May 2021 - 40

Injury Prevention & Rehabilitation
at that level of exertion or below until the specific
movement becomes pain-free - no matter how
long it takes. This is the critical point where some
athletes may try to push through the pain and
risk reinjury to the tissues. Be conservative with
your progressions! Remember that recurrence of
this type of injury is common.
The challenge with rehabbing competitive
athletes is their desire to return to their sport
as soon as possible. They are usually very
motivated and want to return to the field or ice
sooner than they should. The athletic trainer
or physical therapist should understand this
and take the necessary precautions to return
the athlete too soon and risking reinjury.
Remember, hip flexor injuries can be difficult
to diagnose and rehab, so be conservative and
patient through the entire rehab process.
A final medical release is usually given at the
completion of the rehab program. Full recovery
is necessary for safely returning the athlete to
any sport. I recommend an athletic trainer or
strength & conditioning coach take an athlete
through full speed " sport-specific " drills and
participate in a certain number of practices
before playing in a game to assure proper
conditioning has been regained and the athlete
is not experiencing any pain.
CONCLUSION
Hip flexor injuries occur in sports - the highest
rates are in soccer, ice hockey, and track. They
occur somewhat in gymnastics, cheer, and
dance. The specific muscles involved are the
rectus femoris, iliopsoas, sartorius, and tensor
facia latae (TFL). According to some of the
researchers and practitioners, the rectus femoris
and iliopsoas are injured more than the sartorius
and TFL.
Initial proper diagnosis of the injury is
necessary to determine the proper rehab
protocol. In diagnosing hip flexor injuries, labral
tears and hip impingement should be ruled
out - given the similarities in the presentation
of symptoms. Kicking, sprinting, acceleration,
change of direction, and overuse are common
mechanisms of injury for the hip flexors with
most injuries occurring in competition and
being non-contact injuries.
40 | Training & Conditioning | Video Playbook 2021
As with all injuries, prevention is the key. A
proper dynamic warm-up prepares the tissues
for greater forces. Foam rolling the hip muscles
is beneficial before and after practice and games
and specific stretches further prepare the body
for full speed activity. The specific strength
training exercises build the various hip muscles
to help develop strength and prevent injury.
The final part of the rehab protocol is to follow
the specific return to play (RTP) requirements
for their given sport and obtain a final medical
release from their MD to return to their sport with
no restrictions. Obviously, there is a need for
more research on hip flexor injuries - especially
with high school athletes. Finally, follow these
guidelines and suggestions and there is a good
chance your athletes may not have to experience
the hip flexor blues. n
P.J. Gardner, MS, LAT, ATC, CSCS is the
Athletic Trainer at Liberty High School in
Colorado Springs, Colorado. He has written
sports-related articles for various publications.
He can be reached at: pj.gardner@asd20.org
References
1. Boyle, M., New Functional Training for
Sports second edition, p. 42, 59-66, 100.
Champaign Il., Human Kinetics. 2016.
2. Eckard TG, Padua DA, Dompier TP,
et al. Epidemiology of Hip Flexor and Hip
Adductor Strains in National Collegiate
Athletic Association athletes, 2009/2010
through 2014/2015. Am J Sports
Med.2017;45(12):2713-2722.
3. Hoppenfeld, S., Physical Examination of the
Spine and Extremities., p.146, 165., Prentice
Hall. Upper Saddle River, NJ. 1973.
4. Horschig, A. and Sonthana, K., Rebuilding
Milo. Victory Best Publishing Inc., Las Vegas,
NV. 2021.
5. Prentice W.E., Principles of Athletic
Training 16th Ed. McGraw- Hill Education. New
York, N.Y. 2017.
6. Serner A, Weir A, Tol JL, et al.
Characteristics of acute groin injuries in the hip
flexor muscles-a detailed MRI study in athletes.
Scand J Med Sci Sports. 2018; 28: 677-685.
https://doi. Org/10.1111/sms.12939
https://doi
May 2021

Table of Contents for the Digital Edition of May 2021
