Hip Flexor Strain

Reviewed By: Pramod Kerkar, MD, FFARCSI

A collection of muscles present at the front side of the hip are known as the hip flexors. Hip flexors are the group of muscles helps to flex the lower lag at hip joint. The muscles involved in flexion of hip joint are known as hip flexor. The hip flexors help in bending the hip while performing activities and are specifically active while kicking and sprinting. The group of muscles that forms hip flexors are iliacus muscles, psoas major muscles, iliopsoas muscles and rectus femoris muscles. Hip flexor strain is also known as psoas strain, hip flexor tear, hip flexor injury, iliopsoas strain, pulled hip flexor, torn iliopsoas muscle and stained iliopsoas muscle. A hip flexor strain is characterized by tearing of one or more than one hip flexors. The condition results in pain that is mostly concentrated over groin.

The most frequently affected muscle in hip flexor strain is iliopsoas muscle. The iliopsoas muscle begins from the lower back and pelvis and inserts into the femur. Repeated flexion movements at hip joint causes frequent rigorous contraction or stretching of the hip flexors. Such action ads stress on muscles during and after activities. Excessive stress resulting from high force and too much repetition may force the hip flexor muscle fibers to tear resulting in hip flexor strain. The tear could be multiple microscopic or visible tear and most such injuries follows minor or intermediate bleeding and hematoma. The small and microscopic partial tear leads to minimal loss of function and minimal pain, while large tear to a total rupture may cause major disability and unexpected episode of severe pain.

Hip Flexor Strain

Types of Hip Flexor Strain

The hip flexor strain can broadly be classified into three types depending upon the condition of the injury.

  • Grade 1 tear
  • Grade 2 tear and
  • Grade 3 tear

Grade 1 Tear- Grade 1 Hip Flexor Strain occurs only in small number of fibers which is associated with mild pain, but this does not affect the functional ability.

Grade 2 Tear- Grade 2 Hip Flexor Strain involves tear in several muscle fibers, which is also associated with moderate loss of function. The majority of hip flexor strains are grade 2 strains.

Grade 3 Tear- Grade 3 Hip Flexor Strain results in complete rupturing of all or most muscle fibers, which is associated with major loss of function.

Causes and Risk Factors of Hip Flexor Strain

Hip flexor strain is caused due to a sudden contraction of the hip flexor muscles, especially in stretched position. Hip flexor strain is often caused while performing activities such as sprinting and kicking. This particularly results from a sudden explosive movement such as performing a long kick in football, without adequate warm up.

Hip flexor strain is frequently seen in kicking and running sports like soccer and football.

In some cases hip flexor strain or hip flexor tear may develop gradually due to prolonged or repetitive strain on the hip flexor muscles, which may result from excessive sprinting and repetitive kicking. Hip flexor strain is frequently seen in kicking and running sports like soccer and football.

Other Causes of Hip Flexor Strain May Include:

Muscle weakness- Individual may try a marathon running or long distance biking without adequate training. In such cases muscles are weak and not trained for continuous prolong used. The injuries often observed in gluteals, hip flexors or quadriceps. Similarly, individual after prolong illness may attempt to participate in sport like football, basketball or soccer that may result in hip muscle sprain. The malnourishment or prolong illness causes muscle weakness and muscle tightness. The muscle prone to injure are hamstrings, hip flexors, gluteals and quadriceps.

Inadequate warm up- Athlete well trained must warm up prior to starting prolong use of muscles. Individual participating in long distance running, cycling and contact sports must warm up before competition or participation to prevent muscle tear.

Joint stiffness- Aging and prolong non-activities causes joint stiffness. Movement of knee and hip joint need coordination of several muscles. Joint stiffness may cause sudden pain while involved in forceful joint movements. Such pain may induce uncoordinated muscle contraction resulting few muscle working harder and end in spasm followed by tear. The joint stiffness of knee and hip joint may cause hip flexor strain.

Poor posture- Normal or correct posture is important prevent muscle injury and tear. Poor posture leads to bad ergonomics and imbalance of muscle coordination. Poor posture often results in over or under use of group of muscles. If individual tries to sprint or performs vigorous activities weaker muscle may tear. Individual working as security guard or standing for several hours at work may maintained poor posture for several months resulting in weakness of group of flexor muscles.

Poor biomechanics- The joint movements like flexion, extension, abduction, adduction and rotation involves co-ordination of various muscles. Extensor muscle relaxes when flexor muscle contracts and vice versa flexor muscle relaxes when extensor muscle contracts. The coordination of opposing muscles is known as biomechanics. Occasional because of distraction or obstacles during activities the coordination falters and muscle injury occurs. Distraction or obstacles while running or playing contact sports may cause simultaneous vigorous contraction of flexor and extensor muscles during flexion og hip joint that may result tear of muscles of hip flexor.

Muscle Fatigue- Muscle gets fatigue after overuse or when not trained properly. Fatigue is the stage when muscle has reach metabolic endpoint. Metabolic endpoint suggest muscle glycogen concentration is depleted and blood glucose level is low. Inadequate energy supply to active muscles result in poor coordination and abnormal contractility. Continuation of sprinting or playing sports in spite pain that is caused by muscle fatigue often follows hip muscle tear.

Poor core and pelvic instability- Congenital skeletal abnormality like scoliosis, old fracture of pelvic as well as femur and old hip joint dislocation causes poor core and pelvic instability. Such injuries changes posture, causes premature muscle fatigue and loss of muscle coordination during activities. Individual suffering with poor core and pelvic instability may suffer with hip flexor injury.

Neural tightness- Nerves branches out from spinal cord and passes through various tissue to peripheral targeting organ and tissue. Nerve fibers are tightly enclosed together and known as nerve bundle or spinal nerve. The spinal nerve causes pain and symptoms like tingling and numbness if pinch or irritated by surrounding tissue along its pathway. Pinch or irritation of nerve by muscle contraction or scarring of muscles or abnormal positioning of nerve is known as neural tightness. Individual may tear hip flexor while involved in activities if suffering with sudden severe pain because of neural tightness.

Symptoms and Signs of Hip Flexor Strain

  • Person with a strained hip flexor is likely to experience symptoms of pain on the front side of the hip.
  • Sudden development of pain.
  • Worsening of pain when the thigh is raised against resistance can be a symptom of hip flexor strain.
  • Pain is experienced on stretching these muscles.
  • Tenderness is felt when firmly touching the area at the front side of the hip.
  • Signs of bruising and swelling maybe noted in severe cases of strained hip flexor.

Treatment for Hip Flexor Strain

Rest- One of the best treatment for hip flexor strain is to provide enough rest to the hip flexor muscles.

Avoiding activities- Use stretcher or wheel chair for daily domestic and outdoor activities. Avoid activities that aggravate the symptoms of hip flexor stain.

Ice therapy- Another effective treatment for hip flexor strain is ice therapy. Application of ice to the hip flexor muscles for about 30 minutes every 3 to 4 hours until pain-free. Ice therapy stops bleeding is used immediately following injury. Ice therapy helps to relieve pain in later stages.

Non-steroidal anti-inflammatory medication (NSAIDS) The injury causes can help in controlling the pain and swelling associated with hip flexor strain.

Treatment for Hip Flexor Strain

Physical Therapy- Sports and exercise must be avoided until pain free. Returning back to normal activities too quickly before appropriate recovery from Hip Flexor Strain or Hip Flexor Tear may result in chronic problem. Physical therapy for hip flexor strain is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrence of Hip Flexor Strain in future.

Physical therapy for Hip Flexor Strain or Hip Flexor Tear May Include:

  • Joint mobilization particularly the hip and lower back.
  • Using crutches to move around may be advised.
  • Soft tissue massage is an effective treatment for hip flexor strain, but this has to be done during the recovery phase.
  • Application of heat and ice.
  • Dry needling.
  • Activity modification advice.
  • Electrotherapy such as ultrasound.
  • Stretches. Doing stretching exercises regularly may be advised.
  • Progressive exercises for improvement of flexibility and strength, specifically of the hip flexors.
  • Biomechanical correction.
  • Anti-inflammatory advice.
  • Appropriate plan for returning to sports and activity program.

Exercises for Hip Flexor Strain

Hip Flexion Exercise for Hip Flexor Strain:

Hip Flexion Exercise is helpful for Hip Flexor Strain

Hip Flexion exercise for hip flexor strain is performed by lying down on the back. Now gradually bring the knee towards the chest as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Perform 10 times ensuring there is no exacerbation of symptoms of hip flexor strain.

Hip Extension in Lying Exercise for Hip Flexor Strain:

Performing Hip Extension in Lying is Helpful for Hip Flexor Strain

Hip Extension exercise for hip flexor strain is performed by lying down on the back. Now by keeping the buttocks at the very edge of the bed or bench bring the healthy knee towards the chest as far as possible in order to drop the affected leg towards the floor. Hold the position for about for about two to five seconds until a mild to moderate pain free stretch is felt. Perform 10 times ensuring there is no exacerbation of symptoms.

Quadriceps Stretch Exercise for Hip Flexor Strain:

Performing Quadriceps Stretch Exercise Helps With Hip Flexor Strain

Quadriceps Stretch Exercise for hip flexor strain is performed by standing with the hands on a wall or counter for support. Grasp the top area of the ankle and foot on the affected leg. Now pull the foot in the upward direction in order to approach the buttock until a pain free stretch is felt on the front side of the thigh. Hold the position for about 30 seconds and release. Repeat three times.

Tests to Diagnose Hip Flexor Strain

A complete subjective and objective examination is performed to diagnose hip flexor strain or hip flexor tear. Other tests that help in diagnosing and ruling out other potential causes may include:

Soft tissue injury like muscle tear may not be seen in X-Ray or CT scan. X-Ray CT Scan helps to rule out presence of fracture and dislocation or any other incidental bony abnormalities. Muscle swelling, blood clots and bone abnormalities may be observed with MRI. Ultrasound can be helpful to evaluate blood clot and muscle injury.

Hip Flexor Strain Recovery Period:

Strained hip flexor usually requires 2 to 3 weeks to heal if it is a minor tear. For a major tear of the hip flexor muscles to heal, it can take anywhere between 4 to 6 weeks or maybe a little longer in some cases of severe hip flexor strain.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:


Pain Assist Inc.

Last Modified On: September 19, 2018

This article does not provide medical advice. See disclaimer

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