Common Hip Flexor Injuries and Treatments

June 13, 2018

The hip flexor muscles are a group of muscles attached to the hip joint that allow you to both bring your knee toward your chest as well as bend at the waist. In other words, the hip flexor muscles are fundamental to everyday movement. When these muscles are injured, they are painful and limit your ability to live a normal life.

Injuries can occur in either the inner hip muscles, anterior compartment of the thigh, medial compartment of the thigh, or gluteal muscles; however, the pain of an injury is rarely felt in just one area. This makes the cause of hip pain difficult to pinpoint.

This article contains descriptions of common hip flexor injuries as well as conservative, at-home treatments for managing mild to moderate symptoms. To accurately diagnose the source of your pain and receive the most effective treatment, contact a hip specialist.

Hip Flexor Injuries

Hip Flexor Strains

Hip flexor strains occur when hip flexor muscles are stretched or torn. Tears are classified into three grades depending on their severity:

• Grade I – Mild stretching and microscopic tears in muscle fiber which cause some pain. The hip functions normally.
• Grade II – Moderate stretching and tears in muscle fiber which cause pain. The hip may periodically give out while standing or walking.
• Grade III – Muscle fibers are completely torn or ruptured. The hip can no longer bear weight.

In the majority of cases, a hip sprain begins as a microscopic tear that gradually increases in size with repetitive use of the hip. These types of tears are common in sports like cycling, running, swimming, baseball, and golf due to overuse of the hip. If diagnosed early, Grade I and Grade II strains can be effectively treated with rest and other conservative treatments. Grade III strains, however, are one of the most serious hip injuries. This is especially true if the strain is accompanied by a fracture. If your hip cannot bear weight, it is imperative that you contact an orthopaedist for professional treatment.

Causes of hip flexor strains:

• Direct trauma to the hip
• Overuse of the hip flexors
• Osteoarthritis

Signs and symptoms of a hip flexor strain:

• Pain in the front of the hip or in the groin
• Pain, tenderness, and weakness when walking or climbing stairs
• Pain when lifting the knee toward the chest
• Pulling sensation in the front of the hip or in the groin
• Swelling and inflammation
• Bruising
• Muscle spasms
• A limp while walking
• A visible muscle deformity

Hip Flexor Tendonitis

Hip tendonitis is inflammation of any of the hip tendons, or thick cords that attach muscles to bone. Similar to strains, hip tendonitis is commonly caused by overuse. And, also like strains, tendonitis frequently affects the same population—athletes who participate in cycling, swimming, running, and other sports that repeatedly stress the hip. High intensity interval training (HIIT) workouts and other activities that involve a high volume of kicking, squatting, and jumping can also lead to tendon inflammation.

Causes of hip flexor strains:

• Direct trauma to the hip
• Overuse of the hip flexors
• Bad posture or walking habits
• Rheumatoid arthritis, osteoarthritis, or gout

Signs and symptoms of hip flexor tendonitis:

• Pain in the hip, back, or leg
• Pain that gradually develops over time
• Stiffness
• Swelling and inflammation
• Heat and redness around the tendon
• Visible knots surrounding the tendon

Iliopsoas Syndrome (Psoas Syndrome)

The iliopsoas muscles are a group of two muscles—the psoas muscle and the iliacus muscle—located toward the front of the inner hip. The psoas muscles, in particular, is located in the lumbar (lower) region of the spine and extends through the pelvis to the femur. The iliopsoas muscles are the primary hip flexors, pulling the knee up off the ground when it contracts. Because the psoas muscle is also connected to the spine, it contributes to upright posture, assists in lumbar spine movement, and influences the spine’s curve.

Iliopsoas syndrome, which is also called psoas syndrome or iliopsoas tendonitis, occurs when the iliopsoas muscles are injured. Lower back pain is the most common symptom; however, pain can also occur in the hip, thigh, or leg. The iliopsoas bursa, which is a fluid-filled sac located on the inside of the hip that reduces rubbing and friction, is also likely to become inflamed due to the proximity of the two structures. When this happens, the inflamed bursae will make it difficult to move.

Everyone is susceptible to iliopsoas syndrome, although it is relatively uncommon. Athletes are at higher risk of developing the condition, especially those that frequently use their hip. Running and plyometric jumping exercises, in particular, can aggravate inflammation and pain.

Causes of iliopsoas syndrome:

• Sudden contraction of the iliopsoas muscle or direct trauma
• Overuse of the iliopsoas muscles
• Rheumatoid arthritis

Signs and symptoms of iliopsoas syndrome:

• Pain in the lower back, groin, or pelvic area
• Pain radiating down the leg
• Pain when lifting one or both legs
• Pain when climbing stairs
• Pain when standing from a sitting position

Treatment and Recovery

Exercise and Stretching

In order to minimize the risk of a strain, always stretch properly before doing any kind of exercise. Stretch slowly and hold the position to ensure that your muscles are adequately flexible.

The following stretches will help reduce the risk of a hip flexor injury.

Seated Butterfly

1. Assume a seated position with your feet together in front of you and your knees bent to the side. Keep your back straight, shoulders down, and abs tight.
2. Bend forward from the hips until you feel tension. Hold the position for 30 seconds.
3. Return to the starting position.

Lunge

1. Assume a standing position with your body straight, shoulders back and relaxed, chin up, and your abs tightened.
2. Step forward with one leg, lower your hips until both knees are bent at about a 90-degree angle. Make sure your front knee is directly above your ankle. Do not let the pelvis tilt forward.
3. Squeeze the glute of the rear leg. Drive the knee back into the ground while having the hip sink down and forward.
4. Return to the starting position and repeat the stretch with your other leg.

Forearm Plank

1. Assume a push-up position using your forearms instead of your hands. Lower your hips while keeping your body straight from shoulders to ankles.
2. Tighten your abs and squeeze your glutes. Hold the position for 15 to 30 seconds while breathing deeply.
3. Release, pause, and repeat.

It is important to note that hip flexor injuries are not caused by tightness alone. Muscle weakness is also a major risk factor. When muscles are weak they tear more easily. Moreover, other structures in the body must compensate for the weakness.

Consider working with a physical therapist to strengthen weak hip muscles. The physical therapists at Beacon Orthopaedists and Sports Medicine can also recommend a sport-specific training program. This is ideal for golfers, swimmers, runners, and any athlete who not only needs to preserve their hip but also strengthen it in order to remain competitive.

RICE Method (Rest, Ice, Compression, Elevation)

The RICE Method is a simple, at-home treatment for relieving mild pain and inflammation. It can also be beneficial during the early stages of a more serious injury, while you are planning to meet with an orthopaedist.

Rest the Hip: Take a break from unnecessary activities. You may also consider crutches for a short time in order to take stress off of your hips.

Ice the Hip: Apply ice or a cold pack to the hip immediately following an injury. Do not apply ice directly to your skin. Instead, place a towel between the ice or cold pack and your hip. You can continue to apply ice for up to 30 minutes at a time 3-4 times a day.

Compress the Hip: Wrap your hip with an elastic bandage in order to reduce swelling. Make sure that the bandage is moderately tight, but not too tight otherwise it will cause additional swelling.

Elevate the Hip: Elevate your hip on a pillow when you are lying down. Try to keep your hip above the level of your heart to help minimize swelling.

Severe Injuries

Unfortunately, some hip flexor injuries are so severe that they require professional treatment from a hip specialist. Immediately contact an orthopedist if you experience any of the following:

• Inability to bear weight on your hip
• Decreased range of motion in your hip
• Hip pain and swelling that does not subside

Some injuries, such as a Grade III strain, can also occur without any obvious symptoms. If you sustain direct trauma to your hip, it’s important that you see a physician for a professional evaluation.

Contact Dr. Hamilton for an Evaluation

While a sharp pain in the hip, groin, pelvis, or thigh is an obvious sign of a hip flexor injury, pain in the lower back and leg are easy to misdiagnose. After all, it’s natural to assume that radiating pain in the leg or lower back originate from these areas. Unfortunately, diagnosing the source of a patient’s pain is not always straightforward. In fact, it’s possible for patients to go years with a misdiagnosed injury.

Only a professional orthopaedist can accurately diagnose hip pain and recommend the appropriate treatment. Dr. Steve Hamilton is a board-certified hip specialist at Beacon Orthopaedics and Sports Medicine who can conduct a comprehensive evaluation of your condition and provide an accurate diagnosis.

Knowing the exact source of your hip pain can provide you with peace of mind—but receiving the right treatment is even better. Let Dr. Hamilton provide you with both peace of mind and relief from your symptoms. Schedule an appointment with Dr. Hamilton today. For your convenience, he is available at Beacon East, Beacon West, or Summit Woods in Ohio as well as Beacon’s Northern Kentucky location.

Patients can schedule an appointment with any of our 60+ expert physicians at our 20+ locations across the Greater Cincinnati area online or by calling 513-354-3700 to speak with a live representative who’s available 24/7/365.