Subscribe
The hip flexors that get hurt most often are those closest to the surfaces. For example, in athletes we often see the so-called “Hip Pointer” injury. This is really a hip flexor mechanism injury at the proximal insertion of the muscles at the ASIS (the anterior superior iliac spine) – that boney prominence on the front of the hip. Deeper than that are the true hip flexors, Psoas and Iliacus with a common tendon on
the femur Iliopsoas. Because of the proximal insertion of the Psoas on the lumbar spine, people with sway back (a very lordotic standing posture, seem to be more susceptible to hip flexor trouble, especially if active. The reason for this is that a sway back leads to the hip flexor being effectively shortened, and the iliopsoas more susceptible to strain. The anterior pelvic tilt that accompanies a sway back is associated with lower back pain as well.
Manual therapy for shortened iliopsoas includes a myofacial release technique that can be quite painful, and an active/passive manual stretching procedure. For acute injury, I use an extra long ace bandage to support the hip flexors (we call this a spika wrap), and we use ice, occasionally ultrasound and also electrical stimulation to help get us through the acute phase. I also use the Stick to treat the tight muscles of the thigh including the ITB and the Quad mechanism. In the event that you have tightness of the ITB and Quadaceps mechanism, then using a Stick or similar tool at home will help you resolve those restrictions. In any event, the long term key is to first stretching the hip flexors effectively, and then to strengthen them as they gain length.
Three stretches I really like include:
1. Standing: Leg flexed with your foot behind you up on a table, knees aligned to the center, stomach contracted to flatten the back, shoulders upright and then flex the knee of the foot you are standing on. You should feel the stretch in the front of the quad. To increase the stretch, stand further away from the table so you have to reach further back.
2. Half Kneeling: The knee of the hip you want to stretch is on the ground. Your body is upright. Contract the stomach muscles to keep the lower back flat. Bring your weight forward onto the front foot but keep your shoulders upright until you feel the stretch in the groin. Take your same side hand and reach over the top of your head and leaning your body gently over to the side.
3. Prone: Lying face down, arms spread out, bend your knee of the leg you want to stretch. Again, tighten your stomach muscles to keep your back relatively flat. Pick up your knee and try to reach over your body and touch the opposite hand with your foot.
A word about stretching: First of all, stretching SHOULD NOT HURT. Second, you need to hold the stretch for at least 30 seconds. Third, to improve the effectiveness of the stretch, try contracting and relaxing the muscle you want to stretch.
Do muscles get longer when you stretch them? In a word, “no”. The length of a muscle is established neurologically. So why stretch? A fair question. What you are doing is helping the dense connective tissue become hydrated and also “resetting” the relationship between the actin and myoisin components of the muscle fiber. This helps the muscle, in either case, be more tolerant of stretching during activity. In other words, you can be active without the hip flexors experiencing failure.
For strengthening, I like these two exercises:
1. Supine: Lie on your back with your foot on top of one of those big Swiss Balls. Loop an elastic cord over the top of your foot, so that it is pulling downwards (along the line of your leg, parallel to the floor). Bend the knee and pull the toes up to keep the rubber band on the foot until your hip flexors get tired.
2. Sprinting up a hill: Like it says, sprint up a really steep hill over and over. Focus on high knees. This makes you flex the hip to prevent catching your toe. This is very a effective exercise. we usually work up to 10 10 second repeats with a 20 second rest break between sprints. If you amke sure to lift your knees, this exercise will make a big difference.
thanks for sharing this very interesting post
upright exercise bike
Comment by unmth — December 30, 2008 @ 9:57 pm
This was really helpful to me. I’m a runner, and recently my hamstring had been really tight, then just yesterday (seemingly out of nowhere), the outside part of my hip was in A LOT of pain to the point where I could barely stand on it. I immediately thought it might be my hip flexor, but now I’m not so sure..Regardless, when I tried to find info about it on the Internet, your site was one of the first ones to pop up. Really great info here
Comment by janelle. I live — February 20, 2009 @ 6:23 am
Thanks Janelle! Happy to help!
Comment by Neil Chasan, PT, MMT — February 20, 2009 @ 9:50 am
Your description of a ‘hip pointer injury sounds similar to what I’m experiencing. I’m a runner who sensed ‘something’ in my hip (right at waist high, slightly towards the back)about a week ago. Didn’t hurt, just felt like a bruise almost. Then during a 9m run that spot started to hurt more and more and by the time I finished I could barely walk up stairs. A week later (with no running) and I still have a sharp pain in this spot ‘if’ I try to run, or when I put all my weight on that leg (getting out of the car for instance). In addition my hamstring is VERY tight and my piriformis is sore. I can use the Eliptical pain free but can’t run more than a couple of steps without discomfort.
The pain if more than just a strain, and I’m wondering if an avulsion fracture is possible.
The only stretch that seems to really affect the spot is the ITB stretch when you cross one leg in front of the other and lean the opposite direction. In fact, just leaning causes discomfort. Sorry about the rambling on but I just wanted to throw everything out there. My biggest concern is I’ve gone a week without running and it doesn’t seem like its improved at all.
Comment by Steve Wolfe — April 20, 2009 @ 4:19 pm
Steve, two thoughts come to mind: 1. Your SI Joint might be subluxed which is why your hamstring and hip flexor are irritated and 2. This might be a hip pointer. It seems to me that you need someone to take a look at your SI joint. You should call around and find a PT or even a Chiropractor who is familiar with the SI joint to evaluate you.
Comment by Neil Chasan, PT, MMT — April 21, 2009 @ 8:09 am
I am a runner who also seems to have the “hip pointer”. It’s the bony part at the top of the pelvic region on the side. For me it seems to be a recurring problem. It used to occur if I ran really fast in the morning without warming up. It now occurs every few months. If I stop running for a couple of weeks, it clears up. Are there any stretching exercises I can do for it? My orthopedist gave me a prescription medication, which I don’t want to take.
Comment by marathoner — May 12, 2009 @ 2:45 pm
My favorite hp flexor stretch is “The Scorpion” – lie on the floor on your stomach with your arms outstretched. Starting with your right side, raise the right foot off the floor and reach across the body with your foot trying to touch your heel to the floor near your left arm. Of course, you should only go so far as to feel as stretch and not even a painful stretch at that.
Comment by Neil Chasan, PT, MMT — May 12, 2009 @ 3:09 pm
Thank you for the stretching recommendation for my hip pointer problem. Unfortunately, after doing an easy 10 minute run, the pain in the hip pointer started began surfacing again. I am going to stop running again for a few weeks. Are there any strengthening exercises that would stop the hip pointer pain from recurring? My physical therapist doesn’t seem to have come across this problem before, and is devising standard hip stretching exercises
Comment by marathoner — May 19, 2009 @ 10:44 am
OK, so you should ask your PT to perform a Thomas test on you to see if your hip flexors are actually tight or if it is your quads or ITB that is restricted.
The best hip flexor strengthening exercises in my arsenal are a couple non-weight bearing exercises, and one I like where you lie on your back, your knee flexed and your foot up on a Swiss ball. using your foot hold onto a piece of elastic theraband by dorsi flexing. Then roll the ball toward you as you dorsi flex your foot. That will engage your hip flexors.
another non-weight bearing exercise I like is this: You can do this on the bottom step. Sit on the bottom step, your legs straight out in front of you. Lift your bottom off the step by pushing with your hands until your arms are straight. Lift one leg off the floor and when you get tired – about 30 seconds, out that leg down and lift the other leg. Repeat until you are very fatigued. As time passes, you should be able to lift both legs together. You can also do this exercise hanging from a bar. The variation here is to lift both legs together with the knees bent, and then to straighten them out and hold as long as you can.
The other exercise I like for hip flexor strength is one where you either use a treadmill or a steep hill. But you sprint up a hill trying to make sure you lift your knees high when you do so.
Good luck!
Neil
Comment by Neil Chasan, PT, MMT — May 19, 2009 @ 11:02 am
my son is 13 and he is VERY tight in his entire pelvic area. He has limited range of motion in his hips. He plays many sports and is very athletic. I am afraid he is going to hurt himself long term if i do not increase his range of motion. What suggestion would have for me? that you.
Comment by Jenny Keller Kuehn — June 23, 2009 @ 7:44 am
I see this in kids of this age so often because they go through growth spurts where their long bones grow and their soft tissues are not yet lengthened to match. I advise kids to take a week off during a growth spurt and perhaps even the week after in order to avoid injury. The challenge is that to kid this age, taking time off is perceived as dangerous to their development. The reality is that acute or chronic injury is more risky than a week of rest to their development. The key is to get the coaches to support you in this effort.
Beyond that, daily stretching is key as is hydration and a good slow warm up before exertion.
Nei
Comment by Neil Chasan, PT, MMT — June 24, 2009 @ 9:57 am
[...] The Hip Flexor Mechanism [...]
Pingback by Difficult Quad Pain in Runners « SRCPT at Sports Reaction Center — October 8, 2009 @ 10:06 am
Hi Neil,
I recently returned to running after a thigh injury that turned out to be ITBS. My PT had me do standing quad stretches. I noticed in this article you said that stretching “should not hurt.” My stretching did hurt, but my PT asked me if the pain continued after I stopped doing the stretch. I told him no–only pain when I did the stretch, the pain being a 6 or 7 out of ten. I mention this because these stretches were key to making the ITBS go away. I think sometimes stretching does hurt, but as long as the pain stops after the stretch is over, results can be achieved. I’m not saying the pain should be excruciating, but I had definite pain on the lateral side of my knee that slowly went away as I did about 50 quad stretches per day at 5-10 seconds each.
Comment by Ann — May 30, 2011 @ 2:54 pm
Sorry for the delay in answering Steve…an avulsion fracture sounds unlikely. Let me know what you learned…
Comment by Neil Chasan, PT, MMT — August 25, 2011 @ 4:00 pm