Lower Extremity

The Lower Extremity in brief:

The Hip     |     The Thighs     |     The Legs     |     The Pelvic Floor

Understanding how one area of the body affects others is key to getting the most out of your workouts and daily activities.

For example, there are muscles in the hip complex that not only act on the hip but the knee as well. Conversely, there are muscles in the leg and ankle that can have powerful ramification on the hip complex.

The hip complex is made of many components; muscles, ligaments, tendons, fascia, and bone. Muscles, such as the gluteals (buttocks), not only move the hip to allow you to stand, walk, and run; they also have a stabilizing effect on the pelvis. This stabilizing effect in turn impacts the alignment, or misalignment, of the lumbar spine (lower back).

We’ll begin by talking about Hip Flexors and Extensors. The ilio-psoas is the prime mover in hip flexion. They attach to the front/side of the lumbar spine (lower back) and also to the femur (thigh bone).

There are other muscles that flex the hip, but since the iliopsoas actually attaches to and moves the low back and pelvis, we’ll focus on it for now. In our chair sitting society, we are forced to remain in a hip and knee flexed position for extended periods of time. This not only has a tendency to tighten the hip flexors, but the hamstrings (muscles in back of thigh) as well. When the hip flexors are too short, or tight, they pull the lumbar spine forward and tip the tail back, thus increasing what is known as the lordotic curve, and lower back pain will probably result from it.

To make matter worse, instead of working to correct these problems that are inherent in our society, we either:

  • Decide that working out must be the problem, and stop, or:
  • Decide to strengthen our abs to protect our low back, but in the process, end up strengthening our hip flexors more than our abs, which makes the problem worse!

Why does this happen? There is a HUGE misconception that certain ‘abdominal’ exercises will strengthen and tone the abs. Now, without getting too deep into the topic (We have a lot to cover ), know that if the hips are flexed in an open chain (think feet not touching the ground) movement, you’re likely working the hip flexors MORE than the abs.


Now, it’s true that we use our abs a lot when we flex the hips in an open chain.  But the abs have to learn to keep the pelvis and back neutral when the legs lift.  If they don’t (and this happens a lot when you start with your feet off the ground) there is a GREAT chance that you are just being a pain in your own back.

If we take the time to create more length in our hip flexors and strengthen our hip extensors (glutes, hamstrings, adductors), we can improve our posture and alleviate/prevent back pain (Working on the glutes is a GREAT way to strengthen the abdominals).

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Another benefit of working on the glutes is that the union of movement that is supposed to happen between those muscles and the hamstrings will be repaired. In our sitting society, the hamstrings tighten and the glutes shut down. The hamstrings now become a prime mover in hip extension when the glutes should be. This can lead to postural issues with the pelvis and also it can negatively affect the knee. A knee unable to fully extend due to tightness in the hamstrings is in pain. This failure to extend fully may be very subtle, so it may be hard to notice on your own.

The quadriceps group, adductors, sartorius and Tensor Fascia Latae (TFL, NOT a Starbucks drink) all have an effect on the knee as well.

The quads, on the superficial front of the thigh, mostly straighten the knee.  All the other muscles of the mid-leg are stabilizers that prevent the knee from moving in directions we don't want the knee to move -- hyperextension (bending to the back instead of the front) and knock knees are the most common. If there is an imbalance between the stabilizers, there will be friction of the knee against femoral condyles (the rocker-like part of the thigh bone that is the top bone of the knee joint) and the tibial plateau (corresponding top of the tibia, or leg bone). A healthy knee is perfectly balanced between these points, but if there is tension in any of the aforementioned muscles, the knee will shift “off its rocker” toward other bony prominences and cause pain.

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The Leg muscles (from the knee down) need to remain pliable as well.

If they are too tight from inefficient footwear (heels or tight shoes) or inefficient running technique the ankle dorsiflexors (flexing the foot) or plantarflexors (pointing the foot) may be injured, or at least tightened which will affect the hip and knees during closed chain (think feet on the ground) movements.

In the ankle/foot, we need to have good grounding for proper alignment. Grounding means a balance between the balls of the feet and the heel. Due to improper footwear/movement (or lack thereof) histories, we tend to shift our weight toward our toes. This weight shift also puts undue stress unto the knees and creates tension in the hip flexors. By strengthening the dorsiflexors and stretching the plantarflexors, you can help improve your grounding.

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The last major point (certainly not the least) is the overwhelming importance of the pelvic floor. It’s made up of the Pubococcygeal (PYOO-BO-COCK-SIJ-EE-AHL)(PC) muscles, which most women (and hopefully men) exercise via kegels.  This is a diagram of the female pelvic floor, seen from below.  The spine is at the top of the picture and the front of the pelvis is at the bottom:

Kegels are exercises that strengthen the pelvic floor. As I said before, since we sit on our butts all the time, the glutes tend to shut down. And, since we are also sitting on our pelvic floor, those muscles can shut down or become overly tense as well. Tension (or lack of strength) in the pelvic floor is a big problem for a lot of reasons. For the purpose of our goals in this section, let’s just say that the hip flexors and adductors are right by the pelvic floor and will tense up in tandem with it (or if there is low/no strength in the pelvic floor, the aforementioned muscles will tense up to compensate for lack of strength in the pelvic floor) .

For maintaining a healthy posture, it is important to not have a hypertonic (overly tense) or hypotonic (weak) pelvic floor. This will help in allowing the hip flexors to lengthen along with our spine. Kegels are great, but just like we don’t walk around flexing our biceps all the time; we should not tense our pelvic floor all the time either. A healthy muscle is elastic when not in use and tense in use. Imagine being Michael Jordan if all his muscles were hard and tense all the time -- you couldn’t change direction, respond to surprises, or protect your balance without being able to turn your muscles on and off quickly.  Here at Evolved-Fitness, we focus on training muscles to be resilient and adaptive – muscles that are able to turn on and off quickly and efficiently no matter what situation you’re in.

In my own training, massage and chiropractic are incredibly useful in reducing unnecessary tension and building awareness of how to be strong and relaxed, which is the key to feeling great, avoiding injury and evolving your body in the way you want to. The following exercises will aid in regaining the control necessary to maintain the results of a good body work session:

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