Training with a strained hip flexor

[Adam H.]

This is a plea for help!

I posted about this in the injury forum and got no love, so I thought I'd try it in here.

Does anybody have any ideas for leg training while you have a strained hip flexor? I've been doing leg extensions and hamstring curls and boy do I feel lame. I can't do deep squats without pain, so those are obviously out. Power cleans, clean pulls, etc, don't really cause extraordinary discomfort, but I just feel like these movements would be counterproductive to actually rehabbing the injury. And speaking of rehab... if anyone has any idea of what to do to help make this thing go away I would be forever indebted to you. I've tried things like stretching, hip mobility work and ice, although I haven't been religous with it. Would soft tissue work (ART or massage) be beneficial?

I'd appreciate any and all advice.

Thanks,
Adam

[emartin10]

I don't have a hip flexor strain, but a really really tight hip flexor. Bill Hartman showed me some stretches to perform prior to training to loosen it up and boy did they help. I'm sure you know Bill is a master of ART, but this might be down the road a bit for you once you've recovered a little more.

E

[K-Court]

I have a similar problem and feel pain coming out of a deep squat. You might want to try some glute stretches/corrective work too. Bill told me that my hip flexor issue was in part rooted in my glutes. Since I've been focussing on correcting that, I've had much less pain in the hip. I've also been doing a lot of bodyweight squats (both arms out front and overhead - on plates) and that helps. There is no pain now unless I load too heavy. Good luck with it. I know what a pain it is.

[EdChap]

I had a hip flexor strain a couple of months ago and took time off from any direct leg work, if you can powerclean etc then it doesn't sound like it's a horrible strain but I'd still take some time off and concentrate on some light stretching; that helped for me.

[Eric Cressey]

Okay, Cliff's Notes version of things...

Anytime you have a strain or really tight muscle, the first thing you should do is look to a synergistic muscle that isn't doing its job. The injured/tight muscle is going to have to work overtime to pick up the slack. A few quick examples...

Tight/Strained ----- Weak

TFL ------- Gluteus Medius or Psoas Major
Hamstrings ------ Gluteus Maximus
Adductors Magnus ------ Gluteus Maximus
Rectus Femoris -------- Psoas Major
Pec Major ------ Subscapularis
Subscapularis ------ Teres Minor and/or Infraspinatus
Teres Minor/Infraspinatus ----- Subscapularis (goes both ways)
Quadratus Lumborus ----- Gluteus Medius

There are a ton more, but you get the picture (and be sure to remember that you don't usually just have one muscle that shuts down; it's part of a bigger dysfunction, in most cases). Find the dysfunction, and then work back to find and fix the synergist while treating the symptoms. For you, I'd be willing to bet that it's the rectus femoris. If it was the TFL (another hip flexor), the pain would be more lateral. And, psoas strains aren't that common

So, check your psoas major. Stand with your back to the wall, and pull one knee as far up to your chest as possible without leaning back or forward (stay upright). Then, let go with your hand and see if you can maintain the hip-above-knee position. Then, check the other side and compare. You can also have a partner press down on the knee in that position to see if a side-to-side discrepancy is noted. If it is, the psoas is your problem.

[Chris Correia]

Thanks, Eric. Really helpful into. Bill Hartman would be proud.

(You summit attendees should have picked up on this before Eric even answered it.)

[K-Court]

Yes, thanks, Eric. Mine is definitely lateral (where the leg joins the torso) and the pain occurs primarily if the leg is externally rotated.

(Sorry to hijack your thread, Adam.)

[Eric Cressey]

Originally Posted by K-Court

Yes, thanks, Eric. Mine is definitely lateral (where the leg joins the torso) and the pain occurs primarily if the leg is externally rotated.

(Sorry to hijack your thread, Adam.)

As in this lateral?

http://exrx.net/Muscles/TensorFasciaeLatae.html

[kuri]

Great reference site Eric, thanks!

[K-Court]

Originally Posted by Eric Cressey

As in this lateral?

http://exrx.net/Muscles/TensorFasciaeLatae.html

Sorry, Eric, I probably wasn't using the right term. I'm a newbie with all this. Close as I can tell, the pain seems to be in this group, and it's definitely related to external rotation, particularly when the leg is lifted.

http://exrx.net/Muscles/HipExernalRotators.html

[Adam H.]

Originally Posted by Eric Cressey

So, check your psoas major. Stand with your back to the wall, and pull one knee as far up to your chest as possible without leaning back or forward (stay upright). Then, let go with your hand and see if you can maintain the hip-above-knee position. Then, check the other side and compare. You can also have a partner press down on the knee in that position to see if a side-to-side discrepancy is noted. If it is, the psoas is your problem.

Spot on with the assesment, Eric. So what do I do to fix it? How do I strengthen the psoas? Also, what should I avoid / include in terms of programming? Just something general that could point me in the right direction would be great.

Thanks for your help,
Adam

[K-Court]

I guess our issues are different indeed, Adam. I didn't have a problem with Eric's diagnostic test for the psoas at all.

[Eric Cressey]

Originally Posted by K-Court

Sorry, Eric, I probably wasn't using the right term. I'm a newbie with all this. Close as I can tell, the pain seems to be in this group, and it's definitely related to external rotation, particularly when the leg is lifted.

http://exrx.net/Muscles/HipExernalRotators.html

So it's more in the backside? Sounds like piriformis. Get on your back on the floor, and pull the knee on the affected side up toward the opposite shoulder. If it's piriformis, you'll be in pain pretty quickly.

[Eric Cressey]

Originally Posted by Adam H.

Spot on with the assesment, Eric. So what do I do to fix it? How do I strengthen the psoas? Also, what should I avoid / include in terms of programming? Just something general that could point me in the right direction would be great.

Thanks for your help,
Adam

Correct it the same way you test it: just do manual resistance hip flexion with the hip at greater than 90-degrees. You can do it standing or sitting, but watch out for the compensation patterns I noted earlier.

You're also going to want to add in some soft tissue work for the TFL and RF as soon as the acute irritation dies down a bit; foam rolling and active release are a good start. Complement those with plenty of static stretching and mobility work, and you'll be golden.

You weren't ever a hockey player, were you?

[K-Court]

Originally Posted by Eric Cressey

So it's more in the backside? Sounds like piriformis. Get on your back on the floor, and pull the knee on the affected side up toward the opposite shoulder. If it's piriformis, you'll be in pain pretty quickly.

Both really. As I start that move, it hurts on the front side and then more towards the end of the movement, it's the back side in the glute area.

In the front area, the pain is in the area of the letter p and extending over to r & t on the TFL drawing you initially linked us to.

Man, thanks Eric for taking the time to go through this with me.

[Adam H.]

Eric- Thank you so much for the advice. I never played hockey, but I think I messed things up by riding the hell out of a bike that isn't really fit for me... the seat is too low. Then one day coming out of the hole of a deep squat, bam, hip problem. At times I'm stupid and try to force my body into doing things it doesn't like, so I continued to train through the pain for about a week. I need to fix this with the quickness because its really starting to piss me off...

Thanks again for your help!

Adam

[tmathis]

Eric,

On a related note, I tend to pull/strain my piriformis on my right side on a regular basis. What's the synergistic muscle here that I need work on?