Hip Flexor Strain

Flexing of the hip joint refers to the movement of lifting the knee towards the body. The featured photo above illustrates a hip flexor lunge movement – flexing with the left foot, and extension with the right.

Hip flexor strains are most commonly observed in sports that require explosive movements (e.g. soccer, football or sprinting).

The typical symptoms of this injury are pain (along the front of the hip and down the front of the thigh). Swelling is sometimes observed and there may also be muscle spasms and bruising. Running, jumping and even walking will become difficult without experiencing hip and/or thigh pain.

Treatment of mild or moderate hip flexor strains commonly requires resting the damaged muscles and allowing them to recover naturally.. In addition, ice or a cold compress can be used for further pain relief and control of swelling, if needed.

Anatomy

There are 3 muscles involved in the action of flexing the hip. These are the muscles/tendons that may be damaged if you suffer a hip flexor strain:

• The iliacus and psoas major muscle groups situated near the hip bone;
• The rectus femoris, which is one of the group of muscles that makes up the quadriceps.

These muscles play a major role in the acts of lifting the  knee towards the stomach and bending at the waist. They also provide stability to the lower extremity of the body.

Hip Flexor Strain – Risk Factors

This is primarily an overuse injury of the hip flexor muscles and the adjacent tendons. The individuals most likely to experience a hip flexor strain are:

• Cyclists (due to the repetitive high knee lifts required by this activity);
• Dancers and martial artists, who also frequently have to lift the knees towards the chest;
• Football kickers and soccer players;
• People who participate extensively in step aerobics.

Generally, any sport or exercise that requires repetitive high knee lifts (hip flexion) or pulling the thigh backwards (hip extension) increases the risk of a hip flexor strain.

Symptoms

The typical symptoms of a hip flexor tear or strain are:

• Pain at the front of the hip on the side of the affected leg. This pain usually appears suddenly, with no prior warning signs. The patient will likely feel the pain while walking or running;
• The pain will normally get worse when the patient lifts the knee towards the chest;
• The patient may also experience occasional muscle spasms in the hip or thigh regions;
• The painful area at the front of the thigh may be tender to the touch. It may also exhibit swelling or bruising.

Individuals experiencing these symptoms should seek medical advice from a healthcare professional, and preferably from one with sports medicine experience.

Treatment

Non Invasive

Most mild or moderate cases of hip flexor strains are treatable at home. These are the cases wiithout a complete rupture of a muscle or tendon. The typical treatments under this approach are as follows:

• Rest the hip flexor muscles by refraining from activity involving high knee lifts or bending at the waist. Try temporarily changing your exercise routine to avoid these activities. For example, switch temporarily from cycling to gentle walking.
• It may also be a good idea to consider using compression shorts for additional muscle support. This support will aid the healing process by reducing the demands on the injured muscles.
• Apply ice or a cold compress to the painful area to control pain and swelling. Do this for 2-3 days after the injury appears. Avoid directly touching the naked skin with the ice pack or compress – instead, wrap them in a towel before application;
• After the first 2-3 days,  the pain and swelling should have largely receded. At this point, try alternatively applying hot and cold compresses to the area. The hot compresses (or warm baths or showers) will help to loosen the muscles. They will also promote blood circulation through the injured area, which will aid the healing process;
• Try using pain relief medications like Tylenol. If you need to control both pain and inflammation, an anti inflammatory medication like Advil would be a good choice;
• A physical therapist can devise a program of mild hip and thigh stretches to reduce muscle tightness. They will also prepare the hip flexors for an eventual return to normal activities.
• Do not resume regular activities until you are pain free and your normal range of hip flexion has returned. This may take a few weeks for a mild strain (no muscle/tendon tearing). For a moderate injury involving a partial muscle tear, recovery may take six or more weeks.

Surgery

In some cases, one or more of the hip flexor muscles or tendons may have suffered a complete tear. If so, the non invasive approaches described above will not be adequate. Instead, surgery will be required.

The attending doctor will be able to advise on this. However, the good news is that instances of hip flexor strains that require surgery are quite rare.