HIP FLEXOR STRAIN
Hip flexor strains can range from mild to severe, or in medical terms, from first to third degree. A first degree hip flexor strain means one of the hip flexor muscles has been stretched or slightly torn.
Geoff Ruddock / flickr
Second degree strains refers to a partial tear of the muscle or tendon, and in a third degree sprain, the muscle or tendon is completely severed—a rare event. When a tendon is pulled off the bone at the place where it is attached, it is called an avulsion fracture. Depending on the severity of the injury, recovery time ranges from a few days to months.
How It Happens
There are as many as six muscles involved with flexion of the hip, and any of them can be strained. But the one that gets the most attention is the iliopsoas, a hip flexor that can be strained when it contracts forcefully, especially when the leg is fully extended or prevented from moving. Kicking and sprinting are the most common movements that cause strained hip flexors, but bending at the waist will be difficult after the injury has occurred. Hip flexors can be overused, and overuse can lead to strains. Tight hip flexors may make an athlete more vulnerable to hamstring strains.
Who’s at Risk
Soccer players, Kickers and Punter, especially when they take a blow while trying to kick, are at risk, as are runners during the “kick” phase of a race, martial arts athletes and cyclists. Any athlete who has weak or inflexible hip flexor muscles is vulnerable to this injury. Lack of flexibility, cold weather and an inadequate warm-up can increase the risk of a strain.
Pain in the groin area or front of hip
Lack of strength when trying to lift the knee against resistance (when there is a complete tear)
Rest 24-48 hours to prevent further damage. A hip pointer needs time to heal itself.
Apply ice packs for 15-20 minutes, 3-4 times a day for the first 24-72 hours, but don’t apply ice directly to the skin.
Aspirin, ibuprofen, and naproxen may relieve pain.
Compression shorts or a wrap bandage may be helpful.
For second and third degree sprains, rest the leg that has been injured, use ice applications, and see a sports medicine physician.
“Hip flexor strains requires that attention be given to the muscle’s antagonist (opposite mover), the gluteals,” explains Jennifer Lewis, Performance Physical Therapist at Athletes’ Performance in Phoenix, Arizona. “It is important for the glutes to not just be strong, but to be neutrally activated. This means that the muscle is ‘warmed up’ and turned on through proper prehab and movement preparation activities.”
“Also, proper stretching and lengthening exercises are appropriate, depending on the stage of the injury. Pay special attention to proper core stability so that the core maintains a stable spine and provides a solid base for movement of the hip flexors.”
Athletes need two to seven days to recover from a mild sprain, one to two weeks for a second degree injury and four to six weeks following a complete tear. Keep in mind that rehabbing the injury requires good knowledge of why it occurred in the first place (tissue overload, poor pillar strength, a slipping/ traumatic event). If the pain began for no apparent reason, see a medical professional. Long standing groin or hip flexor pain can be indicative of other hip problems and should be cleared by a doctor. You might be advised to use crutches if the pain is severe or movement difficult. Once you are reasonably mobile, cross-training (swimming instead of running, for example) in a sport or activity that does not challenge the hip flexors is a way to stay in shape during the recovery period.
You’ll know you are ready to return to action when you have a full range of motion with the affected leg, when strength on the injured side is equal to strength on the opposite side, and when you can walk or run without limping. Physical therapists might also require you to perform other sport-specific movements. Lewis provides these examples of exercises that can be used during rehab include:
How to Avoid This Injury
Any muscle or muscle group that has been injured previously is more susceptible to a subsequent injury. Observe the ten percent rule: do not increase exercise intensity, duration, or frequency more than ten percent a week. Below are examples of movement prep exercises, but any of the exercises listed under Comeback Strategy are also appropriate for preventing a hip flexor strain.
Femoroacetabular Impingement (FAI)
If femoroacetabular impingement (FAI) is not a term you recognize instantly, pronounce easily or use daily, you’re not alone. But FAI is a condition that affects athletes in many sports and appears increasingly in medical literature, as well as on sports pages. Think Alex Rodriguez and hip surgery.
“FAI is a condition in which abnormal bone growth on both the femur (the large bone in the upper leg) and the acetabulum (the socket part of the pelvis) repetitively contact each other,” says Marc Philippon, MD, the orthopaedic surgeon who operated on Rodriguez. Other high-profile athletes who’ve had orthroscopic surgery to correct FAI include Greg Norman, Mario Lemieux and Kurt Warner. “The constant rubbing damages the articular cartilage on the round head of the femur and the labrum (the rim around the hip socket).”
How It Happens
The hip is a ball and socket joint. For reasons not completely understood, some people develop excessive bone tissue at the top of the femur and around the edge of the hip socket. These people are not born with FAI. It appears to develop early in life as the person grows.
The movement that aggravates FAI is a forceful rotation of the core, including the hips. The longer that repetitive rotational movement occurs over a period of years, the more irritated the area becomes, the more pain can be felt because of bone to bone contact, and the more likely osteoarthritis will develop. When enough cartilage has been worn away from the top of the femur, the athlete will feel the pain.
FAI comes in two forms, cam and pincer. Mospatients have a combination of the two. Cam impingement results from excess bone located at the neck (top) of the femur. Pincer impingement is caused by excessive bone tissue on the acetabulum/socket of the pelvis.
By the Numbers
The percentage of people in the general population who have FAI
The percentage of professional athletes, according to a study of 45 men and women, who returned to their sports following orthroscopic surgery for FAI.
The percentage of pro athletes (same study) who remained active a year and a half after orthroscopic surgery
Who’s at Risk
Philippon calls FAI “a disease of active people.” The greater the number of physically active people, including pre-teens and adolescents, the greater the number of FAI cases. Almost any athlete whose sport requires forceful body rotation can develop FAI, but only if that person is among the 10-20 percent of people in which the condition exists. The rest don’t have to worry about it.
Golf, football, baseball, volleyball, soccer, hockey, lacrosse, field hockey, martial arts, rowing and tennis are the sports most likely to aggravate the FAI. FAI incidence among ice hockey goalies who use the “butterfly technique” (knees in, lower legs and feet down on the ice and out) to stop shots has been described as “epidemic.” Deep squatting performed in power lifting can also irritate the area.
low back, pelvic and buttocks pain
side of hips pain
stiffness or pain in the groin region in front of the hip
increased pain or stiffness after athletic activities and long periods of sitting
Th only thing an athlete can do for short-term relief is to rest, avoid excessive hip rotation movements and use over-the-counter medications, such as aspirin, ibuprofen, acetaminophen or naproxen to relieve pain and reduce inflammation.
Long-term treatment has involved open surgery and is generally successful, but requires an average of nine months for the patient to return to sports. Arthroscopic surgical techniques developed by Dr. Philippon have proven to be even more successful, getting patients back to their sports in as little as three months. Here are some prehab exercises that might be prescribed by an orthopaedic surgeon and supervised by a physical therapist to speed up the recovery process:
How to Avoid This Condition
FAI is not preventable. However, there are sports that bring out the worst in the condition. Avoiding those sports is not an acceptable option for most athletes, so developing a training program to minimize the risk of permanent damage is essential. Below are some movement preparation exercises to strengthen the muscles supporting the hip joint and to make that joint more flexible.
Plantar fasciitis is the debilitating scourge of runners and athletes everywhere. The plantar fascia is a big sheet of connective tissue on the bottom of the foot. It is shaped like a triangle and tapers into the heel bone.
There are multiple causes for pain, including nerve endings getting caught, or an inflamed bursa sac. Either way it hurts every time you plant your foot on the ground which affects your running. Common cause are “heel strike” running, weak hips and poor midline stabilization.
To alleviate issue, you need to work upstream and downstream of the problem. This means selecting mobility exercises that treat your toes, big toe, as well as your heel cord and calf. This treatment will alleviate tightness/tension and give some slack in the area, reducing pain and getting back to normal function.
Groin Injuries are commonly mis-diagnosed for Hip Flexor injuries and vice-versa. The reason being, the two muscle areas are very close to each other on the inner portion of your leg. A pulled groin muscle typically means you did something to your ‘adductor’ or inner region of thigh which is opposite of ‘abductor’ or outer region of thigh. For some reason I see more groin injuries with soccer players than I do with my kickers and punters. Possibly because the leg swing path of a kicking a soccer ball is a bit different than a football kick or punt.
A groin injury can happen in anything- not necessarily just kicking a football or soccer ball, but also other athletic activities such as running, sprinting or weight lifting, to name a few. A groin injury feels very weak and painful and usually you cannot kick at all during a groin injury. In my experience, most soccer and football related groin injuries are pulls or strains that simply require rest to heal. Follow the R.I.C.E. principle which states: Rest, Ice, Compression, Elevation. So, you would take time off from your activity, ice it (maybe 20 minute intervals a few times a day), Compress it which would mean keep it wrapped or tight, and Elevate it (so get off your feet as much as you can and lay down with your feet slightly higher than your chest) so it can take down the swelling in that muscle area.
Pulling or Straining your groin unfortunately is a very common injury in any athletic event or sport. Two things that can really help lower the chances of a future groin pull are:
- Proper Stretching & Warming Up before Kicking or Punting
- Strengthening of your ‘Core’ muscles. i.e. the Lower Abs, Oblique, Low Back, etc. (Your ‘Supporting Muscles’).
Doing the above two steps will help alleviate some of the strain and pressure exerted by the groin and allow other muscle groups to help pull some weight. I also highly recommend wearing compression shorts when you kick and taking extra time to stretch your groin and hip area before you kick. The bottom line is to be smart when you train and when you kick. If you feel you are getting tired and your leg feels rubbery, weak or like you should stop kicking, then you should STOP immediately. I see too many kickers and punters who go those extra 4 or 5 balls and that is how they usually hurt themselves. Be deliberate in all you do, have a daily practice regime and be smart about your kicking/punting practices and your daily training program!
Patellar Tendonitis (Tendinopathy)
Patellar tendinopathy (or as it is commonly known patellar tendonitis or tendinitis) is an overuse injury affecting your knee. It is the result of your patella tendon being overstressed. A common name for it is Jumper’s Knee.
Anatomy of the Knee
The patella tendon is located just below the patella (knee cap). It has attachments on the patella and the tibial tuberosity on the tibia (shin bone). The role of the patella tendon is to transfer the force of the quadriceps muscles, much like a rope around a pulley, as your knee straightens.
Your quadriceps is even more important when controlling your knee as you bend from a straight position eg walking downstairs, landings. Your quadriceps muscles are heavily involved in most sports, especially those which involve jumping, running and kicking.
Why is it Called Jumper’s Knee?
The greatest level of stress through the patella tendon is during jumping and landing activities. During jumping, the quadriceps muscles provide an explosive contraction, which straightens the knee and pushes you into the air. When landing, the quadriceps muscle helps to absorb the landing forces by allowing a small amount of controlled knee bend.
Excessive jumping or landing strains the patella tendon. At first the damage may only be minor and not cause any problem. However, if the tendon is repeatedly strained, the lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a patellar tendinopathy (tendon injury).
Who Usually Suffers Patellar Tendonitis?
Patellar tendonitis usually affects athletes involved in sports such as basketball, volleyball, soccer, football, track and field (running, high and long jump), tennis, dancing, gymnastics and skiing.
In older people the main cause of patellar tendinopathy is a result of degeneration which results from repetitive micro-damage over time. Also, some patients develop patella tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.
Signs and Symptoms of Patellar Tendonitis
Anterior knee pain over the patella tendon
Pain made worse with jumping, landing or running activity and sometimes with prolonged sitting
Onset of pain is usually gradual and commonly related to an increase in sport activity
Localised tenderness over the patella tendon
Often the tendon feels very stiff first thing in the morning.
The affected tendon may appear thickened in comparison to the unaffected side
Typically, tendon injuries occur in three areas:
musculotendinous junction (where the tendon joins the muscle)
mid-tendon (non-insertional tendinopathy)
tendon insertion (eg into bone)
Non-insertional tendinopathies tends to be caused by a cumulative microtrauma from repetitive overloading eg overtraining.
What is a Tendon Injury?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:
Tendinitis (or Tendonitis): This actually means “inflammation of the tendon,” but inflammation is actually only a very rare cause of tendon pain. But many doctors may still use the term tendinitis out of habit.
The most common form of tendinopathy is tendinosis. Tendinosis is a noninflammatory degenerative condition that is characterised by collagen degeneration in the tendon due to repetitive overloading. These tendinopathies therefore do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.
What Causes a Tendon Injury?
Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.
Your tendons are designed to withstand high, repetitive loading, however, on occasions, when the load being applied to the tendon is too great for the tendon to withstand, the tendon begins to become stressed.
When tendons become stressed, they sustain small micro tears, which encourage inflammatory chemicals and swelling, which can quickly heal if managed appropriately.
However, if the load is continually applied to the tendon, these lesions occurring in the tendon can exceed the rate of repair. The damage will progressively become worse, causing pain and dysfunction. The result is a tendinopathy or tendinosis.
Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces generated during sport or an activity causes a tendinopathy. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.
What Causes Patellar Tendonitis?
There are a number of factors which can contribute to the development of patellar tendinopathies. These include:
Rapid increase in amount of training
Sudden increase in training intensity
Playing/training on rigid surfaces
Tight quadriceps and hamstring muscles
Lower Limb Biomechanics
This can include poor foot posture, knee or hip control. Your physiotherapist can assess and treat these issues.
What are the Symptoms of Tendinopathy?
Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
The pain may get worse when you use the tendon.
You may have more pain and stiffness during the night or when you get up in the morning.
The area may be tender, red, warm, or swollen if there is inflammation.
You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be a lot like those caused by bursitis.
The inability of your tendon to adapt to the load quickly enough causes tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.
1. Reactive Tendinopathy
Normal tissue adaptation phase
Prognosis: Excellent. Normal Recovery!
2. Tendon Dysrepair
Injury rate > Repair rate
Prognosis: Good. Tissue is attempting to heal.
It is vital that you prevent deterioration and progression to permanent cell death (phase 3).
3. Degenerative Tendinopathy
Cell death occurs
Poor Prognosis – Tendon cells are giving up!
4. Tendon Tear or Rupture
Catastrophic tissue breakdown
Loss of function.
Prognosis: very poor.
Surgery is often the only option.
It is very important to have your tendinopathy professionally assessed to identify it’s injury phase. Identifying your tendinopathy phase is also vital to direct your most effective treatment, since certain modalities or exercises should only be applied or undertaken in specific tendon healing phases.
How is a Tendon Injury Diagnosed?
To diagnose a tendon injury, your physiotherapist will ask questions about your past health, your symptoms and exercise regime. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or you do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.
How is Tendinopathy Treated?
In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:
Rest the painful area, and avoid any activity that makes the pain worse.
Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
Do gentle range-of-motion exercises and stretching to prevent stiffness.
Have your biomechanics assessed by a physiotherapist.
Undertake an Eccentric Strengthen Program. This is vital!
How to Care for a Sprained Plant Ankle
Ankle sprains are very common injuries. There’s a good chance that while playing as a child or stepping on an uneven surface as an adult you sprained your ankle–some 25,000 people do it every day.
For Kickers and Punters, sometimes poor hip mobility and weak core can aid in vulnerability of an ankle injury. This often happens when a K/P “jumps” into the ball with a hyperextended plant leg, putting more force than necessary on the ankle or hip.
Sometimes, it is an awkward moment when you lose your balance, but the pain quickly fades away and you go on your way. But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it. If it’s a severe sprain, you might have felt a “pop” when the injury happened.
A sprained ankle means one or more ligaments on the outer side of your ankle were stretched or torn. If a sprain is not treated properly, you could have long-term problems. Typically the ankle is rolled either inward (inversion sprain) or outward (eversion sprain). Inversion sprains cause pain along the outer side of the ankle and are the most common type. Pain along the inner side of the ankle may represent a more serious injury to the tendons or to the ligaments that support the arch and should always be evaluated by a doctor.
You’re most likely to sprain your ankle when you have your toes on the ground and heel up (plantar flexion). This position puts your ankle’s ligaments under tension, making them vulnerable. A sudden force like landing on an uneven surface may turn your ankle inward (inversion). When this happens, one, two or three of your ligaments may be hurt.
A sprain can be difficult to differentiate from a fracture (broken bone) without an x-ray. If you are unable to bear weight after this type of injury, or if there is significant swelling or deformity, you should seek medical treatment from a doctor (MD or DO). This may be your primary care physician or pediatrician, an emergency department, or an orthopaedist, depending on the severity of the injury.
Tell your doctor what you were doing when you sprained your ankle. He or she will examine it and may want an x-ray to make sure no bones are broken. Most ankle sprains do not require surgery, and minor sprains are best treated with a functional rehabilitation program. Depending on how many ligaments are injured, your sprain will be classified as Grade I, II or III.
Treating your Sprained Ankle
Treating your sprained ankle properly may prevent chronic pain and instability. For a Grade I sprain, follow the R.I.C.E. guidelines:
Rest your ankle by not walking on it. Limit weight bearing. Use crutches if necessary; if there is no fracture you are safe to put some weight on the leg. An ankle brace often helps control swelling and adds stability while the ligaments are healing.
Ice it to keep down the swelling. Don’t put ice directly on the skin (use a thin piece of cloth such as a pillow case between the ice bag and the skin) and don’t ice more than 20 minutes at a time to avoid frost bite.
Compression can help control swelling as well as immobilize and support your injury.
Elevate the foot by reclining and propping it up above the waist or heart as needed.
Swelling usually goes down with a few days.
For a Grade II sprain, follow the R.I.C.E. guidelines and allow more time for healing. A doctor may immobilize or splint your sprained ankle.
A Grade III sprain puts you at risk for permanent ankle instability. Rarely, surgery may be needed to repair the damage, especially in competitive athletes. For severe ankle sprains, your doctor may also consider treating you with a short leg cast for two to three weeks or a walking boot. People who sprain their ankle repeatedly may also need surgical repair to tighten their ligaments.
Rehabilitating your Sprained Ankle
Every ligament injury needs rehabilitation. Otherwise, your sprained ankle might not heal completely and you might re-injure it. All ankle sprains, from mild to severe, require three phases of recovery:
Phase I includes resting, protecting and reducing swelling of your injured ankle.
Phase II includes restoring your ankle’s flexibility, range of motion and strength.
Phase III includes gradually returning to straight-ahead activity and doing maintenance exercises, followed later by more cutting sports such as tennis, basketball of football.
Once you can stand on your ankle again, your doctor will prescribe exercise routines to strengthen your muscles and ligaments and increase your flexibility, balance and coordination. Later, you may walk, jog and run figure eights with your ankle taped or in a supportive ankle brace.
It’s important to complete the rehabilitation program because it makes it less likely that you’ll hurt the same ankle again. If you don’t complete rehabilitation, you could suffer chronic pain, instability and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament has not healed right, or that some other injury also happened.
To prevent future sprained ankles, pay attention to your body’s warning signs to slow down when you feel pain or fatigue, and stay in shape with good muscle balance, flexibility and strength in your soft tissues.
Gain mobility back to normal range of motion
WHAT IS A QUADRICEPS STRAIN?
A quadriceps strain is a condition that is frequently seen in kicking and running sports and is characterised by partial or complete tearing of the quadriceps muscle located at the front of the thigh (figure 1).
The large muscle group at the front of your thigh is called the quadriceps (figure 1). The quadriceps comprises of 4 muscle bellies which originate from the pelvis and thigh bone (femur) and attach to the shin bone (tibia) via the knee cap (patella). They are:
The quadriceps is responsible for straightening the knee during activity and controlling knee and hip movements and is particularly active during sprinting, jumping, hopping or kicking. Whenever the quadriceps muscle contracts or is put under stretch, tension is placed through the quadriceps muscle fibres. When this tension is excessive due to too much repetition or high force, the quadriceps muscle fibres may be torn. When one or more parts of the quadriceps muscle tear, the condition is known as a quadriceps strain. The rectus femoris is the most commonly affected muscle belly in a quadriceps strain.
Tears to the quadriceps can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture whereby there is a sudden episode of severe pain and significant disability. Quadriceps strains range from a Grade 1 to a Grade 3 tear and are classified as follows:
Grade 1 Quadriceps Tear: a small number of fibres are torn resulting in some pain, but allowing full function.
Grade 2 Quadriceps Tear: a significant number of fibres are torn with moderate loss of function.
Grade 3 Quadriceps Tear: all muscle fibres are ruptured resulting in major loss of function.
The majority of quadriceps strains are grade 2 tears.
Causes of a quadriceps strain
Quadriceps strains most commonly occur due to a sudden contraction of the quadriceps muscle (particularly when the muscle is on stretch – e.g. kicking). They often occur during sprinting, jumping, hopping or kicking activities. This is particularly so during explosive acceleration (e.g. sprinting), when a footballer is kicking on the run or performs a long kick, or, following an inadequate warm-up. Quadriceps tears are commonly seen in running sports such as football and athletics.
Signs and symptoms of a quadriceps strain
Patients with a quadriceps strain usually feel a sudden sharp pain or pulling sensation in the quadriceps muscle at the time of injury. In minor cases, the patient may be able to continue activity only to have an increase in symptoms upon resting later (often that night or the next morning). In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue the activity. Patients with a severe quadriceps tear may also limp or be unable to walk off the playing field.
Patients with this condition usually experience an increase in pain during activities which place tension on the quadriceps muscle. These activities may include squatting, going up and down stairs, running, jumping, hopping, kicking or performing a quadriceps stretch. It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning.
Patients with this condition may also experience swelling, pain on firmly touching the affected region of the quadriceps muscle and bruising in the front of the thigh. In severe cases, a visible deformity in the quadriceps muscle may also be detected.
Prognosis of a quadriceps strain
With appropriate management, patients with minor quadriceps strains can usually recover in one to three weeks. With larger tears, recovery may take four to eight weeks or longer depending on the severity of the injury. Complete ruptures of the quadriceps muscles are rare and are usually managed conservatively. In these cases, recovery may be significantly longer.
How the Tensor Fascia Lata (TFL) Causes Hip Pain
This muscle causes pain in two primary ways:
1) Once the TFL has been tight and ischemic for some period of time, it can develop myofascial trigger points.
Trigger points can then refer pain to other parts of the hip, the groin, the buttocks and even down the leg.
2) When the TFL becomes chronically contracted it can exert a mechanical strain on other muscles by distorting joint movement.
For example the gluteals or the piriformis muscle often suffer from an unnatural “pull” from an excessively tight TFL.
Pain, then, might be felt in one or more of the following areas…
– Deep in the hip joint
– Into the groin
– Wrapping around the outer hip
– Deep in the gluteal muscles
– The sacroiliac joint
– Traveling down the leg
What Causes Tensor Fascia Lata (TFL) Dysfunction?
I have been considering for a long time how the TFL becomes excessively tight and locked up (aka dysfunctional) and have concluded that there are two chief reasons…
1) Weakness in the rectus femoris muscle.
The rectus femoris, the top quadriceps muscle along the front of your thigh, is your secondary hip flexor (after the psoas and iliacus which are your primary hip flexors).
And the rectus femoris muscle so often becomes weak as a result of the second reason for TFL dysfunction…
2) Excessive tightness and shortening of the psoas and iliacus.
This is a common occurrence in many of us who sit for long hours at a desk and/or commuting in our cars. The primary hip flexors, the psoas and iliacus, are put into a shortened position when we’re sitting. This can cause them to adapt to the shortened position.
Chronic shortening of the primary hip flexors, the psoas and iliacus, can causes the secondary hip flexor, the rectus femoris, to atrophy.
I believe this occurs, in part, because short hip flexors will abbreviate your stride thus reducing a full and natural leg swing.
In runners who are heel strikers this problem can be even more exaggerated. The quadriceps, and especially the rectus femoris, are severely underused.
In the reaching stride characteristic of heel strikers, the leg extends and straightens at the knee as the foot hits the ground. This leg movement disables the quadriceps muscles.
An aside for runners: underuse of the quadriceps can be rectified using the “barefoot running technique.” This technique does not require one to actually run in bare feet but rather to…
1) Adopt the upright, “running on hot coals” running method
2) To use a running shoe without the beefed up heels of conventional running shoes which don’t allow your foot to go through its full range of motion.
I recommend the Merrell’s Pace Glove for Women or Merrell’s Trail Glove for Men (the shoe I run in).
How to Treat Tensor Fascia Lata (TFL) Dysfunction
There are three strategies that alleviate excessive tightness in the tensor fascia lata:
1) Direct manual therapy treatment of the tensor fascia lata
I find that putting a client in a side-lying position with a pillow between their knees (and one to support their head and neck) is optimal.
Then direct manual pressure applied at different angles will help to locate the greatest “liveliness” in the muscle (I like to use this word instead of “pain”).
Gentle but detailed work will produce the best, most lasting results.
2) Maintaining flexibility in the entire hip
Stretching of the hip flexors and the entire hip and leg.
See Hip Stretches for excellent video support.
3) Strengthening the quadriceps
I’m not a fan of seated leg extensions on a weight machine to accomplish this.
Much more effective are single leg squats. If squats are not possible due to pain, then sitting against a wall is an excellent strategy.
Your knees should be at a 90 degree or right angle. Otherwise it’s not stable for your knees.