Hip Flexor Muscle Strain.
What is a hip flexor strain?
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(See Figure 1).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 football). Like all muscle strains, they may be graded as mild (grade 1) moderate (grade 2) or severe, complete tears (grade 3).
Figure 1: Hip Flexor.
Strains are common in all sports, but especially in football where sprinting and sudden changes of direction are involved. A strain is generally a stretching or tearing of muscles or tendons. 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.
The severity of a hip flexor strain injury can range from a complete rupture of the muscle, to small micro tears or a ‘stretching’ that the athlete will probably not notice at the time..
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 (See Figure 2)
Figure 2: Hip Flexor Injury.
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 the player do?
Initially the player can use rest, ice, compression and elevation (RICE), as well as some gentle stretching exercises (See Figure 3).
Figure 3: Hip Flexor Stretch.
The player should then see a sports injury professional (a physiotherapist or sports doctor) - who can advise on the correct rehabilitation and guide them back to training and playing football.
What can a sports injury professional do?
A sports physiotherapist will use a number of different techniques to help facilitate a player’s return to training and playing. Some of these include; compression and cold/ heat therapy, acupuncture, the use of sports massage techniques, electrotherapy (See Figure 4), and stretching and strengthening exercises. Strengthening is very important to prevent a hip flexor injury from occurring again. The physiotherapist will prescribe a rehabilitation program and monitor it with you. Most importantly, a physiotherapist will advise the player about their return to training and football. By seeing a sports physiotherapist the player will also provide the muscle with the best possible recover, which will prevent further injuries from occurring.
Figure 4: Electrotherapy.