A hip flexor strain is simply a stretch or tear in one or more of the hip flexor muscles (which leads to pain in the front of the hip). Hip Flexor tendonitis is a different but related condition, which also leads to hip pain. However, in the case of hip flexor strains, the tendon that attaches muscle to the thigh bone or pelvis, becomes damaged or inflamed. The hip flexor carries out an important role by providing stability to the body trunk and providing power to the legs for forwarding motion. The hip flexor consists of several muscles in the front of the hip and pelvis that work together to help you to lift your thigh towards your stomach and to bend at the waist. Therefore, any injury to the hip flexor can make running, walking, climbing, walking up the stairs, or kicking difficult.
Causes & Symptoms
Strain injuries to hip flexor muscles are most common in sports such as football and running short dashes. The repetitive straining of these muscles during a game or practice session can lead to minor tears of the muscle. A more significant tear can occur when an individual suddenly contracts the muscle from a stretched position. This can be seen when a football player makes a very powerful kick. An injury can be sustained if you did not have adequate warm-up and stretching. Besides sports injuries, you can have slight tears to your hip flexor muscles if they are weak. When you make sudden contractions of the hip or perform rigorous exercises you can injure your muscles.
Many people who experience hip flexor strain will have these symptoms:
- Sudden, sharp pain in the hip or pelvis after trauma to the area
- A cramping or clenching sensation in the muscles of the upper leg area
- Loss of strength in front of the groin, along with a tugging sensation
- The upper leg feeling tender and sore
- Inability to continue kicking, jumping, or running
- Muscle spasms in the hips or thighs
- Reduced mobility and discomfort when moving, including walking
- Swelling or bruising around the hip or thigh area
- Tightness or stiffness after being stationary, such as after sleeping
Who Gets a Hip Flexor Strain?
While hip flexor strain can occur to anyone, athletes who play sports such as soccer, football, and basketball are more at risk for developing a hip flexor strain. It is common for an injury to occur when there is a sudden increase in duration, intensity, or frequency of activity. Whilst sports are among the most common causes of hip flexor strains, other factors can contribute to this injury. Overuse, poor posture, walking habits, and arthritis are among some of the possible non-sports-related causes.
How Does It Affect You? How Serious Is It?
Not all hip flexor strains are equal; they vary in severity from Grade 1 to Grade 3. These grades take into account muscle damage, pain levels, and functionality. The injury’s grade indicates the required level of treatment and expected recovery time. These grades include:
- Grade 1 – Damage to a small number of muscle fibers, which causes some pain, but allows full hip functionality.
- Grade 2 – Moderate loss of functionality and moderate pain, due to a moderate to a significant number of torn fibers.
- Grade 3 – Major loss of functionality and severe pain, due to damage to all the muscle fibers.
Recommended Treatment & Rehabilitation
Your doctor will first discuss your general health and ask you about what activities you were doing just prior to the injury. He or she will examine your leg and hip for tenderness or swelling. During the physical examination, your doctor will apply pressure to various muscles in the area and move your leg and hip in various directions to assess your range of motion. Your doctor may also ask you to perform a variety of stretches and movements to help determine which muscles are injured.
X-rays provide images of dense structures such as bone. Your doctor may order an X-ray to rule out the possibility of a stress fracture of the hip, which has similar symptoms. In most cases, no additional imaging tests are needed to confirm the diagnosis. It is important to rest and seek treatment right away for a suspended hip flexor strain or tear. If left untreated, the condition could worsen, and recovery time is extended. Most treatments including rest, ice, compression, elevation combined with anti-inflammatory medication, can help alleviate some of the symptoms of a hip flexor tear or strain. Your physician may also recommend using crutches to keep the weight off the hip. Other recommended treatments include:
- Brace – a brace can help compress and stabilize the hip flexor to speed up the healing process.
- Physiotherapy – if pain persists longer than a couple of weeks, your physician may prescribe a physiotherapy program to help you increase your flexibility and strength.
- Platelet-rich plasma injection (PRP) – an PRP injection can be used to expedite healing by injecting concentrated growth factor platelets from the patient’s own blood into the hip.
Although most hip flexor strains or tears are treated without surgery, if the muscle has been completely torn, you may require surgery to repair the hip flexor and restore function.
Here are some examples of exercises for you to try – the following stretches can help to reduce tightness, increase flexibility, strengthen muscles, and help prevent injury. These include:
Pelvic tilt with marching
First, lie on your back with your knees bent and your feet flat on the floor. Secondly, tighten your belly muscles and buttocks, and press your lower back to the floor. Keeping your knees bent, lift and then lower one leg up off the floor, and then lift and lower your other leg like you are marching. Each time you lift your leg, hold that position for about 6 seconds before lowering your leg before repeating this exercise 8-12 times.
Lie on your back with your knees bent at a 90-degree angle and your feet off the floor. Tighten your belly muscles and buttocks and press your lower back to the floor. Slowly straighten one leg and hold the position for about 6 seconds. Your leg should be about 30 centimeters off the floor. Bring the leg back to the starting position, and then straighten your other leg. Hold that position for 6 seconds, and then switch legs again, repeating the procedure 8-12 times.
Lie flat on your back with your legs straight. If you feel discomfort in your back, place a small towel roll under your lower back. Holding the back of your affected leg for support, lift your leg straight up and towards your body until you feel a stretch at the back of your thigh. Finally, hold the stretch for at least 30 seconds. Repeat this method 2-4 more times.
Lie on your side with your good leg flat on the floor and your hand supporting your head. Bend your top leg and reach behind you to grab the front of that foot or ankle with your other hand. Stretch your leg back by pulling your foot towards your buttock. You will then feel the stretch in the front of your thigh. If this causes stress on your knee, do not perform this exercise. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times.
Hip flexor stretch
Kneel on your affected leg and bend your good leg out in front of you, with that foot flat on the floor. If you feel discomfort in the front of your knee, place a towel under your knee. Keeping your back straight, slowly push your hips forward until you feel a stretch in the upper thigh of your back leg and hip. Finally, hold this stretch for at least 15-30 seconds before repeating 2-4 more times.
Alternative & Homeopathic Treatment
Finding the right hip flexor strain treatment is the first step towards managing the long-term effects of a hip flexor strain. Some treatments can be done in the comfort of your own home whereas others require a health care professional. Some of these at-home treatments include the following:
One of the best ways to reduce hip pain is to give your hip flexor muscles a rest. Constant overuse of the hip muscle fibers makes it tough for injuries to heal. So, it is highly recommended to take a break from sports and physical activities and rest. It is also recommended to make sure to avoid doing things that involve bending at the hip, especially bringing your knee up.
Ice and hot application
Hot and cold therapy works in two different yet complementary ways. Cold therapy is best during the initial injury phase, approximately the first 72 hours when pain is at its worst; the cold will reduce swelling by limiting the amount of fluid that is brought to the site and will help minimize hip pain. After swelling and redness have dissipated you can start using heat – a heat pack or hot shower can be good options. The heat will bring more blood to the area to speed up healing. Avoid sleeping with either an ice pack or a heating pad on your body to prevent any skin injuries.
After you have recovered from the initial injury that caused your hip flexor pain you can start incorporating foam rolling into your recovery. This simple tool has been used by athletes for years and is now a mainstream treatment for muscle injuries.
Compressing the affected area will help reduce swelling. It is necessary to use an elastic bandage or support brace to give your muscles the added assistance. Make sure to use moderate compression, since not compressing enough won’t give you the support needed and compressing too much can be painful.
Massages are another great home treatment option for hip flexor pain. After an injury, many people will have muscle spasms and tension in their muscles and surrounding tissue. A massage will loosen up those muscle fibers and bring in an overall sense of relaxation. Avoid massaging in any area you see bruising or if it causes sharp pain.
Over-the-counter pain relievers like Motrin, ibuprofen (Advil), and naproxen (Aleve), are non-steroidal anti-inflammatory drugs (NSAIDs) that help reduce swelling and sharp pain. These medications are typically safe for most people but always check first with a doctor or pharmacist before you begin to take any prescription medication.