What is Hip Flexor Strain?
Hip flexor strain is also called as psoas strain, hip flexor tear, hip flexor injury, iliopsoas strain, pulled hip flexor, torn iliopsoas muscle, strained iliopsoas muscle.
A hip flexor strain is characterized by tearing of single or multiple hip flexor muscles resulting in pain often in the front side of the groin or hip.
A collection of muscles present at the front side of the hip are known as the hip flexors. The most frequently affected muscle in hip flexor strain is iliopsoas muscle. The iliopsoas muscle begins from the lower back and pelvis and inserts into the femur.
The hip flexors help in bending the hip while performing activities and are specifically active while kicking and sprinting. Contraction or stretching of the hip flexors results in putting stress through the hip flexor muscle fibers. Excessive stress resulting from high force and too much repetition may force the hip flexor muscle fibers to tear resulting in hip flexor strain.
Tearing of the hip flexors may range from a small partial tear which leads to minimal loss of function and minimal pain to a total rupture which involves a major disability and unexpected episode of severe pain.
Types of Hip Flexor Strain
The hip flexor strain can broadly be classified into three types depending upon the condition of the injury.
- Grade 1 Tear of Hip Flexor.
- Grade 2 Tear of Hip Flexor.
- Grade 3 Tear of Hip Flexor.
Grade 1 Tear: Grade 1 Hip Flexor Strain occurs only in small number of fibers which is associated with mild pain, but this does not affect the functional ability.
Grade 2 Tear: Grade 2 Hip Flexor Strain occurs in major number of fibers which is also associated with moderate loss of function. The majority of hip flexor strains are grade 2 strains.
Grade 3 Tear: Grade 3 Hip Flexor Strain results in complete rupturing of all muscle fibers which is associated with major loss of function.
Causes and Risk Factors of Hip Flexor Strain
Hip flexor strain is caused due to a sudden contraction of the hip flexor muscles, especially in stretched position. Hip flexor strain is often caused while performing activities such as sprinting and kicking. This particularly results from a sudden explosive movement such as performing a long kick in football, without adequate warm up.
In some cases hip flexor strain or hip flexor tear may develop gradually due to prolonged or repetitive strain on the hip flexor muscles which may result from excessive sprinting and repetitive kicking. Hip flexor strain is frequently seen in kicking and running sports like soccer and football.
Other causes of Hip Flexor Strain may include:
- Muscle weakness, specifically of the gluteals, hip flexors or quadriceps.
- Muscle tightness, specifically of the hamstrings, hip flexors, gluteals or quadriceps.
- Inadequate warm up.
- Inappropriate training.
- Joint stiffness, particularly the hip, knee or lower back.
- Poor posture.
- Poor biomechanics.
- Decreased fitness.
- Inadequate rehabilitation followed by previous hip flexor injury.
- Neural tightness.
- Muscle imbalances.
- Poor core and pelvic stability.
Signs and Symptoms of Hip Flexor Strain
- Pain is experienced at the front side of the hip.
- Sudden development of pain.
- Worsening of pain when the thigh is raised against resistance.
- Pain is experienced on stretching these muscles.
- Tenderness is felt when firmly touching the area at the front side of the hip.
- Bruising and swelling in severe cases.
Treatment for Hip Flexor Strain
- Avoiding activities that aggravate the symptoms.
- Application of ice to the hip flexor muscles for about 30 minutes every 3 to 4 hours until pain-free.
- Non-steroidal anti-inflammatory medications.
Sports and exercise must be avoided until pain free. Returning back to normal activities too quickly before appropriate recovery from Hip Flexor Strain or Hip Flexor Tear may result in chronic problem.
Physical Therapy: Physical therapy for hip flexor strain is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrence of Hip Flexor Strain in future. Physical therapy for Hip Flexor Strain or Hip Flexor Tear May Include:
- Joint mobilization particularly the hip and lower back.
- Using crutches.
- Soft tissue massage.
- Application of heat and ice.
- Dry needling.
- Activity modification advice.
- Electrotherapy such as ultrasound.
- Progressive exercises for improvement of flexibility and strength, specifically of the hip flexors.
- Biomechanical correction.
- Anti-inflammatory advice.
- Appropriate plan for returning to sports and activity program.
Exercises for Hip Flexor Strain
Hip Flexion Exercise for Hip Flexor Strain:
Hip Flexion exercise is performed by lying down on the back. Now gradually bring the knee towards the chest as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Perform 10 times ensuring there is no exacerbation of symptoms.
Hip Extension in Lying Exercise for Hip Flexor Strain:
Hip Extension exercise is performed by lying down on the back. Now by keeping the buttocks at the very edge of the bed or bench bring the healthy knee towards the chest as far as possible in order to drop the affected leg towards the floor. Hold the position for about for about two to five seconds until a mild to moderate pain free stretch is felt. Perform 10 times ensuring there is no exacerbation of symptoms.
Quadriceps Stretch Exercise for Hip Flexor Strain:
Quadriceps Stretch Exercise is performed by standing with the hands on a wall or counter for support. Grasp the top area of the ankle and foot on the affected leg. Now pull the foot in the upward direction in order to approach the buttock until a pain free stretch is felt on the front side of the thigh. Hold the position for about 30 seconds and release. Repeat three times.
Tests to Diagnose Hip Flexor Strain
A complete subjective and objective examination is performed to diagnose hip flexor strain or hip flexor tear. Other tests that help in diagnosing and ruling out other potential causes may include:
- CT scan.
Hip Flexor Strain Recovery Period:
Strained hip flexor usually requires 2-3 weeks to heal if it is a minor tear. For a major tear of the hip flexor muscles to heal, it can take anywhere between 4 to 6 weeks or maybe a little longer in some cases.