Pain of the hip flexors is a common presentation we see in the clinic. I want to take a little time to go over what constitutes the hip flexors, what causes pain in the hip flexors and how we treat them.
What are the hip flexors?
The hip flexors are the muscles that attach to the front of the hip and are involved in bringing your knee up towards your chest. The primary muscle known as a hip flexor is the Illiopsoas. The Illiopsoas is made of up two muscle bellies (the Illiacacus and the Psoas major). This muscle originates in the lumbar spine (lower back) and inserts onto the anterior side of the femur (thigh bone). Other muscles associated with hip flexion are the Sartorius, Rectus Femoris, and the Tensia Facia Lata. Any and all of these muscles can be involved in causing your pain since they are all involved in flexing your hip. You can palpate your hip flexors by locating the bony point in the front of your pelvis that is just under your belt and going due south an inch or two. If you press in and find the tissue is unusually tender your hip flexors are under some duress.
What causes pain in your hip flexors?
First off we need to determine if you have a strain or just have overly tight hip flexors. Each condition can cause discomfort. Usually a strain is going to be found after exertion such as sprinting or kicking. Therefore hip flexor strains are really common for football and soccer players. It is also common to have a more chronic strain in those athletes who are involved in repetitive exercises, such as long distance runners. Pain from overly tight hip flexors can be found in the very active, but surprisingly can also be found in the desk jockey. The person who sits all day for work will often be found to have tight and painful hip flexors because their lack of use causes the muscle to shorten and tighten. This lack of motion shows up when they ask their hip flexors to work. It is also common for hip flexor tightness to cause lower back pain since the Illiopsoas attaches to the lower back. A lack of abdominal strength can also put a lot of stress on your hip flexors and exacerbate them, as well.
How do we treat hip flexor pain?
How do we treat hip flexor pain in the clinic? If your pain is caused by a strain we will need to determine how severe the strain is. With severe strains we will need to utilize a period of rest from the causative activity and concentrate on reducing inflammation. With mild strains we can usually utilize the same protocol as overly tight hip flexors. We will often manipulate the hip which causes a dynamic stretch to the hip flexors. We will likely utilize a manual therapy treatment such as Instrument-Assisted Soft Tissue Mobilization (we use the technique known as FAKTR). This technique involves utilizing a stainless steel tool to break up scar tissue and improve mobility. It is common to support the muscles with an application of Kinesio tape. And lastly a stretching program is essential. It doesn’t matter if the problem is a strain or a just overly tight muscles we need to get more mobility into the region.
Three popular stretches for the hip flexors are: