Acute Hip Flexor and/or Groin Injury - Three Weeks Out from a Marathon

If it were me, I would go straight to my applied kinesiologist because she can fix this sort of thing 9 times out of 10.

Where do you live?

Google "applied kinesiologist" plus the name of your city and find one.

DO NOT run your marathon with this "minor" problem. You might injure yourself for months or years by favoring one leg during the marathon.

Thanks - just made an appointment.

That's insane dude, that describes what I'm dealing with to a T. Started about 10 weeks ago, and got worse and worse, to the point where I am in week #2 of no running PERIOD. I never made an appt with a doc, but I wish I did. It was so hard to determine if the injury was in my groin or hip flexor, but my symptoms match yours exactly, perhaps higher on the pain scale. Hopefully you will be able to train through yours with some good rehab. I let my pain progress to the point where I had to completely stop, and have cancelled a race next month. There are some intense stretches that help, so maybe ask the doc about those. Good luck.

Thanks. Hopefully it won't come to that point. I'm planning on taking it as easy as I can over the next few weeks as part of my taper. I'll see what my doc says today.

Does it hurt when you crunch your trunk, do ab work...if so then you may have a sports hernia/athletic pubalgia.

Nope, ab work/crunching feels fine.

could be psoas as it's an under appreciated source of hip flexor pain felt in the groin. Google it for some simple ways to check psoas tightness or dysfunction.

Do you have a tight inguinal ligament? And do you have any minor lower back pain on the affected side? Does it hurt to bend to either side or ache?

It sounds possible that you overstretched the psoas major (causing minor microtears) and then allowed that injury to become somewhat acute by finishing your run. This would create more microtears and cause you to have more inflammation. If you did stretch the Psoas Major, it fits your pain pattern (especially when you describe it hurting to stand on the affected leg and bend over slightly to put on your paints). Your PM's function is to bend your torso towards your legs in a closed-chain scenario (foot planted).

It sounds like you keep moving in and out of an acute phase of healing and a subacute phase and cannot get past those tissue stages because you continue to run on it. I realize the pain is not a 8-9/10. I still think it would be in your best interest to not just "take it easy" but to STOP running. Find an activity that does not cause any aching/tightness/etc. If the muscle feels tired after the first 5 minutes (may not hurt any worse) still stop doing that activity. While you don't sound like you have a grade II-III tear or strain, you do sound like you are progressing slowly into a gradual state of inflammation which to be quite honest, is not good. It's much harder to get rid of a chronic inflammation problem than it is to rest a strain/tear for X amount of weeks. The rehab is pretty black and white.

Personally, I would do the following:

1. RICE as much as possible for take next 72 hours. Take NSAIDs then wean off them within 5-7 days.

2. Begin gentle PROM movements and Passive stretching (having someone help you is best). You can lay supine and have them just move your leg around through all the ranges of motion. It doesn't have to be in a certain order. It just needs to be passive, gentle, and ideally for 20-30 minutes of just relaxed movement.

3. Massage the entire area yourself 2-3 times a day (I realize it's time consuming but it works wonders for hip flexor inflammation). You cannot palpate the entire muscle but you can work on the surrounding area, loosen up your groin, and also your abdominal wall. This will really help to relax the area in general and promote healing.

4. Once you have zero pain during passive stretching movements or only feel pain near the end range of motion it's OK to start doing more active stretching and exercises to begin strengthening the area.

Soak a washcloth in icewater, and press it onto the injured area.

As the injury gets cold (5-10 seconds), move your legs gently, and keep pressing the icewater washcloth where you feel any pain.

Do this several times a day, always with the icewater, always with the gentle movement of your legs. You should be 90 percent better in 2 or 3 days.

Sorry - but you might have a labral tear. Not a good thing.

Had an appointment yesterday with an ART doc. The appointment was extraordinarily painful. However, for about an hour afterward, I could walk without pain, and felt great. This morning, I have been a bit sore while walking around. Perhaps that's due to inflammation from the appointment. I have another appointment on Monday. Not planning on running today.

How did you find the ART doc? Is that similar to an applied kinesiologist?

I found the doc because I had gone to him before and he had successfully treated one of my prior injuries. He is an Active Release Therapist -- I am actually not sure what an applied kinesiologist is.

Crazy - you could have been healed by now.

Well, it's looking less and less likely that I'll be able to run the marathon. My hip/groin has continued to regress despite taking two days completely off. It hurts to walk more than it did before. I tried lightly using the stationary bike and then attempting to jog on a treadmill. Immediately upon attempting jogging I was limping and in pain. And the pain was probably higher on the pain scale than before. I'm going to try to swim/aqua jog as much as I can to stay fit, but I doubt I'll be ready for a marathon in two weeks and two days.

Very common - labral tears - been there. Your symptoms are suggestive. Google hip labral tear and/or femoroacetabular impingement. Nick Willis, Tyson Gay and Lisa Dobrisky had them. Sorry about the marathon. Agree you should bag it.

If it's a tear, I suppose I need surgery, right? How long is the recovery time?

A small tear can usually be dealt with with PT. A larger tear (which I had) can only be fixed surgically which depending on the extent, can take a minimum of 12 weeks to up to a yr to fully heal. You would need a MR arthrogram to diagnose.

I dont wish to throw a wet blanket on what is hopefully a more minor problem, but labral tears are underdiagnosed. Keep aquarunning. Easy backstroke kicking is also beneficial for strengthening, and stay off the roads.

Well, if the wet blanket is wet becauase it was floating in ice water, and I can use it to massage my hip, then I don't mind.