You have been working out a bit harder recently (kickboxing, Nia®, Zumba®, weight lifting) and now you have hip pain that’s kind of sharp, it radiates, or it makes your hip muscles feel weak. You may worry, Is it sciatica or a pinched nerve? Should I rest? But you don’t really want to rest or seek a diagnosis right now, you just want your hip to feel better quickly so you can get back to your regular activity.
Solving this problem is rather like fixing a bland-tasting soup. (Yes, really!)
Sometimes the trouble with a healthy but bland, homemade vegetable soup is that you don’t know exactly what is missing, and you need a quick solution. I have been in this situation many times: I have the creative urge to throw together a vegetable soup, perhaps as my contribution to a potluck that is being hosted at my house. Then, Uh-oh! The soup doesn’t have enough depth of flavor, the guests are arriving, and I have only a few minutes to make it more interesting. What do I do?
Not having much time to analyze the balance of flavors, I might throw a little of everything at it: some more salt, a dash or two of tabasco, some balsamic vinegar, a bit of cracked black pepper, and maybe some Worchestershire sauce. Adding a little of each thing and tasting after each addition helps me decide which of these extra ingredients to emphasize. With some tinkering I finally arrive at, “Yes! That was it, the vinegar really perked it up, and the salt too.” This isn’t fine cooking, but it rescues the soup, and I can get on to welcoming my guests.
A similar kind of “quicky first-aid” is what I might use to address hip pain when there isn’t time for a real bodywork session. Perhaps I am responding to my own pinched nerve feeling, or I am trying to help a family member. I simply take the person through my favorite four or five hip stretches to see if we can quickly balance the tension in the hips and relieve the nerve that is likely impinged.
Each stretch works on the hips from a different angle, so simply trying them one after another can help a person decide which one or two are most needed. If the problem is primarily neural impingement in the front, back, or side of the hip, a few simple stretches can give amazingly quick relief. (If there is neural impingement where a nerve root exits the lumbar spine, additional stretching help and/or medical assessment might be needed.)
Why does this approach work? Because hips are complicated! (Fellow anatomy geeks can refer to the end of this article for a detailed explanation.) Your best bet is to experiment a little with working all the angles.
Here are the four or five stretches I would experiment with (in this order):
- “Figure four” stretch in a standing one-legged squat, or lying on the floor (for the posterior hip)
- Lunge stretch at a few different angles (for hip flexors, inner thigh, and groin)
- Bent-knee hamstring stretch, with heel on the ground (especially if you are tight) or up on a chair
- Side-bending lateral hip stretch while kneeling on one knee (for anterior lateral thigh)
- Quad stretch (can help improve nerve glide underneath the inguinal ligament)
Try each stretch for five to eight seconds, doing both sides and exploring slightly different angles as needed. (It is kind of like adding a bit of salt or a dash of vinegar, to see what works.) If you find one thing that really feels helpful, do it again, and this time experiment more with various angles of pull. And especially if it is tight, go gently into the stretch.
Remember, you are trying to free up an impinged nerve by working it free with gentleness. Imagine that a garden hose is wedged under the edge of the car tire–it usually makes things worse to yank on it. You have to pull from a different angle to get it to glide freely.
Sure, there are fancier yoga versions of these stretches, and a yoga teacher or physical therapist will be able to help you refine your approach. But these quick stretches can really help you with do-it-yourself hip maintenance or provide you with a “first-aid” remedy for nervy hip pain.
If these stretches don’t give you adequate relief from your hip pain, I would be happy to help you with some hands-on nerve mobilization in my office. There we can assess the unique situation that is going on with your hip, and we can work on it from a more holistic perspective. For instance, I would be curious about how your hip problem might fit into a bigger pattern of tension. We might find an interesting relationship between your hip, leg, neck and opposite shoulder. The longer term “fix” (addressing this hip problem within the context of everything else, through a series of sessions) will be much more personally tailored than my first-aid approach. I guarantee it will have a more profound effect, and it will probably help you to feel younger and more resilient.
In the meantime, if you encounter hip pain don’t panic. Be curious about fine-tuning your hips as if you were adjusting the flavor of the soup!
Notes for the Anatomy Geek
Here are some of the reasons why you might be experiencing nervy hip pain:
- If the pain is in the front, it could be caused by chronically tight hip flexors–in particular, iliacus, which is fleshier and less tendinous where it crosses under the inguinal ligament. When iliacus is “pumped up” or chronically engaged it crowds the lateral femoral cutaneous nerve, pressing it against the inguinal ligament and causing pain in the region of the tensor fasciae latae (TFL). Additionally, this nerve can get stuck where it emerges from the fascia of the upper thigh, rather like a shoelace that doesn’t glide through the metal grommet of a mud encrusted shoe.
- Pain in the front of the hip could also be caused by generalized tightness in the posterior hip which is preventing the head of the femur from dropping backward in its socket as the hip flexes. This causes the hip to be shoved forward in its socket as you lift your knee, creating a different type of pinching pain in the front. The pain could be the coming from nerves in the joint capsule, or from nerves not gliding well under the inguinal ligament.
- Tight hip abductors (from doing too many strengthening leg raises to the side or side-kicks) may be compressing the superior gluteal nerve, making the abductor muscles feel weak and causing sharp pain in the side of the hip when they try to engage. Standing on one leg (the painful one), especially with lateral hip rotation (as when doing half-moon pose in yoga) will increase the pain by increasing nerve compression deep to the muscle.
- The piriformis muscle may be working extra hard (and be chronically engaged but “locked long”, a term coined by Thomas Myers who wrote Anatomy Trains and a great article about the deep posterior hip muscles called “The Deep Six, Part II” ), because the psoas muscle on the same side is tightened or shortened. This can impinge and annoy the sciatic nerve, or one of the other smaller nerves that emerge next to the piriformis from deep in the pelvis. Some practitioners label this situation “piriformis syndrome.” [Other nerves that can be restricted or stuck when they are supposed to be able to glide out from under the piriformis: The posterior femoral cutaneous nerve runs down past the ischial tuberosity (sitting bone) and fans out over the whole posterior and inner thigh. The inferior gluteal nerve has several branches fanning laterally into the lower gluteus maximus.]
- If there is fascial adhesion deep to the hamstrings, then it is even more likely you’ll feel referral down the posterior thigh. Additionally, shortened hip flexors which are “balanced” by shortened and tight spinal erectors could be causing lumbar compression, creating restriction for one or more nerve roots up at the spinal level. The effects of compression and restriction are cumulative; with each additional source of stress along a neural pathway, the nervy symptoms will increase at the end of the line. Lumbar compression can contribute to any of the above nerve restriction scenarios.