04/04/2025
Dysfunctional hip flexors are a common malady I see in my manual therapy practice. Weak hip flexors can present with a myriad of different symptoms. Letās unpack it.
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Generally, when weāre talking about the hip flexors, weāre referring to the section of the quads closest to the trunk of the body. If that section of the quad has failed, the athlete will lose their capacity to drive the knee forward. Without that knee drive, the lower leg will tend to compensate by either swinging out and around, causing pain and tension on the inside of the knee, or back and around causing pain on the outside of the knee.
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The first muscle that tries to take over is the TFL. Once this guy takes over, it tends to recruit the outside quad, the vastus lateralus, to assist. This combo usually presents as pain in the TFL, however, as this compensation persists, that pain can symptom will begin to present as pain on the outside of the knee as well. The TFL in combination with the glute med blend into the IT band. If the dysfunction is not addressed, it can begin to present as IT band syndrome as well. In a rare case that Iāve seen, this dysfunction can ultimately lead to femoral nerve entrapment, which also presents as IT band syndrome.
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Next up is the Psoas. The attachment point of the Psoas as you can see in the photo provided is high on the inside of the femur making it a wildly inefficient hip flexor, if it is being recruited for hip flexion, itās generally working in conjunction with the TFL to pull the hip into flexion. Dysfunction as it pertains to the Psoas usually presents as low back pain on the opposite side. However, it can present as pain in the high in the adductors or in the crease of the hip.
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Last but not least, we have the Illiacus. This muscle often presents as low back pain on the opposite side as well. If youāve gotten to the point where this muscle has taken over, your hip flexors have been checked out for a while.
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Iāll be posting an easy solution to make your hip flexors more robust tomorrow. Stay tuned!