What is a Hip Flexor Strain?

Hip Flexor Strain is a muscle (psoas) strain felt in the front part of the hip. It is often associated with speed training or compensating for another injury, especially Achilles tendonitis or plantar fasciitis. A ‘hip flexor strain’ or a ‘pulled hip flexor’ is an over-stretching or tear in the hip flexor muscle. The hip flexor muscle is actually made up of ‘two main’ muscles – the ilicus and psoas muscles. These muscles run from the back of the lower spine to the front of the thigh. The difference between a strain and a sprain - is that a sprain is an injury to a ligament, while a strain is an injury to a tendon or muscle.

Strains of the hip flexor muscle, like strains of the quadriceps, usually occur during sprinting or kicking, often as a result of an overload of the muscles, or trying to move the muscles too fast (as when kicking forcefully playing soccer or football or anytime sudden changes of direction are involved). 

Like all muscle strains, they maybe graded as mild (grade 1) moderate (grade 2) or severe, complete tears (grade 3).




What are the symptoms of a hip flexor strain?


 
The symptoms of a hip flexor injury can be graded 1, 2 or 3 depending on severity. 

• A grade 1 injury could consist of a ‘stretch’ of the muscle or a small micro tear in the muscle. 
• A grade 2 injury could be a partial tear in the muscle and,
• A grade 3 injury is usually a severe, complete rupture of the muscle. 

The player feels a grade 2 or grade 3 injury as a sudden pain the hip region during an activity requiring explosive muscle contraction (for example sprinting or kicking in soccer). There is local pain and tenderness and, if the strain is severe, swelling and bruising 

Grade 1: What are the symptoms?
The player may have tightness and pain in the front and very top of their thigh during a game but will still be able to walk properly. The player will usually notice the injury after cooling down or the following day. The player probably won’t have much swelling, but will have trouble or some mild pain when sprinting, kicking a football or changing direction quickly. Often the player may be able to finish the game.

Grade 2: What are the symptoms?
During training or a game, the player may notice a ‘sharp pull’ or ‘cramp’ in the front and very top of their thigh. The player may feel they have ‘strained their groin’. The player will probably be unable to walk properly and will not be able to sprint or kick a football effectively.

Grade 3: What are the symptoms?
The player will often feel a severe pain in the front and very top of their thigh while kicking or sprinting, which will almost always stop the player from playing. A static contraction of the muscle will be painful and might produce a bulge in the muscle. A player will be in severe pain and will notice swelling. However, complete tears of the hip flexor muscle are uncommon. In the long-term, they heal well with physiotherapy.

What can you do?

To see if you have strained your hip flexor muscle try the following maneuver: while standing, flex your hip such that your knee comes up towards the chest, then have a friend apply moderate pressure to pull the knee down while you resist. This test should result in pain similar to your symptoms.

If this is a grade 1 or 2 strain: Rest, Ice, Compression and Elevation (RICE), as well as some gentle stretching exercises

You may be able to run just fine at slower speeds and shorter distances, but as the distance or speed increases; watch out - it can bite. Be sure to fully recover before resuming progressive training.

If you suspect this a grade 3 strain, see a sports injury professional (a physiotherapist or sports doctor) - who can advise on the correct rehabilitation and guide them back to training.