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Dr. Cathy A. Kim, MD, APC

It’s All In the Hips | Ep. 1

It's All In the Hips

It’s All In the Hips | Ep. 1

In Functional Medicine, we reduce reliance on medications by improving the gut microbiome, the key to healthy immunity.  Through diet and lifestyle changes, we can improve many conditions which share the same root cause.  

Having healthy gut bacteria helps our immune system adapt to the daily challenges of inflammation.  It turns out that the pelvis serves a similar pivotal role for our body’s structural integrity.  Whether tilted forward (swayback) or backward (straight back), an imbalanced pelvis often begins with back, hip, or knee pains, but with time, these problems can domino into sciatica, neck or shoulder pain, among other maladies.    

As a Functional Medicine doctor and Body Function Specialist, I focus on the structural root cause of these ailments by addressing the many factors that cause an imbalanced pelvis.   

Watch the video or read the transcript below for my perspective on the importance of our pelvis (and flexible hip flexors) for a structurally healthy body.  (Note: for simplicity, only an anteriorly rotated pelvis is discussed) 


Hi, I’m Dr. Cathy Kim, Founder of Integrative Body Medicine. I’m also a member of the Institute for Functional Medicine and Academy of Integrative Health and Medicine. 

This video explains proper hip balance and illustrates what forces are at work to disrupt this alignment. 

Imagine the upper body is like a house or a shed. It sits on a foundation that’s supposed to be stable, supportive, and flat. The pelvis provides this foundation for our upper body. For proper body alignment, we strive for what’s called a “neutral pelvis”, which is when the top edge of the bowl of the pelvis is close to horizontal and the upper body can balance on top of this horizontal surface. 

In a life filled with a lot of sitting, or repetitive squatting or lifting, or workouts filled with sit-ups or standing with knees hyper-extended, often called having double-jointed knees. The pelvis starts to tip forward and over time this gets more and more marked, getting farther away from the goal of the neutral pelvis. 

As the pelvis starts to tip forward, we don’t stand quite as straight as before and we try to achieve erect posture by lifting backwards more with the back muscles, resulting in an upright torso when viewed from the front. But when viewed from the side we often see a very arched back, and often a prominent gluteal shelf.

Even in bodies where the change seems subtle, the forces pulling the pelvis forward are still operating, causing distress to the muscles that are trying to maintain the erect posture. 

So, what makes the pelvis rotate forward? To answer that question we have to understand the iliopsoas, also known as the hip flexor. The primary muscle responsible for our bending at the hip. The major obstacle to developing awareness of this muscle is that we can’t see it because it’s so deep, but we can learn from another flexor muscle that we can see, the bicep. Look at the primary action of the bicep, to pull the forearm up to close the elbow. 

So now imagine a very muscle-bound weightlifter, whose biceps are very tight because of all the bicep curls they have done. If we challenge them to stretch out the bicep they might, say “hey that’s nothing, I’m so strong just watch me.”  As they move their forearm towards vertical, we would notice that at the same time they move their shoulder forward to compensate, and so the bicep muscle actually just stays the same length. If you look at the angle of the elbow, it is the same as before, not quite 180 degrees. 

When we have tight hip flexors, as we stand, and try to plant our leg down vertically, that hip flexor like the bicep, doesn’t want to stretch. For the bicep, we can see the action at the shoulder. For the hip flexor those attachments are hidden and deep, on the front of our lumbar spine, on the inside of our hip bones, and then deep in the thigh towards the back of the leg. 

When we try to stand and make the leg 180 degrees straight with our torso, the muscle will pull our spine forward, tip our pelvic bones forward. Now let’s imagine that we have just completed a non-stop 5-hour car ride, and we had kept our elbow bent for the entire journey. When we emerge from the car and try to straighten our elbow we feel our tight bicep and we might massage our bicep a little to coax it to relax and get the arm to straighten. 

But how come we feel it in our back when we stand up, and we don’t feel it in our groin where the hip flexor actually is? The bicep has primarily one big place to pull on, the shoulder. While the hip flexor has several joints to pull on, and these all move slightly to accommodate the tension. Then finally in order to complete the act of standing our back muscles work very hard to oppose these powerful hip flexors. The back muscles complain about this effort, and then we feel it in our back. 

This is why getting a back massage and solely stretching the back is not helpful in the long run for back pain. Loosening the back does not correct the original problem of tight hip flexors. 

If this makes sense to you, and you are wondering what you can do to help your pelvis move more towards neutral, please watch my next video. You can also visit my website integrativebodymedicine.com (now drcathykim.com) to learn more about my approach to whole-body health.

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Dr. Cathy Kim

Dr. Cathy Kim is a Board-Certified Family Medicine physician and Body Function Specialist. She practices in Camarillo, CA and specializes in complex cases.

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