Hip Flexor Tendinitis

Hip Flexor Tendinitis takes runners down for months at a time. As one of the more common injuries that runners experience, hip flexor tendinitis can be an extremely frustrating source of hip or groin pain. It’s especially common in those increasing their mileage and often includes symptoms of tightness and pain with running. Hip flexor tendinitis afflicts runners due to the repetitive nature of running. Oddly enough, hip flexors can also be tight in those who sit a lot, with the hips in constant flexion. Tight hip flexors can cause a variety of posture problems, and in runners, it’s due to muscular imbalance, namely weak glutes, the primary hip extensors. This article will explain the causes of hip flexor tendinitis in runners and discuss some easy ways to help correct the problem.

Hip Flexor Tendonitis

Why Runners Develop Hip Flexor Tendinitis

The repetitive, high impact activity of running opens up these athletes to a variety of injuries. Running involves repetitive hip flexion, the motion of bringing the thigh up to the body. This action is accomplished by the hip flexors, numerous muscles that originate in the lower/lumbar back and pelvis and attach to the femur, the long bone of the thigh.

Tight hip flexors cause 3 main biomechanical alterations:

The pelvis tilts forward, causing increased curvature of the lower back, forcing the buttocks out and making the runner appear to “lead” with the chin.
As a result of the pelvic tilt, the hip extensor muscles (the glutes and hamstrings) become lengthened and weaker.
The hip flexors begin to take over some of the abdominals’ work to stabilize the mid body, effectively weakening the core.

Over time, these muscular imbalances lead to a vicious cycle: the hip flexors are overtaxed as the balancing muscle groups of the core and the glutes become weaker. This leads to hip flexor tendinitis and pain. To correct this imbalance and run pain free, runners need to focus on 2 areas: stretching the hip flexors and strengthening the core and gluteal muscles.

Stretches for Hip Flexor Tendinitis

A note about stretching: do dynamic stretches prior to a workout and save the static ones for after. Dynamic stretches are done by moving through the range of motion used in the activity, but in a smooth, controlled and deliberate manner. These stretches should be challenging, but comfortable. Dynamic stretching prior to activity is thought to improve functional range of motion as well as mobility during a workout.

The Pirate stretch: an excellent stretch for tight hip flexors.

Stand up with the feet even.
Step forward into a lunge.
Bend and lower the back knee to the floor while keeping your front, lunging knee over the ankle.
Hold the position for 20-30 seconds.
Repeat the move, switching the lunging leg.
Remember: only stretch to the feeling of mild tension.

Foam Rolling (Self-Myofascial Release): this technique really works for tight hip flexors, but takes patience, as it can be painful at first. It really pays of if you can stick with it.

Lay on your side with the roller positioned just below the hip. Try to angle your hip back a bit.
Roll back and forth on the roller until you find the tight spot.
Hold the roller on this area for 20-30 seconds.
Roll again to find the next tight spot and repeat.

Exercises for Hip Flexor Tendinitis

These three exercises help correct the muscular imbalance that is part of hip flexor tendinitis. They focus on strengthening the glutes, the lower back and the core musculature.

Single Leg Glute Bridge

Lay on your back with your knees bent and feet flat.
Raise one leg off the ground, slightly pulling the knee to your chest. This is the correct starting position.
Execute the movement by lifting your hip upwards, driving your weight through the heel and lift the hips completely off the ground.
Extend the hips as far upwards as possible, pause and then return to the starting position.

The Birddog Exercise:

As this exercise attempts to move the arm and opposite leg simultaneously, it is helpful to watch your form in a mirror, making adjustments as needed.

Begin in a hands and knees position with your knees directly underneath the hips and your arms directly under the shoulders. Your palms are flat with fingers pointing forward. This is the correct starting position.
While keeping the spine in a neutral position, without excessive arching or rounding, engage the core and abdominal muscles, pulling your shoulder blades toward the hips. Imaging tightening a corset around your waistline.
Upward phase: Slowly lift and lengthen the left leg. Raise it off the floor until it is at or near parallel. It should not be above the hip. Avoid rotation of the hips, keeping them flat and parallel to the ground.
With the left leg still raised, slowly raise and straighten the right arm. Lift it to a height at or below the shoulders, keeping it parallel to the ground. The shoulders must also remain parallel to the ground. Think of the head as an extension of the spine. Keep it in line and straight throughout the movement. It should not lift or sag. NOTE: only lift the arm and leg as far as you can while keeping the hips and shoulders parallel to the floor, the core engaged and spine in a neutral position.
Downward phase: Slowly lower the arm and leg back into the starting position while maintaining balance and stability in the shoulders, pelvis and torso.
Alternate sides of this movement while working hard to keep the abdominals engaged. When changing sides, do not shift your weight or flop from one side to the other. Maintain constant balance and control of your movement.

The Deadbug Exercise

Lay on your back with your arms extended above you, hands toward the ceiling.
Bring your legs up parallel to your arms, knees bent at a 90° angle
Deeply exhale to bring your ribcage down and flatten your lower back to the floor, while rotating your pelvis upwards and squeezing your glutes. Maintain this position throughout the move. This is the correct starting position.
Initiate the movement by extending one leg, straightening at the knee and lowering the leg to just above the ground.
Maintain the position of your lumbar spine and pelvis keeping them stable and pressing your lower back flat to the floor, as you will want to arch your lower back.
Keeping the pelvis stable and the abdominals engaged, return the working leg to the starting position.
Repeat on the opposite side

These stretches and strengthening moves can and should be used by any runner and especially those suffering with hip flexor tendinitis. Increasing flexibility and strengthening the core and glutes will restore the proper biomechanics necessary for distance running. It will also lead to better posture, overall strength and balance that in the long run will help prevent further injuries.

If you would like to speak with Dr. Gonzales in person contact us here about your Hip Flexor Tendinitis.

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