May 2021 - 37

Injury Prevention & Rehabilitation
and ASIS and inserts on the IT band of the facia
latae. It contracts the facia latae and assists in
flexion of the thigh (5)
. Only one TFL injury was
recorded from the Serner study. Keep in mind
their study involved only 33 college athletes. I
have evaluated only a few TFL injuries in high
school ice hockey and soccer. Of all the hip flexor
muscles, the sartorius and TFL appear to have
the lowest injury rates (2,6)
.
PELVIC ALIGNMENT
One consideration seldom referred to in hip
flexor injuries is the alignment of the pelvis. It is
the opinion of this author that if it is anteriorly
or posteriorly tilted or if the pelvis is rotated
on one side or the other it could possibly be a
precursor to a hip flexor injury because of the
asymmetrical forces on the muscles involved
that attach to the ASIS. Each side of the pelvis
can be rotated in the sagittal or transverse
plane. There is also pelvic obliquity where
the iliac crests are not level and if one leg is
shorter than the other, as measured from the
ASIS to the medial malleolus - in my opinionthis
could also contribute to a hip flexor injury
(3)
. Pelvic misalignments are rarely discovered
before an injury occurs. It is usually not part of a
preparticipation examination.
INITIAL DIAGNOSIS AND TREATMENT
First and foremost, the injury must be
properly diagnosed by the appropriate
healthcare professional. An accurate diagnosis
is critical. Be certain to understand that anterior
hip pain can also be due to other conditions
such as hip impingement and labral tears -
which can be a much more serious injury and
needs to be ruled out first.
Once an injury occurs and a diagnosis is made,
rest is usually the first step and the length of
time is determined by the diagnosing healthcare
professional. Support for the injury can be
given with a hip spica using an ACE wrap or
-better yet- a 3 " or 4 " rodeo strap really works
well. Crutches are an option too if the injury is
debilitating enough and the athlete cannot bear
weight. NSAIDS or other OTC medications could
also be used to reduce inflammation and pain,
but individuals should always check with their
PREVENTION OF HIP FLEXOR INJURIES
The most obvious approach to preventing any
injury is adequate preparation by dynamically
warming up and going through additional static
stretches - if desired. It has been my experience
some athletes wish to do additional static
stretching of the quad and hip flexor. Warming
up can be jogging a lap around a field or skating
a few laps around the ice rink at a low intensity. A
dynamic warm-up consists of specific movements
(see table 1).
Foam rolling the various muscle groups
surrounding the hip can be beneficial before
and after practice/games (1)
. Myself and our
Head Athletic Development coach - KC Bonnin
also believe foam rolling helps to elongate
tissues, increase blood flow to the area, and
acts as a myofascial release.
Specific stretches should include a hip flexor
stretch being sure to keep the lumbar spine
neutral and not extending it. Michael Boyle in his
book New Functional Strength Training for Sports
recommends a box hip flexor stretch with the
front foot elevated 6 " with the body turned to a
45-degree angle to the box to increase hip flexion
and stabilize the spine. The rear foot-elevated
split squat is a strong movement that Boyle states
" improves the dynamic flexibility of the hip flexor
muscles " (1)
. KC Bonnin utilizes Frankenstein with
grass pickers for full hip flexion and extension
which he states stabilizes the opposing hip and
spiderman walks and lunges are also used in his
dynamic warm-up. " We use lateral lunges and
banded crab walks for frontal plane stabilization "
which he believes reduces non-contact injuries of
the lower extremities.
Dr. Aaron Horschig, DPT, and a competitive
weightlifter points out in his book Rebuilding
Milo, some different diagnoses of hip flexor
injuries such as: snapping hip syndrome and
training-conditioning.com | 37
MD before taking any medications.
A side note for using ice on injuries:
Icing minor injuries are no longer the panacea it
was once thought to be. If the athlete feels he or
she must ice the area; 5-10 minutes is sufficient
to reduce pain. Some current research shows
icing an injury can actually delay healing. (4)
discussion is beyond the scope of this article.
That
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May 2021

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