Hip Flexor & Quad Strains

Proper management during the first 24-48 hours is imperative to expedite return after the injury as quickly and as safely as possible. Refer to the PEACE & LOVE Approach for acute care of the injury. If there is any noticeable deformity, seek out either Urgent Care or an Emergency Department, depending on severity (see Where Should You Go? page for more information). 

After any injury, follow up with your athletic trainer as soon as you can. 

Immediate Care:

A couple of key takeaways from "PEACE & LOVE": 

• Ice and cold treatments are not necessary and can disrupt inflammation, angiogenesis, and revascularisation, delay neutrophil and macrophage infiltration as well as increase immature myofibers, potentially leading to impaired tissue repair and redundant collagen synthesis and prolonging return to sport

• Only take Tylenol/Acetaminophen for the first 24-48 hours as needed to manage pain

• Swelling is good so avoid NSAIDs like Advil/Motrin/Ibuprofen, Aleve/Naproxen Sodium, etc. until at least 48-hours post-injury

• Limit walking and do not stretch for the first 24-48 hours post-injury

Exercises, starting as soon as you get home:

• Complete every hour using available Pain-free Range of Motion: 

  • Quad Sets 3×25: https://youtu.be/au62CidApd0?t=4 

    • Elevate the Knee above the head, if possible, for best results.

  • Heel slides using pain-free range of motion 3×25: https://youtu.be/rAMPY8lAbfY 

Subsequent Care: 

After waiting 24-48 hours after injury, complete these stretches & exercises on your own for the recommended sets, reps, & frequency, provided you are pain-free or pushing yourself to a point of pain. If necessary, see the athletic trainer for more exercises or if exercises need to be modified. The descriptions of each phase are meant to be a guide and if the athlete is having difficulty or ease with completing the listed exercises, they can choose a different stage more appropriate.

Stretches - 4×/Day, 30 seconds each - Typically, wake-up, before practice, after practice, before sleep

• Kneeling Hip Flexor Stretch: https://youtu.be/lqUkxHLt_X0 

• Standing Quadriceps Stretch: https://youtu.be/Uwwuc8pRRc0

  • If Quad Stretch is painful, do a Quad Stretch with a chair, dipping as low as pain allows: https://youtu.be/pAm21cf6OLI?t=8 

Stage 1 Exercises - 2×/Day - If not fully weight-bearing / assistance with weight-bearing needed

1. Quad Sets 3×25: https://youtu.be/au62CidApd0?t=4 

2. 4-Way Straight Leg Raise 3×10 each direction using pain-free range of motion: https://youtu.be/-8MV0sX-C_k 

   • Just do hip extension, adduction, and abduction

3. Heel slides using pain-free range of motion 3×25: https://youtu.be/rAMPY8lAbfY 

Stage 2 Exercises - 2×/Day - If weight-bearing & have not returned to participation

1. Straight Leg Raise 3×15: https://youtu.be/Ka19yzAlIGY?t=4 

   • If still unable to complete Straight Leg Raise, do Quad Sets 3×25: https://youtu.be/au62CidApd0?t=4 

2. Single Leg Step Ups 3×15 ea/side: https://youtu.be/dHRDZhkb-c4 

   • Start with Mid-Shin Height (6"-10") and slowly progress higher as you get more 

3. Eccentric Leg Raises 3×15: https://youtu.be/2lf8YtweH50 

   • Only use pain-free Range of Motion as you are guiding your legs down

Stage 3 Exercises - 1×/Day - Once back participating in a modified capacity (pain-limiting activity)

1. Split Squat 3×15 ea/side: https://youtu.be/UcZVX7Sc9YI 

2. Box Jumps 3×15 ea/side: https://youtu.be/52r_Ul5k03g 

3. Eccentric Leg Raises 3×15: https://youtu.be/2lf8YtweH50 

Stage 4 Exercises - 1×/Day - Once back participating without restrictions

1. Rear Foot Elevated Split Squat 3×15 ea/side: https://youtu.be/I3p2bdtluUk 

2. Single Leg Glute Bridge Hold Leg Raise 3×15 ea/side: https://youtu.be/kiMZahGWmqw 

   • Leg Raise Range of Motion should be from at most 6" above floor to having your leg vertical

3. Depth Jumps 3×15 ea/side: https://youtu.be/AzPJZHOmGEg 

4. Runner's Hip Swings (Flexion/Extension & Abduction/Adduction) ×25 @ max ROM each direction: https://youtu.be/naW8u72lOzI

   • Start with short swings, progressively build up to Full Range of Motion after 10-15 swings

Return to Participation: 

After the acute and subacute phase of the initial injury or reinjury, the athletic trainer will develop a plan for return to participation for the athlete. It is recommended that an athlete should return to athletics after the athlete can flex their knee to 135 degrees or active range of motion, has a lower extremity injury without restrictions if the limb symmetry is at 90% of the contralateral (opposite-sided), unaffected limb, hop tests (single, triple, crossover, and side) for affected leg >95% of contralateral, unaffected limb’s result, and agility tests results are within normal ranges. These evaluations and tests should be completed under the supervision and direction of an athletic trainer or another appropriate healthcare provider. 

Taping/Bracing

If indicated, the Athletic Trainer can tape/wrap the injured area to expedite returning to participation. If the Athletic Trainer is wrapping you with an ACE wrap, please make sure to wash it in a washing machine and hang-dry it overnight. Usually, ACE wraps can get 2 weeks worth of use before a new one is needed. 

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