Can stretching make hip pain worse for some people – yes it can. Throughout our HipPainHelp website we have discussed pain in different locations and the instances when stretching may aggravate rather than help your pain. In this blog we will provide you with a summary of the areas and types of hip pain that may be made worse by stretching.
Sometimes it can be difficult to tell if the stretching is provoking your symptoms, because at the time of stretching there may be some very short term ‘relief.’ This feeling is often described as a sort of ‘good pain,’ but how good is stretching in the longer term? A little stretching is usually fine for most conditions, but many people find themselves spending 1-2 hours across the day stretching a sore area.
Often stretching becomes a key focus of any time set aside for rehabilitation. However, at best stretching usually only provides a very short-term effect and at worst, stretching might be one of the major reasons your pain is not settling.
Try reducing or pausing your stretching routine for a couple of weeks and see how your pain changes. Spending less time stretching will mean you have much more time available to focus on the components of your rehab that are most likely to create a positive effect in the longer term – strengthening, improving movement control, coordination, balance and specific pain management techniques.
What to do for hip muscle pain and tightness if you can’t stretch
You might be thinking, ‘If I can’t stretch, what can I do to help my sore, tight muscles?’ Many people are surprised to find out that sore, tight muscles are quite often weak muscles or muscles that are working overtime to compensate for weak neighbours. One of the most helpful things is usually improving muscle strength and coordination, and particularly working on ‘eccentric strength’ – strengthening into a lengthened muscle position.
What about massage? Massage can help to reduce muscle soreness and the feeling of tightness. Once again, this is usually only a short-term effect, but can assist with controlling pain in the early stages of your rehabilitation while you work on your exercise program. Care must be taken – aggressive massage can be provocative too, so always communicate with your therapist and avoid overly aggressive home massage with balls, foam rollers and other self-massage devices! A good old hotpack can also help to ease those sore, tight muscles. You can check out these wonderful lightweight lupin seed hotpacks that hold heat for longer by clicking here.
Need some help? Our Hip Pain Professionals can assist in getting to the bottom of these sore muscles and develop you an individualised exercise program and provide specific advice for you around stretching for your particular condition.
Hip pain conditions that are often aggravated by stretching
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1: Stretching for buttock pain related to the sciatic nerve
1. Stretching for buttock pain related to the sciatic nerve
For some people, stretching can make their buttock pain much more irritable. “Piriformis syndrome” now known as “deep gluteal syndrome” is a condition that may result in upper, middle and/or lower buttock pain. This is a condition related to irritation of the sciatic nerve as it runs through the buttock. Gentle stretching is helpful in some cases, but strong, long duration stretching can often be provocative for an irritated nerve.
Do you think you might have an irritation of your sciatic nerve in your buttock (piriformis or deep gluteal syndrome)? The most common symptom of this condition is buttock pain in sitting, which may extend down the leg to the foot. The first, free lesson in the course below will step you through other symptoms and a self-test for you to try.
YOU CAN LEARN MORE ABOUT DEEP GLUTEAL SYNDROME AND HOW TO MANAGE IT IN THIS GREAT COURSE “”Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica” – CLICK HERE or THE GRAPHIC BELOW TO LEARN MORE
Which stretches are most likely to irritate your buttock pain?
- Stretches where you pull the leg across the body can further compress the nerve involved (the sciatic nerve), particularly if the stretch is strong and held for longer duration (e.g. more than 10 seconds).
- The “piriformis” or “figure 4” stretch can also aggravate sciatic nerve pain for the same reason.
- “Nerve stretches” where you straighten the leg out in front of you with the foot pulled up towards you (like a hamstring stretch) are often too aggressive when the condition is most severe an irritable.
Check out our online “self-help course” to learn more about what exercises might be beneficial for this condition – click here to learn more.
2. Stretching for lower buttock pain related to proximal hamstring tendinopathy
Lower buttock pain that is felt over your sitting bone (ischial tuberosity) is likely to be related to proximal hamstring tendinopathy or high hamstring tendinopathy. Stretching for proximal hamstring tendinopathy is often provocative, particularly if you are doing a lot of strong and/or long duration stretching.
Pain related to proximal hamstring tendinopathy is felt directly over the hamstring tendons at the sitting bone. Pain is most commonly felt when sitting on firm surfaces or using the hamstring muscles when leaning forward or running, particularly uphill. On occasion the sciatic nerve can also become involved and pain might be felt down into the lower leg and foot
Which stretches are most likely to irritate pain related to proximal hamstring tendinopathy?
- Hamstring stretches: Stretches where you straighten the leg out in front of you with the foot pulled up towards you (hamstring stretches) are often too aggressive while the condition is most severe and irritable.
- Bowing and bending with knees straight: Any stretches or sustained position that bring your thigh towards your chest, or your chest towards your thigh, while keeping the knee straight can be aggravating. This might include positions like “downward facing dog” in yoga or stretches/exercises where you bend forward at the hips such as touching your toes in standing, or even gym exercises such as “deadlifts” and “kettle bell swings.”
3. Stretching for pain over the outside of your hip related to gluteal tendinopathy or bursitis.
Pain over the outside of the hip may be due to gluteal tendinopathy, also referred to as trochanteric bursitis or greater trochanteric pain syndrome. Reducing provocative stretching is one of the key strategies for reducing pain related to this condition. Gluteal tendinopathy is usually felt as pain over the side of the hip, with tenderness lying on the side and pain when standing on one leg to dress, or climb stairs.
Which stretches are most likely to irritate pain at the side of the hip related to gluteal tendinopathy or bursitis?
- Iliotibial band (ITB) stretches, where the hip is pushed out to the side relative to the foot and shoulder (Picture)
- Buttock stretches that bring the knee across the body
Pain in this area is often attributed to tightness of the fibrous band down the outer side of the hip and thigh – the iliotibial band (ITB). For this reason, you might find lots of poor advice on the internet to stretch the ITB as a self-help strategy. However, there is NO evidence to support stretching the ITB as a self-help strategy. In fact, expert Hip Pain Professionals agree that people with gluteal tendon or bursal problems are less likely than average to be short in the ITB are more likely to be provoked by ITB stretching.
Read more here on the high-quality scientific evidence that is now available on successful management of this condition (with NO ITB stretching!).
4. Stretching for pain at the front of the hip related to hip flexor or hip joint pain
Pain at the front of the hip may be related to:
- The hip joint (including femoroacetabular impingement syndrome (FAIS) and hip dysplasia)
- Labral tears
- Iliopsoas tendinopathy/bursitis/impingement
- Anterior snapping hip – snapping of the iliopsoas tendon which can sometimes become painful
- Hip flexor strain, tendinitis, tendinopathy or impingement
You can read much more information about pain at the front of your hip here
Which stretches are most likely to irritate the pain at the front of your hip related to the hip flexors or hip joint?
- Hip flexor stretching in standing
- Hip flexor stretching in kneeling
“Hip flexor” stretches are a favourite of anyone who feels “tight” through the front of the hip. The hip flexor muscles, and particularly the iliopsoas muscle, have become incorrectly demonised in the popular media for being the source of many problems. The underlying issue is generally thought to be related to the muscles becoming overly active and tight. There is unfortunately much misinformation on the internet regarding the hip flexors and poor advice regarding management of true hip flexor issues.
Many people are stretching the hip flexors and placing high loads on the front of the hip unnecessarily, often aggravating their symptoms.
If you’ve been doing a lot of stretching for the pain at the front of your hip and it’s not getting better, try taking a holiday from your stretching. It is also advisable to see a health professional, like one of our Hip Pain Professionals who will assess the hip flexors and the hip joint and decide whether stretching will help or aggravate your particular situation, and develop you a comprehensive management strategy.
5. Stretching for Groin Pain
Which stretches are most likely to irritate your groin pain?
- Inner thigh stretches
- Hip flexor stretches
The instinctive thing to do for groin pain is to stretch the inner thigh muscles, but for some people this can just make the symptoms worse. Inner thigh and hip flexor stretching can compress or tug on tender structures in the groin. One of the largest research trials on groin pain found that active lengthening through exercise was much more useful in reducing symptoms and regaining range of motion than inner thigh stretches.
Still not sure whether you should be stretching?
- Take a holiday from stretching for a couple of weeks and see if your symptoms improve. If they do, you might be better off focusing on other strategies that are more likely to provide long-term pain relief.
- Seek professional help. A health professional, such as our Hip Pain Professionals, can assess your individual situation and give you personalised advice.
We hope this information has been valuable for you and helpful in your quest to reduce your hip pain. Our Hip Pain Help website is full of useful tips on what you can do, what you need to consider being careful of, aids that can help as well as loads of other information. We are here to help you on your journey.
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Check Out More You Can Read on Self Help Ideas at HipPainHelp:
Can stretching Make Hip Pain Worse? In this blog we will provide you with a summary of the areas and types of hip pain that may be made worse by stretching. Understand which hip stretches
Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling Learn ideas for how you might reduce your pain when sitting, a position you need for doing so much in life.
Top Tips on Hip Pain Relief Sleeping – Learn How Sleep is essential for wellbeing. Yet hip and pelvic pain can leave you struggling to find a comfortable position – we will help you with a few simple ideas.
I have hip pain – What is the best activity for hip pain or is rest best? In this blog we will discuss how much you are doing of something and is that too much or too little!
3 Simple Strategies to Reduce Hip Pain with Walking and Running In this blog we share 3 simple strategies to reduce pain when running or walking that we find helpful for people with many different hip conditions
Meet our Hip Pain Professionals
Health professionals that know hips
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.
- Schmid AB Nee RJ Coppieters MW. Reappraising entrapment neuropathies–mechanisms, diagnosis and management. Man ther. 2013;18:449-457.
- Grimaldi, A. (2017). Understanding tendinopathies of the hip & pelvis. Iliopsoas and adductor related groin pain (Vol. 4).
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