Hip Flexor Pain

author : AMSSM
comments : 0

Member Question

I am experiencing hip flexor pain. I hurt it two weeks ago during a race and it's bothered me ever since. Do you have suggestions on how to prevent problems or how to cure it?

Answer by Jeffrey B. Kreher, MD, FAAP 
Member AMSSM 

What are the hip flexors?

The primary hip flexors are the rectus femoris (part of the quadriceps) and iliopsoas (composed of the iliacus and psoas muscles).  The rectus femoris originates from the pelvis just above the hip socket.  The iliopsoas muscle originates from the lower back (lumbar region) and pelvis.  Hip flexors cross the hip joint and therefore flex the hip when shortened.

How are hip flexors frequently injured?

The hip flexors can sustain a muscle strain in which muscle fibers are torn.  Most often this is an acute injury, but injury to the hip flexors can be due to overuse and/or their tendons.  The injury often occurs with explosive motions such as sprinting, changing directions, or kicking.  The muscles or tendons can be injured due to tightness, or decreased flexibility.  In addition, the hip flexors can be injured due to a weak core.  When the lower abdominal muscles are weak, the hip flexors are overly engaged to stabilize the pelvis. 

There are less common etiologies in the multisport athlete.  Iliopsoas can be injured by repetitive injury from an internal snapping hip.  Finally, the rectus femoris can also be injured by a contusion, or blunt trauma, to the muscle.

Some Sports Medicine providers will grade muscle strains.  Grade 1 strains are simple stretching of the fibers—pain with or without minor strength loss.  Grade 2 strains include partial tearing of the junction between muscle fibers and tendons—pain with a greater associated greater loss of strength.  Grade 3 strains are unusual and include complete disruption of the muscle—pain with loss of function.

What are the symptoms of hip flexor injury?

Symptoms can be varied but often consisted of pain with flexion of the hip (such as during jumping, running, going up stairs and if progressed with walking).

What could it be if it is not the hip flexors? 

Hip joint injury [articular cartilage, socket lining, supporting cartilage (aka labrum), or degenerative arthritis] – pain with additional ranges of motion besides just flexion.

Adductor muscles – pain with bringing knees together against resistance

Gracilis or sartorius muscles – pain with resisted knee flexion

Greater trochanteric pain syndrome – pain on the outside of hip

Stress fracture (femoral neck or pelvis) – pain with standing, walking, hopping or heel strike

Fracture of the pelvis (avulsion fracture) – pain with hip flexion but in adolescent

Pain from spine or sacroiliac joint (back of pelvis) – referred pain

Athletic pubalgia (aka sports hernia) – pain with resisted sit up among other findings on examination

Much less commonly: Nerve entrapment, infection, or something within the abdomen or pelvis – such as appendix, prostate, urinary tract, and uterus/ovaries.

How do you treat a hip flexor injury?

  • Phase 1: Goal = reduce pain and inflammation
    • Relative rest (avoidance of aggravating activities)
    • Ice
        
  • Phase 2: Goal = regain range of motion
    • Once pain free, stretching of the hip flexors
        
  • Phase 3: Goal = regain strength and flexibility
    • Strengthening of the hip flexors (usually under the guidance of a therapist)
    • Occasionally, lumbar mobilization by skilled therapists
        
  • Phase 4: Goal = increase coordination
      
  • Phase 5: Goal = return to competition

How do you prevent a hip flexor injury?

The best way to prevent a hip flexor injury is to maintain flexibility and balanced strength across the lower spine, pelvis, and hip.  Exercises to include in your treatment and prevention include:

Hip flexor stretch (aka lunge stretch)

Quadriceps stretch

Straight leg raises

Supine flutter kicks

Back flexibility with knee to chest stretch

Core strengthening with planks, side planks, "supermans" 


Jeffrey B. Kreher, MD, FAAP
Pediatric Musculoskeletal & Sports Medicine Specialist
Assistant, Department of Orthopaedic Surgery
Division of Pediatrics Orthopaedics
Assistant Professor, Department of Pediatrics
Massachusetts General Hospital for Children
Instructor, Harvard Medical School, Boston, Massachusetts

Rating

Click on star to vote
74400 Total Views  |  862 Views last 30 days  |  178 Views last 7 days
date: November 21, 2012

AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

View all 357 articles