Hip Flexor Strain

What is a hip flexor?
As its name implies, a hip flexor is a muscle the flexes the hip. Hip flexion is a movement that brings the thigh and knee upwards toward the torso. The two muscles that make up the hip flexor complex are the iliacus and the psoas; combined they are called the iliopsoas. The originate from the front of the lower spine and the deep surface of the pelvis and extend to the front of the femur or thigh bone.

What causes a hip flexor strain?
The hip flexor is susceptible to over-use and to injuries such as muscle or tendon tears. When this occurs, it is called a hip flexor strain. Inflammation is generally the initial problem followed by muscle or tendon damage. It occurs primarily from over-use. Bicycling, jumping, soccer, or other activities involving forceful kicking such as martial arts are potential causes of a hip flexor strain. Runners may experience a hip flexor strain during cross-training or with up hill training. In addition, over-stretching the hip flexor may lead to a strain.

How is a hip flexor strain diagnosed?
Clinical examination and patient history are typically sufficient to make the diagnosis of hip flexor strain. Placing the hip flexor under stretch will cause pain. In addition, pain deep on the front of the hip are common in a hip flexor strain. An x-ray may be used to rule out other problems such as bone spurs, stress fractures of the femur, and arthritis in the hip joint. On occasion, an MRI is needed to more fully evaluate the hip and upper thigh region.

How is a hip flexor strain treated?
Treatment for a hip flexor strain focuses on two main problems: inflammation and biomechanics. Inflammation is best treated with ice, non-steroidal anti-inflammatory drugs (NSAIDs) and rest from activities that aggravate the pain. Alternative training activities can give the hip region a chance to rest and inflammation to resolve. Physical therapy can help reduce local inflammation and improve the strength and flexibility in the hip and leg region.

When can I return to running?
The goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your hip responds to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, some runners may not have to completely stop running, but merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.

  • You should be able to bend and straighten your hip without pain.
  • Your hip should not be swollen.
  • You should be able to jog in a straight line without limping.
  • You should be able to sprint without limping.
  • You should be able to perform 45-degree and 90-degree cuts without difficulty.
  • You should be able to jump on both legs without pain.
  • You should able to jump on the injured leg without pain.

What can be done to reduce the chances of developing trochanteric bursitis?
The most important factor in preventing trochanteric bursitis involves addressing the root causes. So what are the root causes? It is generally accepted that more than half of all running injuries involve errors in training. This could include total mileage, running intensity, increasing the intensity and mileage too quickly, and finally the physical terrain (hills, trails, etc.). Improving areas of biomechanical deficiency is vitally important. This involves consistent focus on strength and flexibility of the hips and legs.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.