HIP FLEXOR STRAINS: YOUR GLUTES MAYBE THE ANSWER!
In almost all cases that we see in our clinics of Hip flexor Strains, the cause of the problem is the hip muscles, mostly the gluteals. Most people focus on the hip flexor and the front of the hip, as that is where the pain is and where the injury is. However, to fully rehabilitate the problem, treat the underlying cause, and in some cases just to even get out of pain, the Therapist must look at the back of the hip for the answers. We get so many people asking us about how to fix this recurring problem, so here is some info to get you on the right track.
The hip is a ball and socket joint, and requires many little muscles for stability, and is moved my large muscles for big- ger movements. It’s the large hip flexor muscle group, Ilio- psoas that is commonly injured in people who run, exercise and partake in sports or exercise they are not conditioned to. As you run, sprint or move up stairs, this muscle helps pull the thigh forward. It needs to work with it’s ‘antagonist’ the Gluteus Maximus to help move the thigh, and the hip stabi- lisers to maintain pelvic alignment and the ideal working environment.
MUSCLE IMBALANCES AND THE ‘LAZY BUM’
Many people have no idea that they have one side weaker than the other, a ‘lazy’ bum and muscles not working like they should be. The biggest causes of this problem are previous pain and injuries, long period or years of one-sided sport, or when someone is very dominant on one side. Like being right handed, you can also be right footed and have a ‘right glute’. It’s only after an injury do they get assessed and the root of the prob- lem is found and addressed. Even one-sided pain following a back injury, pregnancy or surgery can ‘switch off’ the gluteals and deep hip stabilizers. This in turn means most of the gluteals don’t work to the optimum and lag behind (what we call ‘delayed firing’). If you run and one side is not stablis- ing (called a ‘lack of lateral stability’) then you also may injure other parts of the hip joint including the labrum, as well as your lower back, knee and leg muscles. Such injuries can arise such as patellofemoral pain, shin splints and runner’s knee.
RUNNING OUTSIDE vs THE TREADMILL
If you run on a treadmill, the road is ‘moving’ which means that the hip does not need to be pushed forward as much as the leg is taken back by the belt. This means there is an imbalance between the hip flexor and the glutes, which causes any overuse of the hip flexor!
Therefore it is much better to run outside so you ensure cor- rect muscle use and prevent the hip flexor injuries and main- tain your hip stabilisers and power movers. The more the hip is in flexion, the more your Gluteus Maximus muscle will fire (e.g. hills).
PHYSIO TREATMENT AND MUSCLE REHAB
The best treatment is prevention. This means if you are con- tinually getting light strains in the hip, you should get as- sessed by the Physio to see if one side of your hip stabilis- ers and glutes are activating and firing correctly. The Physio can then teach you how to switch these back on via a series of simple exercises targeting low level firing patterns, and then progressing to more difficult exercises for strengthening. This will always be done in conjunction with deep core muscle re-training as this is always needed. This will help prevent major strains and tears. If you get an injury, the treatment is the same, as well as addressing the injured part.
REHAB EXERCISE EXAMPLE
A great exercise to get you started is the ‘prone leg lift’. This is a reasonably advanced exercise, so if you cannot even get a little contraction from your glutes – see your Physio and don’t attempt to use this as your only form of correction.
Technique: Lie on your front and have a rolled towel under your head. Place your right hand on your right bum cheek. Firstly you need to draw in your inner core and maintain your breathing, using your pelvic floor correctly to around 30% (if you are unsure consult your physio). Make sure you continue to breathe through you lower rib cage and never hold your breath. Keeping your leg straight, THINK about raising your leg, focussing on your glutes that you have your hand on. Don’t lift it just yet, but try to imagine you are lifting a heavy leg with your bum. (Note: Don’t simply clench your glutes – this is cheating!) IF you feel a contraction and get some ‘tone’ in your bum, hold for 10secs and then gently raise your leg in the air about 10cm, not losing the contraction and not losing your core stability or arching your lower back. Lower and repeat 20-30 times.
Remember this exercise is HARD, but that’s the idea. You are always best to be guided initially by your Physio at the start to get the correct technique and prevent you adopting a bad pattern and compensating with other larger and global muscles – this can make it worse!
This just the start. There are many more progressions to get the perfect firing backside and help you stay free of hip flexor strains. But make sure you get assessed first and work to get your glutes pushing you along that little bit better!
Author: Tim Keeley, B.Phty, Cred.MDT, APA Principal Physiotherapist | Director
Tim has over 12 years experience in Physiotherapy and the Fitness Industries. He is also a rehabilitation expert, clinical educator and convention presenter. He is the Director of Physio Fitness Australia operating 4 clinics across Sydney. For more information go to www.physiofitness.com.au.