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Keeping Your Hip Flexors Happy!

Imagine this scenario.  You are in your final weeks of preparation for your A race - a 70.3 distance triathlon.  This weekend, your Saturday ride is a preview of the bike course at race intensity followed by a short brick run.  The race is a three hour drive from your house, and so you wake up and immediately hit the road.  You get out of car and jump on your bike.  You start easy for the first 10 minutes and then settle into your race pace.  You finish the ride feeling good, grab your running shoes and set off for a quick 20 minute run.  You are feeling strong, so you decide to kick it hard at the end.  Training is done and so you hop in your car and make the three hour drive home, reflecting positively on how good your fitness is.  That evening, you are feeling a little tightness in your hip flexors, the group of muscles which connect your upper legs to your lower back, hips and groin. You figure you’re just tired from the day and don’t think much of it.  Off to bed for another day.  You wake up a bit more stiff, but figure it will work it’s way out and so you set off on your session for the day - a 10 mile run with race-pace intervals.  No time for a warm-up, you just start running.   At the beginning of the run, you are feeling some pain in your upper legs and groin area, but it seems to ease up as the run goes, so you do the workout as planned and all seems ok.  You head home and decide to rest, sitting on the couch. Then it happens, you go to stand up and feel a sharp pain in your hip and upper leg.  You try to walk and the pain worsens.  You can’t walk without a limp.   Lifting your knee to your chest is difficult.  You can’t hop on that leg.  Now you are in a panic - what just happened????  After a few days of rest, ice and over the counter pain medications, the symptoms seem to be improving, but not fast enough.  You decide to see a doctor, and she tells you that you have a severe strain/tear in your hip flexor muscles and you will need to pull back on all activities which could cause further strain - i.e., no running and maybe no cycling.  All of a sudden, it sets in.  You are not going to do your A race.  Six months of training, and this is how it ends.  Sound familiar?  Anyone relate?

So … is there anything you could have done to change this story line?  Let’s back up and start with some basics.  First, what are hip flexors?  Hip flexors are the group of muscles located in the upper thighs and pelvic region which link the legs to the pelvis.  The primary hip flexor muscles are the iliacus, which starts at the top of the pelvis and runs down the top of the femur, the psoas major, which originates on the lumbar vertebrae and attaches to the femur, and the rectus femoris, which is one of the four muscles that makes up the quadriceps.  The main functions of the hip flexors are to help raise your bent knee toward you torso and to bend at the waist.  We use our hip flexors everyday to walk, to climb stairs and even to stand tall.  

The hip flexors are also critical in each of the sports of triathlon.  In swimming, hip flexors are used to maintain a compact and steady kick.  On the bike, they are important in powering the pedal stroke.  On the run, they are important to driving the knees forward and setting up a powerful push off.  But each of these sports also puts stress on the hip flexors.  The flutter kick, with it’s intense effort within a small range of motion, can lead to tightness in the hip flexors.  On the bike, particularly in the aero position, our hip flexors are repeatedly contracting but never fully extending.  Over time, this position can shorten the hip flexors.  On the run, the repetitive motion leads to fatigue, and any sudden movements such as accelerations or speed changes can stretch and tear hip flexors.  With repeated use, the hip flexor muscles often become tighter and more fatigued. Performance is impacted and, if not addressed, injury may result. 

To minimize the likelihood of a strain in one or more of the hip flexor muscles, it is important for the triathlete to stretch and strengthen these muscles.  In addition, tight hip flexors cause the primary hip extensors, the glute muscles, to become lengthened or weakened.  As such glute activation and strengthening exercises should also be incorporated.

Here are some tips:

*Incorporate exercises which actively stretch your hip flexors and activate your glute muscles into your pre-run dynamic warm-up routine.  These include, for example, leg raises - forward, side and back, standing knee raises and walking lunges.  

*Include static stretches in your run and bike cool downs.  There are many different stretches, but here are three to get you started:  

(1) Standing hip flexor stretch - start by standing tall, bend you right knee and grab your right foot with your right hand. Gently pull your foot toward your butt and hold for a few seconds, making sure that your bent knee does not move forward of your straight leg.  Then, squeeze your glute muscles on your right side and push your right foot into your hand.  Hold for 20-30 seconds and then switch legs. 

(2) Lying figure four stretch - lie on your back with both knees bent, feet and knees hip width apart.  Cross your left ankle over your right thigh (near your knee) and flex your left foot.  Then gently grasp behind your right hamstring and pull your legs toward your chest. Hold for 20-30 seconds and then switch legs.

(3) Kneeling hip flexor stretch - start in a kneeling/lunge position with your right knee down in back (on a padded surface) and your left knee in front.  With your hands resting just above your left knee or arms raised overhead and your body tall and core engaged, gently shift your weight forward until you feel a stretch in your the upper part of your back leg. Hold for 20-30 seconds and then switch legs.

*Incorporate strength exercises to strengthen your hip flexors and glute muscles.  Examples include:

(1)  Standing lunges with arm raise - start with your feet hip width apart and take a big step forward with your right leg allowing a slight bend in your right knee.  With a tall upper body and engaged core, lower your body down toward the floor by bending both knees.  Your right (front) knee should bend as much as possible up to 90 degrees, keeping your knee inline with your ankle.  Your left (back) knee should have a more open bend so that you can feel a stretch in your hip flexors.  As you lower down, also raise your left arm in the air.  Lower the arm back to your side as you come back to standing.  Do 8-12 repetitions and switch sides.

(2) Bridge with slow hip drops - start by lying on your back with knees bent and feet flat on the ground.  Knees and feet are hip width apart.  Squeeze your hips and press through your heels to lift your hips off of the ground.  Hold a straight position from your knees, through your hips, through your shoulders.  Once in position, slowly return to the starting position and repeat.  Once you are comfortable with the standard bridge, try the one leg with leg extended variation.  Here start with a standard bridge and then raise one leg, keeping the knees and thighs of both legs parallel with each other.  Once in position, slowly lower both hips to the ground and return to the starting position.  Do 8-12 repetitions and switch sides.

(3) Standing side lunge (lateral lunge) - start with your legs around double hip width apart with your feet facing forward.  Keeping a tall upper body and engaged core, slowly lunge to one side, bending that knee until your knee is inline with your foot.  Once in position, slowly return.  Do 8-12 repetitions and switch sides.  

As triathletes, we are usually pretty good about getting in our swim, bike and run training sessions.  But if something has to give, it’s often the dynamic warm-ups, cool downs and strengthening and stretching exercises.  However, maintaining flexibility and strong muscles, is critical to success.  With all of this in mind, what would you tell this athlete on how he could have changed his story line?  

~Reem Jishi - ORR coach

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