Healthy hip flexors for cyclists

Healthy hip flexors for cyclists

by Annie Smit
Three years ago, on walking to the beach, my left hip gave way; I could not walk without support. Four to five RPM (indoor cycling) classes weekly, along with a desk job, had caused my left hip flexors to tighten excessively. Interestingly, the hip pain was all but imperceptible whilst cycling, but it certainly stopped me in my tracks when walking. Now the problem has returned, and I’m back to Step 1: Rest.
Many intricate muscles, tendons, ligaments and fascia work together to support the hips.
The hip flexors comprise:
·         Iliacus and Psoas (Iliopsoas) – the strongest hip flexor
·         Anterior thigh muscles (Rectus Femoris & Sartorius)
·         Tensor Fasciae Latae (TFL) – which inserts into the Iliotibial Band
·         Medial thigh (Pectineus, Adductor Longus & Brevis, Gracilis)
For those interested in the location & other actions of these muscles, Muscles of the hip is a good reference.
To heal an injury, you need to treat its cause—not only the symptoms. You can stretch a tight muscle, but if you don’t address the cause of the tightness, it will persist. It is also important not to overcompensate by over-stretching.
The elements that trigger an injury can be complex and quite different for everyone, as no individual body is sculpted exactly like another. However, if you address an injury with care and careful consideration, chances of recovery are excellent.
Following are six tips.
1.       Rest
2.      Strengthen the surrounding structures
3.      Continue to balance your training routine and stretch regularly
4.      Apply self-massage and/or seek out massage therapy, chiropractic treatment, osteopathy, acupuncture and/or kinesiology
5.      Before returning to cycling, enlist support to check your bike setup
6.      Combat the sitting epidemic
More details and videos follow:
Tips to heal your hip flexor
1.       Rest
It’s tough to rest from your favourite sport and find an alternative, but rest must occur to allow for the healing process. If you push through pain, the problem will worsen. Stop cycling and adjust your training routine until you are ready to resume. It’s an opportunity to try a new activity, and time to stretch.
2.      Strengthen the surrounding structures
In researching this article, I came across a study in the Journal of Orthopaedic & Sports Physical Therapy entitled “Treatment of Iliopsoas Syndrome with a Hip Rotation Strengthening Program”. This research confirmed the importance of correcting muscular imbalances. A PDF of the study is available online.
 “A central concept in all healing arts is that of correcting imbalances within the body… and anything with true healing power also has the capacity to cause injury when practiced without balance” (Ray Long).
When we strengthen the muscles (including supporting structures) that are less active during cycling, we can provide a solid platform for repetitive hip flexion. Activated supporting muscles start to awaken and join in the effort. In your weekly training schedule, include strengthening exercises and stretches for the adductors, abductors, hip flexors and hip extensors. Since time is often precious, if you do only one additional exercise, do the hip bridge (this link gives useful instructions) (& included in "Short & Simple Yoga for Cyclists" video).

 Pilates classes can be helpful; however, all you need is a resistance band and a few minutes twice a week at home. Try these video routines.
Standing routine (4 minutes):

Side lying/prone/supine routine (18 minutes):

3.      Continue to balance your training routine and stretch regularly
Along with treating the cause of the injury and strengthening the surrounding structures, we need to balance activities to avoid further—or prolonged—injury. Variety is not only the spice of life, but a healing herb. Include some serious stretching: yoga or Body Balance can work wonders. This 10-minute yoga routine will do the trick:
    
4.      Apply self-massage and/or seek out massage therapy, chiropractic treatment, osteopathy, acupuncture or kinesiology
While it’s tricky to target areas such as the Iliopsoas and TFL, a knowledgeable therapist can help you to treat tight hips. Self-myofascial release is a great way to release tightness and increase blood and fluid flow. All you need is a serrated roller and spiky ball. Move slowly over the fascia to push the fascial fluid through the area and allow new fluid to flood into the area (with thanks to Michele Waldon of Balanced Health & Fitness). Focus on the Tensor Fascia Latae (TFL) before moving to the Iliotibial Band (ITB), since TFL inserts on the ITB. Then move to the quadriceps, inner thigh area, piriformis, gluteus medius, quadratus lumborum and hamstrings. 
It’s nevertheless important not to apply trigger point release to a structure that is in pain.


For iliopsoas, stretching can be more effective. Try this static stretch, which acts to extend and internally rotate the hip:
1.       Lie in supine with knees bent up, feet hip width and both shoulders on the floor.
2.      Take both knees to the right. Carefully align the left hip and knee to keep the knee safe.
3.      As a progression, rest the right foot on the left thigh, above the knee.
4.      Hold for at least one minute while breathing deeply to allow a release.

 5.      Before returning to cycling, enlist support to check your bike setup
Before you get back into cycling, even if you “know your stuff”, get an expert or experienced cyclist (thanks Georgina Wrigley of Hype Health Club and Andries Smit) to check your bike setup—saddle and handlebar height—and cleat placement. 
·             Position saddle height to allow a soft bend in the knee at the bottom of the pedal stroke (6 o’ clock). Ensure sufficient hip extension balanced by solid hips in the saddle when pedalling. 

·             Position cleats such that the middle of the ball of the foot is in line with the middle of the pedal. How to get your road bike position right offers more comprehensive tips.
6.      Combat the sitting epidemic
Cyclists sit for extended periods with the flexed hips under tension; leading to imbalances in the structures around the hips—tight hip flexors and extensors, along with a weak core, abductors and adductors. Then, many jobs involve sitting for extended periods—behind a desk, at a conference table or driving long distances. We sit when we meet friends for a chat, and come home to sit down for dinner or watch television. Try to avoid sitting whenever you can: a swim or a long walk can clear your mind and calm your senses… something that the television won’t do for you.


 More videos can be found here.

 Sources
Button, DC, Behm, DG, Corey DJ, Cuconato, AL, Drake, CDJ, Macdonald, GZ, Mullaley, ME and Penney, MD, “An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force”, Journal of Strength and Conditioning Research, 2013. 
Cooperman, JM, “Isolated Strain of the Tensor Fasciae Latae”, Journal of Orthopaedic & Sports Physical Therapy, Vol. 5: Issue. 4: Pages. 201-203, 1984, https://doi.org/10.2519/jospt.1984.5.4.201.
Get into Road Cycling, How to get your bike position right, 2014, http://www.bikeradar.com/au/beginners/gear/article/how-to-get-your-road-bike-position-right-39738/
Gottschalk, F, Kourosh, S, Leveau, B, “The functional anatomy of tensor fasciae latae and gluteus medius and minimus”, Journal of Anatomy, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1256751/, 1989.
Johnston, C, Lindsay, DM, Wiley, JP, “Treatment of Iliopsoas Syndrome with a Hip Rotation Strengthening Program”, Journal of Orthopaedic & Sports Physical Therapy, 1999;29(4): 218-224, 1999.
Long, R, Anatomy 101: Balance Mobility + Stability in Your Hip Joints, https://www.yogajournal.com/teach/anatomy-101-balancing-mobility-stability-hips, 2016.
Long, R, Yoga Mat Companion 2: Anatomy for Hip Openers and Forward Bends, Bandha Yoga, 2010.
Long, R, Preventing Yoga Injuries vs Preventing Yoga, Part III: Joint Mobility, Stability and Proprioception, http://www.dailybandha.com/2013/12/preventing-yoga-injuries-vs-preventing.html, 2013.
Rainfrog, LLC, Pocket Yoga Poses, http://www.pocketyoga.com/Pose, 2017 (with permission)
Taylor, T, Muscles of the hip, http://www.innerbody.com/image/musc08.html#full-description

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