Hip flexor muscles cross the hip joint and pull the leg forward bringing the knee toward the chest. The primary hip flexors are Psoas deep in the abdomen and Iliacus in the front of the hip. Both inserting to the top of the Femur at the inguinal crease in the groin. Psoas at the core of our being, linked to the diaphragm, crossing the kidneys and adrenal glands, attached to the lumbar spine, engaging in fundamental locomotion and protective foetal reflexes, activated by fear, has a strong relationship with primal responses. 

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A common cause for Psoas issues I encounter is sitting for prolonged periods...office workers, drivers, travellers or sleepers favouring the foetal position. Hold the hip flexed at 90 degrees long enough and the soft tissue in front of the hip shortens. Joint injury at lumbar spine, sacro-iliac and hip joints can also be culprits. I suspect some recently sighted cases are due to trauma from Caesarian delivery; the degree of dysfunction chronic and acute. I have sighted a similar outcome following hip replacement surgery.

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More broadly, the effects from a structurally short right leg impacting hip and lumbar posture, creating distortion and strain through the pelvis contributes to Psoas and hip flexor dysfunction. Anterior rotation of the left hip is the First Cardinal Sign of Short Right Leg Syndrome shortening and tightening the left hip flexors. The Second Cardinal Sign of SRLS is rigidity through the right hip. Frequently complicated by right sided low level non-catastrophic disk bulging from strain to lumbar spine on a right leaning foundation from pelvic tilt. Where a prominent Right Lower Limb Mechanism is present, chronic spasm in the right Psoas can result. See the numerous articles on this site for further insight. We all have a short right leg. It is a dominant genetic trait that came about through evolutionary adaptation increasing the chance of survival during the child rearing years associated with the mechanics of carrying baby securely on left hip and freeing the strong right arm for work and defence. So, in addition to treatments discussed below, addressing structural leg length discrepancy is also key to managing this condition.

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Interestingly, pelvic tilt and distortion directly impacts the Bladder meridian's complex winding passage about the Kidneys and through the lumbro-sacral region and hips. It is the Bladder meridian that feeds the Kidney meridian energetically where they join in the sole of the foot. Where the effects of SRLS have escalated and a significant Pelvic Block has resulted, Kidney deficiency as defined by Traditional Chinese Medicine will result. This is often accompanied by chronic thickening and tightening, and pain in the right lower limb. Described as Meridian pain, it is most prominent at the Bladder meridian choke points at the Iliac Crest, insertion of the Biceps Femoris tendon to the head of the Fibula at the posterio-lateral aspect of the knee and the lateral aspect of the heel. It may waft and wane under varying influences and can also be felt in the belly of the Hamstrings and Calf. This degree of symptomatic effect is a more advanced instance of SRLS. It is not an uncommon effect to sight in right lower limbs associated with a prominent Right Lower Limb Mechanism. These terms are defined in the SRLS material.

 

Emotionally, the Kidneys are associated with fear. If the Kidneys are deficient or weak, we will be anxious and fearful. If exposed to high degrees of fear for a prolonged period of time, it will weaken the Kidneys. My TCM doctor advises this is a common contributory factor in anxiety cases. Where pulse, tongue and eye diagnosis indicates a Kidney deficiency exists, herbal and acupuncture treatment will also be beneficial for the emotional state. Note that organ energetic deficiency identified by a TCM practitioner does not correlate to disease that might be revealed by medical testing. Energetic Kidney deficiency does not necessarily mean Kidney disease is present. Left untreated, in the longer term it may develop into disease. Should one have concerns in this regard they should consult a Medical Doctor for assessment and diagnosis. I repeat, this is an energetic Qi deficiency as defined by Traditional Chinese Medicine. Where underlying postural anomalies impacting the pelvis are a contributory factor, energetic and spiritual treatment outcomes can be limited and temporary until the structural anomaly of leg length discrepancy is addressed by the use of heel lift adjustment, rehab and treatment.

 

Where acute symptoms are being experienced at the Psoas, apart from stretching and Indirect Fascial Release technique (Positional Release), direct treatment can be helpful. It is deep in the abdomen in a hard to get place that can cause high degrees of discomfort. Positioning the client to take pressure off the abdomen by flexing the thigh at the hip while lying supine or on the side. Slowly pressing through the abdominal muscles and intestines, seeking the hard length of muscle lying next to and anterior to the lumbar vertebrae of the spine. A well developed Psoas feels to be up to an inch in diameter but a more common size is half an inch or less. From its' lowest attachment point at the base of the spine at L5, it traverses through the abdominal cavity to the front of the hip attaching to the top of the femur roughly 2/3's of the way up the inguinal crease. 

 

Initially, direct treatment may be limited to engaging fingertips with the tight Psoas and applying gentle pressure. When release occurs, straightening the leg to open the hip lengthens the muscle and allows further pressure to be applied. Subsequent treatments can progress to more extensive cross fibre massage along the length of the muscle. This work through the abdomen target the belly of the muscle. The insertion point at the head of the Femur can also be addressed with broad handed pressure at the inguinal crease...benefiting lymphatic drainage at the groin to...and more specifically targeted technique at the insertion point.

 

The first sign of a positive outcome is flattening at the small of the back; lying on the table the client will feel more contact between table and back, the practitioner will find less room to slide a hand under the back. The client will report reduced lower back pain, a feeling of standing more erect and improved breath. 

 

Naturally, fascial release of the diaphragm, general somatic release, relaxation, meditation and exercise enabling the body to achieve a para-sympathetic state greatly assists this process.

 

Less invasive and more gentle Indirect Fascial Release techniques targeting the Psoas muscle, hip joint and torso generally are an effective adjunct to the direct approach described above. The direct approach may still be required, particularly for remodelling scar tissue. Strengthening and stretching/relaxing musculature about the pelvis rectifying position of the hips and lordosis of the spine is beneficial. Addressing structural leg length discrepancy is often necessary. Where acute symptoms from pelvic tilt and distortion are present through lower limbs and spine, it is almost like we always have to insert a small adjusting lift under the heel of the short leg. 

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I present a complex mix of known physical attributes described and addressed by conventional therapy and internal organ energetic effects and associated emotion described by Traditional Chinese Medicine. A wholistic treatment approach might include consultation with a TCM practitioner for pulse, tongue and eye diagnosis of internal health and herbal and/or acupuncture treatment. Combined with Remedial Therapy to relieve acute symptoms of pain and discomfort, and address postural and structural issues contributing to the condition. That conditions have degenerated to actual kidney disease requiring medical attention is uncommon in my experience. When that ill, they will usually consult a Medical Doctor. Energetic Qi imbalance and blockage generating symptomatic response in the absence of disease that might be diagnosed by a Medical Doctor is common.

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Amended February 2025 to include effects from postural anomalies at hip and pelvis due to SRLS.