Jon Duellman PT
Is it your Hip Flexor or Hip Impingement?
Updated: Jun 25, 2020
Hi all! Today, we are talking about pain or discomfort in the front of the hip. Common thoughts and ideas around hip pain seem to center around the hip flexor muscles. For some reason, they are the scapegoat for all hip pain. This can lead to confusion and in some cases making things worse. Let's talk about hip flexor related pain and flexibility and then another cause of hip pain, hip impingement.
Hip Flexors: Pain and Flexibility
Let's get to know what hip flexors are. The hip flexors are the muscle group at the front of the hip. They function to bring our thigh up and forward like a high knee or march. Primarily, they are heavy movers rather than stabilizers, but they do help stabilize the femur in the hip joint as well.
What causes Pain in the Hip Flexors?
Strains (muscle injuries) can occur with sudden powerful movements or repetitive overuse. They can feel tight if you aren't used to your activity as well. For instance, if you are doing a lot of core/abdominal work with leg lifts, you can cause tightness or discomfort in the hip flexors that work alongside the abdominals. It is more rare to have significant tearing with heavy trauma.
Hip Flexibility and True Tightness
Hip flexors can have limited flexibility. This is usually caused by one's activity or lack of it. We can stretch the hip flexors, but if you don't change your your posture in sitting for desk work or have appropriate low back strength or stability, then it will stay that way. When I say "True Tightness", I mean the hip flexors actually have limited stretch causing decreased range of motion versus feeling tight which is more common. This can be assessed and determined with simple tests.
What is the best treatment for Hip Flexor Pain?
Simply, we need to build up strength and endurance of the hip flexors to not fall back into tightness and fatigue. There are multiple strategies to this which are chosen based on your activities and sport. Then I determine if there is a need for stretching which may be included. Core strength in the anterior chain (the front muscles that contribute to abdominal, hip flexor, and quad teamwork) may need to be addressed too.
The big key is that stretching alone does not solve the issue. This is a misunderstanding.
Hip Impingement: What the heck is it?
Hip impingement, like shoulder impingement, is a way to describe the closing down of the bony surfaces which can pinch soft tissue structures or put undue stress on the front of the hip joint. This occurs normally to some extent when we flex are hip forward as far as possible. Some people have bony changes to their socket or their femur bone that make it more sensitive to pressure.
Here is an anatomical visualization of hip impingement.
Hip Impingement Pain and Symptoms
It is important to understand that performing a motion like deep squatting or a high kick does not cause painful impingement in one swoop.
"I have pain in my hip flexor."
- Many Previous Patients
People with hip impingement pain will tell me they have pain in the front of their hip with deep squatting or when there hip is flexed to the fullest motion. It occurs only then and is mostly comfortable with other activities. In the early stages, it is just during activity, but if not addressed it can continue to be painful outside of your sport or exercise.
What do I do if I have Hip Impingement?
First, we have to let it calm down. Depending on how long it has gone on for and the severity of the pain, we may need to back away from deep squatting or other provoking motions. There are some manual techniques which can improve your discomfort such as joint mobilizations or soft tissue techniques depending on your individual situation.
Luckily, this condition does allow for continuing to exercise. We have to modify aspects of your exercise and training, but you can perform strength training, cardio, and other rehab exercises that don't provoke the pain. We discuss the best way to stay in shape and improve your support so it doesn't return.
Each case is unique and requires nuance. To be honest, it always presents a little differently and needs specific advice to find what will work for you.
How can we tell the difference between Hip Flexor Injuries and Hip Impingement Pain?
Hip Flexor Injuries
Pain in the front of the hip
Pain when lifting your leg forward
Pain with stretching your leg backward (extension)
Weakness lifting the leg up and forward
Hip Impingement Pain and Symptoms
Pain in the front of the hip, can go into the groin, can feel deep in the joint
Pain with deep squatting or high positions flexing forward
NO Pain with stretching backwards (extension)
No noticeable weakness
There are more subtle differences we assess for, but this may be enough to better understand your situation. Remember, it is more than just knowing what it is. A comprehensive plan should be started by a healthcare provider to make sure you are on the right track and not missing keys to returning at 100%.