Training tips: How your hip flexors could be hurting your back

Since many people are often looking for a quick fix or an elaborate diagnosis, the real cause of lower back pain can remain elusive and undetected.

Over 50 percent of cyclists will experience lower back pain at some point in their career.1 Lower back pain can be both mysterious and debilitating. It can take the fun out of riding, while simultaneously being frustrating and difficult to get to the root cause. Since many people are often looking for a quick fix or an elaborate diagnosis, the real cause of their lower back pain can remain elusive and undetected. One such condition easily overlooked is Lower Crossed Syndrome. Lower Crossed Syndrome is a common cause of lower back pain frequently experienced by cyclists. It can be overlooked because it requires an analysis of the entire body in order to identify muscle imbalances.


What is Lower Crossed Syndrome?

Lower Crossed Syndrome is a compensatory pattern in which muscular imbalances cause your body to function in a particular way. It is characterized by a pelvis that is tilted forward with the muscles attaching to the pelvis reacting to the postural alignment.

With Lower Crossed Syndrome, the hip flexors, attached to the front the of pelvis, pull the pelvis forward. They are short, overactivated, and too tight. When the pelvis is pulled forward by the hip flexors, your lower back will arch and your back muscles (erector spinae) will also be overactivated. With an arched back, your abdominal muscles are inhibited and unable to function properly thus being inactive and sometimes growing weak. In an arched position, your glutes are also unable to fire and become weaker over time as well. As the glutes fail to pick up their slack, the hamstrings kick into overdrive to make sure that your body can still perform the actions asked of it which can present itself as back pain.

As you can see, the body is a kinetic chain. One piece out of place can have a domino effect and can impact each muscle and joint surrounding it. The body is designed to work as a unit, not to compensate for missing pieces and poor alignment. The overactivation of the hip flexors and back muscles and under-activation of the abdominals and glutes can cause pain in the muscles, joints, and ligaments.

Why are Cyclists Prone to Lower Crossed Syndrome?

Lower Crossed Syndrome has become more prevalent as society has moved into more sedentary lifestyles or to be more specific, into prolonged periods of sitting.

When you sit, your body is automatically placed into this somewhat compromised position. The hip flexors, which help to bend the hips, are shortened when the hip is in the bent position such as when seated. For short periods of time, there is no problem with this posture, but extended periods spent in this position will cause more concrete and unwanted adaptations. Pain may follow.

While cycling is by no means a sedentary activity, it still assumes a seated position and therefore predisposes an athlete to fall victim to these muscular imbalances.

Lower Crossed Syndrome is characterized by a pelvis that is tilted forward with the muscles attaching to the pelvis reacting to the postural alignment.

How to Prevent and Rehabilitate Lower Crossed Syndrome

Since Lower Crossed Syndrome is a condition caused by an imbalance of muscles, prevention and rehabilitation will be addressed similarly. Procedures will be focused on strengthening the inhibited muscles and relaxing or lengthening the overactivated muscles. Here are some ideas to get started:

Hip flexor stretching: Since hip flexors are shortened with lower crossed syndrome, it will be important to lengthen them in rehabilitation or prevention. This means that stretches that extend the hip will be beneficial. Try the high lunge stretch or the Thomas stretch.

Low back stretching: It will also be important to relax and lengthen your low back muscles. Try practicing the prayer stretch or even pelvis tilts. To complete pelvis tilts, lay on your back, with knees bent to 90 degrees, and your feet on the ground, and practice pushing your lower back into the ground.

Glute bridges: With Lower Crossed Syndrome glutes are overly lengthened so the rehabilitation focus is on strengthening the glutes. Focus on exercises such as glute bridges and donkey kicks.

Abdominal strengthening: Strengthening the abdominal muscles will be very beneficial. Dedicating a few minutes a day to an abdominal routine can work wonders. Try exercises such as bicycle sit-ups, leg raises, toe touches, or Russian twists.

Foam rolling: Finally, foam rolling can go a long way to help lengthen and relax the overactive muscles associated with Lower Crossed Syndrome. Dedicate your foam rolling efforts to hip flexors, adductors, lower back, hamstrings, and calf muscles.

Balancing Imbalances

You might be reading this article and thinking that the pain isn’t ‘that’ bad or thinking that these types of imbalances couldn’t apply to you because you’re too strong. Keep in mind that these imbalances are just that, imbalances. They don’t have to do with overall strength, but rather your muscles relative to each other. Spend some time utilizing this information to help strengthen and rehabilitate, you have nothing to lose.

Streisfeld, Gabriel M., et al. “Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain.” Sports Health: A Multidisciplinary Approach, vol. 9, no. 1, 2016, pp. 75–79., doi:10.1177/1941738116676260.