Hip Flexor | North Vancouver

HIP FLEXOR INJURIES- as seen in Triathlon Canada Magazine

By: Dr. Jenn Turner

Hip flexor injuries are a common injury in runners, triathletes and cyclists, yet there is little research or information available about how to properly rehabilitate this injury.

The hip flexors are made up of three different muscles, the rectus femoris, the psoas major and the ilacus. These muscles are located in the front of the hip and their action is to flex the hip or bring the knee up. These muscles also play an important role in stabilizing the pelvis.

There are various types of injury that can occur to the hip flexors: snapping hip syndrome, iliopsoas tendonopathy, anterior acetabular impingement or a nerve entrapment. Many of these injuries present very similar to each other, yet each different injury actually causes similar muscle imbalances and thus has a similar biomechanical solution.

Symptoms of a hip flexor injury can include pinching or pain when the knee is brought up to the chest, snapping or clicking in the front of the hip, hip tightness when stretching compared to the opposite side, pain when pushing off while running, or pain in the low back or sacroiliac region. Some athletes report a weakness or a loss of power in the affected leg, and chronic injury can manifest itself in pain or tightness all the way down the leg as compensation.

The pelvis is supported muscularly by the psoas as mentioned above, but also very importantly the gluteus maximus and the gluteus medius muscles. Pelvic stability is often referred to as “core stability”, and the importance of core stability is very prevalent in the athletic society today. That is why when the psoas muscle is dysfunctional as in each of the hip flexor injuries listed above, it is a major concern to pelvic or “core” stability. Various researchers have demonstrated that not only does the psoas provide stability to the lower lumbar spine directly but If the psoas muscle becomes excessively tight or shortened, it inhibits or “turns off” the gluteus maximus muscle. The phenomenon, described as “reciprocal inhibition” can occur in various muscles of the body, and is characterized by a contracted or shortened muscle forcing the opposing muscle to relax. Thus in the above situation, the gluteus maximus is neurologically weakened by this inhibitory reflex and an imbalance of pelvic muscles results.

The resulting muscular imbalance is where the injury becomes a detriment to performance and potential further injury. When the power of the glute max muscle is lost, the body will look for other muscles to compensate beyond their regular capacity. This creates a cascade of tight and weak muscles all the way down the leg in an attempt to recreate proper movement patterns. These muscles then usually end up becoming injured themselves, as they are overloaded and cannot correctly compensate for the dysfunction.

Treatment

It is important that this hip flexor injury or dysfunction be managed timely and appropriately. Many athletes wait too long to deal with this injury and the compensation patterns can take extensive rehabilitation and months to reverse. First the tight tissues must be released. A soft tissue technique such as Active Release Techniques (ART®) can be a useful method to decrease scar tissue buildup. Combined with stretching, massage and foam or triggerpoint ball rolling this can be an effective way to loosen the psoas muscle. Depending on the level of compensation, other muscles of the hip or leg will also need to be released. Active Release of the gluteus maximus can also be helpful to activate the inhibited muscle in preparation for the next steps of rehabilitation. In this next step of rehab, the neuromuscular repatterning of the glute must be re-established and strength of the glute can be restored. The release of the psoas muscle helps with this, but combined with specific neuromuscular patterning exercises can help to expedite the process of normalization. Specific exercises include a split squat, with a focus on keeping a posterior pelvic tilt, which strengthens hip muscles in a lengthened position preventing them from getting over tight. Another exercise for glute firing includes the leg “drop” where the trained practitioner drops the patient’s leg from an extended position and it must be “caught” by the athlete before it hits the table. (see photos).

By introducing certain exercises, pelvic stability can be optimal and provide stability to the lower extremity, lumbar spine and pelvis. A strong hip/pelvis complex helps to prevent injury recurrence, and improve athletic performance.

Dr. Jenn Turner is a chiropractor who is currently completing a post graduate sports residency program to be a sport specialist. She owns two clinics, one in North Vancouver- Moveo Sport & Rehabilitation Centre and one in Chilliwack- Optimum Sport Performance & Health Centre. Jenn deals regularly with tight hipflexors, inhibited glutes and pelvic muscular imbalances in her job as National Team Chiropractor for the National Track & Road Cycling Teams. Contact her at drjennturner@gmail.com for more info.

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