A muscle strain is an injury caused by tearing of the muscle fibres.
Hip strains are injuries to the muscles that surround your hip joint.
Your hip joint is made up of a ball and socket joint. The ball is called the femoral head and the socket is called the acetabulum. The acetabulum is part of your pelvis whilst the femoral head is part of your thigh bones.
Muscle strains frequently occur in the hip area when a stretched muscle is forced to contract suddenly. In athletes, the most common injuries of the hip and groin region are muscle strain injuries.
Muscles around the hip joint are especially prone to strains because of eccentric contraction, which causes tremendous forces in the muscle. Strains around the hip include groin pulls, hip flexor strains and hamstring strains.
The risk of muscle strain increases if you:
- have previously injured your hip muscles
- do not warm up properly before exercising
- attempt to do too much too quickly
Strains may be mild, moderate, or severe, depending on the extent of the injury.
Symptoms
The severity of symptoms associated with hip strains depends on the severity of the strain. Muscle strains are categorised into ‘grades 1-3’ which gives an indication of the degree of muscle injury. The grading system is as follows:
Grade 1 strains involve minor tearing of muscle fibres with only minimal or no loss in strength. Pain is usually mild to moderate with no defect in the muscle tissue when examined by a doctor.
Grade 2 strains involve more severe disruption to the muscle fibres with significant pain and loss of strength. A defect in the muscle tissue may sometimes be felt by your doctor.
Grade 3 strains are a result of complete tearing of the muscle with associated severe pain and complete loss of strength. A defect in the muscle tissue can frequently be felt by your doctor on examination.
Recovery is longer with a high-grade injury, and the long-term outcome is potentially worse.
The following are general symptoms of hip strains:
- Pain. Depending on which muscle is affected, the pain will be felt in different areas. For hamstring strains, the pain is usually felt in the back of the thigh or buttock area. For adductor strains, the pain will be felt in the groin and for hip flexor strain, the pain will be felt in the front of the hip or groin. Usually moving the hip will aggravate the pain, as will pressing on the affected muscle.
- Weakness. The strained muscle may feel weak. This can lead to a sensation of losing power in the legs and may lead to a limp developing.
- Swelling. There may be swelling over the site of the hip strain. Bruising may also be present.
Causes
A muscle strain occurs most commonly when a muscle is stretched whilst it is contracting. This type of contraction is termed ‘eccentric contraction’. If you think about placing a heavy object on the table, your biceps are contracting whilst lengthening. This allows controlled movement as you place the object. The same type of muscle contraction occurs in the hip whilst you are running, kicking or jumping. During these actions, the muscle can stretch too far whilst it is contracting and lead to a muscle strain.
Hip strains usually occur in sporting activities that require the hip to move through a big arc such as kicking or where the legs are lifting a heavy load such as in a rugby scrum. If a muscle is tight due to overuse or not warming up properly, then this can lead to straining the muscle during sports or activities that would normally not lead to an injury.
Another cause of hip strain is repetitive trauma. Distance runners are susceptible to hip strains due to the stress exerted on the hip muscles. The frequency and duration of their running means that the hip muscles can become progressively tight and eventually this can lead to a muscle strain.
Risk Factors
The following are risk factors for hip strains:
- Not warming up correctly: If you do not warm up the hip muscles prior to playing sports which involve large hip movements, there is an increased risk of suffering a hip strain. Prior to exercise, a sport specific warm up should be performed including gentle stretching, sub-maximal cardio workout and range of motion exercises.
- Previous injury: A hip strain that has either not fully healed or left residual scar tissue may predispose to a further hip strain in the future
- Sports activities which hold a risk of hip strains include football (Australian rules), soccer, rugby, basketball, and long distance running or sprinting.
Investigations
Hips strains are initially diagnosed through a thorough history and examination. It is important to tell the doctor when the pain was first felt and the exact movement that was being performed at that time. Once a history of the injury has been taken, the doctor will examine the hip. They may palpate (apply pressure) different areas of the hip looking for pain in order to see which muscle might be affected. They may also ask you to perform various movements to determine which muscle is affected.
Usually strains can be diagnosed in a clinical setting without the need for further investigations. Sometimes if it is unclear as to whether the problem is a hip strain or a stress fracture, an X-ray may be considered. Occasionally in order to determine the extent of the strain, an ultrasound or MRI may be performed which may help in defining the muscle strain. This is rarely necessary however.
Complications
If a hip strain is not properly treated, or a return to sport is made before the injury has had enough time to recover, the hip strain can become chronic. This means that there is ongoing pain in the hip area requiring prolonged rehabilitation.
Hip strains may leave the affected muscle slightly weaker or slightly tighter than prior to the injury. This can predispose to straining the same hip again in the future. It is important to complete the full course of treatment and rehabilitation laid out by your doctor or physiotherapist in order to minimise this risk.
Symptomatic fibrosis (or scarring) occurs less frequently. In some athletes, how-ever, a severe muscle strain injury will result in a painful area of scarring or fibrosis. Treatment for this complication should involve physical therapy with stretching and perhaps the use of modalities such as ultrasound and deep-tissue massage. Very occasionally, surgical intervention is required to remove the area of scar tissue.
Treatment
Hip strains generally recover well. The goals of treatment are to minimise the pain, allow the muscle to heal and then restore normal range of motion and strength. This treatment follows a stepwise process:
Initial treatment – rest and recovery
Initially the hip strain should be managed using the RICE principle: rest, ice, compression and elevation. Your doctor may also prescribe some anti-inflammatory medication or pain relief medication. The use of crutches when walking may be necessary to protect the hip muscles from further damage and to hasten the healing process. If the hip strain is minor, this may be all the treatment that is required. For more serious strains, a physiotherapist may be required for rehabilitation of the area.
Rehabilitation – passive and active range of motion exercises
A graduated flexibility and strengthening program guided by a physiotherapist may be necessary for more severe hip strains. Careful assessment by the physiotherapist to determine which factors have contributed to the development of the condition, with subsequent correction of these factors is also important to ensure an optimal outcome. The rehabilitation will involve moving the hip, first passively and then actively. This means initially, the hip is moved either by someone else or using your arms to assist the movement such that the injured muscle does not work during these movements. Following this hip movements are performed using the muscles that have been injured.
Final stages – strength training
Initially exercises will be given that isolate and strengthen the injured muscle. Once the muscle regains its strength, a graduated return to running or sport specific activities is the final stage of rehabilitation to fully recondition the hip muscles. This should include the implementation of progressive acceleration and deceleration running drills before returning to sport.
Once there is full range of motion of the hip, full strength equal or greater than the uninjured leg, and you are able perform all of the fundamental skills of the required sport pain free, you are ready to return to sport.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Prevention of hip strains requires a focus on good flexibility and strength of the muscles of the hip. By following a few simple rules, the likelihood of hip strains can be reduced:
- Stretching should always be performed before and after sport.
- A warm up should be performed prior to sport which should involve some simple sport specific drills and range of motion exercises (eg. leg swings, jogging, jumping, direction changes whilst jogging, if playing soccer/football)
- Make sure the muscles of the hip are well conditioned through strengthening programs