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Pain in the hip flexor is a common complaint experienced by runners, football players, dancers, hockey players, cyclists, and those who participate in martial arts. It can be described as a sharp pain in the hip flexor in more acute and severe cases, and a dull ache or discomfort in milder cases or more chronic cases that are not acutely aggravated.
The hip flexor is a group of muscles that are at the front of the hip and their action is to flex the hip joint. These muscles are the rectus femoris, psoas, and iliacus. The rectus femoris is one of the four quadriceps muscles that is unique compared to the other quadriceps muscle as it is attached above the hip joint and can help hip flexion. The psoas and iliacus are often referred to together as the iliopsoas but they are two distinct muscles. They both attach to the top of the thigh bone and the psoas attaches to the lower spine at several levels and the iliacus attaches to the iliac crest of the pelvis.
Hip flexor pain location will be around these muscles at the front of the hip joint, often felt in the crease that is formed when we flex the hip. Pain is often worse when the hip is flexed actively by using these muscles and can also be aggravated by being pinched in the fully flexed hip position such as with a deep squat.
You can read more about the quadriceps muscles in our related article: Muscles of the Knee.
A strained hip flexor is when one or several of the hip flexor muscles have been worked beyond their capacity. This can be either with a single sudden overload, or an overload over time without significant time or capacity for recovery. Recovery is much shorter than a tear.
A hip flexor tear is a more severe injury to a strain, there is more tissue damage and recovery will take more time. A tear can be graded 1-3, with one being minor damage and minimal loss of function, and 3 being a complete rupture of the muscle with significant functional impairment.
Hip flexor tendonitis is an injury or overload to the tendon of one of the hip flexor muscles. A tendon connects a muscle to a bone and is structurally different from a muscle. The difference in structure means it can be affected differently to exercise and load than a muscle, and it takes longer to adapt and recover due to less blood supply amongst other reasons.
Treatment should be directed by a medical professional such as a physical therapist who has assessed your injury and has experience with musculoskeletal pain and rehabilitation. For most muscular injuries, stains, or tears, a period of rest will be necessary. The duration of the rest period, and whether complete rest or reduced activity is necessary will depend on the severity of the injury. During this time and when some exercise is introduced, the use of ice can be an effective way to manage pain. Once past the very acute phase of 7-10 days non-steroidal anti-inflammatory drugs can also be effective to use in most cases.
The best hip flexor exercises for pain relief will depend on the cause of the pain and the stage of recovery. In the acute stages, exercises should be orientated towards hip flexor pain relief. For a muscular strain, this might include gentle stretches, for a muscle tear it might be complete rest or gentle active or partially assisted movements, and for tendonitis or tendinopathy, they might include isometric exercises of the hip flexors.
Here is one of the best stretches for the hip flexors. It can be altered in different ways to stretch the specific muscles of the hip flexor group:
Chronic hip flexor pain is often related to the tendon, as muscles can heal well and relatively quickly. In some cases it can be repeated strains to the muscle, however, these would usually be identified as repeated hip flexor injuries rather than continuous and chronic hip flexor pain. Tendinopathy can develop and will remain if not treated and managed appropriately. Unlike a muscle injury tendinopathy will often not resolve with rest and a gradual increase of activity. It may need more active and specific rehabilitation. If you have hip pain that is not improving see an experienced physical therapist for an assessment and the right plan of action to resolve it.