Hip flexors and runners
the misunderstood muscles!

Hip flexors and runners

The hip flexors are often overlooked and not thought of as an important muscle to exercise for the improvement of strength. Many runners that have suffered from lower limb injuries had low gluteal activation. We believe that training of the glutes is a great way to improve efficiency and even speed and running performance. When there is tightness in the glutes, this hip flexor tightness may lessen gluteal activation.

Even though hip flexor tightness doesn’t always mean strength, this with activation are important for pelvic stability, hip stability, and for overall running. We see injured runners who have difficulty getting their hip flexion with other hip muscles really activated.

In a study In 2005, it was found that injured runners had significantly weaker hip flexor as well as muscle groups on the side that was injured. This was compared to a group of non-injured runners where leg dominance did not influence the injured leg. This study showed that by improving hip flexor strengths reduced PFP. We believe that this study and others show that hip flexor strength should be a part of assessments for runners who wish reach peak performance and prevent future injuries.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


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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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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