Hip Flexor Muscles and Injuries (2023)

The hip flexor muscles are a group of muscles situated near the top of your thighs that allow you to lift your knee toward your chest, squat, and bend forward at the hip. The five key hip flexor muscles include the iliacus, pectineus, psoas major, rectus femoris, and sartorius, which work together to enable hip flexion.

When these muscles are involved in explosive leg movements or placed under extreme stress while jumping or running, they can be injured. This can lead to a hip flexor strain in which one or more of the hip flexor muscles becomes stretched or torn.

This article explains how the hip flexor muscles work and common causes of hip flexor pain, stiffness, or tightness. It also explains how to treat hip flexor injuries or prevent them with stretches and strengthening exercises.

Hip Flexor Muscles and Injuries (1)

Hip Flexor Anatomy and Function

Flexion refers to a bending movement that decreases the angle between two body parts. When a flexor muscle contracts, it draws two bones together, typically bending at a joint.

In the case of the hip flexors, they draw together the bones of the leg and the bones of the hip or spine at the hip joint. If the hip is already flexed, such as when you are sitting, these muscles aren't working.

A sedentary lifestyle can lead to weak and tight hip flexors, which are always in a shortened position. Tight hip flexors can lead to a limited range of motion, poor posture, lower back or hip pain, and even injuries.

Your hip flexors get a workout when you are standing and doing movements such as raising your leg to climb stairs, run, or ride a bicycle.​

Hip Flexor Muscles

The muscles that make up the hip flexors include:

  • Psoas major: The psoas muscle is a deep muscle that connects your spine to your leg. In fact, it's the only muscle that does so. It runs from your lower back through your pelvis, passing to the front of your hip, where it attaches to the top of your femur, which is your thigh bone.
  • Iliacus: The iliacus is a flat, triangular muscle that lies deep within your pelvis. It attaches from your pelvis to your thigh bone (femur). Its primary action is to flex and rotate your thigh.
  • Rectus femoris: This muscle is one of the four quadriceps muscles attaching your pelvis to the patellar tendon of your knee. Squats and lunges exercise the rectus femoris.
  • Pectineus: The pectineus muscle is a flat, quadrangular muscle that lies at the top of your inner thigh, often referred to as your groin muscle. It's primarily responsible for hip flexion but also rotates your thigh and adducts, which means it pulls your legs together when the muscles contract.
  • Sartorius: The sartorius muscle is a long thin muscle that runs down the length of your thigh from your pelvis to your knee. It's the longest muscle in the human body and helps flex the knee and leg.

Hip Flexor Injury Symptoms

The chief symptom of a strained or torn hip flexor is pain in the area at the front of your hip where it meets your thigh. Your experience can vary and may involve:

  • Mild pain and pulling
  • Cramping and sharp pain and/or severe pain
  • Bruising
  • Swelling
  • Muscle spasms (in the case of a complete tear)

You may feel pain or a pulling sensation when you come up from a squat or when you stand up after sitting.

With a complete tear, which isn't as common as a strain, it may be hard to walk.

Causes of Hip Flexor Pain

You can strain or tear one or more of your hip flexors when you make sudden movements such as changing directions while running or kicking. Sports and athletic activities where this is likely to occur include running, football, soccer, martial arts, dancing, and hockey. In everyday life, you can strain a hip flexor when you slip and fall.

You're more likely to get a hip flexor injury if you've had one in the past, you don't warm up properly before engaging in athletic activity, your muscles are already tight or stiff, or your muscles are weak from being overused.

If, while exercising, you try to do too much at once in too short an amount of time, you can also put yourself at risk for a hip flexor injury.

Diagnosing Hip Flexor Problems

Muscle injury grading systems and classifications are currently being revamped and studied to be more comprehensive so they can include more precise diagnostics. However, the traditional grading system is often still used.

Grade I (Mild)

A grade I injury is a small tear in your muscle that's mildly painful and may cause some minor swelling and tenderness. You're able to continue doing your regular activities, including sports. It may take a couple of weeks to recover fully.

(Video) Injury Spotlight - Hip Flexor Strain

Grade II (Moderate)

A grade II injury is a larger tear in your muscle that makes it difficult to move and causes a moderate amount of pain, especially when you move the affected muscle, swelling, and tenderness. You may have 5% to 50% loss of function, and you may be limping.

You can't go back to sporting activities until the tear is completely healed. These injuries can take anywhere from a couple of weeks to a few months to heal, depending on how bad they are.

Grade III (Severe)

A complete tear in your muscle causes severe pain and swelling. You can't bear weight on that leg, making it difficult to walk. You've also lost more than 50% of your muscle function. These injuries are less common and may need surgery to repair the torn muscle. They can take several months or more to heal completely.

Hip Flexor Treatment

As long as it's not severe, you should be able to treat your hip flexor strain or tear at home using the PRICE (protection, rest, ice, compression, elevation) protocol and pain relievers. Here's what to do:

  • Protection: Protect your injury to keep it from getting worse or injured again. For example, you can use a walking support to take pressure off the hip.
  • Rest: Stay off your hip as much as possible for the first few days and avoid any activities that cause pain.
  • Ice: Using ice or a reusable ice pack can help relieve pain and reduce muscle swelling. Apply immediately after you get the injury for 20 minutes and repeat every three to four hours for the next two to three days.
  • Compression: If you're worried about swelling or find that it's increasing, try wrapping the injured area lightly with a bandage or wearing compression shorts.
  • Elevation: Put your leg up so it's higher than your heart as often as possible. This helps reduce swelling and inflammation. (Note that this may be harder to achieve with a hip injury; ask your healthcare provider or physical therapist for hip-specific protocols.)

You can use over-the-counter remedies such as Motrin or Advil (ibuprofen) or Aleve (naproxen) to help with pain and swelling. Tylenol (acetaminophen) works for pain relief but doesn't treat inflammation and swelling.

If you have heart disease, high blood pressure, kidney disease, or if you've had ulcers or internal bleeding, check with your healthcare provider before taking any of these medications.

When to See a Healthcare Provider

If your symptoms don't improve within a couple of weeks or you start having a hard time moving your leg and/or hip, it's time to see your healthcare provider. Your injury could be more severe than you originally thought. It may require other treatments, or it may be unrelated to the hip flexors entirely.

Physical Therapy

You may be given exercises to do at home, including hip flexor stretches. If your strain is severe or it isn't getting better, you may need to see a physical therapist who will help you work on gradually strengthening and stretching your muscles. Complete tears may require you to use crutches until you're healed and to seek surgery to reconnect the muscle.

You can also consider soft tissue release techniques and trigger point therapy. These are both alternative therapies that help treat and relieve pain. A soft tissue release is an advanced form of massage therapy that targets specific muscle fibers that have become damaged or tangled up and helps stretch and strengthen them.

Trigger point therapy focuses on trigger points, which are areas that cause pain when they're compressed. However, when pressure is put on these trigger points, it can actually relieve pain. This can be done with dry needling, chiropractic care, or massage.

Preventing Hip Flexor Problems

To prevent hip flexor injuries, keep these tips in mind:

  • Always warm up before engaging in any exercise or physical activity, even if it's just practice.
  • Make sure you do a cool down after activity. Slowly stretch each muscle group and hold the stretch for a few seconds.
  • Keep your muscles in good shape by regularly exercising. Exercises that help stretch and strengthen your hip flexors include pigeon pose, bridges, lunges, seated butterfly stretch, straight leg raises, and squats. Don't push too hard; these shouldn't hurt.
  • Work on strengthening your core muscles and glutes. These muscles work together to give you balance and stability and to help you move through the activities involved in daily living, as well as exercise and sports. When one set of these muscles is weak or tight, it can cause injury or pain in another, so make sure you pay equal attention to each.
  • Before you go back to your regular exercise or sports, be sure that your injury has fully healed and that the muscles are back to the same strength and flexibility you had before the injury (or better). Not taking enough time to heal can lead to reinjuring yourself, which can set you back even further.

Frequently Asked Questions

  • What is the primary hip flexor?

    The pectineus is the primary muscle in charge of flexing the hip. Other hip flexors include the psoas major, iliacus, rectus femoris, and sartorius, each of which has its own unique role.

  • What are symptoms of tight or weak hip flexors?

    Symptoms of tight or weak hip flexors include a limited range of motion, lower back and hip pain, and poor posture.

    (Video) Everything You Need to Know About Treating Hip Flexor and Iliopsoas Injuries
  • Where are the hip flexors located?

    The hip flexors are primarily located in and around the pelvis. The muscles originate at the spine or pelvis and attach to the thigh bone. Some muscles, like the rectus femoris, reach all the way down to the knee joint.

  • Where is hip flexor pain felt?

    Hip flexor pain is typically felt where the thigh meets the pelvis in the upper groin. The pain can be felt closer to the inner thigh, across the front of the thighs, or in the front of the up. Tight hip flexors are commonly caused by sitting for long periods.

  • Should I stretch my hip flexor if it hurts?

    It depends. Stretching your hip flexors before and after physical activity or anytime they feel tight can help relieve pain and improve the range of motion. But use your judgment. In general, a stretch should feel good or mildly sore. If stretching your hip flexor increases your pain, don’t force it.

    It is possible to over-stretch your hip flexors and make the pain worse. If you have been trying to relieve hip flexor pain through stretches without success, take a break from stretching for a few days to see if that improves it.

  • How do you relieve hip flexor pain?

    Sore hip flexors can be relieved with moist heat, ice, and over-the-counter NSAID pain relievers like Advil (ibuprofen) or Aleve (naproxen). Hip flexor exercises and stretches can also be helpful for easing tight hip flexors and relieving pain.

    (Video) Hip flexor strain: Mechanism of injury, diagnosis and treatment

4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. MedlinePlus. Hip Flexor Strain—Aftercare.

  2. Grassi A, Quaglia A, Canata GL, Zaffagnini S. An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. 2016;4(1):39-46. doi:10.11138/jts/2016.4.1.039

  3. Mount Sinai. Hip flexor strain - aftercare.

  4. Harvard Medical School, Harvard Health Publishing. The Real-World Benefits of Strengthening Your Core.

Additional Reading

  • GRASSI A, QUAGLIA A, CANATA GL, ZAFFAGNINI S. An Update on the Grading of Muscle Injuries: a Narrative Review From Clinical to Comprehensive Systems. Joints. 2016;4(1):39-46. doi:10.11138/jts/2016.4.1.039.

  • Massagetique. Soft Tissue Release.

  • Ortho Info. Hip Strains. American Academy of Orthopaedic Surgeons.

    (Video) Hip Flexor Pain | Strain | Tendinitis | Tendinopathy Rehab (Iliopsoas Strength & Mobility Exercises)

By Elizabeth Quinn
Elizabeth Quinn is an exercise physiologist, sports medicine writer, and fitness consultant for corporate wellness and rehabilitation clinics.

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(Video) Best Exercises For Hip Flexor Pain - From a Physical Therapist

FAQs

Which muscle is involved in a hip flexor injury? ›

A hip flexor tear or strain is an injury to the muscles in the hip. The hip flexors are the group of muscles, including the iliacus and psoas major muscles (iliopsoas) as well as the rectus femoris (part of quadriceps).

How do I know if my hip flexor is strained or torn? ›

Symptoms of a hip flexor tear or strain

Pain when lifting the leg to the chest or stretching the hip muscles. Swelling, bruising or tenderness in the hip or thigh area. Muscles spasms in the thigh or hip that occur when walking or running.

What does a hip flexor injury feel like? ›

The most common symptom of a hip flexor tear or strain is pain located at the front of the hip. You may experience hip pain as you walk or run. Other symptoms associated with hip flexor tears or strains include: Sharp pain in the hip or pelvis after trauma.

How long does it take for a hip flexor muscle to heal? ›

The recovery time for a hip flexor strain will depend on the severity of the injury. It typically requires one to three weeks of rest and treatment to recover from mild conditions fully. On the other hand, more severe cases can take around four to six weeks or longer.

Can you walk if you tear your hip flexor? ›

Depending on the extent of damage sustained, a hip flexor strain may be felt either as mild pain or a sharp and cramping one that can make it hard for you to walk without limping. The reason behind it is that the top of the thigh muscle may budge, making it hard for you to walk, indicating a tear which is less common.

What is the fastest way to heal a hip flexor strain? ›

Applying ice or heat to the affected area of the hip or groin. This can be done with ice cubes or frozen vegetables (in plastic bags) wrapped in a towel, or a hot water bottle. Compressing the affected hip with an elastic bandage to reduce any swelling. The elastic bandage can be wrapped around the hip and pelvis.

Should I stretch a sore hip flexor? ›

Hip flexor stretch (kneeling)

If you feel discomfort in the front of your knee, place a towel under your knee. Keeping your back straight, slowly push your hips forward until you feel a stretch in the upper thigh of your back leg and hip. Hold the stretch for at least 15 to 30 seconds. Repeat 2 to 4 times.

How do you fix a sore hip flexor? ›

How to Relieve Hip Flexor Pain in 30 SECONDS - YouTube

How do you treat a hip flexor injury? ›

How are hip flexor strains treated?
  1. Rest: Stop the physical activity that caused your strain to avoid further damaging your muscle.
  2. Ice: Apply an ice pack or cold compress for 10 to 15 minutes every hour for the first day after your injury.
3 Aug 2022

Where is hip flexor pain located? ›

You will feel a hip flexor strain in the front area where your thigh meets your hip. Depending on how bad the strain is, you may notice: Mild pain and pulling in the front of the hip. Cramping and sharp pain.

Does heat help hip flexor pain? ›

You should use heat if you are experiencing tightness, stiffness, or if you are still having soreness several days after a workout or race. Such injuries may include: Significant hamstring, calf, or hip flexor tightness. Knee stiffness.

Will a hip flexor strain heal on its own? ›

Usually, a hip flexor injury will get better with time and rest. However, if you have symptoms that persist beyond one to two weeks, see a doctor to rule out other injuries and ensure you get the proper treatment.

How should I sleep with hip flexor pain? ›

Managing hip pain at night
  1. Change your sleeping position. Keep experimenting to find the most pain-reducing position.
  2. Place wedge-shaped pillows under your hip to provide cushioning. ...
  3. Sleep with a pillow between your knees to reduce stress across your hips.
  4. Put one or more pillows under your knees.

How do I know if my hip pain is serious? ›

Seek immediate medical attention
  1. A joint that appears deformed.
  2. Inability to move your leg or hip.
  3. Inability to bear weight on the affected leg.
  4. Intense pain.
  5. Sudden swelling.
  6. Any signs of infection (fever, chills, redness)

Should I massage hip flexor strain? ›

Stretching and massaging your hip flexors can help loosen these muscles and decrease any pain you're feeling. An added benefit is increased flexibility, so this is an important exercise to try.

How do you massage hip flexors? ›

Psoas Release Techniques (4 Ways to Massage Hip Flexors) - YouTube

What causes chronic hip flexor pain? ›

Hip flexor strains are often caused by either overuse or periods of prolonged sitting combined with weak hip muscles. While this condition is typically not serious, it can be quite painful and can severely limit your activity if left untreated.

Can sitting too much cause hip flexor pain? ›

A sedentary lifestyle can lead to tight hip flexors and hip flexor pain. That's because excessive sitting causes the muscles to relax and deactivate. They become progressively weaker and shorter, sometimes causing a painful condition called adaptive shortening.

Can a chiropractor help with hip flexor pain? ›

With appropriate manipulations and adjustments, chiropractic care can alleviate hip flexor pain and discomfort.

What does a pulled hip muscle feel like? ›

Symptoms of hip flexor strain

sudden, sharp pain in the hip or pelvis after trauma to the area. pain when lifting the leg. cramping, stiffness, and weakness in the muscles of the upper leg area. swelling.

Why is hip pain worse at night? ›

What causes hip pain when sleeping? A variety of conditions can cause hip pain when sleeping. The most common causes are bursitis, osteoarthritis, sciatic-piriformis syndrome and tendonitis. Other causes include injury to your muscles or soft tissues, pregnancy, the position you sleep in and your bed or pillows.

What is the best exercise for hip pain? ›

The best types of exercise when you have hip or knee pain
  • An elliptical trainer. ...
  • A stationary bike. ...
  • A rowing machine. ...
  • Pool exercises. ...
  • Short brisk walks. ...
  • Tai chi.
1 Aug 2021

How should I sit to avoid tight hip flexors? ›

Seated Hip Flexor Stretch
  1. Begin sitting upright in a chair.
  2. Move to the side of the chair, extending your leg back backward.
  3. Hold onto the chair or another sturdy object for balance.
  4. Gently rock your pelvis forward to feel a stretch in the front of your hip.
21 Oct 2019

Where are the hip flexor muscles? ›

Your hip flexors are a group of muscles along the front of your upper thigh. They include the iliacus, psoas major, rectus femoris and sartorius.

What causes hip flexor injuries? ›

Sudden movements, such as sprinting, kicking, and changing direction while running or moving, can stretch and tear the hip flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to have this type of injury.

What muscles are involved in hip extension? ›

The primary hip extensors include the gluteus maximus, posterior head of the adductor magnus, and the hamstrings (TABLE 2).13 , 17 In the anatomic position, the posterior head of the adductor magnus has the greatest moment arm for extension, followed closely by the semitendinosus.

What muscle wraps around your hip? ›

The psoas muscle is located in the lower lumbar region of the spine and extends through the pelvis to the femur. This muscle works by flexing the hip joint and lifting the upper leg towards the body.

How do you treat a strained hip flexor? ›

How are hip flexor strains treated?
  1. Rest: Stop the physical activity that caused your strain to avoid further damaging your muscle.
  2. Ice: Apply an ice pack or cold compress for 10 to 15 minutes every hour for the first day after your injury.
3 Aug 2022

Where is hip flexor pain felt? ›

You will feel a hip flexor strain in the front area where your thigh meets your hip. Depending on how bad the strain is, you may notice: Mild pain and pulling in the front of the hip. Cramping and sharp pain.

Should you stretch a strained hip flexor? ›

Stretching the hip flexors when they feel tight can help improve your mobility. Keeping these muscles loose and flexible can also help you avoid issues with other muscle groups, like the quadriceps or low back.

Does heat help hip flexor pain? ›

You should use heat if you are experiencing tightness, stiffness, or if you are still having soreness several days after a workout or race. Such injuries may include: Significant hamstring, calf, or hip flexor tightness. Knee stiffness.

What does iliopsoas pain feel like? ›

The symptoms of Iliopsoas tendinopathy/bursitis are: A deep aching pain felt in the front of your hip (in the crease of your hip). A clicking or clunking sensation or sound when flexing your hip (lifting your knee up). Sharp pain with sitting and standing, especially after prolonging sitting.

How would you test for a hip extensor strain? ›

Hip Extension Assessment - Quick Test - YouTube

Which muscle is the prime mover for hip extension? ›

The primary hip extensors are the gluteus maximus and the hamstrings (i.e., the long head of the biceps femoris, the semitendinosus, and the semimembranosus). The extensor head of the adductor magnus is also considered a primary hip extensor.

Which muscle flexes the thigh at the hip? ›

The sartorius flexes, abducts, and laterally rotates the thigh at the hip joint. It also aids in the flexion of the knee joint and the medial rotation of the leg in this position. The sartorius is a long band-like muscle that runs lateral to medial, crossing the anterior aspect of the thigh.

Does an MRI show psoas muscle? ›

MR images provided better contrast between the normal and abnormal psoas than CT scans in nine cases; MR images were inferior to CT scans in two cases because calcifications (one case) and air bubbles within an abscess (one case) were not detectable.

What does iliopsoas bursitis feel like? ›

Most people with iliopsoas bursitis feel pain in the front of the hip and the groin. Sometimes it radiates down the inside of the thigh to the knee. The area can also be tender when touched. Bending (flexing) your hip—like when jogging, walking up stairs, and standing up from a seated position—makes the pain worse.

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