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  • Lionel Pannunzio PT / SCS


Introduction


Playing soccer puts a high demand on Groin muscles in general and the hip flexors in particular. The most common cause of anterior hip pain is IlioPsoas-Related Pain


The two main Hip Flexors are:

  • Ilio-Psoas

  • Rectus Femoris



Anatomy of the Injury





The Ilio-Psoas Muscle is located deep in the anterior hip joint area and creates powerful hip flexion contractions necessary for kicking (shoelace type of kick or long balls), sprinting and change of directions .

The injury of the hip flexors occurs due to excessive load or strain on these muscles creating a muscle injury than can go from a small microtrauma of the fibers to a complete rupture of the IlioPoas.

The most common mechanisms of injury are Kicking, sprinting and change of directions.

In my years working with soccer players, these are very common activities or situations, that increase the risk for a hip flexor injury:

  • Shooting practices where the player takes multiple kicks .

  • Goalie practices where the goalkeeper rehearse goal kicks or punts over an over .

  • Repetitive sprint training .

  • Overuse from back to back games without proper resting is another cause that predispones soccer players to this injury. (See our hip mobility drills to restore proper length of the hip musculature in previous posts)




How severe is my Hip Flexor Injury and how long will it take to heal ?





Playing soccer puts a high demand on your hip flexors and they can easily get injured.

The main muscle affected is usually the Psoas and The most common injury is a Hip Flexor Strain or Muscle Tear which can occur from one of these mechanisms: Sprinting, change of direction or, Kicking.

The severity of the muscle tear could go from a minor strain to a complete tear or avulsion of the muscle. Of course, the larger the tear the longer it will take to heal. Soccer Players recovering from a Hip Flexor injury must be sure they restore hip mobility (especially full hip extension) and adequate strength in Ilio-psoas and Rectus Femoris Muscles before returning to play. Without proper rehabilitation, the strength of these muscles usually doesn’t come back to normal levels and the Player is at risk of a new injury or he/she will be able to return to Play but at a much lower performance level. Persistent weakness in the Hip Flexor Can also set the stage of developing Chronic Groin Pain and Pain Can spread to other tissues like the inner thigh or lower abdominal wall.



Rehabilitation for Hip Flexor Injuries: Physical Therapy is the best option

Research shows that a comprehensive Physical Therapy and Rehabilitation program is the gold standard for this type of injury


As part of the rehabilitation process players need to start adding tension to the affected area to mobilize the scar tissue forming in the muscle after the injury.

Mobility Work for Hip Flexor

This drill is very important for two reasons:


1- the stretch is easy to control allowing the patient to apply the right amount of tension to the muscle and


2- second promotes hip extension with an active core. Remember hip Extension is a “must have “ movement in soccer.




Strengthening for Hip Flexor Injuries


Do the Exercises shown in this Video to start helping the recovery process . Stop Kicking or Sprinting until you strengthen your hip flexors .



1- 90/90 Abdominal Bracing and Hip Flexor Isometric contractions

The goal of this exercise is to create a contraction of the Abdominals and Hip Flexors synchronically which will make you more tolerable to Hip Flexor activation to promote healing with less pain.

Setup

  • Begin lying on your back with your knees bent and feet resting flat on the floor or on the Swiss Ball.

  • Tighten your abdominals and lift one leg up to a 90 degree angle, then lift your other leg to the same position and hold, keeping your abdominals tight. Then lower each foot in the same order to the Ball or the floor if you don’t have a Ball.

2- Psoas March

This one requires a lot of core stabilization in sync with the Hip Flexion activation


Setup

  • Begin by lying on your back with your hips and knees bent, and feet resting flat on the floor. Put a light Rubber Band around your feet.

Movement

  • Do a posterior pelvic tilt and the Tighten your core muscles so your lumbar spine is flat on the floor

  • Lift your legs off the ground, then slowly straighten the non-injured leg, and hold the injured hip still at 90 degrees of flexion.

  • At the beginning do one repetition at the time. A good progression can be 1 rep x 6-8 sets. Then move to 5 reps x 4 sets , then 8 reps x 3 sets and finally 10 reps x 3 sets.








Hip Flexor Rehabilitation- Kicking

Before returning to play, all the functional skills are tested: sprinting , jumping , landing , change of directions , short and long kicks to be sure that the hip flexor is forced into the demands of the sport.

in Soccer, one of the main functions of the hip flexor is kicking. To rehabilitate the hip flexor we need to strengthen and force the hip flexor specifically in kicking. This video shows to of the techniques we use.





Conclusion:


  • Hip Flexor Injuries are extremely common in soccer players and hard to recover from because of the high forces that Soccer Places on these tissues in the front of the hip.

  • As in any muscle injury, resting alone will not help and will put you at risk of new injury.

  • The rehabilitation process must include mobility workouts at the beginning to restore the hip movement , then strengthening exercises to restore the strength of the hip flexors and finally sport simulation with emphasis on kicking and sprinting to restore all the functions of these muscles .

  • Research shows that a comprehensive Physical Therapy and Rehabilitation program is the gold standard for this type of injury.

  • Learn more about Groin Pain in this other blog post




Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

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Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy


  • Lionel Pannunzio PT / SCS

Introduction


Playing soccer puts a high demand on Groin muscle in general and hip flexors in particular.

If you been around soccer for a while I'm pretty sure that You may heard about " I pull my hip flexor " or " hip flexor injuries".

In today's post I will discuss with you, the different type of injuries Soccer Players may have surrounding the front of the hip and more specifically problems associated with the Hip Flexors.



What are the Hip Flexors ?





The Hip flexors are a group of muscles located in the front of the hip joint.

There are two main muscles in this group : The IlioPsoas and the Rectus Femoris. These muscles, when working together, create powerful hip flexion contractions necessary for kicking (shoelaces kick , long balls), sprinting and change of directions .



Hip Flexor Injuries



Location of Hip Flexor injury ( light blue area)



The most common cause of anterior hip pain is IlioPsoas-Related Pain.

The IlioPsoas is a two-part muscle ( Illio and Psoas ) located deep in the anterior hip joint area

The injury of the hip flexors occurs due to excessive strain on these muscles creating a muscle injury than can go from a small microtrauma of the fibers to a complete rupture of the IlioPoas.


What can cause a Hip Flexor Injury?


The most common mechanism of injury are Kicking, sprinting and change of directions.

In my years working with soccer players, these are very common activities or situations that increase the risk for a hip flexor injury:

  • Shooting practices where the player takes multiple kicks or goalie practices where the goalkeeper rehearse goal kicks or punts over an over are very common scenarios for Hip flexor Strains.

  • Overuse or overload from back to back games without proper resting or hip mobility drills to restore proper length of the hip musculature is another cause that predisposes soccer players to this injury. (see my post on hip mobility on how to restore hip mobility after games or practices)



Severity of the Injury and Time for Healing




Hip Flexor Exercises


Restoring the strength of the hip flexor and mobility of the hip is a challenge and you should not return to play without proper treatment because this problem has a high rate of re-injury. Follow the exercises below to start working of these two pillars of a good recovery: movement and strength.

Hip flexor Mobility in Half-Kneeling







Knee to Chest Mobility Work



Setup

Begin lying on your back with your legs straight.

Movement

Using your hands, slowly pull one knee toward your chest until you feel a gentle stretch in your lower back.

Tip

Make sure to keep your back relaxed and flat on the ground during the stretch.




Hip flexor Isometric



Setup

Begin lying on your back with your knees bent and feet resting on the floor.

Movement

Bend one leg up to a 90 degree angle and place your hand on your knee. Try to bend your leg toward your chest, but resist the movement with your hand.

Tip

Make sure to keep your trunk stiff and do not arch your low back during the exercise.




Hip Flexor Strengthening at 90/90 with Abdominal Bracing



Rationale:

Create a contraction of the Abdominals and Hip Flexors synchronically which will make you more tolerable to Hip Flexor activation to promote healing with less pain.

Setup

Begin lying on your back with your knees bent and feet resting flat on the floor or on the Swiss Ball.

Tighten your abdominals and lift one leg up to a 90 degree angle, then lift your other leg to the same position and hold, keeping your abdominals tight. Then lower each foot in the same order to the Ball or the floor if you don’t have a Ball.





Hip Flexor Strengthening with band



Setup

Begin by lying on your back with your hips and knees bent, and feet resting flat on the floor. Your arms should be flat at your sides, palms facing the ground.

Movement

Lift your legs off the ground to 90 degrees , then slowly straighten the opposite leg holding the involved leg at 90 degrees in an isometric contraction resisting the pull from the band.

Tip

Choose a light band first and Do not allow your back to arch during the exercise.



Conclusion


  • Hip Flexor Injuries are very common in soccer players

  • Follow the progression of exercises listed above in the order presented: first mobility, then isometric contractions , then band workout

  • Soccer players need strong but at the same time mobile Hips.

  • You will feel stronger and quicker once you do these Drills



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