Recently I have seen an increased number of younger athletes turning up to the clinic with complaints of pain at the front of their hip and/or groin. Their stories share a common theme of rapid movement at the hip resulting in pain, either from kicking a soccer ball or fast direction changes between bases when playing ball. In each situation the most likely diagnosis has been a strain of the muscle that bends the hip forwards, a muscle commonly known as the ‘hip flexor’ (Iliopsoas muscle).
The hip flexor attaches to the pelvis and front of the lower spine then runs down across the front of the hip to attach to the upper bone of the leg known as the femur. It is the main muscle responsible for bending the hip forwards when we are walking, running, kicking or swimming. If you think about how much power is required in the hips when we are sprinting or kicking a ball, it’s not hard to imagine how much force is being placed on this muscle. If the force is beyond what the muscle can withstand, a tear can occur within the fibers of the muscle belly.
If you suspect a muscle strain of this kind, the recommended initial management is to get ice over the area for 15 minutes every hour for the first 1-2 days and rest. The healing time for a muscle strain of this kind would be 2-6 weeks depending on the size of the tear. The way you manage the return to your sport is crucial for a smooth and timely recovery. Firstly, you have to respect the pain, it is telling you that you are working the injured area too hard. Think of a cut on your knuckle, if you keep bending your finger you will keep pulling the cut apart and it won’t heal, this injury is much the same.
For the first 5-7 days activity should be limited to gentle active bending and straightening of the hip while lying on your back, as well as gently stretching the hip back for 30 second holds. If you are able to perform an activity pain-free it is a good sign that you are ready to progress to the next stage. Progressions should include increasing your walking pace and distance, building to a jog, then run and sprint. Sport specific progressions should also be included. For example, a soccer progression would include beginning with individual ball dribbling skills, followed by light passing, then faster ground balls and finally lifting the ball with kicks on goal. These progressions would be expected over a 2-6 week period, depending on your pain. Strength training is another extremely important part of recovering from a muscle strain. If adequate strength isn’t regained then the risk of re-injury is high. Weights, exercise balls or exercise bands can all be used for targeted strength exercises.
It is important to remember that other injuries to the hip can occur in similar ways to the hip flexor muscle. I would always recommend an initial assessment from your medical doctor or physiotherapist to ensure your injury is managed in the most appropriate and timely fashion.
Nick Black is a Registered Physiotherapist at Sun City Physiotherapy Winfield. He can be contacted at the Winfield clinic (250.766.2544) or by email at winfield@suncityphysiotherapy.com.