Recurring Hip Flexor Pain

author : AMSSM

comments : 2

I have had hip flexor pain on and off the last two years. This morning I really aggravated it. I've been stretching to get it to go down, but I'm just worried that it's going to get worse again.

Member Question

In September of 2010, I pulled my hip flexor. It hurt to the point where I couldn't lift my knee more than 90 degrees. It ended up getting better in January of that Christmas beak, but it was still noticeably tight.

About February of 2011, it got tweaked again. Same pain, just not quite as severe. Again, pain went away August of that year.

In January through June of 2012, I went to Basic Training/AIT. No pain at all, but still a slight, but noticeable, tightness.

Now to the present day. All semester so far up until about a week ago I have had no hip flexor pain, but still the very noticeable tightness. I'm in the Army ROTC on the Ranger Challenge Team and I am training for a half marathon later this month. My mileage is getting to 7-8 mile normal runs and a few tempo runs and other speed workouts. I ran cross country from 2008 to 2010, so I am not new to distance running. In the ROTC Ranger Challenge, we do 4-7 mile ruck runs in boots and 35lb ruck. We did one this morning and it REALLY aggravated the flexor pain. I've been stretching to get it to go down, but I'm just worried like no other that it's going to develop into what it used to be.

I have never been frustrated this much with a running injury. I'm hoping that I can get some help with this.

Answer from Michael Cosgrave, D.O.
Member AMSSM 

Your running background probably makes you in tune with your body and this could be a hip flexor strain that is taking a long time to heal.  However, any injury that is persistent beyond what would be considered a normal healing time warrants further investigation.  Usual reasons for common injuries to take longer to heal include underestimating the severity of the initial injury, improper treatment course, not allowing sufficient time before returning to activity, and failure to identify and address the underlying cause. 

A hip flexor strain is a common injury that can be treated effectively with traditional modalities including activity modification, ice, heat, electrical stimulation, stretching, and strengthening.  Anti-inflammatory medication is also commonly used, however, this type of medicine has also been shown to delay muscle repair.  

Of the above mentioned therapies, it is very common for stretching to receive a lot of emphasis while strengthening is given relatively little attention.  The danger in this practice is that a muscle strain is essentially a stretch injury and trying to do too much stretching can be detrimental and then can prolong recovery.   If the muscle is not strengthened, a return to activity can leave a muscle more susceptible to re-injury. Controlled strengthening through recovery helps to promote muscle fiber growth and prepares the muscle to adapt to increasing demand. 

In considering injuries of the hip that either have a prolonged healing course or persistent re-injury, it is necessary to look for an underlying cause and rule out the most concerning causes such as a stress fracture to the hip.  Other problems could include a problem with the hip joint, pelvic alignment, leg length discrepancy, or muscle imbalance.  Hip pain can also come from the nerves of the low back that are irritated by bulging discs in the spine or at certain points along their course from the back to the thigh.  Injured muscle attachments on the bones of the pelvis or upper thigh can also be a cause of persistent pain.  Bursitis can result from an inflamed bursa in these same areas.

Since this injury has been recurring for over two years, I would recommend being evaluated by a sports medicine physician who can test for some of these problems and give appropriate recommendations on rehabilitation and use of medication.  Potential treatment could include of a consistent physical therapy program, osteopathic manipulation, or injections. Modifying your training is also an important aspect of healing.  Running up hills or with heavy gear (i.e. – boots, rucksack) definitely puts more demand on your hip flexors.  Imaging with x-ray, ultrasound, or MRI may be necessary to help to identify the correct diagnosis and rule out more serious things such as a stress fracture to the hip.  

In summary, this injury may be a recurrent hip flexor strain, however, there can be underlying causes that can be treated and other conditions that should be considered.  A sports medicine physician would help to identify the problem and guide the correct treatment course.  

Michael Cosgrave, D.O.

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date: December 11, 2012