Hip flexor injury = pain in the butt?

Injury/Nutrition Other

6 years ago 01/02/2018 3:58pm EST

Hi all,

I've been grappling with a confusing injury for six months. Has anyone else damaged a hip flexor, and had referred pain in the glutes? or anything similar to what I describe below?

It probably started with a mis-timed steeple run-up six months ago. I got far too close, wrenched by lead leg up hard, just missed the barrier, and felt a sharp pain high up in the glutes, as well as stiffness all around the hip. Things seemed to get back to normal but I wasn't in regular training then.

Over the next few weeks it turned into general stiffness all down left hip, thigh and back; back pain that got so bad I couldn't walk more than half an hour; lots of 'nerve pin' symptoms; and a near-total inability to run. Meanwhile a month or two of stretching and strengthening glutes, core, everything you can think of, I'm back to normal in terms of back pain, walking, mobility, and strength at most exercises in the gym ... except that I cannot run faster than 10-minute miles. Any faster and I get that sharp pain high up in the butt, and if I overdo it, I get pain for up to 2 days down the front/outside of right thigh. A week ago I tried a short hill stride to test out the glutes and got acute pains, had throbbing pains down outside of left thigh all next day, and needed about 3 days rest.

After 3 MRIs (lumbar, hip and knee) and numerous visits (massage, PT, orthopaedic surgeon and specialist sports rehab doctor) the docs' verdict is nothing major seems to be wrong except for an inflamed left SI joint. They cannot understand why I can't stride 100m at 7-min-mile pace, or run up a hill.

Before anyone says it, there is NO piriformis syndrome nor any gluteus medius problem. Every PT and doc suspected that, all tests are negative, and they are flexible and very strong. I also had deep massages on both glutes, and there is nothing where the pain is.

This morning I was starting a very slow jog and caught my left foot on a kerb as it was swinging forwards. Instant, massive stabbing pain in the butt, exactly like the injury I remember in June, except it was obviously the hip flexion being impeded by the concrete kerb. I've been doing some tests and it seems that anything sudden or demanding on the hip flexor produces the pain. I have good mobility (lunges, sofa stretch) but when I come out of a stretch, again, pain in the bum for the next minute. Also very bad when standing up after prolonged sitting (e.g. driving), exactly when you would expect hip flexor to complain.

So I figure I'm just "wired up wrong", I have damaged the hip flexor and I feel the pain in a misleading place, and the hip flexor needs a lot of soft tissue work and rehab.

Any similar experiences, suggestions or tests are most welcome. If it's possible to feel a pain in the wrong place, that explains everything and I know what to do.

Thanks, all...

5 years ago 08/09/2018 5:04pm EDT

re: Pain in the Butt

5 years ago 08/10/2018 8:17am EDT

re: Pain in the Butt

I'd like to know too. Bump.

4 years ago 10/15/2019 5:52pm EDT

re: Painful

Hi I’m experiencing exactly the same thing! Did you figure it out? I’m so anxious and no one seems to know what is wrong with me. It’s not piriformis and the pain is high up in the glute and feels so sharp with certain moves / running at high speeds. Please help!!! I’ve been off training for a month (cold turkey) and nothing is improving.

4 years ago 10/15/2019 6:12pm EDT

re: nf1111

Maybe a labral tear in the hip. Would need MRI with contrast to identify.

4 years ago 10/15/2019 6:21pm EDT

re: Pain in the Butt

Sounds like an overactive iliopsoas trigger point. Referral patterns are to the lower back, and the front thigh and lateral thigh. The patient usually is unable to extend the hip without feeling pain. Your symptoms seem to match. What really points to a hip flexor trigger point is your inability to run faster than 10 min pace - barely any hip flexor is required for that pace.

Best way to treat this is with trigger point release. It can be difficult. Your PT or someone you know that is experienced must be strong. They will have to find the trigger point first and tackle it via reciprocal inhibition. The PT must press down upon the trigger point, then the patient will recruit the hip extensors isometrically at the same time to stop the hip flexors from firing. It may be painful.

Good luck.

4 years ago 10/15/2019 9:16pm EDT

re: Hip flexor

Hip flexor wrote:
Sounds like an overactive iliopsoas trigger point. Referral patterns are to the lower back, and the front thigh and lateral thigh. The patient usually is unable to extend the hip without feeling pain. Your symptoms seem to match. What really points to a hip flexor trigger point is your inability to run faster than 10 min pace - barely any hip flexor is required for that pace.
Best way to treat this is with trigger point release. It can be difficult. Your PT or someone you know that is experienced must be strong. They will have to find the trigger point first and tackle it via reciprocal inhibition. The PT must press down upon the trigger point, then the patient will recruit the hip extensors isometrically at the same time to stop the hip flexors from firing. It may be painful.
Good luck.

All most ... but just shut up about trigger points; focus on the ILIACUS...(nothing to do with the PSOAS) ... look at the most proximal and medial of its fibers ... ah yes the SIJ ... make an appointment with someone who actually understands human movement and not just a bunch of confusing jargon.

Best wishes,

Jzs

4 years ago 10/16/2019 10:05am EDT

re: Jzs

Jzs wrote:
Hip flexor wrote:
Sounds like an overactive iliopsoas trigger point. Referral patterns are to the lower back, and the front thigh and lateral thigh. The patient usually is unable to extend the hip without feeling pain. Your symptoms seem to match. What really points to a hip flexor trigger point is your inability to run faster than 10 min pace - barely any hip flexor is required for that pace.
Best way to treat this is with trigger point release. It can be difficult. Your PT or someone you know that is experienced must be strong. They will have to find the trigger point first and tackle it via reciprocal inhibition. The PT must press down upon the trigger point, then the patient will recruit the hip extensors isometrically at the same time to stop the hip flexors from firing. It may be painful.
Good luck.
All most ... but just shut up about trigger points; focus on the ILIACUS...(nothing to do with the PSOAS) ... look at the most proximal and medial of its fibers ... ah yes the SIJ ... make an appointment with someone who actually understands human movement and not just a bunch of confusing jargon.
Best wishes,
Jzs

The iliacus and psoas muscle work together to flex the hip, the PT must assess both of the muscles. SIJ dysfunction can also contribute to his low back pain. Ultimately, you and I cannot make judgments about what the offending factors are or aren't because we aren't physically in front of the OP. If we were, I would punch you in the mouth and then treat this guy.

4 years ago 10/16/2019 6:14pm EDT

re: hip flexor

hip flexor wrote:
Jzs wrote:
All most ... but just shut up about trigger points; focus on the ILIACUS...(nothing to do with the PSOAS) ... look at the most proximal and medial of its fibers ... ah yes the SIJ ... make an appointment with someone who actually understands human movement and not just a bunch of confusing jargon.
Best wishes,
Jzs
The iliacus and psoas muscle work together to flex the hip, the PT must assess both of the muscles. SIJ dysfunction can also contribute to his low back pain. Ultimately, you and I cannot make judgments about what the offending factors are or aren't because we aren't physically in front of the OP. If we were, I would punch you in the mouth and then treat this guy.

Triggered much..? I’ll give you my address and see if you’ve got the balls to punch me in the mouth.

Yes the iliacus and psoas work to flex the thigh, they are by no means the same tissue..having separate innervation ...but yes, they do have a common tendon at the most distal attachment at the lesser trochanter.

Now if you’re actually interested in helping fix the issue you’d know the both insertions (prox and distal) of both the Iliacus and the psoas.. from there you’d know that the psoas 88.88% of the time is weak and inhibited; the insertions of the psoas has zero to do with the SIJ. On the other hand the proximal attachment of the iliacus has many strong fibers that run directly into the SIJ. Which might be the cause of the pain at that joint.

As for trigger points ..they don’t actually exist , but yes I would release along the entire belly of the iliacus..although you won’t be able to directly touch upon the tissue of the iliacus....what I’d look for would be the most sensitive (trigger points to you)...

Other things to consider... I’d also test the piriformis to the iliacus and the glutemax..to see how they interact with each other during the exam. Next I’d look at the TFL ..testing against the obliques...

I’m sorry you are too busy having your ago hurt to actually give sound advice to this would be client that might be at some point in time in front of you and you’ll need to get busy doing the proper work to free this person of the pain they are experiencing. Good luck and best wishes,

Jzs

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