The Role of the Hip Flexors in Running

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If you are a dedicated runner, you most likely already know how important strengthening exercises are for injury prevention and performance improvement. With so many body parts and muscles to pay attention to, you may end up having to pick and choose just a few to focus on when time is limited. One of the most common areas to get injured or experience pain for runners is the knee joint. Unlike most other injuries, knee pain in runners is usually not from a trauma. The majority of knee issues begin with a gradual onset of pain and/or instability that is caused by poor mechanics or weakness elsewhere in the body. Lower back issues follow the same pattern, as do other joints less commonly. These problems are generally caused by weakness and imbalances in the hip joint.

Some of the most common leg strengthening exercises performed by most athletes are squats, lunges and step-ups. These are effective movements to target big muscle groups that play an important role in running such as the gluteals and quads, which are the main muscles used for the push-off phase of the running cycle. When trying to improve running form and speed, it is important to examine each phase of the running cycle separately and find your weaknesses.

The Problem is in the Hip Flexors

A frequently ignored muscle group that is active in most phases of the running cycle is the hip flexors. Most runners ignore strengthening this group due to experiencing significant tightness and assuming it is because they are already strong, but overworked. This is not the case. Tight muscles do not equate to strong muscles. There is a reason the hip flexors are usually tight in runners. It is because they are a highly active group of muscles that are actually not strong enough. The hip flexors are in charge of driving the leg up and forward during the swing phase. They also work eccentrically during the push-off phase when the opposite muscles are firing in order to control the motion.

When attempting to increase speed during running, hip flexion is naturally increased to clear the ground and lengthen the stride. Over time, if the muscles are lacking sufficient strength for this motion, overuse injuries may occur. Either the hip flexors will become significantly tight and eventually limit the amount of stride, or inflammation may build up in the joint. There are several muscles that create the hip flexion movement, and it is not uncommon for more than one of these muscles to be affected. The pain caused by the overuse injuries in this area of the hip can be considerably sharp and make running nearly impossible.

Another common cause of hip flexor dysfunction is poor posture. Individuals with a highly arched lower back or those who carry extra weight through the stomach tend to develop tight hip flexors due to the constant forward tilt of the pelvic bones. This is also common in pregnant woman. This is the case of significant tightness in the muscles being the main issue, versus weakness. The weakness in this case would be in the core and lower spine postural muscles.

Symptoms

The most common symptom for a hip flexor strain is initially sharp pain in the front of the hip, usually when lifting the knee high. The pain will become a deep ache if activity continues. The pain will decrease with stretching, but return once the aggravating activity is resumed. Other motions that may worsen the pain are standing after prolonged sitting and squatting activities. Most runners tend to ignore hip flexor issues since the pain will ease after warming up. As the run continues, the pain will return once the muscles are worked beyond their available strength and flexibility.

Treatment

Of course the initial coarse of treatment begins with rest, especially from running and other aggravating activities. If you are getting pain with regular movements such as walking, sitting to standing, squatting, or climbing stairs, then running should be avoided. During this time it is important to get the inflammation down as much as possible with icing and elevating the leg throughout the day. Light to moderate massage or foam rolling will also help with pain management and easing the tightness in the tendon.

Once the inflammation and pain are under control, flexibility and strengthening exercises are the next step in the treatment process. This step should be ongoing even after the issue is healed in order to prevent it from flaring up in the future. The strengthening should not only target the hip flexors, but also the entire core muscles as well. The core consists of the muscles of the chest, upper and lower back, abdominals, and the hips. This may seem like a great deal of areas to target during a workout session, but all it takes is a rotation of a few effective exercises. Examples are floor bridges, clamshells, planks, push-ups, supermans, standing arm rows, and step-ups. Incorporating a knee raise movement at the top of a step-up is one way to target those weak hip flexors.

Stretching the hip flexors is easiest done with a standing lunge, which will stretch the hip flexor of the back leg. Another option is to lie at the edge of a bed or table and hang the leg off of the side until a stretch is felt. The quad muscles most likely are also a tight area with hip flexor dysfunction, since a part of this group of muscles is also in charge of flexing the hip. As mentioned above, regular foam rolling will help keep these muscles loose and prevent mobility issues.

If you are experiencing pain or tightness in the area of the hip flexors, especially with the moves mentioned above, it may be a case of weakness. Many runners skip strengthening exercises and just focus on running, but this is a mistake and will eventually lead to fatigue and overuse injuries. Running may strengthen some areas of our body and build endurance, but specific exercises are required to target other muscles that become overused during the running cycle. It is a good idea to make time for strengthening and stretching during training. Paying attention to posture is also important, as weakness in the core muscles will exacerbate tightness in the hip flexors as well. Hip problems often lead to problems in other parts of the body. Continuing to ignore hip pain will only lead to other injuries and pain in the body and eventually leave you out of running for a longer period of time.

Sources

  1. Timothy G. Eckard, PT, DPT, OCS, Darin A. Padua, PhD, ATC, Thomas P. Dompier, PhD, ATC, Sara L. Dalton, MEd, LAT, ATC, Kristian Thorborg, PT, PhD, Zachary Y. Kerr, PhD, MPH, Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, Journal, Jan 09, 2018
  2. Timothy F. Tyler, MS, PT, ATC, Takumi Fukunaga, DPT, ATC, CSCS, and Joshua Gellert, DPT, Rehabilitation of Soft Tissue Injuries of the Hip and Pelvis, Journal, Jan 09, 2018
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