What Causes Hip Flexor Pain—and How Do You Treat It?
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Medically reviewed by Theresa Marko, PT
The hip flexors are a group of muscles located toward the front of your hips and the top of your thighs. There are five types of hip flexor muscles: the iliacus, pectineus, psoas major, rectus femoris, and sartorius muscles. You use these muscles to lift your knees and bend forward at the hip. These muscles also help maintain the stability of the pelvis when you walk, run, or perform other physical activities.
Hip flexor pain often happens when you over-stretch or tear these muscles when you do a sudden movement, like sprinting or kicking. The pain is common among athletes, but can occur in anyone who participates in rigorous exercise or plays contact sports—especially without stretching before activity. Hip flexor pain can range in severity, but treatments like rest, medications, and therapy can support recovery.
What Does Hip Flexor Pain Feel Like?
Hip flexor pain affects the front of the hips and the top of the thighs. Specific symptoms depend on the exact cause of your pain and the severity of your condition. Pain in your hip flexors may cause:
Dull pain or tension on the front of your hips
Muscle stiffness
Sharp, stabbing pains
Limping
Difficulty walking
Trouble standing up from a seated position or squat
Trouble climbing stairs or walking downhill
Limited range of motion
In more serious cases, hip flexor pain may cause muscle spasms, swelling, extreme pain, bruises, and difficulty walking without crutches. These symptoms may be a sign of a complete muscle tear. In some cases, a hip flexor injury can also cause other discomfort, such as lower back, ankle, or knee pain.
Potential Causes
In most cases, hip flexor pain occurs when these muscles and tendons become overstretched and tear. Common causes of pain in your hip flexors include injury, posture problems, and a sedentary lifestyle.
Injury
Since the hip flexors work to raise the knees and flex the hips, pain can often occur when you experience an injury, accident, or fall. Sprinting, kicking, or changing direction while running or in motion can also strain and damage these muscles. Sudden and jerky movements may also impact the muscles and lead to hip flexor pain.
Athletes—especially those who perform high kicks or jumps—are particularly prone to hip flexor injuries. This includes people who play sports like soccer, hockey, kickboxing, football, cycling, gymnastics, dance, track and field, and martial arts. Your risk for hip muscle injuries also increases if you have muscle weakness, improper conditioning, lack of warm-up or stretching before activity, and a previous hip injury or muscle strain.
Postural Problems
Poor posture can also weaken or damage hip flexor muscles. Walking with a slouched posture or having a condition like kyphosis (a rounded spine) or lordosis (curved lower spine) can put extra pressure on your hips, back, ankles, and knees. The extra pressure can increase the risk of muscle strains and lead to pain.
Sedentary Lifestyle
Another common cause of hip flexor pain is having a sedentary lifestyle—sitting too much and not getting enough physical activity. This reduces hip mobility, which makes the hip flexors tighten and increases the risk of pain and injury. Since these muscles assist with spine stability, not moving your body can also contribute to lower back pain.
When to Contact a Healthcare Provider
If you're experiencing muscle pain in your hips, it's important to contact your healthcare provider for testing or ask them for a referral to a physical therapist for assessment, diagnosis, and treatment. But, you may need more immediate medical support if you:
Had a fall or serious athletic injury
Experience bleeding, bruising, or deformity in your leg
Can't move your hip, walk, or stand on your leg
Diagnosis
Healthcare providers diagnose hip flexor pain by evaluating your medical history and assessing your symptoms. They’ll ask about your previous injury history, any other health issues you have, medications you're taking, and if you have a family history of hip or other mobility problems. You can expect your provider to ask you questions like where you feel pain, how long the pain has lasted, and how severe your symptoms are.
Your provider will likely also conduct a physical exam which may involve evaluating how well you can lift your knees, checking the range of motion in your legs, and assessing your gait (how you walk). But in more severe cases, your provider may order imaging tests such as an ultrasound or magnetic resonance imaging (MRI) to test for conditions like:
Tumors in the bladder
Grading Hip Flexor Strain
If you are diagnosed with a hip flexor strain, your healthcare provider will grade your injury based on its severity. Getting a grade on your injury helps your provider recommend the best treatment options for recovery. There are three grades for a hip flexor strain, which include:
Grade 1: Mild hip flexor injury occurs when there’s a small rip to the muscle that causes pain, tenderness, and swelling. With this type, you’re usually able to resume regular activities.
Grade 2: Moderate hip flexor injury means there’s a more substantial tear. Limping, pain, swelling, and tenderness are more common in this grade. There’s about a 5% and 50% loss of mobility and function here.
Grade 3: This is a complete tear of the muscles, causing severe pain and swelling. Limping is severe, and the leg can’t bear weight, making walking difficult or impossible. This grade of injury causes a loss of more than 50% of your muscle function and may require surgery to treat.
Treatment Options for Hip Flexor Pain
Treatment approaches to hip flexor pain vary and depend on the cause of the issue. They range from taking medications to manage pain and home treatments to physical therapy and surgery.
Home Management
Most cases of hip flexor pain can be treated with home management. Healthcare providers often recommend the PRICE protocol—which stands for protection, rest, ice application, compression, and elevation—to treat mild pain.
Protection: Using assistive devices like crutches or limiting jerky movements that can cause extra pain
Rest: Getting enough rest and avoiding putting any pressure on the muscles, especially during the first 48 hours after the injury
Ice: Applying an ice pack for 20 minutes at a time to reduce swelling
Compression: Putting pressure on the affected area—with compression socks or bandages—to improve swelling and pain
Elevation: Sleeping or lying down with the affected leg elevated higher than the heart to ease pain and improve blood circulation
Medications
Available over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen), help ease pain and swelling. Some people with hip flexor pain may also opt to use Tylenol (acetaminophen), which treats pain but not swelling.
Stretches and Exercises
Regularly stretching the pelvis can help your hip flexors recover from injury. Your healthcare provider will show you stretches you can do at home. As you recover, exercises that don’t strain these muscles, such as cycling or swimming, can also help.
Physical Therapy
The goal of physical therapy is to stretch the hip flexors and strengthen them. Physical therapy can ease symptoms and assist in recovery. Your physical therapist can help you practice stretches, teach you exercises you can do at home, and give you tips on how to prevent future injuries.
Alternative Therapies
Alongside other approaches, trigger point therapy and soft tissue release are alternative therapies that can help reduce symptoms. With trigger point therapy, a chiropractor or acupuncturist presses on or applies a technique called needling to painful points on the body. This stimulation reduces pain.
Soft tissue release is an advanced massage therapy technique that focuses on stretching and massaging damaged portions of the hip flexors. This promotes blood circulation and helps to ease symptoms.
Surgery
While most hip flexor pain problems don’t require surgery, this option may prove necessary with grade 3 injury. Surgery can repair muscles that are completely torn or reattach ligaments and tendons that were separated from the bone.
Recovery Time
The recovery time for a hip flexor injury depends on how severe the injury was and the status of your overall health. For grade 1 and grade 2 hip flexor strains, recovery usually happens within one to two weeks. Severe hip flexor injuries, especially those requiring surgery, may require up to eight weeks.
As you recover, it’s critical to follow your rehabilitation plan. Be sure to resume physical activities gradually. If you feel pain or discomfort with an activity, stop doing it. It also helps to keep in contact with your healthcare provider or physical therapist to learn when it's safe for you to continue full activities again.
How to Prevent Hip Flexor Pain
There are several ways to prevent hip pain in your flexor muscles. Some strategies include:
Conditioning your muscles and body properly before starting rigorous physical activities
Trying squats, lunges, straight leg raises, or other exercises that stretch your hip flexors
Doing warm-up exercises and stretches before engaging in strenuous activity
Gradually cooling down after physical activity with slow stretches
Healing from another injury fully before trying difficult physical activities or contact sports
Working with your physical therapist or healthcare provider to learn exercises that can strengthen your hip flexors and related muscles
Living With Pain
While most hip flexor pain problems heal, some can cause chronic (long-term) pain or weakness. Depending on the underlying cause, this can lead to permanent disability. Some strategies that may improve your quality of life when living with pain include:
Keeping up with physical therapy and home exercises
Developing a regular stretching routine that targets the hip flexors and related muscles
Adjusting your diet or changing lifestyle habits to manage any excess weight that may be putting additional pressure or strain on the hips
Taking part in physical activities that are easier on the hips, such as swimming or cycling
Using walkers, wheelchairs, or other assistive devices for mobility
Not only can chronic hip pain affect your ability to walk or perform daily tasks, it can affect your mental health. Studies have found between 35% and 45% of people with chronic pain experience depression. If you're noticing changes in your mental well-being, talk to your provider about a referral to a mental health professional or any support groups they recommend.
A Quick Review
Hip flexor pain occurs when the hip flexor muscles get overly stretched or tear, often due to physical activity. This type of pain usually develops in the front of your hips and the upper part of your thighs. While anyone can develop hip flexor strains, this pain is common in athletes and people who regularly participate in sports or strenuous activities. Rest, ice, compression, and medications, among other treatments, can help improve pain.
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