Josh Sainsbury
03 April , 2020
Struggling to stand up straight away after you’ve been sitting? Are you suffering from stiffness or pain in the front of your knees, side of your hips or even your lower back? These things can all be due to reduced mobility through your hips.

The hip joint is the second most mobile joint in your body – a ball and socket joint compromised of the “ball” which comes from the top of the femur, or thigh bone, and the “socket” which actually is part of your pelvis. Many muscles and ligaments attach around the joint giving us the strength and power we need to move, but also often resulting in the problems of stiffness and pain we experience.

“…Some of the biggest culprits in causing stiffness and pain in this region are your hip rotators, hip flexors and hip adductors..”

Josh Sainsbury – Musculoskeletal Physiotherapist

Some of the biggest culprits in causing stiffness and pain are your hip rotators (piriformis), hip flexors (iliacus and psoas major) and hip adductors (brevis, longus and magnus). Our hips have a huge influence on how we move over multiple areas of the body.

Further down the chain, the knees can become affected due to tightness in the hip adductors and hip flexors and a weakness in the lateral gluteal muscles (notably gluteus medius and minimus). This allows the hip to rotate inwards resulting in the knee ”falling in” towards the midline instead of staying over the foot. Most commonly the structures on the inside or medial part of the knee are placed under more stress. As the knee “falls in” the knee cap can fall victim to maltracking as the iliotial band (ITB) and thigh muscles pull it in the opposite direction. (See Pic 1 – lunge)

As the knee turns inward, the kneecap is pulled outwards by the Iliotibial band (ITB) and other outer quadricep muscles and upwards by the rectus femoris (a hip flexor), causing discomfort as it moves in a non-optimal pattern over the femur.

More centrally, if there is tightness in the hip flexors from prolonged sitting, as we stand this tightness can cause the pelvis to tilt slightly forward. We then often see the muscles in the lower back try to compensate for this, trying to “pull ourselves back upright” almost fighting the hip flexors. This brings us into an “anterior pelvic tilt” which can cause localised lower back pain from the muscles that are overworking.

Check out our blog on the lumbar spine and our Lumbar Lockdown Loosener video series video if you think you might be having problems in this area, or better still get in touch and we can assess this for you and make sure you have the correct program of exercises (link here with our phone number of email)

In order to prevent hip stiffness and a potential multitude of other issues in the back, knees and hips, these exercises below are designed to improve flexibility in these areas. Take a look at these and if appropriate you can try some of them.

Hip Rotator Stretch – Piriformis
There are two versions of this stretch.

  1. Supine piriformis stretch – bend the knee up into the midline in line with your nose, and grasp with your hand. Grasp the lower leg and whilst keeping the knee in the midline, bring the foot slowly around towards you. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs
  2. The 90/90 stretch is a more progressive way of stretching the muscles. Adopt this position and then slowly lean forward until you feel a stretch in your gluteal region. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs

Hip Adductor Stretch
There are two versions of this stretch.

  1. Trikonasana or triangle pose is often used in yoga routines. This stretch targets the inner thigh, stretching it on the front leg. Keep both knees straight and support yourself with one hand on your front knee, shin or thigh and the other arm should raise up towards the ceiling to feel the stretch along the side of your body as well (an added bonus). Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs
  2. Standard abductor stretch. Stand with your feet apart and then bend one knee and lunge to that side. You should feel the stretch in the straight leg. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs

Hip Flexor Stretch
This stretch can be done in a standing lunge position or a kneeling position, whichever you prefer. Try both and see which one works best for you.

  1. Kneeling – once kneeling as below, place your hands on your hips and squeeze your buttocks (like in a backward pelvic tilt). Hold this squeeze and you transfer your weight forward onto the front foot. You should feel the stretch in the front of your hip and thigh. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs
  2. You can progress this exercise by raising the arm above your head on the stretch side and slightly tilting your upper body away> This will give you a lovely stretch right down the side of your trunk. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs
  3. Standing – once in the step lunge position you can repeat the above steps to achieve the same stretch in this alternate position. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs

Quadriceps & Lower Hip Flexor Stretch
This stretch is done while standing. Bend your knee up behind you and grasp hold of your foot or ankle. Make sure your knees stay together and the stretching side knee is pointing straight down to the floor (not out to side or to the front). To increase the stretch, gently squeeze your gluteal muscles. Hold this stretch for 30 seconds. Repeat on both sides 2-3 times. Alternatively hold once for 60 secs

To see me putting myself to the test with these stretches, take a look at our social media pages – Instagram & Facebook where I’ll take you through the 90/90 position stretching and an extra flow to target the adductors, hamstrings and hip flexors all together!

Important Note:
These stretches are of course a general guide to improving and maintaining mobility. If you’re experiencing any significant pain and discomfort you should contact your physiotherapist or other health care practitioner for advice. You can also contact us here at Vanbrugh Physiotherapy for more information on how we can help.

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