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How can weak and tight hip muscles cause neck pain?

Today, I want to talk about inhibited hip muscle pattern while doing standing flexion test.

Let’s look into the pictures below.

The first picture is normal pattern in standing flexion exam. You can see the smooth flexion curve in the spine and good flexion angle in the hip and pelvis.

Normal hip range in standing flexion
Inhibited hip muscle pattern in standing flexion

The second picture is showing the poor hip joint range of motion while doing standing flexion test indicating tight and short hamstring, hip external rotators (e.g. piriformis) and weak gluteus muscles.

This condition can happen with long time sitting position and lack of good stimulation in hip muscles such as stretching and strengthening.

These tight hip muscles tilt the pelvis posteriorly (backward) and decrease the natural C- curve in your back (Lordosis) resulting in flattened lower back and forward head posture.

Second, tight hip external rotators (especially piriformis muscle) can compress the sciatic nerve resulting in lower leg and foot weakness.

Piriformis muscle often gets tight with trigger points (Irritated muscle knot) and entraps the sciatic nerve resulting in weakness in ankle, foot and toes which is supplied by the nerve branches of sciatic nerve.

As I mentioned in the previous article, there is a strong relationship with poor posture and foot and toe weakness. Foot and toe weakness can cause slouched and head forward posture leading to neck muscle fatigue, stiffness and pain.

Treatment Tip: We should suspect hip external rotator tightness as a cause of foot weakness when the weakness is not just in one direction of foot but all directions of ankle, foot and toes (Ankle inversion/eversion/dorsi flexion, toe flexion, extension).

In conclusion, there are 2 patterns how the inhibited hip pattern can contribute to neck stiffness and pain.

1. Tight hip external rotators -> Compress Sciatic Nerve -> Foot and toe muscle weakness -> Slouched posture and head forward posture -> Neck stiffness and pain

2. Tight hamstring and hip external rotators -> Posterior pelvic tilt -> decreased lordosis, increased kyphosis and head forward posture -> Neck stiffness and pain

Solution Guide from Dr. Jo

Then, how can we improve this inhibited hip pattern and neck stiffness?

  1. Hamstring and hip external rotator stretches
  2. Gluteus strengthening program
  3. Ankle, foot and toe muscle reactivation treatment (Manual Therapy)
  4. Improve thoracic spine flexibility (Increase Thoracic extension ROM)
  5. Neck and scapula stabilization exercise (Back, Rhomboid, Serratus anterior and posterior deltoid muscle group)

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