Hip Strains

A hip strain¹‚² happens when a muscle or tendon is stretched or torn. Hip Strains most often involve the lower abdominal and hip flexor muscles. A tear in the muscle or tendon (thick, fibrous tissues that connect muscle to bone) is susceptible to reinjury. Repeated Hip Strains can result in a sports hernia that could require surgery.

The hip is the largest ball-and-socket joint in the body and can move in multiple directions. The acetabulum of the pelvis forms the socket, while the femoral head (upper end of femur/thigh bone) creates the ball. Several muscles—hip flexors and gluteals—anchor on the pelvis, while the abductors, adductors, quadriceps, and hamstrings travel along the thigh to the knee.

Causes

Forced contraction of a stretched muscle is the most common source of Hip Strain injuries.² Hip Strains can be caused by repetitive activities (as in sports) or by an acute injury (fall, overextension, or direct trauma). The risk of a Hip Strain increases when there has been a prior injury to the area and there is muscle tightness (often from failure to warm up properly before activity).

Symptoms

The most common symptom of a Hip Strain is pain in the injured area. Other symptoms include swelling, muscle weakness, bruising, and limited range of motion (ROM).

Diagnosing

The diagnostic process includes a physical examination and a complete medical history, emphasizing the events of the injury. During the exam, your physician will test for tenderness and pain during range of motion and stretching to determine the injured muscle/tendon. Diagnostic imaging is not usually necessary, though X-rays may be used to determine if there is a stress fracture in the hip. An MRI can show the severity of a muscle or tendon tear.

Treatments

Treatment of Hip Strains often involves avoiding the activity that caused the injury and strengthening the musculature around the injury. Further treatment includes preventative measures to keep the injury from happening again. Proper warm-up and use of protective gear can reduce reinjury risk.

Conservative Treatment Options

Most Hip Strains can be treated conservatively, even with severe injuries. Take oral nonsteroidal anti-inflammatory medications (NSAIDs)—such as ibuprofen or naproxen—to reduce inflammation and pain.

The RICE protocol:

Rest: Avoid activities that aggravate the area, including excessive weight-bearing.
Ice: Applying an ice pack immediately after injury helps reduce inflammation. Ice should be applied at most 20 minutes at a time and never directly to the skin.
Compression: Wrapping with a soft bandage or wearing a compression garment can improve swelling and prevent additional swelling.
Elevation: Resting the affected leg above the level of the heart will encourage excess fluid to be reabsorbed by the body, thus reducing swelling.

Heat is most effective at least 72 hours following injury. Usually combined with ice therapy, heat can aid in reducing pain and swelling. Apply heat using a hot bath or heating pad; keep the application no longer than 20 minutes at a time.

Physical Therapy, including home exercises that focus on strength and flexibility of the muscles and tendons involved, can aid in restoring function. Depending on the nature of the injury, a physical therapist may create a personalized exercise program to assist in returning to activity.

Surgical Treatment

When a significant muscle or tendon tear or the tendon is pulled away from the bone (creating an avulsion injury), surgical treatment may be required to repair the tear or reattach the tendon. If you are experiencing significant pain and loss of function following an injury, talk with your orthopedic surgeon about treatment options.

References:

Alaia, MD, FAAOS MJ. Hip Strains. Ortho Info. Published July 2020. https://orthoinfo.aaos.org/en/diseases–conditions/hip-strains/
Tyler TF, Nicholas SJ. Rehabilitation of Extra-Articular Sources of Hip Pain in Athletes. North American Journal of Sports Physical Therapy : NAJSPT. 2007;2(4):207-216. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953304/