Hip Flexor Pain

Depends. Is it just soreness? Or a strain?

How is your kid's mobility? Did he get a FMS by his trainers?

He's very flexible.

This goes back to June of last year. He strained it. Sat out 10 days and was then able to play. Played for 3 straight months. Actually played A TON of baseball in those 3 months.

Then October became the offseason. He trained extremely hard for 6 months. Once in a while, it would bother him but he never wanted to shut it down.

Three weeks ago, HS workouts started and he says it's killing him again. Going to an orthopedic specialist soon. He's convinced that he's going to need to shut down for a long time. I say "wait and see what the doctor says."

It is a challenge to relieve the doomsday cloud from a teen. Has he tried other treatment modalities such as the TENS unit (marc pro)? What does his trainers think?

Yeah. Last summer he did PT and Tens during the 10 days off. And, I keep reminding him that it could be the same thing this time. But, in his mind, since it's back now, he thinks it will be more time.

His trainers all say it's from overuse. I don't doubt it. For six months he was training 5 to 6 days a week for 2 to 3 hours a day. (His choice. Not mine. In fact I would ask him to take days off - because I am the transportation - but he would insist on going.)

I remind the knucklehead that this is the consequence of performing adult workouts in an adolescent body. He may have the size of an adult but his muscles and joints are still of a youth.

Our experience:

Son complained of hip flexor issues, usually at the start of the high school season.  Coming off basketball, then going into a SS position where you move side to side.  He complained every year about the same time of year. FINALLY, took him to an ortho to get an xray and some PT his senior year.

His Freshman year in college he heard/felt a "pop" in his hip.  Got a contrast MRI and it showed he had a hip impingement with tears.  He played through the season with a cortisone shot.  Had surgery on both hips, one month apart, during the following summer since impingements are usually bilateral and inherited.  This was on the college's insurance dime, btw, since he heard the pop in college and treatment started there.

It was probably the impingements that were bothering him in HS.  Apparently it can be a fairly common thing among short stops.  Son kept telling me "A-Rod had it done"!

Thx keewart

Flexibility doesn't equal mobility, one is being able to be manually put into a range of motion, the other is to be able to control joints at end ranges of motion.

Hip flexors are a group of muscles. I'd be a little skeptical and want another opinion if a practitioner said just to rest. In my and my kid's experience, complete rest has almost never been the answer.

Francis, depending where you are in NJ, I'd highly recommend you check out Challenger Strength.

@Francis7 posted:

They say rest is key. But, how much rest?

Rest in terms of not doing anything that really flares it up and makes it hurt worse, but generally speaking 100% rest is not indicated. An example would be:

An OF and their hip flexor hurts during sprinting, and this has affected their ability to run down balls and getting out of the box.

Might have them do standing cable hip flexion. Maybe they can't do 20 pounds without flaring up their pain to a 5-6/10, but they can tolerate 5 pounds with 2-3/10 pain. Great, there's a starting point. And go from there. So like I said, very rarely would I ever look at an athlete and say, "This needs 100% rest," but that would be based on what was found during the examination and how they're presenting.

Well, it's not an avulsion fracture.

Cross your fingers on the MRI.

Saw this online:

"How Long Does It Take to Recover from a Hip Flexor Injury?

Depending on the severity of the injury, it may take 1-6 weeks for a hip flexor injury to heal. Minor injuries typically require 1-3 weeks of recovery time, while more severe muscle tears can take 4-6 weeks or longer. Untreated severe injuries may take even longer or cause chronic pain. "

So, on average (?) it's 2.5 to 4.5 weeks, generally speaking? And, midway, it's 3.5 weeks?

Yeah, I know that's not really how math works...

My brain is just shot over this thing because Opening Day is Monday and the season is only 7 weeks long.

It sucks to get injured, especially right before the season. Or during the season. Or any time really, it's never fun. As for recovery, it just depends. Most pain and injuries get better within three months. Groin strains are usually back within 2 weeks, but can take 2-4 (longer if it's a grade 3). Hamstrings 2-7 weeks. Patellofemoral pain gets better within three months, but there are a subset of people that still are not returned to sport in a year. Subacromial shoulder pain (aka rotator cuff related shoulder pain aka formally known as shoulder impingement) gets better within three months, but there are a subset of people that will have pain for over two years. Back pain typically gets better within 2-6 weeks, the list goes on.

All that to say that yes, the majority of things do get better. It's just frustrating when it happens right before a season. Hopefully the athletic trainers and the doctor will have a good plan of action for him.

Thanks @XFactor

The weird thing is that he played on April 8th and April 10th. And, he looked good and performed well. But, now he says it's killing him. So, I asked him "How could you play so well just a week ago if it hurts so bad?" And, his answer was "I was full of motrin when I played. It's when I am not taking motrin when it hurts."

Is that good news or bad?

The other part of this is the medical delay. Orthopedist and x-rays yesterday. But, the MRI is TBD pending insurance pre-approval. And, then he needs to see the Orthopedist again after the MRI and that's TBD. So, no PT until then...which is also TBD.

So, what happens then? Three or four weeks until maybe he's clear? But, then there's risk of playing after a month layoff and straining something entirely different.

Is it good news or bad news that a player takes OTC medications to block pain so they can play, well, that's a fantastic question that could be aimed at you, him, and the medical professionals working with him.

I mean, playing with discomfort and soreness isn't out of the ordinary, right? Everyone who has ever played a sport in their life knows that. However, if he has a strain, could he make the recovery longer by playing on it? Yes, but if he can play at a level that is acceptable to him, the coach, the doctor and you as the parent, then that decision has to be weighed of "Is this okay enough to get through the season, does this need to be changed, or if not now, at what point does it need to change?"

If it's a tendinopathy it's along the same thought process. If it's a stress fracture that would not be the same thought process.

@XFactor - On the "good or bad news" question, I was wondering if it was a clue to the severity of the injury? He says it's very painful now. Too painful to play. In his mind, he's convinced that it's a tear and it's going to be a long recovery and possibly surgery - and there's zero chance of him playing this HS season. (Me? I say let's wait for the MRI before jumping to conclusions.) Anyway, back to the good/bad news motrin thing. My thought/wondering is this: If taking an OTC pain reliever masks the pain well enough to allow him to go and play and play as if nothing is wrong, is that a tip off on the severity of the injury? Could it possibly be a Grade 3 or a tear - worse case scenarios and most painful - and nullified by motrin? Or, does the OTC painkiller providing 99% relief mean that it's probably a Grade 1 strain and there's hope that it might be more like 2 or 3 weeks recovery rather than 4 to 6?

Have you seen anyone to evaluate him physically to determine what caused the injury? Obviously, getting healthy is key, but staying healthy is just as important. A place similar to Cressey should be able to evaluate his movements and muscle groups to see if there are weaknesses that need to be addressed.

1) On the "good or bad news" question, I was wondering if it was a clue to the severity of the injury?

There's not a clear 1:1 correlation between pain and damage. We see this rotator cuff tears, SLAP tears, with pitchers, volleyball players, etc... being pain free and fully functional. We see people with disc herniations, osteoarthritis, again being pain free and fully functional. If it is a strain, the pain level doesn't really tell you how serious it is. Low levels of self-efficacy (i.e. I can't do anything for this vs. I have the tools to improve my outcome), catastrophizing (i.e. this hurts so bad something serious must be wrong), high stress can all play a part not only in the recovery but also some of that in pain levels.

The more you think you need to protect a certain area because you fear something is wrong and damaged, your brain will pump up the sensitivity to protect that area. Case in point, there was a construction worker that jumped onto a plank and had a 7 inch nail pierce through his boot in the 90s. He went to the ER, needed strong drugs for the pain, they took an X-ray and then removed the boot. The nail had passed between his toes, it didn't pierce anything. But his pain was through the roof because of the situation (context) and his belief that he needed to protect that area. That pain was real. So pain doesn't always tell you about damage, and pain can be influenced by many things.

2) He says it's very painful now. Too painful to play. In his mind, he's convinced that it's a tear and it's going to be a long recovery and possibly surgery - and there's zero chance of him playing this HS season.

See this tells me more about where his head is at. This happened before, it happened again. It hurts, something must be wrong. And there could be, I have no idea and this isn't medical advice to him, the athletic trainers could have spoken to him about what is or isn't going on, the doctor may have done that too, so that could play into it.

3) Anyway, back to the good/bad news motrin thing. My thought/wondering is this: If taking an OTC pain reliever masks the pain well enough to allow him to go and play and play as if nothing is wrong, is that a tip off on the severity of the injury?

The severity of the injury would be assessed through taking a thorough history and through examination. So they would have asked: Has it happened before, if so what happened? How long did it take to resolve the first time? Does this feel like it does before or is there anything different? What did you do during the off season, did it hurt at all during the off season and if so what happened and how long before it felt better. What happened to cause this problem, had anything changed leading up to the event? What do you think is going on, what do you think will make this better? How much does it hurt just nothing, how much does it hurt walking, how much does it hurt swinging a bat, playing baseball, whatever aggravating activity, all good questions that I'm sure have been asked.

The examination would then look for swelling, ecchymosis, any defects in the muscle, range of motion, strength. So after all that, they'd have a good idea of how severe the injury is or isn't.

4) Could it possibly be a Grade 3 or a tear - worse case scenarios and most painful - and nullified by motrin? Or, does the OTC painkiller providing 99% relief mean that it's probably a Grade 1 strain and there's hope that it might be more like 2 or 3 weeks recovery rather than 4 to 6?

A grade 3 tear you're going to see a defect in the muscle, swelling, ecchymosis, sometimes pain but sometimes not, but it's nothing that's going to be played on.

If it's a muscle strain but he keeps hammering into the pain it won't feel better anytime soon. That doesn't mean you can't play or practice, things just may need to be modified while it settles down a bit and then build him back up to the demands of the sport. Recovery would be again anywhere from 2-7 weeks.

If it's a tendinopathy it won't feel better just slamming into it over and over, the same thing applies, except recovery would be out at least 12 weeks. People can practice and play with tendinopathy, it just depends, sometimes it's not the case.

If it's a bone injury it's not something that you'll want to play/practice on, and recovery won't be 2-3 weeks.

@TerribleBPthrower posted:

Have you seen anyone to evaluate him physically to determine what caused the injury? Obviously, getting healthy is key, but staying healthy is just as important. A place similar to Cressey should be able to evaluate his movements and muscle groups to see if there are weaknesses that need to be addressed.

Yeah. Everyone is saying it's overuse.

@XFactor posted:

1) On the "good or bad news" question, I was wondering if it was a clue to the severity of the injury?

There's not a clear 1:1 correlation between pain and damage. We see this rotator cuff tears, SLAP tears, with pitchers, volleyball players, etc... being pain free and fully functional. We see people with disc herniations, osteoarthritis, again being pain free and fully functional. If it is a strain, the pain level doesn't really tell you how serious it is. Low levels of self-efficacy (i.e. I can't do anything for this vs. I have the tools to improve my outcome), catastrophizing (i.e. this hurts so bad something serious must be wrong), high stress can all play a part not only in the recovery but also some of that in pain levels.

The more you think you need to protect a certain area because you fear something is wrong and damaged, your brain will pump up the sensitivity to protect that area. Case in point, there was a construction worker that jumped onto a plank and had a 7 inch nail pierce through his boot in the 90s. He went to the ER, needed strong drugs for the pain, they took an X-ray and then removed the boot. The nail had passed between his toes, it didn't pierce anything. But his pain was through the roof because of the situation (context) and his belief that he needed to protect that area. That pain was real. So pain doesn't always tell you about damage, and pain can be influenced by many things.

2) He says it's very painful now. Too painful to play. In his mind, he's convinced that it's a tear and it's going to be a long recovery and possibly surgery - and there's zero chance of him playing this HS season.

See this tells me more about where his head is at. This happened before, it happened again. It hurts, something must be wrong. And there could be, I have no idea and this isn't medical advice to him, the athletic trainers could have spoken to him about what is or isn't going on, the doctor may have done that too, so that could play into it.

3) Anyway, back to the good/bad news motrin thing. My thought/wondering is this: If taking an OTC pain reliever masks the pain well enough to allow him to go and play and play as if nothing is wrong, is that a tip off on the severity of the injury?

The severity of the injury would be assessed through taking a thorough history and through examination. So they would have asked: Has it happened before, if so what happened? How long did it take to resolve the first time? Does this feel like it does before or is there anything different? What did you do during the off season, did it hurt at all during the off season and if so what happened and how long before it felt better. What happened to cause this problem, had anything changed leading up to the event? What do you think is going on, what do you think will make this better? How much does it hurt just nothing, how much does it hurt walking, how much does it hurt swinging a bat, playing baseball, whatever aggravating activity, all good questions that I'm sure have been asked.

The examination would then look for swelling, ecchymosis, any defects in the muscle, range of motion, strength. So after all that, they'd have a good idea of how severe the injury is or isn't.

4) Could it possibly be a Grade 3 or a tear - worse case scenarios and most painful - and nullified by motrin? Or, does the OTC painkiller providing 99% relief mean that it's probably a Grade 1 strain and there's hope that it might be more like 2 or 3 weeks recovery rather than 4 to 6?

A grade 3 tear you're going to see a defect in the muscle, swelling, ecchymosis, sometimes pain but sometimes not, but it's nothing that's going to be played on.

If it's a muscle strain but he keeps hammering into the pain it won't feel better anytime soon. That doesn't mean you can't play or practice, things just may need to be modified while it settles down a bit and then build him back up to the demands of the sport. Recovery would be again anywhere from 2-7 weeks.

If it's a tendinopathy it won't feel better just slamming into it over and over, the same thing applies, except recovery would be out at least 12 weeks. People can practice and play with tendinopathy, it just depends, sometimes it's not the case.

If it's a bone injury it's not something that you'll want to play/practice on, and recovery won't be 2-3 weeks.

Thanks! I sincerely appreciate all your time here.

I will keep everyone posted on what happens.

My heart is breaking for him. This was going to be his most important and fun HS season. Also, he's getting some heat because the team needs him and the coaches and others don't see it since he's walking around fine. It's not like he's on crutches or in a cast or a brace. Everyone sees him and is thinking and saying "Why isn't he out there?"

I know you are well meaning but while I like how engaged you are but could it be that you are stressing him out by being that engaged into anything?

It is good to support him but in the end it is his career and you should be there to support him and maybe even sometimes giving him a little push but I wonder if the Francis emotional Rollercoaster is being tough for him.

I'm not saying he is faking it but maybe he actually is glad he is getting a little break from that.

I'm not trying to criticise you, I know you are a loving and well meaning dad but this can be tough.

I had a similar thing when I got my cancer treatment with my girlfriend. She was freaking out over it and reading every article there is and I was more let the docs do their job and whatever will be will be. I know that is super tough giving up control but in the end it stressed me almost more to worry about my GFs emotional ride and maybe it is a bit of the same for your son.

I know you don't want to pressure him but he is feeling how anxious you are and thus he has not only to carry his pressure but also your emotional ride.

Continue to support him and maybe even do some background research if it helps your mind but try to step back and chill a little even if it is super tough.

Dominik85 - I'm not pressuring him. I know he's a 100 MPH player. And, that said, running out there on three tires and no brakes is a bigger accident waiting to happen. I just want to make sure he's not jumping to conclusions and not basing decisions on emotions rather than facts. Once he gets that MRI and sees the orthopedist again, then he will know whether or not this HS season is wiped out.

He is a teenager but he also has a good head on his shoulder. Keep reminding him that is out of his control and he should focus on what he can, rehab etc. He is committed to school that is at least one stress less than he has to deal with

@2022NYC - would be worse if not committed, for sure. But, just sad (if he has to miss a lot) because this is probably the last really good season for our HS team. Losing three senior SP who are excellent. And they are two way players who bat 1st, 4th and 5th. That's another hit. There's no one in the program now who can match them next year. 2022 is going to be something like a .300 winning percentage season. This year was supposed to be a lot more fun.

Can swing the bat and get to first?  Maybe he can participate as a PH or even DH.

@Francis7 posted:

Yeah. Everyone is saying it's overuse.

What types of people have evaluated him? Overuse is a lame cause. He’s using a bunch of other muscles the same right? Why aren’t those parts overused. There has to be a structural or mechanical flaw that needs to be identified in order to fix it so it doesn’t happen again. A lot of times there is a weak muscle somewhere in the kinetic chain that causes another body part to overcompensate, in this case, the hip flexor. Why is the hip flexor hyper active?

@JCG posted:

Can swing the bat and get to first?  Maybe he can participate as a PH or even DH.

I think that's what his coach would like to see happen. He's a very good 1B and the current one is not a strong player. But, he doesn't want to risk it because running really bothers him.

@TerribleBPthrower posted:

What types of people have evaluated him? Overuse is a lame cause. He’s using a bunch of other muscles the same right? Why aren’t those parts overused. There has to be a structural or mechanical flaw that needs to be identified in order to fix it so it doesn’t happen again. A lot of times there is a weak muscle somewhere in the kinetic chain that causes another body part to overcompensate, in this case, the hip flexor. Why is the hip flexor hyper active?

I'm wondering. He's never had the issue before last summer. So, something happened. Last year he said it started when he went to block a pitch out of a one knee stance. Then it popped running. In the offseason, any time he ran a 60 in a showcase he said it really bothered him afterwards. He never got the MRI last year because he was playing. Hopefully we get an answer this time with a MRI.

At least the coach is willing to work with him around his injury to get him some field time. I think he should focus on the positive. There are lots of ways this could play out that includes him on the team. If you a not satisfied by the consult, you are in a great area to get additional opinions. Don't let the kid and yourself drown in the what ifs and coulda/woulda scenarios

If the people you’re seeing can’t give you a clear answer other than overuse, I’d find someone who can. Maybe the block or the sprint caused it. Maybe it didn’t. Why did it go away and come back? Did the people who have evaluated him done full body evaluations? The chiro that fixed my sons back could see from a video of him throwing a weak area in his core that was disrupting the chain causing other parts to overcompensate. And he isn’t a crack your back type of chiro which I thought was weird. But the guy knows his stuff. If they are only looking at his hip they are probably missing the overall cause of the injury.

I don't know if it went away and came back? Maybe it did? Not sure?

I know it happened in June 2020. Never really got better and by July 1st he couldn't walk and the orthopedist had him on crutches. Ten days later he said F-it and he was playing again. Over the next 90 days, he played around 33 games. Sometimes using motrin. Sometimes complaining of discomfort. Other times no pills and no complaining.

Then, for the next 160 days he was off the field and in the gym. 5 or 6 days a week for 2 to 3 hours each day. Some really heavy stuff - like dead lifting 800 pounds - and other times some extreme cardio. Depended on the trainer's plan and the calendar. Once in a while he would complain about the hip flexor. But, he would work around it.

Did a showcase on 2/20 and says he totally screwed it up running the 60.  Did another showcase 2 weeks later. Said he wasn't going to run but he did anyway. By the end of the showcase he said his hip was killing him.

March 26th was pitchers and catchers. Seemed OK. Practices seemed OK. Scrimmage games on April 8th and 10th he played well.

After the 10th, he says he's been using motrin to get through it and it's killing his stomach and he's not taking it anymore and he's not going to play hurt because it's too painful.

His future college coach also told him to be careful because it's the injury that ended his pro career.

We were able to get him to an orthopedist on the 16th who did an X-ray and ruled out a fracture. Recommended MRI but it requires pre-authorization by insurance before we can schedule it.

Maybe it never really healed 100% and he keeps making it worse? I don't know.

Sent you a PM

Seems like a lot of warning signs that were ignored early on. I'm sure the MRI is going to reveal some structural damage that will take time to heal. A good PT or trainer should be able to identify while it was vulnerable to begin with and strengthen the areas needed.

Francis, has your son had the MRI yet?  Was it a contrast MRI?  (I learned that from this site

One thing I forgot to mention:  I asked the doctor/surgeon if playing with (torn) hip impingments would make it worse.  No, he said.  Once it is torn, it is torn.  So, son got the cortisone shot and played the rest of the season.  But it got it fixed first thing during the summer so he could play the next season.

Thx. No MRI yet. The medical insurance is giving us a hard time on approving it. Recommended PT first but the Orthopedist didn't want to risk further aggravating it with PT.

Sorry to read. I am shocked the ins is fighting a MRI given how common this diagnostic is.

It's really stupid. The insurance has a 3rd party vendor for the review. It's done by a physician there. For all the money spent on review, probably cheaper to do the MRI. Plus, I'm the one paying for it anyway because of our deductible. But, I guess they don't want the cost to go towards satisfying our deductible.

@Francis7 posted:

It's really stupid. The insurance has a 3rd party vendor for the review. It's done by a physician there. For all the money spent on review, probably cheaper to do the MRI. Plus, I'm the one paying for it anyway because of our deductible. But, I guess they don't want the cost to go towards satisfying our deductible.

Have you considered paying out of pocket and then being reimbursed once it's approved? Where we live I think it was $300-400 but the newest MRI machine facility.

It might come to that...