Hip Flexor Tendinopathy – what is it?

Firstly, what are your hip flexors?

Hip flexion is the act of bringing your thigh bone up in front of you, such as bringing your knees towards your chest, and there are several muscles that are involved in this. However, for the purpose of this article we are going to focus on iliopsoas which is a combination of 2 muscles: iliacus and psoas major.

Secondly, what is a tendinopathy?

A tendinopathy can be thought of as a structural change in a tendon in response to excessive and repeated loading. It is actually your body responding to this excessive load to try and adapt adequately to the demands you are placing on it – essentially new fibres are laid down to try and spread the load on the tendon. Initially this will most likely produce no symptoms, but if it continues to be excessively loaded over time, pain can start to develop.

So why does it happen?

As already mentioned, a tendinopathy tends to develop as a result of excessive and repeated loading of the tendon. Often this is due to some form of exercise, such as Achilles tendinopathy in distance runners. The extremely repetitive nature of distance running means that, if there are issues with technique, strength or just not enough rest between training sessions, this structural change can start to happen in the Achilles tendon.

A tendinopathy can also develop in the hip flexors for similar reasons, such as from lots of long distance cycling or running. However, this may be predisposed by tightness in the hip flexors which can result from sustaining positions where the hip flexors are in a shortened position. A good example of this is someone who works at a desk, as many of us do, and then goes and does a lot of running. The hip extension that your hip goes into when you are running can put quite a stretch on the hip flexors so the tendon ends up having to work very hard and this, over time, can lead to a tendinopathy.

So what can be done about it?

A good way of thinking about how to treat a tendinopathy is the aim of getting the thickened, altered structure of the tendon back to its original uniform shape and alignment, and the best way to do this is strengthening through a good range of movement.

Start with the straight leg raise exercise below – try repeating nice and slowly for 1 minute (or about 10 repetitions), building up to 2 minutes as you’re able to. 3-4 times per week should be fine:

This may be enough to get rid of the symptoms, but even if it does it may be wise to progress to some walking lunges and also this cable-resisted hip flexion.

The good news is you should be able to continue your normal activity alongside these exercises, as long as the symptoms aren’t flaring up too much the following day.

We will shortly be adding information on 2 other common hip injuries so keep your eyes peeled. However, if you would like any further information at this time just give us a call on 020 8247 3624 or email contact@physiotherapycentral.co.uk

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