May 2021 - 39

Injury Prevention & Rehabilitation
cutting, kicking, change of direction, and even
deceleration are the causes for most hip flexor
injuries and this is why most are considered
" non-contact " .
Working at the high school level the past
several years, I see 8-12 hip flexor injuries
every year. There also have been a few avulsion
fractures of the ASIS. As a point of interest
with this type of injury, I know of one 15-yearold
hockey player who had an avulsion fracture
of the lesser trochanter. The injury occurred in
the first shift after accelerating with a change
of direction. I mention this because the athlete's
MD informed me that this is a very rare injury.
REHAB
Many different modalities and treatments can
be used for hip flexor injuries. Some of the more
common ones include heat, ice (see side note),
ice massage, hot or cold whirlpool, ultrasound,
iontophoresis, PNF stretching, therapeutic
exercises, electrical stimulation, massage,
cupping, IASTM and positional release therapy,
and dry needling. The Athletic Trainer or Physical
Therapist will use the modalities they believe are
most effective to reduce swelling and pain and
to gradually increase the athlete's full pain-free
range of motion. Strength training exercises will
begin once those goals are accomplished.
RETURN TO PLAY CRITERIA (RTP)
Once the rehab protocol is completed, then
return to play (RTP) requirements can be
initiated. As stated above, the athlete should
have a full pain-free active range of motion
(AROM) in hip flexion, extension, abduction,
adduction, internal and external rotation. There
should be no point tenderness on the anterior
hip or any of the hip muscles involved with the
injury. The athlete should be able to run, cut,
kick, skate, change direction, accelerate and
decelerate at full speed without pain.
If any pain occurs with gradual progression to
full-speed movements, the athlete should remain
INNOVATIONS FOR TREATING INJURIES &
IMPROVING PERFORMANCE
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