Hip and groin pain - Sports Injury

Tight psoas muscle? Here’s 3 simple and effective psoas…

by Pete Colagiuri - Sports Physiotherapist

The psoas muscle is one of the lynchpins to pelvic biomechanics, so a tight psoas muscle can be disastrous.

The Psoas muscle connects across the hip and pelvis up to the lumbar spine.

Why does a tight psoas muscle cause so much trouble?

Psoas is a key player in control and movement of the hip and lower back when it’s functioning well, or it can restrict movement and overload the spine when it’s not behaving normally.

As a tight psoas muscle shortens, it adds a sustained pull on the lower back and restricts hip extension (movement of the leg behind you).

Unfortunately the lower back tends to lose out here – the leverage of the leg just adds more pressure to the lower back and your tight psoas can quickly lead to lower back pain.

Why does a psoas muscle shorten?

A tight psoas muscle can shorten for a number of reasons. It will slowly shorten due to spending most of its time in a short position like sitting, or it can rapidly (but temporarily) shorten after strenuous exercise like fast running.

Given that our lifestyles now involve so much desk time, the first issue seems to be the culprit for most people.

In sitting, the psoas is in an extremely short position. It still gets used every time you sit forward to reach for your mouse (or coffee).

As the body is wonderfully adaptive, it alters its length to be best suited to the main role its performing.

So gradually over a number of months, the psoas will lose its length and flexibility.

How can you fix a tight psoas muscle?

The key to stretching a tight psoas muscle lies in the same adaptive process.

Just stretching for a few minutes each day isn’t enough stimulation to cause the body to adapt – it can’t offset 8+ hours of sitting.

Combining psoas stretches with muscle activation is more successful – using the muscle against resistance in a lengthened position will generate a faster and larger adaptation in length.

Adding a repetitive exercise involving lengthened positions, such as yoga or fast walking, and you have yourself the perfect remedy to a tight psoas.

What’s the best stretch for psoas?

The most effective, and simplest, stretch for a tight psoas muscle is a walking lunge. No weights or equipment required, it can be done safely by almost anyone.

Place your hands on your hips to improve balance and body awareness.

Take a long stride forward and lower your back knee towards the ground.

It’s important that you don’t lean back as you lunge.

As the psoas connects to the lower back, a forward lean as you stretch is your body’s way of letting you know that your muscle ran out of length.

Forcing your back upright will only add more pressure to it and cause back pain.

Another simple stretch is a reverse lunge.

From a standing position, take a long step backwards as you lower your hips towards the ground.

Aim to get your back leg as far back as comfortable without making your trunk tilt forwards.

Ideally the knee of your back leg should be behind your hips to maximise the stretch.

How long should you stretch for?

You’ll typically need around 2-5 minutes of stretching each day to notice an improvement in flexibility.

If you’re a stiffer body type, it may take longer to loosen up so give yourself at least 5 minutes and ease into it.

We generally advise that you continue your routine as long as you’re feeling that there’s an improvement with each repetition.

For each stretch, alternate legs on each repetition to get the best effect – otherwise your first leg will stiffen up again while you’re stretching the second leg.

What else can help a tight psoas?

Combine a daily stretching routine with a regular walk or run, ideally immediately after your stretches, and you’ll feel an improvement in muscle length with a week or two.

Just remember though, the muscle adaptation that caused the tight psoas muscle was a gradual process.

The return to normal length is just as gradual (even a bit slower according to the research).

Be patient and consistent for the best results.

2 reasons to avoid hip flexor stretches

by Pete Colagiuri - Sports Physiotherapist

Hip flexor stretches are commonly used yet poorly understood by many trainers and athletes.

The hip flexor group involves a number of muscles, some of which originate from the lumbar spine (aka. lower back). Their main function is to bend the hip forward so they’re quite active during running and abdominal exercises like planks.

Who should do hip flexor stretches?

As fatigued muscles often shorten for a few days after exercises, stretches generally can help relieve post-exercise tightness and associated soreness.

Hip flexor stretches are great for anyone who has performed exercise that has vigorously loaded the area – fast or downhill running, abdominal exercises and kicking sports (field sports and martial arts) are all examples of sessions that should benefit from post-workout hip flexor stretches.

Why might hip flexor stretches cause problems?

Contrary to popular belief though, the use of hip flexor stretches needs more caution in those prone to lower back pain or in stiffer body types.

This is due to the involvement of the spine as a muscle attachment point and the potential for other factors limiting the stretch.

During the stretching movement, the muscles pull firmly on the lumbar spine. If the spine can effectively brace itself, the stretch works as intended. If the spine is fatigued and isn’t braced well, the joints in the back are compressed and can cause lower back pain.

In stiffer body types, hip flexor tightness is often caused by hip joint compression rather than muscle fatigue. In a long lunge hip flexor stretch, the hip joint then limits the movement and prevents the muscles from stretching effectively.

The stretch then inadvertently overloads the hip joint and lower back, which needs to arch backwards to accommodate the hip stiffness. In this situation, you’ll often hear the comment that the stretch isn’t felt in front of the hip regardless of how hard the stretch is pushed.

Who should avoid hip flexor stretches?

If hip flexor stretches are not felt in front of the hip and/or upper thigh, or if you feel it in your lower back, these stretches should be avoided.

If the stretch can’t be felt without really forcing the position, avoid it.

Otherwise if the stretch position is comfortable and only felt in the muscles in front of the hip and upper thigh, it’s worthwhile adding it to your regular mobility routine.

10 ways to keep running through an injury

by Pete Colagiuri - Sports Physiotherapist

For any runner, running through an injury is a dilemma that you’ll face sooner or later.

This is because a running program is designed to stress your body to get it to respond and improve.

So during that stress and recovery cycle, it’s possible that the stress may lead to inflammation and injury.

Once you experience the early signs of a niggle, it’s important that you don’t stop training completely.

That often amplifies the causes of the injury and makes things worse in the long run. You can read more about that here.

So you’re then faced with the choice: either back off your training or continue running through an injury.

Running through an injury

Depending on the injury and the injured area, there’s often away you can modify your training and continue running through an injury without losing training volume.

Here’s a list of common running injuries and ways that you can modify your training.

Click on the injury to get more detailed information about it.

Running injuries and modifications to training

Achilles tendinopathy

Achilles tendinopathy is a painful reaction inside the Achilles tendon.

This injury actually prefer more regular running rather than having extended breaks.

It’s just one example of when running through an injury is your best approach.

Modification

Switch to running 5 to 7 days a week and reduce your distance per session to maintain your weekly running distance (eg. 3 x 12km = 36km/week, which becomes 6 x 6km to maintain 36km/week.)

ITB syndrome

ITB syndrome is caused by a poorly controlled inwards rotation of the leg, usually due to muscle fatigue.

If you can improve leg rotation control, the injury typically settles down and resolves.

Modification

Reduce the effect of fatigue by adding a 2 minute walk break after every 6 to 8 minutes of running.

Improve leg biomechanics by running slightly faster than your current pace – read more about how this works here.

You can also instantly improve your leg control with the addition of Low Dye taping or soft orthotics.

Plantarfasciitis

Plantar fasciitis can be the results of ankle or calf tightness, poor stability and/or poor choice of footwear.

It can be difficult to monitor as it often warms up after the first few kilometres of running.

Modification

You can instantly improve plantarfasciitis by supporting it with Low Dye taping.

Move your sessions away from grass and onto hard surfaces (helps improve foot stability.)

Move your sessions to flat ground and away from hills.

Shin splints

Shin splints covers a broad range of injuries and then each got slightly different modifications.

Whether you should continue running through an injury really depends on the underlying diagnosis of your shin splints.

Three most common types of shin splints are tibial bone stress injury, tibial periostitis and chronic exertional compartment syndrome.

Modifications

Tibia bone stress injury: reduce your training session distance so that your symptoms resolve sooner after each run and avoid downhill running.

Tibial periostitis: start each run with a 5 minute brisk walk to allow the pain to ease and avoid hard downhill running.

Chronic exertional compartment syndrome: add in a 2 minute walk break every 6 to 8 minutes to allow the compartment pressure to ease during the run.

Proximal hamstring tendinopathy

Proximal hamstring tendinopathy is often a chronic injury so any improvements are gradual.

You can keep running through an injury but you need to maintain some consistency in your approach to detect results.

Modification

Reduce fast and uphill running for a few weeks.

Add in some gentle running drills at the start of each session to improve tendon bounce.

Calf muscle overload

Calf muscle overload often feels like deep pain and tightness through the calf area.

These symptoms can often get mixed up with the symptoms of tibial bone issues so it’s worth confirming the diagnosis if it’s not improving.

Modification

Move your hill training onto stairs and ensure you place your whole foot on the step (not just your toes).

Use cross training every third day instead of running to give your calf muscles time to recover.

Deep hip rotator overload

Literally a pain in the bum, this injury is often a sign that your training beyond your current capacity.

You can read about the injury in detail here.

Modification

Where possible, some of your training onto technical trails as this provides more variety for the deep hip rotator muscles.

Switch your tempo or continuous running into an interval format with faster running and regular breaks.

Patellar tendinopathy

Patellar tendinopathy is a gradual onset injury and shouldn’t be mixed up with Osgood Schlatters disease or patellofemoral pain syndrome.

Modification

Avoid downhill or stair running – if there is a hill on your regular run, turn around and run down backwards to take all pressure away from the tendon.

For trail running, stay away from technical trail whenever possible.

FAI

Hip impingement can be tricky because it can trigger in slightly different positions for everyone.

Modification

Avoid any significant hills as these are associated with increased hip movement.

Reduce your fast paced running to a level that feels comfortable and doesn’t trigger the injury.

Lower back pain

Running with an injury like lower back pain really depends on avoiding specific cause of your issue.

Commonly this relates to hip movement or muscle overload.

Modification

Reduce the pace and duration of your run to reduce the chance of a cumulative muscle overload.

Avoid hilly runs as they often force hip movement and cause pressure on the back.

What’s causing my deep hip pain?

by Pete Colagiuri - Sports Physiotherapist

If you’re experiencing deep hip pain, you know just how frustrating it can be!

Trying to find a diagnosis feels like finding a needle in a haystack.

So is there any way to figure out what’s causing the pain deep in your hip?

More importantly, is there a quick way to reduce the pain or get rid of it?

Finding a diagnosis for deep hip pain

The difficulty with getting a diagnosis is that one pathology will often generate other issues.

So while your first problem might have related to the hip joint, it very quickly becomes a joint + muscle + tendon issue.

That means any treatment targeting a symptomatic area might not be effective as they’re missing the underlying cause.

Top tips to identify the main cause of your hip pain

So here are the best questions to consider to diagnose your deep hip pain:

1. Is it worse first thing in the morning or after a prolonged period of inactivity?

This indicates an inflammatory component to the underlying issue.

These diagnoses include hip arthritis and hip muscle tendinitis/tendinopathy.

2. Does it flare up during high intensity exercise (eg. running) or hip strength exercises?

Pain during exercise tends to indicate a component of overload.

These diagnoses include muscle fatigue and bone stress injuries.

3. Is there a prolonged effect from taking anti-inflammatory medication?

This means that the pain stays reduced for days/weeks after you’ve stopped taking the meds, not just while you’re on them. This confirms an inflammatory condition rather than just a pain-relieving or masking effect from the meds.

These diagnoses include hip arthritis and hip muscle tendinitis/tendinopathy.

4. Have you lost range of motion in your hip?

You might notice that it’s more difficult to reach your shoelaces or that you can’t bring your knee to your chest on the painful side. A loss of range is usually an indication that the hip joint is involved.

This includes diagnoses such as hip osteoarthritis and femoroacetabular impingement (FAI).

5. Does the pain extends further down into the leg or up into the lower back?

If the pain radiates from the buttock down into your leg or hamstrings, that can indicate nerve involvement, referred pain or hamstrings muscle pathology.

Diagnoses in these categories include sciatica, referred lower back pain, nerve root compromise at the lower back and hamstrings tendinopathy.

6. Do you have pins & needles or numbness into the leg?

Tingling or numbness in the leg, anywhere from the back of the thigh right down to the foot, is almost always an indication of a nerve problem.

These symptoms are usually the results of a compromised or pinched nerve in the lower back.

Treatment for deep hip pain

Once you’ve identified the possible underlying cause from the questions above, you need to carefully plan your management strategy.

If there is a possible involvement of nerve, with tingling, numbness or referred pain down the leg, the best plan is to seek proper assessment with a health professional. This type of injury is difficult to self manage and can become a more significant problem if not addressed.

When the joint is part of the underlying cause of your hip pain, a combination of exercises and medication give the best results.

Over-the-counter medication is limited to short periods of use due to the likelihood of side effects. Seeing your doctor for prescription medication is a better option as it can be used more consistently for longer periods.

The exercise approach needs to focus on building hip strength without irritating the symptoms. Because the “no pain, no gain” approach often causes more trouble than it fixes and worsens inflammatory reactions.

Muscles and tendons respond well to loading – more specifically, to strength exercises.

The trick is striking a careful balance between doing enough to stimulate improvement without doing too much and irritating symptoms.

Start with a simple collection of exercises that seem like they’re challenging but comfortable. It might be a little boring to start with but it’s a necessary building block.

Every two weeks, make the exercises slightly more challenging and monitor your symptoms. If you experience of flare up when you first change exercises, stick with it for another two sessions.

If the pain is getting gradually worse or the soreness after exercise is not improving, drop back to the previous program. Then you can try a different set of exercises after a week or so.

If you experience repeated flare-ups, or if you don’t seem to making progress, speak to a health professional to diagnose your injury and design and appropriate program.

Why does a tight psoas muscle cause so much trouble?

Why does a psoas muscle shorten?

How can you fix a tight psoas muscle?

What’s the best stretch for psoas?

How long should you stretch for?

What else can help a tight psoas?

Who should do hip flexor stretches?

Why might hip flexor stretches cause problems?

Who should avoid hip flexor stretches?

Running through an injury

Running injuries and modifications to training

Finding a diagnosis for deep hip pain

Top tips to identify the main cause of your hip pain

1. Is it worse first thing in the morning or after a prolonged period of inactivity?

2. Does it flare up during high intensity exercise (eg. running) or hip strength exercises?

3. Is there a prolonged effect from taking anti-inflammatory medication?

4. Have you lost range of motion in your hip?

5. Does the pain extends further down into the leg or up into the lower back?

6. Do you have pins & needles or numbness into the leg?

Treatment for deep hip pain

Treatment for nerve-related hip pain

Treatment for joint-related hip pain

Treatment for muscle- or tendon-related hip pain