I’m a physio in Australia who specialises in high-end rehab for athletes. I have a particular focus in traumatic knee and shoulder rehabilitation, but have experience managing sports injuries across the board.
I currently work across multiple settings including:
2 of the premier sporting academies in the state
A nationally-recognised sports physiotherapy clinic, with a strong background in soccer and tennis injuries
Minor league soccer and basketball
Private consulting
I’m also lucky enough to have interned with a ProRaw powerlifting coach, national-level athletics coaches, a professional Australian football team and minor league rugby league and rugby union teams.
As a way to help more people and build my education skills, I thought I’d create this AMA thread. The goal here is to help people triage new injuries, understand existing diagnoses, develop plans of care, and create strategies to modify training.
For legal reasons, I won’t be diagnosing or interpreting medical images. However, I’ll do my absolute best to help as much as possible, within the boundaries of what’s medically appropriate
Nice! How about a hip flexor strain/injury I’ve been dealing with for almost a year? It feels better after stretching, but it becomes tight regularly and I have pain after getting up from a bent/seated position for a long time. I feel like the pain is almost starting to radiate down into my lower calf of the same leg.
Nice to have another Aussie in the house (I am down in Melbourne) and great of you to post this. Seems like good timing given I am currently undergoing physio treatment for a small mid pec tear.
How long has that been the case? Any history of back pain?
A couple of other questions:
What, exactly, have you done for physical activity in the past 2 months
What, exactly, did your physical activity ook like in the 1-2ish months preceding the onset of hip pain
In the gym, what is most provocative?
Do you get pain with: ascending stairs, descending stairs, sitting up in bed, tying your shoes, taking a dump
Given what you’ve told me, two possible contributing factors are:
A - Legitmate hip issue: either a joint restriction, chronic tendon pain or chronic muscle pain. However, these typically won’t radiate and typically will feel worst when sitting, not after
B - Lumbar referral: given the duration of symptoms, worsening with slumped postures, and radiation into calf there is also a possibility that the lumbar spine is contributing to the hip pain via a nerve referral. Crucially, that doesn’t mean you’ve done anything hectic like blowing a disk, more like the lumbar nerves could be mildly irritated - a common issue in lifters
If you can give me a bit more info RE the questions at the start, that would be great!
Personally, I don’t think “preventative” measures are massively helpful.
I truly believe people should train as hard as they can when they feel good, accept that set-backs will happen at some point, and know how to deload when the time is right. On a population level, we know that just about everyone will experience pain at some point, and a lot of the time the onset of pain coincides with unpredictable “outside stressors” or random movements which are very challenging to account for prospectively (more on that later).
However, some basics are:
A. Make sure your shoulder can move like a shoulder: Consistently exposing your shoulder to all of its motions (refer below), across all of its ranges of motion, across a variety of contexts, can help prevent any part of our body becoming chronically “underloaded”
Some useful exercises that help hit “blind spots” for lots of people include those below. Crucially, you don’t need to always be doing all of them at all times, but a little bit of these “sketchier” exercises goes a long way.
Incline curl
Deficit push-up to a deep stretch
Rows and pulldowns to a deep stretch. Chest supported T-Bar row is the best apparatus for this hands down
Avoid stupid volumes or stupid intensities you aren’t prepared for
Be consistent. Don’t randomly jump program to program
Beware deloading. Sometimes you might miss 1-2 weeks of training, don’t be an idiot when you get back
Pay attention to your body. I have seen more niggles/injuries crop up when athletes are over-stressed, over-tired, over-emotional or sick. Don’t let gutting through a session during a shitty day (or month) derail the next 10 weeks.
Three main things:
A. Even though I do diagnose thoracic outlet syndrome, it’s debated whether or not the condition even exists. IIRC there is about 1 case of TOS per 100 000 people. However, 90% of these are “disputed” TOS which is a collection of TOS style symptoms but no measurable nerve or vascular deficit. Hence, “true” TOS may occur in as few as 1 in 1 million, hence I feel it can be over-diagnosed. Having TOS symptoms (and surgery) is far more common than that, so either TOS is massively over-diagnosed or its massively under-reported in the research.
B. Lifters seem to blame TOS before blaming cervical issues. What is more common statistically is TOS-esque symptoms caused by a nerve referral from the neck. I would always ensure the neck is clear before operating on a TOS diagnosis
C. “IF” we’re going to manage TOS symptoms as TOS, I again simply approach it as managing workloads and getting everything doing its job. Hence, I look to control
The training program, removing all potentially irritating factors in the early stage. This doesn’t mean not training at all, but we’ll only train with exercises we know are non-provocative. Typically, this means exercises where the shoulder stays below 90 degrees, and we do not go out past the scapular plane (so minimal work which stretches the pec or lat). We then return to usual activity as symptoms improve (3-6 months, easily)
The movement exposures, making sure the athlete regains control through all motions of the ribcage, thoracic spine, neck, jaw, shoulder blade and shoulder joint. We will start in low-load, low-speed, mid-range environments and progress from there. Useful starting points include breathing work, thoracic and scapular CARs, as well as “regular” isolation training in comfortable positions
Just a regular hip flexor stretch with the affected hip flexor leg lunging out in front of the other leg and driving my hip forward.
Maybe a month or two. No history whatsoever of back pain.
I have continued to lift weights and do regular training. I haven’t changed anything.
It looked the same as it does now.
I would say doing anything where I bend excessively at the hips. Also, where I overextend the hip flexor or overstep. I’ve found that putting something under my heels when squatting helps reduce any pain tremendously and I completely stay away from walking lunges (this is where I think I strained it a long time ago).
Tying shoes, but just because I bend clear over while sitting.
Unfortunately (for me) I go for The Bombers, although being a Pome I don’t follow it that closely. Moved here is 2005 and picked Essendon, really just because a guy I was working with in my new job was a big bombers fan and took me to my first game. I have had 20 years of disappointment and scandal but at least it hasn’t been boring. LOL
EPL team in case you follow football is Tottenham Hotspur
So if you’re “stretching” the right hip flexor you have the right leg up and left knee down?
Gotcha
More details please: split, sets x reps, approx %1RM or RIR, any additional training/exercise outside the gym (e.g. cardio, rec sport, work)
None of this is out of the ordinary, but some more details around training and management to date will help me make some better recommendations for you
You’re the same as my dad! Poor guy moved to Melbourne in '94, got sucked into supporting the Bombers by a colleage, and moved to Brisbane in '99. I feel your pain mate
Unfortunately I was raised in an Arsenal household
Not to keep cluttering (although I will), but look at the fantastic quality and quality of information already in this thread - this is a great forum and thank you @j4gga2!
To be specific, it’s my left hip flexor. If I put my right knee down and step out with my left, I then can shift my hips forward to get a good stretch on the left hip flexor.
Monday, Tuesday, Thursday, Friday, Saturday. Total rest on Sunday. Wednesday I go to the gym and walk for 20 minutes and foam roll legs. I do the traditional bro split. Typically higher reps on most lifts;15-20. I try to reach failure in all, but for sure 1-2 RIR. I hit 12,000 steps per day. I walk for five minutes each hour of the work day. I have a standing desk and stand all day. No rec sports.
It’s highly unlikely you have a hip flexor strain, given that:
The left hip flexors don’t lengthen with a right knee down lunge
Muscle strains should not persist beyond 4-5 months outside of sprinting/agility
Hip flexor injuries don’t refer down the leg
Hip flexor injuries don’t hurt when bending forward
It’s far more likely what you’re dealing with is more along the lines of intra-articular hip pain (pain coming from within the hip joint itself). Management here can be relatively complex, and will ideally involve:
In-person assessment of the capsular mobility within the hip joint
Careful modification of strength training to restrict depth for a period of time
Careful technical coaching, looking at the position of your pelvis during activity (these symptoms will typically be associated with greater anterior pelvic tilt under load)
Some specific strength training targeting the hip in all planes
If seeking a proper in-person assessment is out of the question, I would do the following for at least the next 3 weeks:
Remove the majority of your single/split leg lower body exercises
Stay above 90 degrees of hip flexion unless you know the exercise is pain-free (e.g. slant-board squats)
Goodness. Just got to the gym this morning and stretched out my hip flexor and realized I told you wrong. I stretch my left hip flexor with my left, not right, leg back and my right, not left knee down. I’m so sorry if this screws up everything you said!
