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Managing hip health to stay hip

Because of their position in your body, your hip flexors can be injured by direct trauma, repetitive strain, or power and speed activities.

Hip flexor muscles can cause problems for athletes of all fitness levels. These muscles start at the low back, overlay the pelvis and run down through the front of the thigh. The position of the hip flexors makes them vulnerable to injury from direct trauma, repetitive strain, or power and speed activities.

The hip structure disperses athletic forces that impact the lower body, which has a great impact on the flexor muscles. Kinetic energy is transferred through the pelvis and spine into the upper body. If the pelvis and hip are not properly aligned, the hip flexor can cause problems through the body. If athletes rely on their quadriceps and hip flexors instead of utilizing their hamstring and glutes, the flexor muscles may become weak.

Stiffness in the upper or lower back is caused by stress on one specific hip flexor muscle, the iliopsoas. It’s the strongest of the hip flexor muscles that attaches to the low back vertebrae and inner thigh. Joint stiffness limits shock absorption and the iliopsoas works harder to stabilize the body during activity. As a result, the iliopsoas may become even tighter and become inflamed around the hip joint capsule and surrounding tissues.

Athletes that rely mainly on their lower extremities, such as runners, are particularly susceptible to hip flexor stress. These muscles often become very tight due to repeated muscle contraction and overuse. The result can cause decreased stride length, muscular tight- ness or even pinching on the front of the hip.

Acute hip flexor injury is uncommon. However, it does happen with sprinters because this type of running demands long, powerful strides that can tear the muscle. Distance runners are more subjected to strain because they use shorter, but more frequent steps.

Runners can expect some general wear and tear around the hip joint due to the repetitive nature and impact of their sport. There’s an elevated risk of experiencing hip joint trouble if there has been previous trauma to your hip (i.e. bone bruise from a fall); if you have a family history of osteoarthritis; or if you’re overweight.

General hip stiffness (particularly in the morning), soreness within an hour of training or night pain are all common symptoms of hip joint irritation. If you experience any of these symptoms, you should be assessed by your family physician or physiotherapist.

A simple test can identify if your symptoms are caused by your hip flexor: Lie on your back with the affected leg hanging off a bench or table, while the opposite knee
is bent into your chest. If pain and discomfort increases when you bring the other leg towards your body, that indicates a stressed hip flexor muscle. You may suspect more of
a hip joint problem if the hip catches or feels pinched when you pull your leg towards your chest or rotate your hip. These symptoms or any catching or clicking should undergo assessment by a physiotherapist.

Common treatments for hip muscle or joint injuries include manual therapy, soft tissue techniques (such as massage), modalities for pain (acupuncture) and exercising to restore muscle balance.

To avoid hip flexor issues, stay away from aggravating activities and gently stretch and strengthen the area. General exercises that improve pelvic and gluteal muscle strength are important to maintaining healthy posterior hip muscles that contribute to shock absorption and muscle power generation. Clamshell exercises enhance gluteal muscle strength, while bridge poses and planks (front and sideways) improve important core stabilizing muscles. These are all simple and effective exercises for hip injury prevention.

Tissues require time to adapt to training stresses, so don’t increase the level of your training too quickly. Increase training volume and/or intensity by 10% or less per week. Gradually introduce tempo runs, interval training and hills to improve your fitness and strength. Cross-train with other activities and consider running on a variety of surfaces in order to keep you body challenged and fit.

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Author: Agnes Makowski is a Sport Physiotherapist with Striowski & Associates Physiotherapy in North York (Toronto), Ontario.