Hip flexor strain – a long term problem for hockey players">

SPORTS MEDICINE: Hip flexor strain – a long term problem for hockey players

The hip flexors are a group of muscles that help you flex or move your leg and knee up towards your body. The major muscle is the iliopsoas muscle. A hip flexor strain occurs when one or more of the hip flexor muscles becomes stretched or torn. Because the hip flexors are a muscle group that play an important role in facilitating many hockey skills and movement players are very prone to strains due to overuse or sudden movements such as changing directions while running or when executing an over reaching lunge tackle.

Strains range from grade 1 (micro tears), to grade 3 (all muscle fibres are ruptured resulting in a major loss of function).

Hip flexor strains can range from mild to severe, or in medical terms, from first to third degree. A first degree hip flexor strain means one of the hip flexor muscles has been stretched or slightly torn. Second degree strains refers to a partial tear of the muscle or tendon, and in a third degree sprain, the muscle or tendon is completely severed—a rare event. When a tendon is pulled off the bone at the place where it is attached, it is called an avulsion fracture. Depending on the severity of the injury, recovery time ranges from a few days to months. Hockey players tend to experience a Grade 2 tear most often

Factors that can lead to hip flexor strain include:

  • Weak muscles
  • Not warming up
  • Stiff muscles
  • Trauma or falls

Signs of hip flexor strain

You will feel a hip flexor strain in the front area where your thigh meets your hip. Depending on how bad the strain is, you may notice:

  • Mild pain and pulling in the front of the hip.
  • Cramping and sharp pain. It may be hard to walk without limping.
  • Severe pain, spasms, bruising, and swelling. The top of the thigh muscle may budge. It will be hard to walk. These are signs of a complete tear, which is less common. You may have some bruising down the front of your thigh a few days after injury.

You may need to use crutches for a severe strain.

Symptom relief

Follow these steps for the first few days or weeks after your injury:

  • Rest – stop any activity that causes pain.
  • Ice the area for 20 minutes every 3 to 4 hours for 2-3 days. Do NOT apply ice directly to your skin.
  • Take pain medicine if you need to. For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

Talk with your health care provider before using pain medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. Do not take more than the amount recommended on the bottle or by your health care provider.


Your health practitioner may recommend exercises to help stretch and strengthen your hip flexors ( see Go Hockey News article on hockey fitness). While resting the area, you may want to do exercises that don’t strain your hip flexors, such as swimming.

For a severe strain, the health practitioner will work with you to:

  • Stretch and strengthen your hip flexor muscles and other muscles that surround and support.
  • Guide you in increasing your activity level so you may return to your former activities.

Psios stretch – Thomas stretch

This test is to determine if you have a tight psoas or tight hip flexors. Failing this test puts you at risk for low back pain, hip pain, knee pain, plantar fascitis…even headaches.

How to tape for a hip flexor strain


Nicola T, El Shami A. Rehabilitation of running injuries.Clinics in Sports Medicine
Lacroix VJ. A complete approach to groin pain.Phys Sportsmed
Philippon MJ, Decker MJ, Giphart JE, et al. Rehabilitation exercise progression for the gluteus medius muscle with consideration for iliopsoas tendinitis: an in vivo electromyography study. Am J Sports Med
Shah A, Busconi B. Hip, pelvis, and thigh. In: DeLee JC, Drez D Jr, Miller M, eds.DeLee and Drez’s Orthopaedic Sports Medicine

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