Anatomy: The deep hip flexor (M iliopsoas) consists of two muscles. The Psoas muscle originate from the lumbar vertebra and the Iliacus muscle from the inside of the hip bone. The two muscles fuse and are both fastened on the inside of the femur (trochanter minor). The iliopsoas is the strongest flexor muscle of the hip joint.

Symptoms: In light cases a local tenderness is felt after the load (“sprained muscle”, “imminent pulled muscle”) e.g. kicking a ball with the instep. In severe cases a sudden shooting pain is felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a violent snap is felt, rendering the muscle unusable for e.g. walking up stairs (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain upon pressure, stretching and activation against resistance. In some cases the bleeding can be so great that it entraps the nerve to the bone (nervus femoralis) with increasing pains, reduction of power and symptoms into the leg (article).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort when walking normally (“sprained muscle”, “imminent pulled muscle”), medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In case of more pronounced tenderness or pain medical examination is required to ensure the correct diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. It is known that the larger the bleeding is assessed in the ultrasound scan, the longer the rehabilitation period (Ultrasonic image), (article).

Treatment: The treatment usually consists of relief and careful rehabilitation (article). Only in very rare cases is surgery indicated (e.g. in case of total ruptures or very heavy bleeding).

Complications: In case of lack of progress it should be considered if the diagnosis is correct or whether complications have arisen. In particular the following should be considered:

• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture in the femoral neck
• Complications for muscle ruptures

Anatomy: The superficial hip flexor (the forward straight thigh muscle, musculus quadriceps femoris) originate from the front edge of the hip (processus spinosus anterior inferior) and from the upper edge hip joint socket (acetabulum). The muscle is joined by three of the other thigh muscles and is attached in a common joint muscle tendon (quadriceps) on the upper edge of the kneecap (patella). The function of the superficial hip flexor is to stretch the knee and bend in the hip.

Symptoms: In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”, “tendinitis”). The symptoms can often decrease after a thorough warm-up, only to return when the sports activity has ceased. In severe cases a sudden shooting pain is felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain when applying pressure, stretching and activation against resistance. In total ruptures a defect in the muscle can often be seen and felt, and a swelling is felt above or below the rupture (the contracted muscular belly and the bleeding).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort with ordinary walking, medical examination is not necessarily required. The extent of the tenderness is, however, not always a mark of the degree of the injury. In cases of more pronounced pain or tenderness, medical examination is required to ensure the correct diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed (Ultrasonic image). X-ray examination is recommended when it is suspected that the bone on which the muscle tendon fastens has been torn off.

Treatment: The treatment usually comprises relief and rehabilitation. Only in very rare cases is surgery indicated (e.g. total ruptures in the muscle tendon, close to the fastening). Even large ruptures in the femoral muscle can usually be rehabilitated without resulting in functional harm (but often cosmetic damage, with an irregular femoral muscle). If the condition concerns tendinitis where there has been no sensation of a “snap” in the muscle, and smooth improvement has not been achieved after relief and gradually increasing rehabilitation, treatment can be supplemented with rheumatic medicine (NSAID) oand possibly injection of corticosteroid in the area surrounding the inflamed part of the muscle attachment point. If it concerns ruptures, (“total or partial muscle rupture”) the injection of corticosteroid is not indicated.

Complications: If the treatment does not progress according to plan, it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

• Complications for muscle ruptures
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Degenerative arthritis in the hip joint
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture in the femoral neck
• Nerve entrapment

Anatomy: Between the deep hip flexor and the joint capsule is a large bursa (bursa iliopectinea), with the function to reduce the load on the muscle, when it slips over the hip joint. The bursa often communicates with the hip joint.

Symptoms: Pain when applying pressure on the bursa, which occasionally (but far from always) may feel swollen. Pain is agravated upon activation of the deep flexor (flexing the hip joint).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain or lack of progress a medical examination should be carried out to ensure that the diagnosis is correct and commence any treatment. The diagnosis is most easily and quickly made with ultrasound (which allows simultaneous treatment) (article).

Treatment: The treatment primarily comprises relief. The treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa preceded by draining of the bursa, which can advantageously be done under ultrasound guidance (article).

Complications: If progress is not smooth the correctness of the diagnosis or whether complications have arisen, should be considered:

• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture of the femoral neck
• Inguinal hernia
• Inflammation of the adductor muscle of the thigh (tendinitis m adductor longus)
• Rupture of the adductor muscle of the thigh (ruptura m adductor longus)
• Rupture of the abdominal muscle fastening on the pubic bone (ruptura m rectus abdominis)
• Inflammation of the pubic bone joint (osteitis pubis)
• Nerve entrapment
• Lumbago

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: On the outside of the outer femoral bone projection (trochanter major) is a large bursa which reduces the load on muscles and tendons when these slide over the bone projection.

Symptoms: Pain when applying pressure on the thigh corresponding to the bursa, which sometimes (but far from always) can feel swollen. The pain can radiate down the thigh.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness medical examination is not necessarily required. In case of more pronounced pain or lack of progress, a medical examination should be carried out to ensure the diagnosis and commencement of any treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed (Ultrasonic image).

Treatment: The treatment primarily comprises relief. If the direct cause of the complaint is known, it should of course be removed. The treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa, which is best performed under the guidance of ultrasound.

Complications: If progress is not smooth, the correctness of the diagnosis should be considered or whether complications have arisen:

• Tendinitis at the sitting (ischiatic) bone
• Rupture of the rear femoral muscle fastening on the sitting (ischiatic) bone
• Piriformis syndrome
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture of the femoral neck

Special: Shock absorbing shoes or inlays will reduce the load. In case of lack of progress or recurrences after successful rehabilitation it can be considered to have a running style analysis, to evaluate whether correction of the running style is indicated.