Hip Flexor Strain

A hip flexor strain is an injury to the muscles at the front of the hip.

It is a common source of hip and groin pain, particularly among athletes and physically active individuals.

Hip flexor strains can range from mild overstretching to complete muscle tears. They can cause upper thigh pain, weakness, stiffness, muscle spasms and reduced function.

In this article, we'll take a deep dive into everything you need to know about hip flexor strains, from anatomy and injury grades to diagnosis, treatment, recovery, and prevention.

What Is a Hip Flexor Strain?

A hip flexor strain is when there is overstretching or tearing of one or more of the hip flexor muscles. These muscles bend the thigh, lifting the leg towards the chest, and play a key role in walking, running, and kicking.

Grades of Hip Flexor Tear

Hip flexor strains are classified into three grades, depending on the extent of the injury:

• Grade 1 (Mild): Minor stretching or microscopic tears. Symptoms include mild discomfort and slight stiffness, with minimal functional impact.
• Grade 2 (Moderate): Partial muscle tear, resulting in moderate pain, swelling, and difficulty walking or lifting the leg.
• Grade 3 (Severe): Complete rupture of the muscle fibers, often accompanied by severe pain, bruising, and loss of function. Surgical intervention may be needed.

Hip Flexor Strain Causes

Common causes of hip flexor strain injuries are:

• Sudden, explosive movements such as sprinting, jumping, kicking or rapid changes in direction
• Overuse from repetitive sports or training without proper recovery
• Inadequate warm-ups, leading to unprepared muscles
• Muscle fatigue, reducing strength and coordination, increasing injury risk

The hip flexors are particularly susceptible to tearing when they work from a stretched position or when they contract quickly against a force. Athletes in sports that involve repetitive stop and start movements, especially quick starts or pivoting movements e.g. soccer, football, hockey, martial arts, and dance are especially vulnerable to hip flexor strain injuries.

Risk Factors

Certain risk factors can make you more prone to hip flexor tears:

• Muscle imbalances between the hip flexors and extensors (glutes and hamstrings)
• Tight hip flexors that lack sufficient flexibility
• Previous hip or thigh injuries

Hip Flexor Strain Symptoms

Common symptoms of a pulled hip flexor muscle include:

• Sudden, sharp pain at the front of the hip or groin that gets worse when bending the hip
• Swelling, bruising, or tenderness in the upper thigh or hip
• Difficulty with daily activities e.g. walking, running or climbing stairs
• Muscle spasms or a pulling sensation during activity
• Weakness or stiffness in the hip, especially after resting or sitting
• A noticeable limp or inability to bear weight comfortably

Hip flexor pain is often localized to the front of the hip but may radiate into the upper thigh.

Diagnosing Hip Flexor Injuries

Accurate diagnosis of hip flexor pain may involve both clinical evaluation and, in some cases, imaging:

• Patient History: Understanding when the pain started, what caused it, and how it behaves helps pinpoint the injury.
• Physical Exam: Your provider will check hip range of motion, tenderness, swelling, and strength.
• Functional Tests: Resisted hip flexion or straight leg raises may reproduce pain.
• Imaging: MRI or ultrasound may be ordered for moderate to severe strains to assess tissue damage and rule out more serious pathology.

Differential Diagnosis

Conditions that can mimic hip flexor strain include:

• Hip labral tears
• Iliopsoas bursitis
• Inguinal or sports hernias
• Groin strains (adductor muscles)
• Femoroacetabular impingement (FAI)
• Lumbar disc herniation or femoral nerve impingement

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Hip Flexor Strain Treatment

Most hip flexor strains can be managed conservatively without surgery. Early treatment focuses on pain control, while later phases aim to restore strength and mobility.

Acute Phase (First 48–72 hours)

• Rest: Avoid movements that cause pain or stress the injured muscle, and avoid stretching the muscle. If necessary, use crutches
• Ice Therapy: Apply ice packs for 15–20 minutes every 2–3 hours to reduce pain and inflammation
• Medication: pain-relieving medication such as paracetamol/acetaminophen can be taken regularly to reduce hip flexor pain. Avoid any anti-inflammatory medications e.g. ibuprofen/Advil for the first 2-4 days as they can actually slow down the healing process if taken too early
• Avoid Heat: initially as this increases inflammation and swelling

Rehabilitation Phase

Once the hip flexor pain subsides, rehab focuses on:

• Physical Therapy: A structured program to restore flexibility, strength, and functional movement
• Manual Therapy: Techniques like massage or myofascial release can help reduce tension and speed healing
• Progressive Loading: Controlled strengthening exercises are essential for long-term recovery

Hip Flexor Strain Exercises

Rehabilitation exercises for hip flexor strain recovery include:

• Strengthening Exs: for hip flexors, quads strengthening and glute strengthening
• Stretching Exs: hip flexor stretches, quad stretches. Don’t start stretching exercises until isometric (static resisted) hip flexion is pain free
• Functional Training: Gradual return to sports-specific movements such as dynamic balance drills and sport-specific drills before return to play

Always progress hip flexor strain exercises gradually and stop any exercise that causes sharp pain.

Surgery For Hip Flexor Tear

Surgery is not usually necessary for a hip flexor strain unless there is a complete rupture or if the tendon has pulled away from the bone (avulsed).

Hip flexor tear surgery typically involves reattaching the injured tendon back onto the bone.

Pulled Hip Flexor Recovery

Recovery time for a hip flexor strain depends on the severity:

• Grade 1: 1 to 2 weeks with appropriate rest and rehab
• Grade 2: 3 to 6 weeks with structured rehab; physical therapy plays a key role
• Grade 3: 8-12 weeks or longer; surgery may be required in rare cases of complete rupture

Returning to sport should only happen once strength and flexibility are fully restored and pain-free movement is achieved else you risk ongoing hip flexor pain.

How To Prevent Hip Flexor Injury

To reduce the risk of hip flexor tears, follow these prevention tips:

• Warm up properly before all activity
• Incorporate dynamic stretching for the hips and thighs
• Strengthen both hip flexors and extensors to maintain balance
• Core stability exercises to support hip mechanics
• Avoid overtraining and schedule regular rest days
• Use proper technique in sports and workouts

Hip Flexor Strain Summary

Hip flexor strains are common but manageable injuries that typically respond well to rest, physiotherapy, and a structured rehab program.

Pulled hip flexor injuries are usually caused by sudden over-stretching or repetitive overuse of the hip flexor muscles. They are particularly common in active individuals.

Common symptoms include pain in top of thigh that worsens with walking or lifting the leg, swelling, weakness and muscle spasms.

Most cases of hip flexor strains settle down within a few weeks with home treatments such as ice, rest, strengthening and stretching exercises.

You may also be interested in the following articles:

• Hip Impingement Syndrome
• Hip Labral Tear
• Hip Bursitis
• Quads Tendonitis

Related Articles

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Medical & Scientific References

1. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes. The American Journal Of Sports Medicine
2. Hip Flexor Strain - Aftercare. MedlinePlus
3. The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis. International Journal Of Environmental Research & Public Health

Last Updated: May 14th, 2025
Next Review Due: May 14th, 2027