Strained Hip Muscles? One of the key factors that increase the risk of injury to your hips is short and tight hip muscles, mainly the gluteal, rectus femoris and iliacus muscles. Jumpers are more likely to strain or tear one of the hip muscles, due to the high intensity of the muscles’ contraction. These muscles are quite large and able to generate a lot of power & torque and any discrepancy in the direction of pull on the hip muscles may cause more strain on some fibers than others.
The muscles tend to tear at the joining point between muscle, tendon and bone, therefore athletes that require a large range of movement in their hips are more prone to develop hip muscle pain.
Muscles around your hip
In order to identify the cause of your hip muscle pain, we must look at the movements in your hip to establish which muscle may be injured. We will discuss each muscle separately to understand how it works inside your hip. Try to relate your pain to a specific movement to determine which muscle may be the origin of your hip muscle strain.
Gluteus Maximus Muscle
This is the largest of the gluteal muscle group and is regarded as one of the strongest muscles in the human body. The gluteus maximus is an important hip muscle, because it is a prime mover of the leg bone into extension (moving the leg backwards) during walking or running and extending the hips.
It propels your body forward like standing up out of a chair, straightening your hips to get to an upright position. Ever climbed a flight of stairs and felt the burn in your buttocks? Well that’s your gluteus.
Gluteus Medius muscle
Gluteus medius muscles pull your leg outwards (abduct), and plays a vital role in keeping your hips level when standing on one leg or for that matter, just walking. It works in conjunction with your adductor muscle group on the inside of your thigh to keep your pelvis stable when you are transferring your weight from one leg to the other.
Its connection with the iliotibial band steadies the femur (thigh bone) on the articular surfaces of the tibia during standing, walking and jumping. This influences the force that is transferred to your leg, knee and ankle.
Gluteus Minimus muscle
The Gluteus minimus is one of the secondary muscles that assist with extending the hip, this basically means that it’s not the prime mover, but helps other muscles to extend the hip. It is located deep and somewhat to the front of the gluteus medius muscle. Gluteus minimus helps to move your leg sideways away from your midline and turns the thigh inwards. Together with the gluteus medius, it acts to stabilise your hip and pelvis when the opposite leg is lifted off the ground.
Iliacus & Psoas Major muscle
The iliacus combines with the psoas major passing through your pelvis to insert onto the femur. The iliacus and psoas are thus collectively referred to as the iliopsoas muscle – they act together to flex your hip, as well as help outwards rotation of your thigh. This muscle is the strongest hip flexor in the body.
Rectus Femoris (One of the Quadriceps)
The Rectus Femoris muscle has attachments on the front of the pelvis, just above the hip joint and is one of the muscles that help to flex the hip and pelvis forward.
Sartorius muscle
Originates just below the Rectus Femoris muscle, but runs inward towards the knee helping to flex the hip and assists with turning the thigh outwards.
External Rotator group
These muscles all originate on the pelvic area and insert onto the greater trochanter of the femur. They are mainly responsible for turning the thigh outwards. These muscles are the deepest layer in your buttock: Superior Gemellus, Inferior Gemellus, Obturator Externus, Obturator Internus, Quadratus Femoris, and the piriformis muscle.
Adductor muscle group
This is a group of muscles that are more related to groin pain. They are muscles that pull the thigh inwards and are involved with pain when pinching your thighs together (squeeze test). For the purpose of this article we will stick to hip muscles, but see groin pain if you are feeling muscle pain in your groin area.
How does a hip muscle strain happen?
The hip muscles tear when they are forcefully contracted while in a stretched position. One or multiple muscles may be involved. The muscle fibers can’t manage the amount of stress or load placed on them. The small muscle fibers will tear when the force of contraction is too much, or tear even more when the muscle is in its lengthened or stretched position.
Repetitive overload on the muscle will cause small tears inside the muscle. Your body will respond by contracting the muscle to protect it from injury, as a result we see that patients tend to train through this ‘niggle’ of pain and continue to run, cycle, jump etc. Eventually a small tear develops into a bigger tear, until it is too painful to use or stretch the muscle. The most common site for this type of tear to develop is where the tendon meets the muscle (Musculotendinous junction). In most of these cases there is a tendinitis accompanied by a hip muscle strain.
“Acute” relates to a sudden & fast onset of pain, where “chronic” describes the influence of things that might have increased your risk of having a strained hip muscle.
Acute injury
- Overload – Increasing the load of your exercises, for example squats, too quickly. You can just imagine if you jump from 20kg to 40kg in one week. The muscle won’t be able to keep up. The muscle is subjected to a sudden forceful contraction that it can’t handle.
- Overstretch – Running uphill drills or on an incline will force your hip muscles to contract from its stretched position. A muscle is at its weakest in a lengthened position, thus taking the muscle beyond its normal boundaries.
Chronic wear & tear
- Overuse – Increasing your running distance too fast or a sudden increase in repetitive hip muscle contractions.
- Weakness & Endurance– Muscle fatigue can play a role in runners who are not strong enough to run the distance. A “Weekend warrior” is the perfect example, when you don’t train at all during the week, but over the weekend you do a 10km fun run.
- Poor technique – During training (form) or the wrong movement pattern can load the hip muscles significantly more, or even one muscle more than the others.
- Inadequate warm-up – A fast sudden contraction like a jump or start sprinting while the muscle is not prepared for it can put you at risk or a hip muscle strain.
- Excessive stretching – Overstretching the muscle against a force, for example during weight lifting like a deadlift. When the load is applied on both sides of the tendon and the different parts are forced to contract and lengthen at the same time.
- Wrong shoes – Poor support for your foot will cause muscle forces to concentrate along the inside of your leg, which load those muscle fibers more than the outer part. This abnormal force on the inside of your leg will cause the fibers to fatigue faster and tear first.
Causes of a hip muscle strain
Hip muscle strains are mainly caused by large & powerful movements of your hip like kicking, running, sprinting and landing from a jump. These movements place high demand on your hip muscles to generate torque & absorb tension. If the force is in excess of what the muscle can handle you may end up with hip muscle pain. There’s a wide range of ways as to how the muscles surrounding your hip can start to tear or take excessive load.
Let’s start with when you first noticed the pain:
Fast & Sudden
A single contraction that overloads the muscle and is too much for it to handle, may tear some of the muscles in the hip. Like when you forcefully kick a punching bag, causing a single contraction that is in excess of its normal ability to withstand the impact. This may cause small tears (Grade 1) or big tears (Grade 3) in the hip muscles.
Slow Progressive
Some muscles in your hip may take more strain during your training or you may be compensating with your stronger muscles/ side/ leg, which in turn will load these muscles more. This tends to develop with repetitive movements and progressively gets worse if sufficient healing is not allowed to take place in the muscle’s fibers.
Symptoms of a hip muscle strain
How bad is my hip muscle injury?
Just treating your hip pain solve the problem, even though you might get temporary relief. It’s important to find the cause of your hip pain to know how to manage the problem effectively and keep it from getting worse.
Your hip muscles’ dysfunction won’t just go away on its own, so rather call us for a proper evaluation and treatment plan. If treatment of your hip muscle strain is delayed, you’ll develop more pain radiating down your thigh or into your lower back, which leads to spill over to other structures in and around your hip.
Severity
Muscle strains are graded from a grade 1 to grade 3.
- Grade 1 hip muscle strain:
A small number of muscle fibers are damaged. You’ll be able to do the movement, but have pain at the end of the range. Stretching your hip muscles will cause pain. - Grade 2 hip muscle strain:
A larger number of fibers are torn and there is more pain during the whole movement of your hip. You won’t be able to move to end of range or to stretch due to pain in your hip muscles. - Grade 3 hip muscle strain:
A complete rupture of one or more of the hip muscles. You will have a severe loss of movement and too much pain to move. There will also be significant weakness of the injured hip muscle.
Pain intensity
Pain isn’t always a good indicator of muscle damage – think of stubbing your little toe: you will have severe pain, without actual damage. However, with a hip muscle injury we would expect your pain to improve with rest or if you deload the muscle by using crutches. If there is no change with rest you might not just have an uncomplicated muscle injury. You could be dealing with an inflammatory condition like rheumatoid arthritis. Rather be safe and call us for an assessment.
Area
A hip muscle strain will usually be localised to the buttock, but can spread to your lower back or upper thigh without treatment. However, if you have symptoms in your lower leg or foot, like pins and needles or a burning pain, you might be dealing with sciatica hip pain and not a hip muscle injury.
Diagnosing a hip muscle strain
Our physiotherapists are experts at detecting a muscle tear because we spend 8 hours a day working on soft tissue. We will test the range of movement of your hip, asking you to flex, extend, abduct, adduct and rotate your hip in various positions, with and without weight. This will give us a better idea which hip muscle is causing your pain. We will test all the hip and surrounding muscles’ strength individually which also gives us an indication of the muscle length.
During our assessment we will screen your lower back and your hip joint by doing tests that stress these areas. These tests will either rule out others areas, or let us know that your problem is not just a hip muscle injury.
Sonar (Diagnostic Ultrasound)
This will be the investigation of choice, as the soft tissue (muscles, ligaments and bleeding) can be visualised. An ultrasound (diagnostic sonar) is very helpful to visualize the severity and size of the tear. If we suspect a hip muscle tear, the best way to confirm the diagnosis is to see it, measure the width, depth and length of the tear by using a Sonar or Ultrasound (Diagnostic Sonar).
X-Rays
In some cases we may refer you for an X-ray to exclude any other structural hip pathology, but this is rare. X-rays only show the bones and will therefore not show what is happening in the muscle bellies. It will be used to exclude any other possible problems around the hip joint.
X-rays show the bone edges and how your hip socket connects to your femur head, so after a fall, X-rays will be taken to rule out fractures. Even if nothing abnormal is found on an X ray and you are still experiencing pain, do not despair, a lot of structures are not visualized on X-rays. Get our expert’s advice to help you understand where your pain is coming from.
MRI or CT scan
MRI is a very expensive test but, is a good way to see detailed images of the muscle injury. We are able to pinpoint with extreme accuracy the structures involved in your hip, before we resort to taking an MRI.
MRI and CT scans aren’t necessary to detect a hip muscle strain, but may exclude structures inside your hip joint like labrum tears.
Why is my hip muscle pain not going away?
If you are asking yourself “why is it taking so long for the pain to go away” then you might want to consider the following: When the muscle tears your body attempts to repair the injured fibers by sending cells to reattach the torn ends of the fibers.
It reacts similar to repairing an open wound, like having a cut at the bottom of your foot. When you keep on walking on it, you will shear away the cells that are healing and closing the wound. The more you walk or run through the pain, the longer it will take to heal. If the pain comes back every time you start running again, you have missed the most vital aspect of the cause of the muscle tear. The muscle length must return to normal before you can return to exercise.
If you take a few days off and the pain in your hip muscle is gone (usually 3 days) and try to run again, the pain just returns. If the muscle length is not restored, you will rip the wound wide open and start from the beginning again. This is the most common reason why patients consult us.
If you are taking anti-inflammatory medication for the hip muscle strain, STOP taking them. Inflammation is the body’s natural way of healing the injured muscle fibers. The medication is preventing this process from taking place, not to mention, masking the effect of the trauma on the tissue.
What NOT to do
What you should do
Making the injury worse
A big problem we see with hip muscle pain
Ignoring the pain
Your hip muscles are subjected to a lot of load during a normal day – walking, climbing stairs, getting in and out of the car. So much more if you run or cycle. We often see that patients carry on through their hip muscle pain: “No pain, no gain”? Pain is the brain’s way of telling you that something is wrong, so if you have pain that isn’t just normal “stiffness” after training you should call us for an assessment. Especially if you only have pain on one side!
Stretching and foam rolling
Muscles are not tight for no reason. With a hip muscle injury you will notice that stretching just makes your pain worse and the stiffness doesn’t get better when you stretch. This tightness is part of your body’s protective mechanism – trying to keep your muscle from working so that it can heal. If you keep on stretching the injured hip muscle this healing process has to start all over again.
Stopping treatment too soon
The normal healing process of a muscle takes 4-6 weeks, but the pain generally improves within a week or two. Just because the pain goes away doesn’t mean the problem is gone! Some patients stop their treatment and go back to training etc when their pain improves, so their hip muscles start acting up again soon after. It’s important to complete the rehabilitation process and that we clear your movements before we stop your treatment. At your last session your physiotherapist will use tests to make sure that your hip muscle injury has healed completely and the muscle strength and length are restored.
Poorly designed rehabilitation protocols
Exercises that emphasize single plane (one direction) movement or low load only can be done diligently, but not yield the results that you were looking for. You rely on your hip to move in three dimensions, front to back, side to side, in a circle or a combination of all these movements. Like kicking a ball on the run, the muscles work in all the different directions. Giving up is not the answer. Consider a full rounded treatment option to beat your hip muscle pain.
Medication or injections
Medication or injections will definitely give you symptomatic relief, where the triggering movement is done with ease or no pain at all. It is like mopping up water and not fixing the burst pipe. Ideally you should address the root cause during this time of pain free movement. Or you risk your pain returning once the medication has worn off, with some nasty side effects maybe (constipation, peptic ulcers, etc.).
Physiotherapy treatment of a hip muscle injury
The first thing your physiotherapist will do is a detailed assessment to find out what the problem is. We also identify contributing factors that could affect the healing process. Once we have established the cause of your hip muscle strain we can start the correct techniques to rehabilitate your specific injury.
Physiotherapy treatment will include:
- Electrotherapy like laser and ultrasound for pain relief and to promote healing.
- Soft Tissue Treatment like massage and dry needling to help relieve muscle spasm and tightness.
- Strapping to help with support of the painful area.
- Exercise programs to strengthen the muscles around your hip and also for rehabilitation of your injured muscles.
- Education about your condition and teaching you how to manage your pain.
Protection
Patients tend to continue walking on the injured leg with a limp. There is still a lot of load on the hip muscles during walking that can interfere with healing. Rather use crutches or a walking stick until you can walk without pain.
Education
A major part of physiotherapy is education. There are different possible diagnoses for hip muscle pain and we do a thorough assessment to confirm or rule out other areas. From this information we can make a diagnosis and give you the necessary information about your condition. We can answer any questions and give you advice on how to manage your symptoms.
Load
It’s important to manage load placed on your hip muscles appropriately. Too little movement can delay healing and cause other problems like stiffness, but too much movement will aggravate your pain and possibly cause more damage. We can guide you through this process to get you moving without pain again.
Avoid anti-inflammatory medication
Anti-inflammatory medication can interfere with your body’s normal healing process.
Exercise
The right exercises are important to get you moving, regain strength and speed up the recovery process. Complete rest will aggravate your hip muscle pain. You will find that your stiffness & pain increase if you stop moving.
2nd Phase: Restore pain free range of movement
When you start with rehabilitation the range of movement of your hip will be limited due to pain. During this phase we focus on treating your pain to improve this range of movement. Treatment will include soft tissue techniques like dry needling and massage and electrotherapy like laser and ultrasound. We will also start isometric exercises to start activating the muscle in a range that doesn’t aggravate your symptoms.
3nd Phase: Tissue healing
Throughout your rehabilitation we will monitor the tissue healing of your hip muscle injury. A soft tissue injury takes 4-6 weeks to heal and we will make sure that the treatment and load on your injury is appropriate to the phase of healing. Too much load will delay healing, but it’s also important not to take away the load completely. If there is no load on the muscle the scar tissue that forms at the site of the injury won’t be strong enough and won’t move with the surrounding muscle fibers.
4th Phase: Concentric strengthening
As healing progresses and your pain free range of movement improves we will start with concentric (shortening) exercises. Shortening of the muscle during a contraction improves muscle strength and your exercises will be progressed gradually as healing takes place. At first you will only perform these exercises against gravity, then with your own body weight. As the hip muscles get stronger we will add elastic resistance to increase the load.
5th Phase: Weight-bearing exercises
Your hip muscles work together to stabilise and control the movement of your pelvis when you are standing or walking. If some of these muscles are weak or not functioning properly, there will be too much or too little movement at your pelvis leading to other problems like lower back pain or knee pain.
During this phase of rehabilitation we will start with exercises in standing. First with both feet on the ground and, as your hip muscle strength improves, standing on one leg.
6th Phase: Eccentric strengthening
An eccentric muscle contraction is when the muscle lengthens to control movement, for instance sitting down slowly involves an eccentric contraction of your quadriceps muscles. If the quadriceps are not strong enough you will just drop down into a chair.
In this phase of rehabilitation we will add eccentric exercises to your strengthening program. This is a very important function of your hip muscles during any weight-bearing activity like walking, running, jumping etc. because the hip muscles of the leg standing on the ground will keep the other hip from dropping.
As you progress through this phase we will add movement in different directions and increase the range of movement to make exercises more challenging.
7th Phase: Strengthening the kinetic chain
Your leg is made up of different joints connected to each other by muscles, working together to do everyday activities like when you move furniture or pick up heavy boxes. This means that movement or dysfunction in one part of your leg will affect the other areas.
During this phase of rehabilitation exercises will also be aimed at strengthening other parts of the kinetic chain like your knee and lower back. This phase is important to ensure that weakness in other areas of your leg don’t put extra strain on your hip muscles and cause re-injury.
8th Phase: Endurance exercises
One of the last phases of rehabilitation will be to build up endurance of your hip muscles. At this stage you should have full range of movement of your hip and be able to control the movement of your pelvis during standing on one leg, walking, climbing stairs etc.
This phase is important for example when you walk long distances or even just stand for a long time. If your hip muscles get tired during these activities it will have a negative effect on the movement of your whole leg and you will risk another injury.
9th Phase: Back to everyday heavier activities
This is the final stage of rehabilitation and our physiotherapist will still continue myofascial release, trigger point release and electrotherapy modalities as needed, but functional rehabilitation is the most important part of this phase.
We will start with more complex exercises involving your lower back, hip and knee to make sure your hip muscle pain doesn’t come back when you move furniture, go hiking or get back to weight training.
Healing time
Most uncomplicated hip muscle strains take approximately 4 – 6 weeks to heal, depending on the grade of the muscle tear. In the first two weeks we will see you twice a week for treatment. However, you may not regain full fitness for another 2 weeks. After the first two weeks we will see you once a week to treat your pain and adapt your exercises where needed. As your home exercises get more difficult we will see you less often (every 10 days to 2 weeks) to monitor the healing of your hip muscle injury.
Depending on the severity of your injury it may cause longer term effects. When a significant hip muscle injury occurs, a number of other structures in your hip may also be injured. Injury to these structures can delay recovery. Recovery can also be delayed if the injury is not managed correctly, causing tight, weak muscles around your hip that are more likely to be re-injured in the future.
Your hip muscles are responsible for stability of your pelvis and hip and this is why it is of utmost importance to restore normal movement and function . This is why the rehabilitation process takes so long. Patience is key.
At the end of the rehabilitation process we will do tests to “clear” the hip muscles. This involves loading the muscles and hip in different positions and movements to make sure that your hip can do its job without instability and flare-ups.
Other medical treatment
- Your GP can prescribe medication for pain relief, but won’t solve the problem. Medication can make the pain more manageable, but will only mask the symptoms.
- A biokineticist can help with conditioning training and further strengthening once you have regained full range of movement and have minimal pain.
- Chiropractic manipulation of the hip joint may give you some symptomatic relief for your buttock pain, but it won’t influence the muscle’s healing process.
- Walking aids like crutches can be useful if you have pain when you walk.
Surgery for hip muscle pain
Surgical repair of a muscle tear is frowned upon because of the muscle’s ability to regenerate. Very few studies are available, because of the common belief that surgery gives similar of worse results to non-surgical options. The risk with surgery, complication and excessive scar tissue make non-surgical treatment like physiotherapy a safer option. Surgery is only considered for full thickness (grade 3) hip muscle tears.
Surgery could also be a last resort when physical therapy and injections do not provide lasting relief. In many cases, a torn hip muscle can be repaired arthroscopically by sewing the torn part of the anchor to the bone using tiny suture-anchors. This procedure aims to restore strength to the injured hip muscle.
What else could it be?
- Labrum tear – Usually with groin pain and sometimes hear a clicking sound with hip movement.
- Osteoarthritis of the Hip joint – One of the main characteristics is marked stiffness in the mornings or after sustained positions. The stiffness goes away with movement.
- Referred pain from your lower back – A dull ache in your buttocks that is difficult to pinpoint. The ache gets worse with specific movements of your lower back like leaning backwards.
- Gluteal tendinitis – Direct pressure, like lying on the affected side causes pain.
- Hamstring tendinitis – Pain over your “sitting bone” that gets worse when you sit on a hard surface.
- Hip Bursitis – Causes acute, sharp superficial pain on movement and may be accompanied by swelling and feel warm.
- Pinched Sciatic nerve over the hip – Symptoms are worse after sitting, slumping or contracting the gluteal muscles.
- Avulsion fractures or Stress fracture of Femur Head – Sudden pain after an incident, like a car accident, and you wouldn’t be able to take weight on the leg.
