Anatomy of the Hip Muscles

The hip flexors are a group of two muscles known as iliopsoas (the illiacus muscle and the psoas muscle). They sit at the front of the hip, originating deep in the abdomen and inserting into the upper thigh. They are responsible for flexing (bending) the hip, bringing the knee towards the chest.  (And vise versa – they help to bring the chest towards the legs).

Muscle attachments (also pictured)

  • Psoas:
    • Originates from the transverse processes of lumbar vertebrae L1 to 5 and the vertebral bodies and discs of vertebrae T12 – L5 (the spinal column itself!)
    • Inserts into the lesser trochanter (inside of the thigh bone)
  • Illiacus:
    • Originates from the iliac crest (top/inside of hip bone) and the outside of the sacrum (tail bone)
    • Inserts into the lesser trochanter (inside of the thigh bone) as does illiacus


Labelled Attachment Points of the Hip Flexor Muscles


Tightness in the Hip Flexor Muscles can Lead to Pain

If you have experienced a tightness / pulling sensation directly at the front of your hip this could be tightness of the hip flexor muscles.

Common symptoms

Along with pain at the front of the hip, the most common indicator is a deep clicking sensation when you lift your leg – especially when lying down.


What does all of this mean?

Issues that are caused by the hip flexors are mainly due to their attachment into the lower back and pelvis.
If they get tight, they pull the lower back and pelvis forward.

This is known as anterior pelvic tilt (pictured below).
Simply put, this can cause compression in the lower back and stress on the surrounding structures.

Excessive anterior pelvic tilt is a postural dysfunction that can explain why you might be experiencing pain at the front of your hips… but also discomfort in the lower back.




Why do the hip flexors become tight?

A lot of the activities we do in every day living can cause the iliopsoas to shorten.
For example, sitting at a desk for work, or in the car / bus while travelling – puts these muscles in a shortened position.

Exercise such as running involves a repetitive activation of the hip flexor muscles to lift the foot and clear the ground with each step you take. As they are overused they often fatigue – which again can lead to tightness. View our article on how muscle fatigue can lead to tightness.


How can we prevent this anterior hip pain?

Stretches that place the hip flexor muscles in a lengthened position are the most effective to combat tightness developed from prolonged positions or repetitive use.

A simple version of this is the kneeling hip flexor stretch:

  • The most important focus with a hip flexor stretch is to ‘posteriorly tilt the pelvis’
  • This can be done by aiming to:
    • Lift your belt buckle towards the roof
    • Tuck an imaginary tail (on your back) between your legs
    • Picture your hip bones as a bucket of water and aim to tip the water out the back
  • This position reverses the anterior pelvic tilt (pictured above) that puts the hip flexors in a shortened position
  • There are a number of ways the stretch can be progressed: sliding the hips forward into further extension, adding upper arm movements , adding resistance bands



How can Physiotherapy help to manage this?

  • Demonstration of the mentioned stretches
  • Therapist assisted hip flexor stretching
  • Guided progression into strengthening exercises for the hip flexors and opposite muscles eg glutes / hamstrings
  • Trigger point muscle release
  • Postural retraining
  • Work environment / ergonomic set up
  • Treatment to the lower back – mobilising the origin points of the tight muscles

If you’d like an assessment on your hips or full demonstration of the mentioned stretches visit us today!