Key takeaways
- Cycling, walking, hiking and stair climbing all work the hip flexors repeatedly.
- The psoas, one of the main hip flexors, attaches directly to the lower spine, so when it's tight it pulls on your back.
- Tight hip flexors can cause lower back, SI joint, groin or outer knee pain, and trouble standing up straight.
- Stretching, soft-tissue work and the right exercises usually help.
When gyms closed during the pandemic, many people turned to home workouts, yoga, Pilates and, of course, stationary bikes. Since then, many of the patients coming to us with lower back pain have shared something in common: they had recently increased their cycling, at home or on the road, along with walking, hiking or stair climbing.
These activities repeatedly work and tighten one particular group of muscles. Most of my patients had no idea. That group is the hip flexors.
What are the hip flexors?
The hip flexors bend the hip, bringing the front of your thigh toward your body. On a bike, they're working every time you lift your leg to get ready for the next push on the pedal. The main hip flexors are:
- Psoas - attaches to the front of the lumbar vertebrae (L1 to L5), crosses in front of the sacroiliac (SI) joint and connects to the top of the thigh bone
- Iliacus - lines the inside of the pelvis and joins the psoas at the thigh
- Tensor fasciae latae (TFL) - runs from the front of the pelvis into the IT band on the outside of the thigh
Because the psoas attaches directly to the lower spine, a tight psoas pulls on your lower back every time you stand up.
Signs of tight hip flexors
- Lower back pain, especially when standing up after sitting
- Sacroiliac (SI) joint pain
- Groin pain
- Pain on the outside of the knee
- Difficulty standing up straight
Patients describe it anywhere from a dull ache to a sharp, stabbing pain, and some describe a burning or crushing feeling in the lower back. Stair climbing, elliptical machines, hiking, running and sports like soccer can tighten the hip flexors too.
How do you treat it?
- Soft-tissue work - massage, myofascial release, Active Release Technique, Graston technique, and foam or stick rolling to release tight muscle
- Stretching - daily hip flexor stretches, like the kneeling lunge stretch in our home exercise videos
- Home exercises - a regular routine to keep the hips flexible and the core strong
- Inversion or decompression - in some cases, gentle traction can take pressure off the lower back. Inversion isn't safe for everyone, including people with high blood pressure, glaucoma or heart conditions, so ask first.
You don't have to give up the bike. Check your seat height, take breaks on long rides, and make hip flexor stretches part of your routine.