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Home Blog Healing and Rehabbing Hip Flexor Tendinosis

Hip Flexor Tendonitis
Rehabilitation

About the Hip Flexor Muscles

Your hip flexors are a group of muscles that act at the hip to lift your leg toward your trunk. During walking and running, the hip flexors play an important role in the swing phase of the gait cycle. For many people, excessive sitting creates shortened and tight hip flexors that restrict hip range of motion, force the body out of alignment, and create gait deficits.

Over time, tight hip flexors can lead to poor balance and increased risk of hip flexor tendinitis. Rehabilitating hip flexor tendinitis entails addressing underlying issues, restoring balanced muscle tension at the hip, and retraining neuromuscular pathways that govern hip movement.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Hip and Tendon Specialist Dr. Lev Kalika

NYDNRehab clinical director Dr. Lev Kalika has devoted his life’s work to revolutionizing the way physical pain syndromes and motor disorders are diagnosed and treated. Dr. Kalika is a world-renowned expert in diagnostic musculoskeletal ultrasonography, and has contributed multiple research articles to the growing body of scientific literature on its use in rehabilitative medicine.

The clinic at NYDNRehab features the highest resolution ultrasound equipment available for imaging large structures like tendons, ligaments, nerves, muscles and bones. Our equipment also gives us the capability to test tendon density via sonoelastography, and enables us to detect early signs of tendon fiber healing via superb microvascular imaging (SMI).

Dr. Kalika leverages musculoskeletal ultrasonography, advanced regenerative technologies and cutting edge therapies to treat and rehabilitate hip flexor tendonitis. His 20+ years of hands-on experience and his ongoing commitment to finding the most advanced treatment methods for his patients make NYDNRehab the clinic of choice for musculoskeletal pain treatment in NYC.

Why Stretching Tight Hip Flexors is
Not Enough

Tendonitis vs Tendinosis

In many cases, sensations of tightness at the front of the hip are not directly caused by tight hip flexor muscles. They are sometimes caused by up-regulation of the nervous system due to hip microinstability. In such cases, the feeling of hip flexor tightness cannot be resolved by gently stretching the muscle-tendon unit, and aggressive stretching may cause further damage.

In other cases, hip flexor tendinosis is due to the inability of the foot to push off from a stable base. It can also arise from poor spinal stabilization due to weak and uncoordinated pelvic and trunk musculature, or from other structural issues that shift load to the hip flexors.

If you have sensations of tightness in your hip flexors that are not helped by gentle stretching, you should consult with a qualified therapist who understands the complexity of hip and pelvic architecture, and is aware of the many other factors that contribute to hip flexor tendinitis

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Hip Flexor Tendinitis
Symptoms and Causes

Symptoms

  • Pain and tenderness at the front of the hip

  • Pain that intensifies when you bend your hip

  • Hip and/or groin soreness to the touch

  • Stiffness and reduced hip range of motion

  • Clicking or snapping sounds or sensations when walking or running

  • Symptoms that worsen over time

Causes

  • Overuse from sports, running or exercise

  • Excessive sitting and sedentary lifestyle

  • Traumatic injury

  • Overstretching

  • Suboptimal gait mechanics

  • Imbalanced hip muscle tension

Quantitative Analysis is Key to Accurate Hip Flexor Diagnosis

When based on symptoms alone, hip pain issues can easily be misdiagnosed or under diagnosed. When that happens, it can lead to insufficient or inappropriate treatment that costs you time and money and prolongs your pain. In many cases, inappropriate treatment can worsen your symptoms and increase your risk of further injury.

At NYDNRehab, we believe that what cannot be measured cannot be successfully treated. While your symptoms can help steer us in the right direction, that is only the tip of the iceberg. To get an accurate and comprehensive diagnosis, we leverage advanced technologies that eliminate guesswork and give us objective data.

We use high-resolution diagnostic ultrasonography to get crystal-clear real-time images of the structures of the hip in motion. Ultrasound imaging lets us view all the structures that come into play during hip movement, and enables us to compare the injured and uninjured sides of the body, providing us with insights that cannot be gleaned from Xray or MRI.

In addition, our research-grade ultrasound equipment gives us capabilities for sonoelastography to test the elastic properties of tendons, and superior microvascular imaging (SMI) to detect signs of tissue healing.

Our human movement lab is equipped with advanced technologies for 3D gait and movement analysis, to identify and measure gait anomalies that cannot be detected with the human eye. By collecting data on joint angles, force loads, weight distribution, muscle firing patterns and more, we are able to establish a baseline for treatment. We re-measure periodically throughout the rehabilitation process, to ensure that your treatment protocol is working.

Quantitative Analysis is Key to Accurate Hip Flexor Diagnosis
Pre-Treatment Paves the Way for Physical Therapy Success

Pre-Treatment Paves the Way for Physical Therapy Success

Mainstream clinics often rely on one-size-fits-all physical therapy protocols that do not take into account the unique characteristics of the individual patient. In doing so, they overlook underlying conditions that ought to be treated before beginning physical therapy.

At NYDNRehab we take a personalized and holistic approach to patient care. We treat the patient and not just their symptoms. When conducting a thorough and quantitative analysis, we look for other issues that need to be resolved before beginning physical therapy exercises.

Issues that should be pre-treated prior to beginning physical therapy include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

Pre-treatment eliminates impediments that cause pain and restrict movement, to optimize the effectiveness of physical therapy.

Why Traditional Treatment Methods Fail to
Resolve Hip Flexor Tendinosis

Traditional treatment for hip flexor pain often involves rest, ice and pain management, often with NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids. Because traditional practitioners are often unable to distinguish between tendonitis and tendinosis, conventional treatments often fall short of resolving hip flexor pain and stiffness.

At NYDNRehab, your healing journey begins with an accurate diagnosis that identifies the precise locus and extent of injury. Our patient-centric approach values and encourages your feedback, making you a contributing stakeholder in your recovery. Our personalized one-on-one treatment protocols are customized, based on your unique patient profile.

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Regenerative Technologies Set You Up for
Optimal Results

Prior to beginning physical therapy exercises, we identify and treat underlying issues that limit your ability to move freely. We use our advanced regenerative technologies to heal tissues and optimize movement, to set you up for physical therapy success.

Focused Shockwave Therapy

Focused Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendons and muscles. This technology produces high frequency sound waves to stimulate cell neogenesis and accelerate healing.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a new technology that transmits high energy magnetic pulses that synchronize with the body’s own magnetic fields, to permanently eliminate inflammation in targeted tissues.

Electromagnetic Transduction Therapy (EMTT)

Electromagnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT uses acoustic pressure waves to enhance blood circulation, to relax and release large areas of tight muscle and fascia.

TECAR Therapy with INDIBA

TECAR therapy helps to restore the ionic charge of damaged cells, to enhance the effectiveness of manual release therapy. With INDIBA, what once took months to achieve flexibility in the deep hip flexor muscles and fascia now only takes a few sessions.

HIGHENERGY INDUCTIVETHERAPY (HEIT)

HIGH ENERGY INDUCTIVE THERAPY (HEIT)

Ultrasound Guided Dry Needling

Injection therapies, including platelet rich plasma (PRP) and Prolotherapy, use natural/neutral solutions to stimulate cellular repair and accelerate tendon healing. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

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Advanced Training Technologies Restore
Muscle-Tendon Integrity

At NYDNRehab, our advanced training technologies flip muscle strengthening on its head by introducing advanced approaches that circumvent the pitfalls of traditional strength training.

Kineo Intelligent Load System

Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. Kineo uses artificial intelligence to design eccentric loading protocols that promote tendon healing.

Blood Flow Restriction Training (BFRT)

Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while joints and connective tissues are still healing is a challenge for athletes who need to return to sport in the shortest time possible. BFRT enables you to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Biofeedback Motor Control Training

Biofeedback Motor Control Training

An important part of rehabilitation is restoring coordinated muscle firing patterns. Our high-tech performance lab has you covered with AI and VR assisted technologies that fine-tune your every move, to optimize hip flexor function and eliminate movement errors.

Avoiding Hip Flexor Tendinitis

Your hip flexor muscles contribute significantly to hip and pelvic mobility and stability. Employ these strategies to avoid injury and optimize hip flexor function: 

  • Avoid overtraining, and allow for ample recovery between training sessions.

  • Eat a nutrient-dense diet with plenty of collagen-rich protein to support joint and tendon health.

  • Get enough sleep.

  • Avoid extended periods of sitting, and take frequent breaks to move and stretch.

  • Get regular exercise — daily walking is a great place to start.

  • Avoid extreme or aggressive stretching of the structures surrounding the hips.

  • Get a 3D gait and movement analysis, to identify and correct issues that contribute to hip flexor pain.

There are several muscles that contribute to hip flexion:
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Get Cutting-Edge Hip Flexor Rehabilitation
in NYC that Really Works!

Tendons are notoriously slow to heal due to limited vascularity and their unique collagenous structure. Once damaged, tendons can gradually degenerate, exacerbating pain and dysfunction, and reducing your overall quality of life.

At NYDNRehab, our experience and expertise, coupled with our advanced regenerative technologies, are game-changers for hip flexor tendon rehabilitation. Accurate diagnosis followed by fast and effective treatment make NYDNRehab your clinic of choice for pain syndromes and movement disorders of all types.

You don’t have to live with musculoskeletal pain. Contact us today, and get back to pain-free movement so you can live your best life.

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    Hip Flexor FAQs

    How can I tell if my hip muscles are out of balance?
    If you are experiencing pain and/or stiffness in your hip and pelvic region, muscle imbalance is likely a contributing factor. However, there may be other factors in play that cannot be resolved by exercise and stretching. Ultrasound imaging, along with 3D gait and biomechanical analysis can give you a total picture of issues that underlie your hip pain.
    Is it OK to run with tight hip flexors?
    For optimal running gait, you need both mobility and stability in your hip joints. Tight hip flexors inhibit your stride after toe-off, creating gait deficits that slow you down and increase stress on other structures. If gentle stretching does not release your hip flexors, other issues may be at play. Best to seek professional help to resolve them if you want to avoid further injury.
    Will doing yoga help me avoid hip flexor tendinitis?
    While yoga often helps to increase hip mobility, extreme yoga postures can undermine joint stability, setting you up for injury. Excessive stretching of the hip flexors can actually increase your risk of hip tendonitis.
    How long will it take to rehabilitate my hip flexor tendinitis?
    Hip flexor tendinitis can be slow to heal due to limited vascularity in collagenous tendon tissue. Regenerative technologies and ultrasound guided needling therapies can dramatically speed up the healing process. Biofeedback motor control training helps restore neuromuscular pathways that govern optimal movement patterns, to prevent re-injury. The pace of rehab will depend on multiple factors. Be sure to get personalized treatment that treats the whole patient, and not just your symptoms.
    When should I seek professional help for hip flexor pain?
    If gentle stretching does not reduce your hip flexor pain and tightness, you should not hesitate to seek the help of a tendon specialist. Failure to seek early treatment can lead to tendon degeneration that worsens your pain and downgrades your mobility.
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      Physical therapy and rehab can be time consuming,
      and a faulty diagnosis can make treatment a total waste of time.

      Failure to accurately diagnose a condition in its early stages can lead to chronic
      problems and sometimes devastating results

      Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

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      Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

      Learn more »
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      Accurate Diagnosis Is the ONLY way to
      Successful Treatment
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      A bad physical therapy experience is one of the primary causes of unnecessary surgery

      At NYDNR, we believe in
      medical innovation

      We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.

      • ACL Robotech
      • С.A.R.E.N.
      • Kineo
      • Alter G
      • Proteus shoulder arm recovery
      • Zebris
      • Manuthera 242
      • ESWT
      • Surface Electromyography
      • Vertimax
      • Ankle Stabilizing Device
      • Blood Flow Restriction
      ACL Robotech ACL Robotech С.A.R.E.N. С.A.R.E.N. Kineo Kineo
      Alter G Alter G Proteus shoulder atm recovery Proteus shoulder atm recovery Zebris Zebris
      Manuthera 242 Manuthera 242 ESWT ESWT Surface Electromyography Surface Electromyography
      Vertimax Vertimax Ankle Stabilizing Device Ankle Stabilizing Device Blood Flow Restriction Blood Flow Restriction Training
      • Aplio i800
      • Vibration Platform
      • Sensa mat
      • Force Plate
      • Fascial Gun
      • ShooTools Slider
      • Redcord
      • Cryo Therapy
      • Skier's Edge
      Aplio i800 Aplio i800 Vibration Platform Vibration Platform Sensa mat Sensa mat
      Force Plate Force Plate Fascial Gun Fascial Gun ShooTools Slider ShooTools Slider
      Redcord Redcord Cryo Therapy Cryo Therapy Skier's Edge Skier's Edge

      Most importantly,

      we are the only facility in the US

      where structural medical diagnosis is reflected in functional treatment, and vice versa.

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      In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

      Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

      The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

      Dynamic ultrasonography examination demonstrating
      the full thickness tear and already occurring muscle atrophy
      due to misdiagnosis and not referring the patient
      to proper diagnostic workup

      Demonstration of how very small muscle defect is made and revealed
      to be a complete tear with muscle contraction
      under diagnostic sonography (not possible with MRI)

      image

      Complete tear of rectus femoris
      with large hematoma (blood)

      image

      Separation of muscle ends due to tear elicited
      on dynamic sonography examination

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