Hip Flexor Injury

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Hip Pain

Published: 28 November 2015

The hip flexor injury is one I see on a regular basis. It can be difficult to know when your hip flexors are tight, and it is one of those injuries that people frequently misdiagnosed as something else! However, I rarely fail to spot it as I suffered from it myself five years ago!

The most common symptom of hip flexor injury is lower back pain or pain at the front of your hip. However, there are many other possible causes of lower back pain and anterior hip pain so if you think you have a hip flexor injury, seek a qualified therapist’s advice to ensure a correct diagnosis!

What are your hip flexors?

Your hip flexors are made up of three main muscles:-

• Iliacus - which attaches from your iliac crest to your femur.
• Psoas major - which attaches from your lumbar vertebrae to your femur.
• Rectus femoris - which is the only one of your quadriceps muscles that crosses your hip joint, and hence it is involved in both knee and hip movements.

Each bone in your body is designed to be held in position. It is your muscles and ligaments that hold your bones in these correct positions. They are like the mortar around the bricks! If your muscles become tight the result is often that the bones attaching to the affected muscle are pulled out of alignment. This faulty alignment sometimes places excess pressure on the affected joints, which can often result in pain and stiffness.

The most common type of hip flexor injury that I see happens as a result of them being too tight. When your hip flexors are tight they pull your pelvis out of alignment, usually into an anteriorly tilted position. This, in turn, places excess pressure on your lower back often resulting in lower back pain.

When your pelvis is tilted too far forward, it eventually causes your tummy muscles to weaken over time. This is because no one muscle works alone, they work as a team, so if your hip flexors are injured, other muscles or muscle groups can be affected also, the usual ones being your abdominals and bum muscles!

So, if you have a hip flexor injury you must attend to your tummy and bum muscles as well.

Treating a Hip Flexor Injury

The key to treating hip flexor injuries is getting the diagnosis correct in the first place. Once the diagnosis is correct the treatment will be quick and effective in most cases. A correct diagnosis is the key! Always seek the advice of a medical professional experienced in hip flexor injuries.

Treatments include stretching, soft tissue release techniques, strengthening exercises and trigger point therapy. A chartered physiotherapist or physical therapist will guide you on the most effective treatment of choice.

Treatment of hip flexor injuries should also be toward the cause. I always aim to identify and remove the cause of your hip flexor injury, in other words what is the reason that your hip flexor muscles have become tight. I would then continue to fully resolve your injury with manual treatment techniques. For an example of what I mean by this, see George’s story below.

George’s Story.

Recently I treated George with a hip flexor injury. George was a 37 year old engineer. He complained of right sided lower back and hip pain. It had been present for three months but was slowly getting worse.

Six months ago George changed jobs. He had been a field engineer which involved a lot of walking and moving around. Since then his job changed to a desk job where he was working on a computer for nine hours a day.

When I assessed George I found that he had a big arch in his back known as a lordosis. When he was sitting he sat with his pelvis tilted forwards which, in turn, increased the depth of his lumbar lordosis. His hip flexors were tight and overactive and many trigger points were palpable.

His weight was hanging on his lower back as he sat. George stood in a similar posture.

As a result of his posture, his hip muscles were being held in a shortened position and over time had become too short, which then effected the movement of his hip and lower back. In this lordotic posture his abdominal muscles were not being asked to work so they had become weak and inhibited. Similarly his bum muscles were lazy!

The cause of George’s pain was primarily down to his posture. To help him correct this I released some tension in his hip flexors and showed him how to do the same using stretches and trigger point techniques. I taught him how to sit with his pelvis and spine in their correct position and I gave him some strength exercises for his bum and tummy!

After two sessions he reported that his pain had reduced by 50%. I advised him to continue his home programme and asked him to come back to me 4 weeks later. At this stage he was pain free with almost full length in his hip flexors. I suggested that he continue the hip stretches and I increased the strengthening program for his bum and tummy muscles.

Overall George did very well!! Identifying the cause of Georges hip flexor injury was the key to the quick resolution of his pain. George’s posture was the main cause of his condition and with early detection was easily resolved.

Poor posture is a very common cause of hip flexor injuries. Always seek an expert’s advice with hip flexor injuries.