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lena_chita
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Jun 6, 2007, 4:48 PM
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Anyone has any experience with climbing-related hip flexor injuries?
I managed to do something last Wednesday... And awkward high step, followed by explosive throw-type move, and ouch. Nothing "snapped", it just started hurting.
I went to PT. She said that she can't be sure if it is ligament tear or the tendon. Rest, ultrasound treatment, massage, resistance exercises (flexed hip& bent-knee, pressing down on the knee and resisting) etc.
I think it is rectus femoris tendon. The pain is in the front, right in the hip crease, about 2-3 inches below the iliac crest.
I have no problem walking or taking stairs. I tried light climbing/traversing yesterday. I can do about 20 min of traversing with no pain, after that I started feeling a bit sore and stopped right away. But high steps hurt.
I guess what I want to know is, how long do you think it is going to take to recover? Weeks? months?
Waaaah, WHY does it have to happen now?
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pseudolith
Jun 6, 2007, 5:36 PM
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Hi, Lena. I actually did have an injury just like that last Winter. I can't recall any particular moment that I hurt it, but discomfort had been building during the last couple hours of the LRC Triple Crown event. The last problem I tried involved a contorted sit-start that had my left leg stretched about as far into a split as it could go. When I tried to pull off the ground, I felt the flare of pain, and realized there was no way I was goingt o get my ass off the ground.
The next day on the drive back to Florida, I couldn't lift my left leg high enough to step into the car. I had to grab the fabric of my pants at the knee and pull up to help lift my leg. Ice, rest, etc. for a few weeks, and the pain had mostly gone away.
Then I went to the gym and one of the problems I did involved a dyno where I started low and pushed off with my left leg. That time, I did feel a *pop* and the area went numb. I did not see an orthopod about it, because I still had full use of adduction/abduction, and flexion/extension. But I did take about two months off of climbing. I must have partially torn something, because Icould feel tendons rubbing against each other in a way they hadn't before. Especially when I would stand up after sitting down at my desk, or getting out of my truck. It was like that position would get things "crossed up" somehow, and after a couple steps, they would pop back into the proper position.
Fortunately, I was in the middle of buying a new house and moving, so I didn't have too much extra time to climb anyway.
In the week immediately following the dyno-related injury, I iced it and took plenty of ibuprofen to reduce inflammation. It never did swell, but the injured area did feel slightly warm.
So I guess my advice to you is to take it as easy as you can. No super-stretchy stemming or high stepping. It took me two months of NO climbing or running to heal back to 100%. And now I may look silly being the only guy at the regular gym who uses the hip abductor/adductor machines, but if I did tear some ligament loose, I want to have as much muscular support around the joint as possible. Injuries suck, but letting an acute injury turn into a chronic one sucks worse than having to take a little time off.
- Mike
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lena_chita
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Jun 6, 2007, 5:52 PM
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Thanks for sharing your experience.
Yes, I did feel immediately after the injury that lifting my leg up to step in my car was a bit of a struggle. I could do it, but it felt that it was weaker all of a sudden, and I pulled it up by the pant leg fabric to help it get up. It seems to be getting better now, but it feels like I have to conciously tighten the leg muscles to lift the leg...
And I do feel that there is something shifting/rubbing/clicking sometimes if I stand up after sitting at my desk.
The PT wasn't too concerned about it. She said that it is expected with this kind of injury, but I obviously didn't tear the tendon completely, b/c in that case I just wouldn't be able to lift the leg at all.
So, couple months, huh? Just when I was starting to feel that things were coming together.  waaaa!!!!!
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aerili
Jun 7, 2007, 4:02 AM
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Why would you think it is the rectus femoris? This muscle is primarily a knee extensor and is only a secondary mover in hip flexion. Hip flexor pain could easily be felt in the exact same area and can also feel "superficial" in nature.
I would do whatever your PT recommends.
Injuries can happen for all kinds of reasons, but again, cross training and a good total body weight lifting program in a regular gym is always a great practice to have to help oneself avoid these types of things if possible.
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bent_gate
Jun 7, 2007, 5:19 AM
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I have injured (pulled/strained) my hip flexor and it took about six months for it heal to the point where it got as good as it was going to get. I did six weeks of physical therapy. I have to continually keep it stretched and conditioned, or I still have problems. It is now two years later. I hurt it doing an inside flag on the wall (pushing hard with the outside muscle on the hip) without any significant stretching or warm-up. Sitting all day tends to let these muscles significantly shorten and tighten so they are easy to strain.
My specific muscle of the group that I injured was the Tensor Fasciae Latae. If you think your injury is to the Rectus Femoris, it is the next muscle strand over. On my injury, you feel it when you walk down the stairs. If you don't, then the Rectus Femoris is probably closer to the right spot.
Here is an anatomy source: The hip flexors is a muscle group (including the iliopsoas which passes through the pelvis) that acts to flex the femur
The hip flexors include:
Tensor fasciae latae (my injury)
Sartorius muscle
Pectineus muscle
Adductor longus muscle
Enlarge to Read
 - 
Other muscles in the group:
Part of the Quadriceps:
Rectus femoris muscle (what you think your injury may be)
Collectively known as the Iliopsoas:
Psoas major muscle
Psoas minor muscle
Iliacus muscle
If you have health insurance, I recommend all the PT you can get, mainly to learn what minimal maintenance you need to do to live with it. I later got into Yoga which has really help with advanced stretching and strengthening. Again, this really helped.
This type of injury can really effect your climbing and general ability to do activities. Hopefully yours won't be to severe. Good Luck! 
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majid_sabet
Jun 7, 2007, 6:39 AM
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[URL=http://imageshack.us]
(This post was edited by majid_sabet on Jun 10, 2007, 5:59 PM)
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reno
Jun 7, 2007, 1:27 PM
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lena_chita wrote: I went to PT. She said that she can't be sure if it is ligament tear or the tendon.
Huh? Differentiating between a tendon and a ligament injury is one of the more basic skills.
If it hurts when you actively flex the muscle, AND when you passively stretch the muscle, it's tendon. If it only hurts when you stretch, and doesn't hurt if you flex the muscle, 'tis ligament.
Either way.....
In reply to: Rest, ultrasound treatment, massage, resistance exercises (flexed hip& bent-knee, pressing down on the knee and resisting) etc.
That's your treatment of choice.
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lena_chita
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Jun 7, 2007, 2:51 PM
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aerili wrote: Why would you think it is the rectus femoris? This muscle is primarily a knee extensor and is only a secondary mover in hip flexion. Hip flexor pain could easily be felt in the exact same area and can also feel "superficial" in nature.
I guess I think it is rectus femoris b/c in my mind I expect the sartorius muscle tendon to hurt right at the ilias crest -- "hip pointer" kind of thing. And the iliopsoas to hurt more along the top edge of the pelvis or feel like back pain
The sore spot is right here:
reno wrote: lena_chita wrote: I went to PT. She said that she can't be sure if it is ligament tear or the tendon. Huh? Differentiating between a tendon and a ligament injury is one of the more basic skills. If it hurts when you actively flex the muscle, AND when you passively stretch the muscle, it's tendon. If it only hurts when you stretch, and doesn't hurt if you flex the muscle, 'tis ligament..
Well, see, it doesn't hurt when I "passively stretch" the muscle-- at least to the extent that PT made me stretch it (grab the foot and bring it behind your thigh in a typical quadrucept stretch is what she tested... not much of a quadrucept stretch for me. But I have tried on my own the reclining hero pose http://www.yogacards.com/.../Supta-Virasana.html and it doesn't hurt either)
It doesn't hurt when I flex the muscle as in when the PT was pushing down on my knee and I was resisting it--again to the extent that she was pushing, with about 20-25 pounds of force, I'd say.
But if I press on the sore spot (see ilustration above)with my fingers, it's scream-with-pain painful.
The immediate symptoms were the soreness/pain in about 3-inch segment from the hip crease down the front of the leg, and the fact that lifting my leg up to step into the car was difficult, though not impossible.
I can physicly lift the knee up to my chest and lower it down, it is just that doing it even once or twice makes that spot really sore. And it hurts both on the way up and down... more on the way down.
And the part that freaks me out is that there is something moving/shifting there in a way it shouldn't... maybe there is some fascia damage instead of the tendon? Some sort of a bursitis? Hmm... I don't know much about it.
I suppose it doesn't really matter in the end b/c the treatment is the same, but I wish I had more info.
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aerili
Jun 12, 2007, 5:13 AM
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In your case, bent_gate, the TFL injury wouldn't exactly be thought of as a hip flexor injury...It would be considered an abductor injury (abduction being its primary movement and the involved motion in mechanism of injury apparently in your case). The TFL, like the rectus femoris, is only an assistant hip flexor.
Also, pain or lack of when walking down stairs is hardly a diagnosis for a rectus femoris injury. Basically, only her PT can really know exactly what is wrong since she's the one who examined her!
Injuries suck. Just be pushy with getting as much info out of the PT as possible. Also, all PTs are not created equal...I have had some less-than-quality rehab, even with decent therapists on hand. Unfortunately, a lot of these franchise or chain operations seem to have lower quality of care IMO (I say having been on both treating and receiving ends). Often the PTs seem too busy gabbing all day long with each other across the tables while supposedly "working" or "focusing" on their patients. If you think this your case, I would find another PT clinic, probably a privately-owned and/or independent place.
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lena_chita
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Jun 12, 2007, 8:52 PM
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aerili, that's true, re: not every PT being created equal. I have a limited choice of places to go, due to insurance reasons. There is one place that I had very good experience with, dealing with wrist injury, and another place where I had rather shitty experience after back injury. A friend of mine works at the place I liked when I had wrist problems, so I went for her evaluation...
The main thing right now is that the hip is feeling better. not 100%, but it no longer feels like something is shifting and clicking every time I get up from the chair... I'm still taking it easy, and keeping my fingers crossed.
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talus_
Jun 22, 2007, 1:56 PM
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Sorry about your hip. And that is probably the way to put it. If there is anything that orthopods have learned over the past twenty years is that groin pain is highly suspicous for a problem in the hip joint. Tendon injuries around the hip happen, sure. Just not nearly as common. The mechanism, the mechanical symptoms you describe, and he location of the pain are pretty classic for a labral tear. doesn't mean that's what it is. Just that if it doesn't start improving relatively quickly find a doctor that has an interest in modern hip surgery that will order a gadolinium MR arthrogram to see what is going on. In the US most orthopods won't know what to do so ask around until you find the right guy/woman. Good luck!
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crankyclimber
Jun 22, 2007, 2:45 PM
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I had the same injury a couple of years ago. I notice as I age it takes longer and longer to heal. i'm 40 and would say it took over 9 monthhs to heal. I made sure not to high step with my right foot and did yoga to stretch. It forced me to look for better footholds.
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