T Nation

Training Legs while Resting Hip Flexors


#1

Currently have some severe pain in my hip flexors. Mainly the left, but some in the right too. Finally went to a PT and I'm working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I've had since December, and build up my glutes (medius & minimus) in the process.

I'd rather not completely neglect leg training while I do this, but have always just stuck to squats, deads, cleans, etc. I'm not really a BB type lifter, but am willing to do some isolation work while I rehab. Just looking for some advice on exercise types, sets/reps, etc while I go through the process. Any help is appreciated!


#2

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat.


#3

All deadlift variations where you start at the top. Romanian deads, Dimmel deads, stiff-legged deadlift.

Moves where you extend, or push the hips through. Back raises or hyperextensions. Glute/Ham raises or reverse hypers. Pull thru’s on a low cable.

Partial deadlifts from the rack or blocks, starting at a height that takes your hips “out” of the lift. You can also do these partials against bands, to really focus on driving through, and locking out with the glutes.

Try all of the above with a band around your hips, knees, ankles or even your feet. This will really get your external hip rotators and glutes going. This can “teach” you to use your hip flexors less, and your glutes more.


#4

[quote]jskrabac wrote:

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat. [/quote]

This is literally what a PT did for me when I had hip flexor pain that lasted for months, ditched him after 2 sessions. Saw an ART (active release technique) doctor and a good massage therapist, a couple weeks later no pain at all.


#5

[quote]jskrabac wrote:

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat. [/quote]

Okay you hit the nail on the head… In addition to what was recommended below, what would you recommend? I assume since you said it’s tissue quality, foam rolling and…? Thanks for all the answers thus far. I am stopping all aggravating moves, but want to be as aggressive with my treatment as possible. Summer is coming around and at the very least, I’d love to be able to enjoy the outdoors with some sprints.


#6

[quote]heard10 wrote:

[quote]jskrabac wrote:

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat. [/quote]

Okay you hit the nail on the head… In addition to what was recommended below, what would you recommend? I assume since you said it’s tissue quality, foam rolling and…? Thanks for all the answers thus far. I am stopping all aggravating moves, but want to be as aggressive with my treatment as possible. Summer is coming around and at the very least, I’d love to be able to enjoy the outdoors with some sprints.
[/quote]

Foam rolling yes. A standard foam one may not be enough depending on your pain tolerance though. I go into hips with PVC pipe or a lacrosse ball.

Don’t get me wrong, you do need to eventually stretch and work to lengthen your hip flexors and basically “unlock” that joint, but if any stretch is aggravating right now, it’s not the time. I know tissue quality is very hard to measure and can be somewhat subjective, but a basic gauge is the less pain you feel when you dig in with a lacrosse ball or your thumb on a troublesome spot, the better. You know you’re making improvements when going over a troubled area no longer bothers you and just feels like a deep massage.

I’m posting a link here for some good stretches. thegriphouse.wordpress.com/2014/07/15/superior-hip-mobility-a-how-to-guide/

As far as training, how do single leg movements feel?


#7

[quote]cparker wrote:

[quote]jskrabac wrote:

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat. [/quote]

This is literally what a PT did for me when I had hip flexor pain that lasted for months, ditched him after 2 sessions. Saw an ART (active release technique) doctor and a good massage therapist, a couple weeks later no pain at all.[/quote]

It’s so irritating. My sister’s a by-the-book PT so I can’t even talk to her about this stuff anymore. They only think in terms of isolation and perform these “tests” that somehow indicate a weak muscle group. If you’re squatting any respectable weight, you’re not going to have weak glutes. Basically everyone fails the test, because it’s a new stimulus and neurologically your hips are like “wait, what? that’s new!” Just do it everyday for like 3 days and you’ll adapt, but the PT will think it’s the treatment “working.”

Cueing and/or activating a certain muscle group within a movement pattern…that’s a whole different story and a heavy part of any halfway decent therapy protocol.


#8

Even my one-legged movements bring about some pain. I think I’ve just let this issue progress for far too long. I’ve got a pretty good foam roller, made of metal on the inside with a little padding on the outside, and a lacrosse ball. Just haven’t been putting as much use into them as I should be. As far as PT goes, it’s subsidized at our school, so I think I’ll see her a few more times. Is there anything inherently wrong with ultrasound, even if it’s not the best treatment option?


#9

[quote]heard10 wrote:
Even my one-legged movements bring about some pain. I think I’ve just let this issue progress for far too long. I’ve got a pretty good foam roller, made of metal on the inside with a little padding on the outside, and a lacrosse ball. Just haven’t been putting as much use into them as I should be. As far as PT goes, it’s subsidized at our school, so I think I’ll see her a few more times. Is there anything inherently wrong with ultrasound, even if it’s not the best treatment option? [/quote]

Not that I’m aware of. I don’t think they’d use it for pregnant women if it presented any risk to the fetus.

Ask her if she intends to do any soft tissue work.

Definitely get in there with the foam roller and ball though. Does it feel like it’s strained? Is it a dull pain, straining pain, sharp pain?


#10

It’s a sharp pain upon flexion, but can be aching as I sit throughout the die, or lie in bed at night. I guess I can’t tell if I would call it a “strain.” Certain movements feel like it’s pinching.


#11

[quote]cparker wrote:

[quote]jskrabac wrote:

[quote]heard10 wrote:
Finally went to a PT and I’m working on icing, stretching, and ultrasounds during the visits. Anyway, I want to give the flexors a rest as I finally try to rid myself of the issue I’ve had since December, and build up my glutes (medius & minimus) in the process.[/quote]

Sounds like you need a new PT. I was convinced of this at “ultrasound.”

This is a very cookie-cutter, by the book prescription for general knee/quad/hip flexor issues. Let me guess, during your initial assessment, you were told that the PT has a “good idea of what’s going on.” He did a few basic flexibility tests with you, you did some side lying clams while he pushed down on your legs, etc. And lo and behold, your issue is just that you need to strengthen your glutes (especially glute meds) and core, and improve flexibility in hamstrings, calves, and hip flexors! You warm up on the stationary bike, do some stretches for hams, calves, quads, and then banded walks and planks and stuff to “strengthen” that core and glutes. Am I close?

Given you have had pain since December, it sounds like your tissue quality is poor throughout your quads and hip musculature. Addressing those trigger points should come first. Stretching may provide very temporary relief (basically you’ll return to same state by the time you get home from PT), but more than likely it’ll actually be aggravated if you are aggressively stretching it.

As far as ultrasound therapy…tell your PT it’s no longer the 1950s, and also that vibrating belt machines don’t really help you lose belly fat. [/quote]

This is literally what a PT did for me when I had hip flexor pain that lasted for months, ditched him after 2 sessions. Saw an ART (active release technique) doctor and a good massage therapist, a couple weeks later no pain at all.[/quote]
This is my experience as well. I’m beginning to think ART solves everything.


#12

My tissue quality is bad. When rolling my IT band, it feels like I have a ball of something about 1/4 of the way down from the ASIS. I’ve been rolling a lot since the advice was given. No major improvements yet, but I can tell I have a lot of work to do. I definitely feel like I have “knots” in my glutes as well, especially the medius. Any idea how long it takes to see some improvement?

Also, I’d like to start lifting again tomorrow. If tissue quality is the main issue, it shouldn’t really set me back, right?


#13

I could be 100% wrong about this.

If you have lumps and knots and tightness your tissues are “shortened.” Your quads, or IT bands or hip flexors are not as long as they would be if you were looser. If you do lifts like squats were flexibility is important, you are putting lots of stress on the already inflammed muscles/tendons. This could just undo all your rolling and icing.

I also think that doing the big moves with tight hips and glutes can lead to faulty movement patterns, or bad technique, poor positions. This can cause immediate problems like groin pulls or disk issues. Or over time can lead to crooked hips, ATP, or scapular problems.

I would advice you to start out kinda easy. Try some pulldown abs, and really focus on your neutral spine, and square hips. Try some back raises or hyperextensions, hugging a medicine ball to your chest. Concentrate on driving with your glutes, keeping a neutral spine and not overarching at the top.

Try some single leg stuff like Peterson Step Ups, or lunges with 1 dumbbell “suitcase” style. Exercises where you need to use your abs, glutes, hips and quads at the same time, but 1 leg at a time. You can also control the depth on these moves, to avoid excessive stretching.


#14

Should we really care about trigger points and such? I mean, who doesn’t have painful trigger points? I have plenty but I have no pain whatsoever to train everything properly with heavy ass volume and frequency (for years now). And I refuse to assume that I’m in any way a special snowflake. I’m a stickler for good form/technique/setup on any exercise though. Bad form leads to shit ROM & possibly pain/injury.

OP: Is it safe to assume that you are one of those skinny guys with excessive resting anterior pelvic tilts? If so, you should probably try to reduce that tilt with the proper cues before doing leg exercises. Proper form always trumps these silly mobility stuff. But maybe throw in some strict hip thrusts to get a feel for your glutes working & a more posterior pelvic tilt.


#15

I’m pretty sure I do have some bad anterior pelvic tilt. Correct by strengthening the glutes, with glute specific work you are saying? I’m about to start Eric Cressey’s High Performance Handbook, which has some weighted glute bridges & hip thrusts written into the program.


#16

The mobility stuff is only really useful if you take what it teaches you into your real lifting.

Lunges let you know how it feels to use your glutes and the “outside” of your thigh. You stay upright, braced, not excesively bent forward, or over-arching your back. You keep your knee out, focusing on it not collapsing in. You develop both sides evenly.

Then, when you squat, you understand the cue “knees out.” You know how it should feel to drive your hips through, and finish with the glutes. The lunge is just to “teach” you to squat better. And to build muscles that poor squat technique misses.

If you can’t lunge without falling all over the place, your squat is probably going to be a little off. You just need an easier exercise. Just get in the half kneeling position, then push with your down side glute. This will lengthen and stretch your hip flexor, and get your butt going. Then you can glute bridge. Then lunge. And after you can do those, you can squat.

Crawl, walk, run! In any sport or activity you start with easy, fundamental stuff. Then you gradually add more complex moves. If you’re ready for squatting day 1 thats awesome. If squatting actually hurts you, you’re doing it wrong. Back up, build strength with back raises, step ups, abs, what ever you can do correctly. Then squat.


#17

After a week on intense foam rolling (at least 1x/day, sometimes up to 3x), and band work with the glutes, I am noticing some improvement. I deadlifted yesterday at only 1x BW, but it felt great. Best I’ve felt in a long time. Still feel a little something in the hip, but the fact that I could even do it was cool. I’m following Cressey’s High Performance manual, and I have a few more days until I hit the legs again. Until I feel great, I’m avoiding sprints. I’ll keep rolling and stretching the glutes/piriformis and see where it takes me in the next week. Thanks again for all of the advice. I’m sure it’s a multitude of things- Anterior pelvic tilt (weak glutes), tight glutes, and poor fasical quality.