Strained Hip Muscles? One of the key factors that increase the risk of injury to your hips are short and tight hip muscles, mainly; the GluteusRectus Femorus and Iliacus muscles.  Jumpers are more likely to strain or tear one of the hip muscles, due to the high intensity of the muscle’s contraction. These muscles are quite large and able to generate a lot of torque & power and any discrepancy of direction of pull on the hip muscles may load some fibers more.

The muscles tend to tear at the joining point between muscle, tendon and bone, therefore Athletes that require a large range of moment in their hips are more prone to develop a hip muscle strain.

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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 you may end up with torn hip muscles. There are a wide range of ways as to how the muscles surrounding your hip can start to tear or take excessive load. 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.

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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 over time if sufficient healing is not allowed to take place in the muscle’s fibers.

Muscles in the Hip

In order to identify the muscle that is causing the 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 

It is the largest of the Gluteus 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) as when walking or running, and extending the hips.

It propels your body forward like when standing up out of a chair, straightening your hips to get to an erect position. Ever climbed a flight of stairs and felt the burn in your butt… Well that’s your gluteus.

Gluteus Medius muscle

Gluteus medius muscles is a muscle that pulls your leg outwards (Abduct), as wells as plays a vital role in keeping your hip 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 the 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 the leg, knee and ankle.

Gluteus Minimus msucle

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 in front of the gluteus medius muscle. The 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 the hip and pelvis when the opposite leg is raised from the ground.

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Iliacus & Psoas Major muscle

The iliacus combines with the psoas major to enter in front of the thigh and insert onto the femur. The iliacus and psoas are thus collectively referred to as the iliopsoas muscle – they act together to flex the thigh at the hip joint, as well as help outwards rotation of the thigh. The iliopsoas muscles are the strongest hip flexors.

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Rectus Femoris (One of the Quadriceps)

The Rectus Femoris muscle has attachments on the front of the pelvis, just above the hip joint socket and is one of the muscles that help to flex the hip and pelvis forward.

Piriformis muscle

This is a muscle deep inside the hip that mainly turns the hip outwards

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.

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External Rotator group

These muscles all originate on the pelvic area and insert onto the greater trochanter of the femur mainly responsible for turning the thigh outwards. These muscles  are the deepest layer of muscles 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 pain on the inside of the groin. 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.

Causes of a Hip muscle injury

These are some reasons why the hip muscles tear if the end result is confirmed to be 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.

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Acute injury

  •  Overload – Increasing the load on your squats too fast. 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. Muscles are very weak in its stretched 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 ideal candidate, (when you don’t train at all during the week, but over the weekend your will run 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 of tearing.
  • Excessive stretching – of 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 it is 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 that the outer part. This abnormal force on the inside of your leg will cause the fibers to fatigue faster and tear first.

How the hip muscle becomes injured

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 stretched position.

Repetitive overload on the muscle will cause small tears inside the muscle. Your body will react 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 contract or stretch the muscle. The most common site for this type of tear to develop is where the tendon meets the muscle (Musclotendinous junction). In most of these cases there is a tendinitis accompanied by a a hip muscle strain.

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Hip muscle strains can be classified as:

  • Grade 1: a small number of muscle fibers are damaged, able to do the movement, but painful at the end of the range. Painful to stretch.
  • Grade 2: a larger number of fibers are torn and there is more pain during the whole movement. Unable to move to end of range and unable to stretch due to pain.
  • Grade 3: a complete rupture of one or more of the hip muscles. Severe loss of movement, too painful to move.
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Diagnosis of a Hip Muscle strain

Our physiotherapists are experts at detecting a muscle tear because we spend 11 hours a day working on soft tissue. Forgive us when we say “we just have the feeling for it”. 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.

We will test all the hip and surrounding muscles’ strength individually. This also gives us an indication of the muscle length. 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).

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Sonar (Diagnostic Ultrasound)

This will be the investigation of choice, as the soft tissue (muscles, ligaments and bleeding) can be visualised. A sonar would show the depth, length and direction of the muscle tear enabling us to treat you optimally.

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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.

MRI

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. It will be excessive to take an MRI to establish a hip muscle strain.

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Symptoms

Mild

  • Pulling feeling when the muscle is contracted
  • Pain only at the end of range of hip movement
  • No loss of muscle strength (Able to do all movements, but with pain)
  • Dull pain when standing and bending the knees
  • Little swelling
  • No bleeding seen (under the skin surface – blue)
  • Unable to pinpoint it to one specific spot
  • Able to continue playing (sport), but with pain.

You need help

  • Sharp sting and pulling feeling over your hip
  • Unable to put weight on the leg
  • Unable to climb up or down stairs
  • Weakness in the hip
  • Pain through the range of some movements of your hip
  • Loss of muscle strength (Weakness when trying to contract your hip muscles.
  • Sharp pain when stretched
  • Little to severe swelling
  • Unable to continue play (sport), have to stop moving (running, jumping)
  • Able to pinpoint it to one specific spot

It’s serious

  • Hearing a loud pop, snap when it happens.
  • Unable to continue playing, have to stop moving
  • Visible gap in the muscle when the muscle is contracted
  • Severe pain when stretched
  • Always swelling
  • Always considerable amount of bleeding under the skin (blue)
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What NOT to do

If you suspect you may have a hip muscle strain, do not carry on with any activities that make your symptoms worse. This may prolong your recovery and could cause long-term complications.

What you should do

If you notice any of the symptoms of a hip strain, you should have a physiotherapist assess you as soon as possible. You can apply ice wrapped in a damp towel straight away to reduce the swelling and minimize your pain.

Why my Hip pain doesn’t go 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 the 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. If 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 returns 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 the hip 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.

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Hip Muscle Strain

Physiotherapist treatment

Physiotherapy to treat hip strains include a home exercise program, hydrotherapy and cryotherapy (ice) techniques. Additional treatments may include:

  • Acute injury treatment
  • Ultrasound
  • Medications
  • Soft tissue massage
  • Electrotherapy treatment
  • Laser (Low Level Laser therapy)
  • Acupuncture & Dry Needling
  • Heat packs (Thermal therapy)
  • Kinesiology Tape
  • Rigid Strapping or taping
  • Neurodynamics (Nerve tissue mobilizations)
  • Dynamic Strapping
  • Strengthening exercises
  • Guided loading protocol
  • Stretches (Static, dynamic and ballistic)
  • Moon boot
  • Brace
  • Compression Bandage or Sleeve
  • Supportive strapping and taping
  • Biomechanical Analysis
  • Gait Analysis
  • TENS
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Other Causes of Hip pain

Could there be any long-term effects from a hip strain?

Low grade hip sprains can be resolved with physiotherapy alone but a serious rupture of the hip muscle may require surgery. Following your operation, you should begin a personalized physiotherapy program to optimize your recovery.

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Physiotherapy Treatment

1st Phase: Protection & initial Healing

Key Action
P Protect We have found that patients tend to continue walking on the injured leg with a limp. The muscle still contracts every time that your weight is put onto the leg. It’s better to get crutches and keep the load off the hip muscles. The main concern is to prevent the muscle from tearing any further.
R Rest No weight on the injured leg & hip. Use crutches to take the load off the hip muscles.
I Ice Ice cubes warped in a towel, tied around the hip reduces pain & inflammation and speeds up the healing process. For at least the first 3 days or until the swelling goes down, apply an ice pack for 20 minutes every two hours. Always keep a towel between the ice and your skin (to prevent a cold burn), and press the ice pack firmly against all the curves of your hip.
C Compress Use strapping (Leukotake S) or elastic compression bandage to keep the muscle supported and prevent blood pooling in your thigh. This can be done either with taping or tube grip bandage and helps to control swelling.
E Elevate Lying on your back with your foot on a chair (your thigh must be higher than your heart to allow gravity to assist in draining the pooled blood in your leg.) Raise your calf for 15 minute intervals during the day.
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2nd Phase: Regain Full Range of Hip Movement

The most important component of rehabilitation is to regain full range of movement of the hip muscle fibers. The scar tissue that form inside the site of the tear must be lengthened and orientated to allow the muscle to contract without any restrictions. We use massage, stretches and neurodynamic mobilizations to achieve full range of movement. This will also prevent future re-occurrence.

3rd Phase: Eccentric Hip Muscle Strength

A muscle contraction works in two directions: One where the Gluteus muscle is contracted and it shortens like walking up a step (concentric), and controlling the descent bending down forwards (eccentric). This loads the muscle fibers while being lengthening. These type of exercises are vital to conditioning the hip muscle fibers to absorb a force.

4th Phase: Concentric Hip Muscle Strength

Shortening of the hip muscles during a contraction involves strength and power exercises that will be progressed gradually as healing takes place. This will be tested frequently to determine if you can progress from non-weight bearing to full weight bearing (walking without crutches). The physiotherapist will guide and monitor the muscles reaction to normal forces like walking, climbing stairs and driving.

5th Phase: High Speed, Power, Proprioception

The hip muscles must be tested under high load and speed to ensure that the muscle will be able to keep up with the demand of your body. During this phase the physiotherapist will guide you to return to normal activities, as well as to challenge the muscle past its ‘normal’ boundaries to determine how it reacts to different forces and prepare you to return to participating in your sport.

6th Phase: Sport Specific Training

Depending on your sport, the physiotherapist will tailor specific exercises that will help strengthen the hip muscles pertaining to your sport. A successful outcome is when you have gained knowledge throughout the rehabilitation program and can participate at full power and speed, while also minimizing your chance of future injury.

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