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Lower Back Pain? It Might Be Your Hip Flexors

by Dr. Davina, L.Ac., DAOM.

Lower back pain is one of the most common conditions affecting people today.

Between sitting at the office, sitting in the car, and sitting at home, we put a lot of strain on our lower back. People often stretch or massage the back directly, but could it be the hips?

This blog will give a quick review of the hip flexors, its impact on health, how it is impacted by stress, then how to get it better, through self-care, and how we might treat it with acupuncture and massage.

The Hip Flexors

Hip Flexors Diagram - Hip or Back Pain?The hip flexors include two muscles, the Psoas and Illiacus.

When contracted, these muscles lift the leg, or conversely, bend us over.

Both insert into the top of the femur, then the Iliacus muscle connects to the ridge of the pelvis, while the psoas connects to the lower back, usually up to L2, though it can also connect into the diaphragm.

The Psoas is the muscle we mainly focus on for lower back pain.

Since it connects into L2, when the psoas is tight, it will pull the lower spine – the lumbar region – forward, contributing to poor posture and lower back pain. Even when the issue is within the back itself (slipped disc, spinal issue, etc.), releasing the hips often significantly improves lower back pain.

Additionally, the hip flexors on one side are often tighter than the other, which pulls the leg up into the hip, leading to uneven leg length. This can lead to a tilt in the pelvis and a compensatory counter tilt in the shoulders, which can contribute to pain in the hip, low back, shoulder, and neck.

Before Treatment - Hip Flexor
Before treatment: Left leg is substantially shorter than right

After Treatment - Hip Flexor

After Treatment: heel length is equal

The Hip Flexors and the Stress Response

Tension in the hip and flexors is also commonly associated with emotional stress. The hip flexors are major muscles of movement and are primed for motion by the ‘flight or fight’ response. Yet, they also pull the knees into the stomach to curl us into a fetal ball when the ‘freeze’ response is activated. Thus, relieving chronic stress can help the psoas muscle to relax.

One of the easiest ways to do this is deep relaxed breathing, like that done in yoga, taichi, or qigong.

For this type of meditative breath, you should breathe all the way down into the pelvis. If you place your thumbs in the belly button, and cross your hands over the lower abdomen, you should feel your tummy expand all the way to this area when you breathe in, and should feel your hands sink in as you breathe out.

Deep breathing like this will both alternately stretch and compress the psoas muscle as well as activate the vagus nerve. The vagus nerve is the “rest, digest, and recover” system that acts to counter the “flight, flight, or freeze” response, both relaxing the muscles itself, and the body overall.



There are several stretches that can help keep the hip flexors loose and flexible. The primary stretch is done in a lunge.

When doing the lunge, it is important to keep the feet at a shoulder width distance when stepping forward. It can be useful to practice where there are lines on the ground such as a tile or hardwood floor.

Start with the feet shoulder width apart. Turn the back leg to 45°,  and align the forward foot to a line, then when you step forward into a lunge, make sure your front foot follows this same line. Square the hips to the  front and move your pelvis forward into the stretch. You should feel the stretch in the lower hip of your rear leg.


There are several acupressure points that relax and release the hip flexor.

The easiest to find is the psoas release point found near KD 4.

To find the point, make a line from the tip of the  inner ankle and the tip of the heel, then about halfway in between these two points, massage around until you find an especially tender spot. Massage it in a circular motion for 30-60 seconds. Kick the hip a few times to release, and check that the hip feels looser. If not, massage the point again.

Hip Flexor Acupressure Release Point

Acupuncture and Massage

Of course, if pain worsens or persists, it’s always best to see an expert.


Direct massage on the psoas is very uncomfortable, and is often quite painful, especially if the hip flexors are tight. I prefer to avoid this and opt for more comfortable techniques. The two main techniques I use are leg pulls and muscle shortening.

For leg pulls, I would check the length of the ankles, massage the psoas release point, then pull the leg until leg lengths even out.

Muscle shortening, sometimes referred to as strain-counter-strain or positional release, is essentially the opposite of a stretch. In this technique, I would bring the two ends of the hip flexors together, thus shortening the muscle. After about 90 seconds, the brain resets the muscle tone of the shortened muscles, painlessly releasing tension in this sensitive region.


Acupuncture is very effective for pain and inflammation, anywhere in the body, which naturally includes the psoas. Treatment would usually consist of several points specifically for releasing the psoas, combined with general points that improve circulation and reduce inflammation.

Many Lives Chinese Medicine
Acupuncturist Redwood City
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