The Hip Flexor Mechanism

The hip flexors that get hurt most often are those closest to the surfaces. For example, in athletes we often see the so-called "Hip Pointer" injury. This is really a hip flexor mechanism injury at the proximal insertion of the muscles at the ASIS (the anterior superior iliac spine) - that boney prominence on the front of the hip. Deeper than that are the true hip flexors, Psoas and Iliacus with a common tendon on
the femur Iliopsoas. Because of the proximal insertion of the Psoas on the lumbar spine, people with sway back (a very lordotic standing posture, seem to be more susceptible to hip flexor trouble, especially if active. The reason for this is that a sway back leads to the hip flexor being effectively shortened, and the iliopsoas more susceptible to strain. The anterior pelvic tilt that accompanies a sway back is associated with lower back pain as well.




Manual therapy for shortened iliopsoas includes a myofacial release technique that can be quite painful, and an active/passive manual stretching procedure. For acute injury, I use an extra long ace bandage to support the hip flexors (we call this a spika wrap), and we use ice, occasionally ultrasound and also electrical stimulation to help get us through the acute phase. I also use the Stick to treat the tight muscles of the thigh including the ITB and the Quad mechanism. In the event that you have tightness of the ITB and Quadaceps mechanism, then using a Stick or similar tool at home will help you resolve those restrictions. In any event, the long term key is to first stretching the hip flexors effectively, and then to strengthen them as they gain length.





Three stretches I really like include:
1. Standing: Leg flexed with your foot behind you up on a table, knees aligned to the center, stomach contracted to flatten the back, shoulders upright and then flex the knee of the foot you are standing on. You should feel the stretch in the front of the quad. To increase the stretch, stand further away from the table so you have to reach further back.

2. Half Kneeling: The knee of the hip you want to stretch is on the ground. Your body is upright. Contract the stomach muscles to keep the lower back flat. Bring your weight forward onto the front foot but keep your shoulders upright until you feel the stretch in the groin. Take your same side hand and reach over the top of your head and leaning your body gently over to the side.

3. Prone: Lying face down, arms spread out, bend your knee of the leg you want to stretch. Again, tighten your stomach muscles to keep your back relatively flat. Pick up your knee and try to reach over your body and touch the opposite hand with your foot.

A word about stretching: First of all, stretching SHOULD NOT HURT. Second, you need to hold the stretch for at least 30 seconds. Third, to improve the effectiveness of the stretch, try contracting and relaxing the muscle you want to stretch.

Do muscles get longer when you stretch them? In a word, "no". The length of a muscle is established neurologically. So why stretch? A fair question. What you are doing is helping the dense connective tissue become hydrated and also "resetting" the relationship between the actin and myoisin components of the muscle fiber. This helps the muscle, in either case, be more tolerant of stretching during activity. In other words, you can be active without the hip flexors experiencing failure.

For strengthening, I like these two exercises:
1. Supine: Lie on your back with your foot on top of one of those big Swiss Balls. Loop an elastic cord over the top of your foot, so that it is pulling downwards (along the line of your leg, parallel to the floor). Bend the knee and pull the toes up to keep the rubber band on the foot until your hip flexors get tired.

2. Sprinting up a hill: Like it says, sprint up a really steep hill over and over. Focus on high knees. This makes you flex the hip to prevent catching your toe. This is very a effective exercise. we usually work up to 10 10 second repeats with a 20 second rest break between sprints. If you amke sure to lift your knees, this exercise will make a big difference.