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Anterior Hip Pain

Kneeling on Mountain

Anterior hip pain is frequently due to straining the hip flexors, especially in athletes.  There are a number of reasons that athletes strain their hip flexors, many being things they don’t think about or attribute to being related to their hips.

Low back tightness

It seems backward to most, but tightness in the low back can contribute to straining your hip flexors.

A quick anatomy lesson…without getting into too much technical anatomy…

Your hip flexor muscles attach to the front of your lumbar spine and pelvis and then to the front of your thigh bone (femur).  Your spinal extensor muscles run along both sides of the spine, and some also attach from the pelvis to the bottom ribs.

If you have done a workout that has caused your back to tighten up, when you do something that either needs to fire your hip flexors or allow them to extend, they can get overworked/overstretched and cause a muscle strain.

If you feel yourself starting to compensate in any way when working out with a tight low back, stop before you hurt yourself.  A workout is not worth an injury.

 Hip adductor tightness

The hip adductors connect from the medial femur (inner thigh) to the pubic region.  These are the muscles typically injured in a “groin” injury.

The primary job of this muscle group is to either flex or extend the hip, depending on the position of the leg.

When the adductors are tight, the rest of the muscles around the hip are required to fire differently to compensate for the tightness, which may cause a muscle strain.  Because of proximity and normal functions the body goes through, it is typically the hip flexors that take the hit.

Quadriceps tightness

Quadriceps tightness as a contributor to a hip flexor strain.

One part of the quadriceps is also a hip flexor muscle. Because of this, if the quadriceps are tight it is very easy to strain your hip flexors; specifically the one that crosses the hip to assist hip flexion. I find this one to be most commonly strained when sprinting, especially when starting from a dead stop and going into a sprint, such as when playing sports such as baseball, softball, or soccer.

How do you know if this is the problem versus one of the other hip flexors. A good test is a lunge. If it is more uncomfortable when the knee is on the ground as the back leg in the lunge rather than when the leg is actively coming forward when standing back up, it is likely this specific muscle group that has been strained.

Pelvic asymmetry

Our pelvis (the big “bowl” your hips attach to) and sacrum (the triangle at the bottom of the spine) can become rotated.  This can be due to an injury, but is most often caused by sitting and standing habits we maintain throughout our day, such as crossing one leg over the other more consistently or frequently being shifted to one leg when standing.

Because of the attachments of muscles on the pelvis and on the femur, if the pelvis is slightly rotated (which is more common than you think), the muscles on the right and the left are either placed on increased tension or slack, depending on the muscle and on the direction of rotation.  This causes the muscles to fire differently when going through routine movements.  Typically, it will be the muscle put on increased tension that will become injured rather than the one on slack.

Stretches to do for the area

Keeping the back and hip area loose and mobile can help.  Try out the stretches in this video.                                                    

Hip stretches include Hip pinwheels, Frog, Sampson, Lizard, and Pigeon.

“Smashing” the area

If you have access to a kettlebell, you can use the horn of the kettlebell to “smash” the hip flexor in order to try to decrease the tightness.

Check out the video HERE

How I address it with physical therapy

When the hip feels tight, doing self maintenance by stretching or other “smashing” techniques is a great way to address it.

But, when the area is strained, many times it needs more care that what you can do on your own.

Typically, it is a process, especially because there are multiple things going on.  I need to do the following:

  • Decrease the pain/tightness in the injured area
  • Decrease tightness in areas that likely contributed to the injury or have gotten tight due to compensations
  • Restore proper movement patterns

If only the area of injury is addressed and not everything else, it is likely that re-injury will occur.  This is why even though the pain is gone, it does not mean the “problem” is resolved.  It is important to continue care to make sure all issues are resolved so you are less likely to re-injure the area in the future.

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