Hip flexor strain is an injury which involves tearing of one or more of the hip flexor muscles. This causes pain in the front of the hip or groin.
The hip flexors are a group of muscles at the front of the hip. The most commonly involved muscle in a hip flexor strain is the iliopsoas. The iliopsoas muscle originates from the anterior lower back and pelvis and inserts into the medial anterior thigh bone or femur.
The hip flexors move the knee towards the chest. They are particularly active when sprinting or kicking. When the hip flexors contract and the tension is excessive due to too much repetition or force, the hip flexor muscle fibres can tear. If this occurs, the condition is known as a hip flexor strain.
Tearing to the hip flexors ranges from a small partial tear with minimal pain and minimal loss of function, to a complete rupture which involves a sudden severe pain and significant disability.
Hip flexor strains range from grade one to grade three:
- Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function and minimal discomfort.
- Grade 2 Tear: a large number of fibres are torn with moderate loss of function.
- Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function and disability.
Most hip flexor strains are grade 2.
What causes of a hip flexor strain
This often occurs during sprinting or kicking activities. Particularly during explosive acceleration activities or when a footballer performs a long kick, especially following an inadequate warm up.
Hip flexor strains usually occur due to a sudden contraction of the hip flexor muscles (usually in a position of stretch). Sometimes a person may develop this condition gradually due to repetitive or prolonged strain on the hip flexor muscles. This includes repetitive kicking or sprinting excessively in sports like football and soccer.
Signs and symptoms of a hip flexor strain
A sudden sharp pain or pulling sensation in the front of the hip or groin at the time of injury is most often felt. In minor strains, pain may be minimal allowing careful continued activity. In more severe grades, persons may experience severe pain, muscle spasm, weakness and having to discontinue the activity. People with a severe hip flexor strain may also be unable to walk without limping or receiving aid or using crutches.
Pain is usually experienced when lifting the knee towards the chest (especially against resistance) or during activities such as running, kicking or climbing stairs. Pain or stiffness after these activities with rest is usually felt. The pain and movement is always worse in the morning. Swelling, tenderness and bruising may also be present.. In a grade 3 tear a visible deformity in the muscle may also be evident.
How long does a hip flexor strain take to repair?
With appropriate management, patients with a minor hip flexor strain can usually recover in one to three weeks. Worse tears may take four to eight weeks and longer to repair depending on the severity. Complete ruptures of the hip flexor muscles are rare and are managed carefully. These cases take significantly longer to repair.
Management of a hip flexor strain
Management of this condition is vital to hasten the healing process. For optimal outcome and to reduce the likelihood of recurrence careful treatment is essential.
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- joint mobilization (especially the lower back and hip)
- dry needling
- anti-inflammatory advice
- the use of crutches
- ice or heat treatment
- progressive exercises to improve strength and flexibility (particularly of the hip flexors)
- biomechanical correction
- activity modification advice
- establishment of an appropriate return to activity or sport plan
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