Achy breaky hip flexor
November 30, 2009 5:31 AM   Subscribe

Hey, runners (and anyone else): can you help my achy breaky hip flexor?

I am training for a 15k and run about 13 miles per week slowly (~11:20 mile) and increase mileage by 10% per week. I have been running for about a year and a half. I have really good running sneakers that do not need to be replaced. I do my long runs on a trail that is a mix of packed dirt and asphalt. I do shorter runs on the sidewalk.

Two problems plague me--my right knee and my right hip flexor. My knee problems are on and off--I seem to have learned through research and physical therapy what kinds of things I can do to avoid knee pain (stretching, etc.) and I also am pretty sure it's a psychosomatic type of injury (whole 'nother story). However, my right hip flexor almost always hurts after a run of more than 40 minutes or so. Then, it stays achy for a couple days. Every now and again it "pops" and feels a little better temporarily. Currently I stretch before and after I run, mindful that stretching cold muscles is a no-no. I do some basic butterfly type stuff for my hip flexor. I want to keep running for years because I love it and other than when I first started running, this has not been a problem for me.

My question is: What can I do pre, during or post run and on rest and cross-training days to help this? Are their exercises I should do? Specific stretches? Something to wear? Ideas for running form/gait? Tonics or elixirs to apply topically or consume? Seriously: whatever your thoughts are, I am open to it. I am a big believer in the mind-body connection, nutrition, good energy, strong vibes, and other crunchy stuff like that. Also, I am open to suggestions on what not to do and what to avoid.

I realize that opinions on exercise habits such as stretching are fairly controversial and that some studies show, for example, you should not stretch too much and others that you can never stretch enough. I realize that some people think that running barefoot is the only way to avoid injury and others swear by their trusty Nikes to keep them strong and healthy. I know that there are no definitive answers, just ideas of what might work for me because it's worked for you or your friend in the past. I know, MMMV.

Thank you in advance.

Related bonus: I want to do something with no/limited impact for crosstraining and because I have no access to a pool, riding the bike at the gym seemed great. However, it seems like that would only inflame my hip flexor problem (unless I use a recumbent, maybe). Does this sound right? If so, any other crosstraining exercises that will keep me aerobically active but not in pain?

Notes: Unfortunately, physical therapy isn't an option. I am an Alexander Technique student when I can afford it. I've tried yoga but not recently.
posted by Rudy Gerner to Health & Fitness (16 answers total) 12 users marked this as a favorite

Stretch Piriformis & Abductors

Internal Rotation of the leg stretches.

Seated Leg Cross-Overs

ITB type - side stretch.

Stretching The Hip Flexors:

The "quad stretch" with your leg held backwards like a bow offers some stretch to the anterior hip flexors.

Stretching The Adductors:

Roll legs out with sole of the feet touching.

Stretching The Hamstrings:

Lie on your back. Bring one leg up to your chest. Hold for 30 seconds.

Lower that leg and bring the other leg up to your chest. Hold for 30 seconds.

Bring both legs up to your chest. Hold 30 seconds.

Repeat sequence 3 times.

Strengthen Hip Abductors and Core Muscles

Strengthening and Stretching

Exercise 1)

While standing lift the affected leg. Try to rotate the leg in so that your toes point towards the other leg. Hold ten seconds, repeat 10 times. This is easy to do, and should not aggravate symptoms.

Exercise 2)

After much progress has been made and the patient is relatively asymptomatic, this may be carefully tried. Stand on a 6" platform or step near a rail. The injured leg should be the high side, the uninjured dangles. Bend the upper supported knee slightly, only 10 - 20 degrees and move your body forward. The hip of the upper leg should be higher than that of the lower leg. Move your body forward several inches and then try to move it backwards without touching the lower legs foot to the floor. It seems well suited to strengthen and stretch many of the external rotators and abductors.

In running, avoid hills and canted surfaces. Shorten your stride and curtail your speed work. Also, try a brief rest of a few weeks, while continuing your stretching and strengthening exercises.
posted by netbros at 5:59 AM on November 30, 2009 [1 favorite]

I'm just going say that I've been going through a similar thing ad have found that squats has helped my knee and more importantly, I realized that (perhaps due to a toe surgery as a teen) I was favouring one leg. If one knee is good and the other not good, then really examine what you're doing that might be causing an unsymmetrical gait. For me, I wasn't swinging my hips the same amount on each side and it came from there. I don't buy into the "psychosomatic" injury theories I've read on other threads.
posted by bonobothegreat at 6:03 AM on November 30, 2009

Not a runner but recently former dancer and movement teacher. A lot, not all, of knee and hip stuff has to do with tightness in the lower back ie. pelvis area. Not sure what other stretches you do for your hip but you may want to try some psoas muscle stretches. Crudely, it is the muscle that connects your hip joint to your lower pelvis and spine. You can find some ideas of stretches to do on the web. I also have tight psoas muscles which my knee compensates for if I'm not careful. The thing with stretching that I've learned is that you can't just stretch one part of the body. It works best if if stretch the whole body. For me, for example, I do a lower, middle and upper back stretch which leads to psoas stretch which leads to thigh stretch which leads to calf stretch hitting all the large muscle groups that can and will be affected. It helps me have a longer and fuller stride when I start moving. I stretch again after moving being careful not to over do it since my body is warm and over-stretch beyond my boundaries. In terms of mind/body connection, when stretching I breathe on a counted breath (inhale 1,2,3 exhale 1,2,3) and while moving, I imagine my whole pelvis and the initiator of all movement and think of it as being relaxed and full. Not sure if that works for running and probably tmi but that's what works for me. Hope that's somewhat helpful and good luck!
posted by Hydrofiend at 6:06 AM on November 30, 2009 [2 favorites]

Is it possible for you to hire your Alexander teacher to evaluate your running form, one on one? Or ask an experienced runner to do so? My bet is that it's a technique thing that is proving not to be useful over the longer distances.

I don't mean to imply that other ideas aren't worth a try. Good luck.
posted by rainbaby at 6:31 AM on November 30, 2009

Best answer: Try rolling your legs daily on one of these foam rollers. Runner's World has some suggestions on how to do it. It's like a deep tissue massage, it hurts like hell but it's really effective for loosening those tight spots on your ITB and hip flexor.

Strengthening your core can really help (probably related to what Hydrofiend mentions above). Add some sit-ups, etc, to your routine, maybe try a pilates or yoga class if you have access at your gym or something. Elliptical machines provide a similar motion to running but with less impact, so you might try that as part of your cross-training.

I've had similar issues and found the best results from a really, really good massage therapist who works with lots of runners, but that's pricey and not always available. Maybe something to look into when it is a possibility? Or ask for a few massages (get recommendations first) for a birthday/holiday present?
posted by min at 6:35 AM on November 30, 2009

I was always able to keep my hips happy for the most part by with:

starting the run (especially long run) very slowly
slow walking lunges after every run
stretching well after
posted by Pax at 6:59 AM on November 30, 2009

It would help if we knew your age.
posted by Rad_Boy at 8:31 AM on November 30, 2009

I'm in the no stretching camp.

I used to occasionally get hip flexor pain after long runs. When I started to consistently do bridges as one of my core exercises the pain went away.
posted by OmieWise at 9:38 AM on November 30, 2009

It would help if we knew your age.

posted by OmieWise at 9:38 AM on November 30, 2009

Response by poster: I am 30, 5 feet tall, 108 lbs. Aries. Brown/brown.
posted by Rudy Gerner at 9:39 AM on November 30, 2009

I'm a runner with knee issues, including IT band and hip flexor misbehavior and I second the foam roller. My PT has me roll my body weight on my side over a foam roller from the hip most of the way down to the knee. He also has me do the same thing on my glutes. I suspect strengthening glutes and quads will help with your hip stability and tracking.

Squats, lunges, bridges (with many variations, one leg, or just the top of the range), stepping up and sloooowly stepping down, yoga, and pilates are a huge part of my non-running days.

This is the single best thing I've learned. I call it the Magic Stretch: lie face-up on a bench, grab the knee of the leg that is not bothering you and pull it toward your chest. With your other, misbehaving leg hanging off the bench, grab the front of your foot the way you would with a quad stretch and pull that foot down and toward your butt. Do this before you run and whenever the hip flexor is acting up. You look a little ridiculous, but nothing stretches everything between your hip and your knee like it.

You might also consider avoiding runing on asphalt and sidewalks.
posted by *s at 10:18 AM on November 30, 2009

I just found out that all of my hip problems (which graduated to preventing my pelvis from healing properly after pregnancy/birth) are all due to insanely over-tight and weak lower back muscles. A few weeks of physio and the change is immense. So I second the lower back/bridge recommendations.
posted by geek anachronism at 3:54 PM on November 30, 2009

I think yoga could meet all the needs you mention in your question. Hydrofiend's information about what's really going on in your body is really helpful, and yoga has done wonders to help with my hip/quad/pelvic/psoas/lower back issues. It loosens up the muscles and also builds strength where you need it: in the low back and core. Strength in your core and back will help stablize you when you're running, which will translate to less strain on your hip flexors and knees. Yoga will also help you develop your awareness of your body, so you can run more intelligently and listen to what your body has to tell you.

Try a yoga class if you can -- preferably try more than one since they can be very different. Lunges and warrior poses will do a lot to loosen up your hip flexors, and if you can get those stretched out, you should feel some relief in your knees as the (now-very-short) muscles in your thigh stop trying to pull your knee up toward your hip. You didn't mention your IT band, on the outside of your thigh, but since you're a runner I would urge you to try pigeon pose, too. I have recently discovered that some poses where you fold forward -- like child's pose -- offer a different but still wonderful hip flexor release. Add some quad stretches and the foam roller min mentioned, and you should really notice a difference.

Also, if you do a vigorous yoga practice (try Vinyasa or Ashtanga or "Flow"), you can get some cardiovascular and strength training benefits with practically no impact. I find that running and yoga are a great combination for well-rounded fitness. (I've also recently added cycling, and FWIW I find that wearing the shoes that clip to the pedals and using the entire pedal stroke prevent strain on my hip flexors.)
posted by TrixieRamble at 4:24 PM on November 30, 2009

Could be an indication (could, not has to be) that your stride length is too long / your foot spends too long on the ground per stride. You could give "pose" running a try, if you aren't already.

I've heard good things about PNF vs. normal stretching, but I haven't tried it myself.
posted by ctmf at 5:31 PM on November 30, 2009

Best answer: I have similar symptoms: knee pain and a tight hip flexor both on the same side.

Of all the things I tried, none got the hip flexor to relax as well as the Egoscue Supine Groin Stretch:

I remember walking for the first time afterwards... and it was like "oh my god, this is how I'm supposed to move."
posted by dualityofmind at 6:16 PM on November 30, 2009 [3 favorites]

Response by poster: Just wanted to provide a quick update. dualityofmind's stretches have been great and my 5-mile slow run Wednesday went really well--no pain during or after. Wow, the Egoscue Supine Groin Stretch is amazing for how inert you feel while doing it. It really not only stretched me but relaxed me, which is something that other stretches sometimes lack--they often can just make me feel more inflamed, you know?

min, I have a foam roller but I hadn't realized that (duh) of course I can use it for hip flexor related exercises. I will be adding those next week (trying one thing at a time) as soon as I find them.

Thanks for folks who pointed out core and lower back issues. I am sure it is all related. (OmieWise, I hate doing bridge which means it's hard for me which means I lack core strength which means I should do bridges way more. Thank you for reminding me of that, I do need to get back to my roots re: focusing on core.)

ctmf, as for pose running, it looks really interesting but I think I might take that on when I am not mid-training for a run but rather over the summer when I have time to rethink my running and really work on form.

Thanks all!
posted by Rudy Gerner at 4:49 AM on December 4, 2009

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