Tight hip flexors: This is a real problem a lot of runners. Too many of us sit all day and our hip flexors and anterior hip joint just gradually become shorter. This can be a cause of low back pain as well as hip pain. There is a phrase in medicine now. I hate the words but I love the message. It says, “Sitting is the new smoking.” The more you sit the sooner you will die and the worse your old age will be. It’s not like we have a choice. Most of our bosses have a simple rule; if you don’t work they won’t pay you.
History: Usually insidious onset, no trauma. No pain with most daily activities. Most running pain is with push-off phase of gait, when the hip is supposed to fully extend. Running up hills is usually worse because it needs more hip extension.
Self-Exam: Here are some things you can look for in yourself.
1) Stand in front of a mirror and look at your hip joint. You may see this appearance. It may be subtle and you may not notice. VID
2) Try this hip stretch. Grab your ankle with your hand and do a quad/hip flexor test. If your thigh does not extend past your back, it is probably your hip flexor tightness. PH
3) Lie on the end of your bed and let your leg hang down. If it does not straighten, you should stretch your hip flexors (Thomas test) . VID .
4) Complete a dynamic lunge. If you notice your hips rotate toward the back leg, it may be your hip flexors. VID
Treatment:
1) Manage the pain:
a. NSAIDS will help.
b. Kinesiology probably won’t help. (I don’t even want to think about taping myself in that area.) LIN
c. Ice or heat can relieve your pain.
i. Ice right after you get done running
ii. Heat on non-running days
d. Continue running but avoid aggressive speed work and hill repeats.
2) Restore full motion:
a. There are several ways to stretch your hip flexor muscles. Each one of these has the potential to make your back sore. Make sure you are putting tension on your quads and hip muscles, not your back
i. Sequential short-term running will address these muscles. VID
ii. Hanging your leg off the end of the bed as in this video VID
iii. One of the best stretches for the hip flexor muscles is using a chair. I like this one because it provides the best protection for your back. Knee in chair. VID
iv. Stretching does not have to be part of your warm-up or cool-down. But it HAS to be part of your training program. LIN
3) Begin non-weightbearing exercises to restore strength without all the pressure on the joints
a. You should not do too much for strength. These muscles are short from too much sitting. You do not to make them stronger.
4) Begin body weight exercises with emphasis on control versus strength and power.
a. You should not do too much for strength. These muscles are short from too much sitting. You do not to make them stronger.
Click here for video to know if you are ready to progress to more aggressive exercises.
5) Correct running mechanics.
a. Gradually return to your previous running. Start on relatively flat ground or even on a treadmill. The best part of returning to running with a treadmill is that you can actually hear your footsteps. Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move. If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running. Listen and ‘feel’ how you run. Is one leg hitting the ground harder than the other? Does one arm swing differently than the other? Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.
b. As soon as you can run without pain and without a limp you can return to your normal running routine.
6) Return to running speedwork and hills. After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.
7) My favorite step, get back to full running! Have fun. Eventually you will bust something else and be back to the website to fix that.
8) If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do. We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.