight glutes! The hip flexor can no longer flex and extend as designed, due to the dysfunctional joint position. This will cause dysfunctional gait patterns and ultimately pain until we restore proper alignment.

In some cases, when the femur is being rotated externally by strong tight hip flexor muscles, it also put the pelvis in an anterior pelvic tilt as seen in the picture below.

Pete Egoscue describes this posture as Condition 1 “The anterior pelvic tiltâ€. Here is an excerpt from his book “Health through Motion” to describe this posture:

“Keep in mind that the body is a unit and that the body is linked functionally from head to toe. The anterior tilt of the pelvis is often caused by the strong, tight hip flexor muscles and puts excessive arching into the low back. The more a person walks with the tight hip flexors, the more they pull down on the spine and exacerbate the problem. To relieve the tension on the spine, the upper back rounds – taking the shoulders forward – and the head tilts downward. To relieve the tension in the hips, the femurs externally rotate, taking the knees and feet outward. This is a formula for pain up and down the body.”

For people with an anterior tilt and external femurs, the tower can be an effective exercise. Under optimal conditions, it will allow the femur to rotate back to a neutral position by holding the foot at 90 degrees. As the muscles relax and the femur position becomes more functional, it allows the pelvis to return to its neutral position and come out of the anterior tilt. This decreases lordosis (the excessive curve in the lower back). This chain reaction up the body relaxes the curve of the upper back and shoulder muscles taking the spine out of kyphosis (a term for excessive curvature in the upper back). This whole reconnection of the kinetic chain can help to remind the hips how to function correctly again and reposition the other load bearing joints unlike a basic hip flexor stretch.

So now do you understand why “just†stretching the flexors may not give you the long- term relief you are looking for?

When our hip flexors are tight, we can’t just stretch this individual muscle, because the rest of the body needs to be addressed, as it’s been compensating for the dysfunctional position of the pelvis causing the tight hip flexors.

HOW TO USE THE TOWER

Click on the picture/video below to find out more about The Tower, how to set it up, and what to look for at each level. In many cases, your therapist may prescribe shoulder exercises to be performed at each level of the tower in order to release the scapula and thoracic back, allowing for a better hip release. They will most likely also prescribe corrective exercises to be done prior to the tower as well as after to stabilize the more functional pelvic position.

SHOULD EVERYONE USE THE TOWER?

A quick word of warning: In rare cases, such as someone with extreme knee hyperextension or excessive torque from the femur to the lower leg bone (tibia), the tower can cause some discomfort in the knees. If you experience knee pain in the tower, your therapist may prescribe some exercises to be done prior or choose a different exercise.

Another diagnosis that requires consideration before using the tower is hip degeneration. Although the tower can be very beneficial in many cases of hip degeneration, staying toward the top levels when beginning so as not to aggravate the symptom may be advised. This also may apply to people with severe stenosis or spondylolysthesis.

If someone has a posterior tilt, a therapist may advise placing rolled towels under the neck and lower back to help to re-educate the body to find its neutral S shape curve. They may also advise using only the bottom level of the tower. This may also be recommended for people with internally rotated femurs.

One final thought: If you have a severe hip rotation or pelvic disparity and are having issues with the tower, another exercise called the double pedal may be an option your therapist suggests. This device locks both feet in the tower. In doing so, it traps the hips, femur, and pelvis in a bilateral position without the hip separation the tower provides, so as not allowing for any rotation. It is still typically advised to progress to the single pedal tower and allow for the separation of the hips, once the rotation is reduced.

In my personal experience, when I first used the tower I experienced some minor issues, but by integrating a few scapular release exercises at each level, and adding some corrective exercises both before and after the tower, I’ve regained more function to my body than I EVER dreamed possible. 

As with any exercise, first and foremost, LISTEN to your body. Not “every” exercise is good for every “body,” and often a sequence of exercises to set you up for the tower and restabilize the body in neutral after the release is important.

If you are interested in experimenting with the tower, feel free to contact me at [email protected] or www.alignedfit.com and I’d be happy to answer any questions or introduce you to this transformative hip flexor release. 

Lisa Decker M.S.

PAS, CES, PES, CPT, CAMQ

www.alignedfit.com

[email protected]