Hip Flexor Strain
Hip Flexor Strain
Injuries to Hip & Groin > Hip Flexor Strain
(Also known as Hip Flexor Injury, Iliopsoas Strain, Psoas Strain, Hip Flexor Tear, Strained Iliopsoas Muscle, Torn Iliopsoas Muscle, Pulled Hip Flexor)
What is a hip flexor strain?
A hip flexor strain is an injury characterized by tearing of one or more of the hip flexor muscles and typically causes pain in the front of the hip or groin.
The group of muscles at the front of the hip are called the hip flexors.
The most commonly involved muscle in a hip flexor strain is the iliopsoas (figure 1). The iliopsoas muscle originates from the lower back and pelvis and inserts into the thigh bone (femur).
The hip flexors are responsible for moving the knee towards the chest (i.e. bending the hip) during activity and are particularly active when sprinting, hurdling or kicking.
Whenever the hip flexors contract or are put under stretch, tension is placed through the hip flexor muscle fibres. When this tension is excessive due to too much repetition or high force, the hip flexor muscle fibres may tear.
When this occurs, the condition is known as a hip flexor strain.
Tears to the hip flexors can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture involving a sudden episode of severe pain and significant disability.
Hip flexor strains range from grade 1 to grade 3 and are classified as follows:
Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function.
Grade 2 Tear: a significant number of fibres are torn with moderate loss of function.
Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function.
The majority of hip flexor strains are grade 2.
So the hip flexors are a group of muscles that help you flex or move your leg and knee up towards your body. A muscle strain occurs when a muscle is over-stretched or torn. A hip flexor strain occurs when one or more of the hip flexor muscles becomes stretched or torn.
More about your injury: So Hip flexors allow you to bend your knee and flex your hip. Sudden movements such as sprinting, kicking, and changing direction while running or moving can stretch and tear the hip flexors. Runners, or people who do Hurdling, martial arts, football, rugby, and hockey players are more likely to have this type of injury.
Other factors that can lead to hip flexor strain include: Weak muscles or imbalances. Not warming up properly. Stiff muscles. Trauma, knocks or falls. Sprinting when not strong enough.
What to expect
You will feel a hip flexor strain in the front area where your thigh meets your hip.
Depending on how bad the strain is, you may notice:
Mild pain and pulling in the front of the hip.
Cramping and sharp pain. For some it may be hard to walk without limping.
Also for some cases, Severe pain, spasms, bruising, and swelling. The top of the thigh muscle may bulge. It will be hard to walk then. These are signs of a complete tear, which is less common. You may have some bruising down the front of your thigh a few days after injury.
Anatomy of a hip flexor strain (Iliopsoas)
So I repeat Main causes of a hip flexor strain
Hip flexor strains most commonly occur due to a sudden contraction of the hip flexor muscles (particularly in a position of stretch). They often occur during sprinting, hurdling or kicking activities. This is particularly so during explosive acceleration, hurdling or long kicking action, particularly following an inadequate warm-up.
You may develop this condition gradually due to repetitive or prolonged strain on the hip flexor muscles. So this may occur due to repetitive kicking, hurdling or sprinting excessively.
Signs and symptoms of a hip flexor strain
So runners with this condition usually feel a sudden sharp pain or pulling sensation in the front of the hip or groin at the time of injury.
In minor strains, pain may be minimal allowing continued activity.
In more severe cases, you may experience severe pain, muscle spasm, weakness and an inability to continue the activity and with a more severe hip flexor strain may also be unable to walk without limping.
With this condition you usually experience pain when lifting the knee towards the chest (especially against resistance) or during activities such as running, kicking, hurdling or going upstairs.
It is also common to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Some swelling, tenderness and bruising may also be present in the hip flexor muscles. In cases of a grade 3 tear a visible deformity in the muscle may be evident.
Prognosis of a hip flexor strain
With appropriate management, runners with a minor hip flexor strain can usually recover in 1 to 3 weeks.
With larger tears, recovery may take 4 to 8 weeks or longer depending on the severity.
Complete ruptures of the hip flexor muscles are rare and are usually managed conservatively. In these cases, recovery may be significantly longer.
Contributing factors to the development of a hip flexor strain
There are several factors which can predispose patients to developing this condition.
These need to be assessed and corrected possibly with direction from a physiotherapist or massage therapist.
Some of these factors include:
muscle weakness (particularly of the quadriceps, hip flexors or gluteals)
muscle tightness (particularly of the hip flexors, quadriceps, hamstrings or gluteals)
inappropriate training, (too fast, too soon, too weak, too inflexible).
inadequate warm up, (do warm up run, strides, proprioceptive drills).
joint stiffness (especially the lower back, hip or knee)
poor biomechanics, (need drills).
poor posture, (over-striding, leaning too far forward, not centered footplant).
inadequate rehabilitation following a previous hip flexor injury.
decreased fitness, (so body can’t cope with intense quality sessions or sprints yet).
fatigue, (tiredness, lack of sleep, over-worked, run down, poor co-ordination).
poor pelvic and core stability, neural tightness, muscle imbalances.
Physiotherapy for a hip flexor strain
Physiotherapy type treatment for runners with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
soft tissue massage
electrotherapy (e.g. ultrasound)
joint mobilization (especially the lower back and hip)
mobility, yoga stretches, core strengthening
progressive exercises to improve strength and flexibility (particularly of the hip flexors)
biomechanical correction
education and activity modification advice
anti-inflammatory advice
the use of crutches ? severe.
dry needling ? severe.
establishment of an appropriate return to activity or sport plan
So what to do. Exercises for a hip flexor strain
The following exercises are commonly prescribed to runners with this condition.
Generally, the basic ones should be performed initially 2-3 times daily and only provided they do not cause or increase symptoms.
Begin the initial exercises and eventually progress to the intermediate and advanced exercises, provided there is no increase in symptoms.
Hip Flexion
Slowly take your knee towards your chest as far as possible and comfortable without pain
Repeat 10 times provided there is no increase in symptoms.
Hip Extension in Lying
Begin lying on your back, with your buttocks at the very edge of a bench or bed. Take your good knee towards your chest as far as possible, letting your injured leg drop down towards the floor
Hold for 2 - 5 seconds at a mild to moderate stretch and repeat 10 times provided it is pain free.
Hip Knee Flexion (right leg)
Slowly bend and straighten your knee as far as possible pain free, sliding your heel up and down the bed or floor. Repeat 10 times provided there is no increase in symptoms.
Hip Flexion
Lying on your back, slowly take your knee towards your chest as far as possible and comfortable without pain. Then slowly return to the starting position. Repeat 10 times provided there is no increase in symptoms.
Straight Leg Raise
Begin this exercise lying on your back with one leg straight and one leg bent Slowly lift your straight leg to approximately 45 degrees keeping your knee and toes facing the ceiling. Hold for 2 seconds and then slowly return to the starting position. Repeat 10 times provided the exercise is pain free.
Foam Roller Hip Flexor Release.
Place the foam roller under your hip flexors (front of your upper thigh and pelvis) as demonstrated. Using your arms, slowly move your body forward and backwards allowing the foam roller to massage the front of your hip and pelvis. Breathe normally keeping your legs and pelvis relaxed. Repeat this process for 15 – 90 seconds provided it is comfortable and does not cause pain.
Hip Flexor Stretch
Get in lunge position with back knee resting on the ground. Keep your upper body tall and press forward with your hips. Switch legs. Hold each stretch for 30 seconds per leg after a run to build strength and flexibility.
Bridge:
Back bends help open the shoulders and the front of the body, and also strengthens the core. They are good counter poses to running, because the longer we run the more we tend to hunch forward.
Lift your hips up toward the sky and try to keep your body in a straight line with your core engaged.
To open your chest even further, clasp your hands together underneath your pelvis and try to roll your shoulder blades toward each other.
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COBBLER’S POSE
Sit on the floor. Bring the soles of your feet together and let your knees fall apart toward the floor. Place your hands on your ankles. Hinge forward from your hips until you feel the stretch in your inner thighs. Hold for 10 to 30 seconds. Repeat three to four times.
Pigeon Pose:
Another hip opener that also relaxes the mind and stretches out the lumbar spine.
Start in downward dog and bend the right knee and bring it forward. Take the right knee just outside the right hand while releasing the top of the left leg to the floor.
Then square your hips to the floor and bring your torso down towards your leg so that you’re doing a forward fold over your right leg. Keep your left foot pressing down onto the top of your mat as you breathe into the tightness of your hips and continue to square them off.
Hold this posture for a minimum of five breaths.
It isn’t easy initially, so progress it over weeks
Bound Angle or Cobbler
This hip opener is a formidable solution to tight and sore hip flexors, abductors and adductor muscles.
The effects of this exercise are understated and the benefits are much more than you realise. I like to repeat this exercise lying on my front for a variation.
