It's all in the hips - How to deal with pain or pinching in the hips
Lately, it seems that most of the patients walking through our door are doing so because they are experiencing hip pain with movement or activity. The next few posts will shed some light on the anatomy of the area, and things we commonly see that cause people’s hip pain – and best of all, things you can do to get rid of, or prevent hip pain from occurring.
To begin with, let’s look at the area and get a basic understanding of the involved structures. The hip joint is the articulation between the femur (thigh bone) and the pelvis. The three bones that comprise our pelvis (ischium, ilium, pubis) come together to make a socket called the acetabulum, which is what the head of the femur fits into. This arrangement provides a lot of stability for the hip joint, while still allowing a generous range of motion. There are very robust ligaments, which help to stabilize this joint.
Lastly, we need to look at the muscles surrounding the area. Today we’re only discuss one, but it is arguably the most important. The psoas is probably the muscle you think about the least, but may be causing you the most grief. The psoas combines with the iliacus muscle to become the iliopsoas, the prime mover for hip flexion – that is, when we bring our leg up off the ground in front of us (as in walking, running, and basically any other movement) the iliopsoas is doing the bulk of the work.
The psoas muscle is unique because of its attachments to the spine and the femur. This means it can influence not only hip pain, but back pain as well. When we sit, the psoas is in a shortened position because our leg is flexed. If we sit for long enough, we can develop a psoas contracture. This means the psoas wants to stay in this shortened position. When we do get up and try to move around, the shortened psoas causes all kinds of biomechanical changes. It can increase the curve of our low back, placing excess stress on the spine, it can draw the femur forward in its socket causing pinching in the hip, and it can tilt the pelvis causing widespread changes in the way we move.
So what can you do about this? Well, to start with, there are some stretches you can do at home. As with any stretch, the goal is to put the muscle in a lengthened position. Because of the orientation of the psoas, in order to do this effectively, a few things need to happen. The picture below demonstrates a great stretch, but there’s more going on than you may realize at first glance so we’ll walk through it together. To start with, find a mat or another comfortable but firm surface, then get into a lunge position with the targeted leg extended behind you as in the picture. Once you’re in the position, you want to try and drop your pelvis towards the ground on the targeted side. This will further lengthen the psoas. Lastly, take your arm on your targeted side, and reach overhead and towards the opposite side. Hold this stretch for no less than 20 seconds. Relax, take a few breaths, and repeat 2-3 times. Perform it on both sides even if only one hip is bothering you to keep things balanced.
That stretch is a great place to start, but the psoas muscle is often a stubborn one and may need some more intensive soft tissue therapy to help it return to a normal state. Some practitioners ignore this muscle because it is difficult to palpate and treat due to its location in the body, however they are doing their patients a great disservice. With proper technique, the muscle is easier to treat than you may think given its orientation. ART® is a great way to effectively lengthen the muscle and increase the relative motion between the psoas and the surrounding muscles and nerves, decreasing pain, and improving function.
If you spend a lot of time in your car, at your desk, on your bike, or just sit more than you’d like to, and suffer from hip pinching/pain or back pain, try incorporating the psoas stretch into your daily routine. If you’re unsure of what’s causing your symptoms, or you’re up against a stubborn muscle, reach out to us and we’ll help you figure out what’s going on.
Dr. Lee Brotherston
Partner and Chiropractor at
Oak Ridges Health Group
58 Brock Street W, Suite 201
Uxbridge ON, L9P 1P3
Liebenson, C. (2014). Functional training handbook (1st ed.). Philadelphia: Wolters Kluwer Health.
Moore, K., Dalley, A., & Agur, A. (2006). Clinically oriented anatomy (1st ed.). Philadelphia: Lippincott Williams & Wilkins.
Vizniak, N. (2012). Muscle manual (1st ed.). [S.l.]: Professional Health Systems.