Written by Dr. Laurie L. Glasser
Hip Flexor Pain
“Hip flexor pain” is a common complaint in athletes, dancers, runners and active adults but it also affects people who sit for prolonged periods of time, including those with sedentary jobs. Patients often describe pain in the front of the hip or groin, stiffness when standing up from a chair, discomfort with walking uphill or climbing stairs, or pain with running, dancing, or kicking.
Although the term “hip flexor strain” is frequently used, pain in this region can have many potential causes, and an accurate diagnosis is essential for proper treatment and management.
What Are the Hip Flexors?
The hip flexors are a group of muscles that allow the hip to bend and lift the thigh toward the body. The primary muscles include the iliopsoas, which is made up of the psoas major and iliacus, as well as the rectus femoris, one of the quadriceps muscles. These muscles are involved in walking, running, rising from a seated position, and maintaining posture. These muscles are used to perform sports specific movements such as sprinting, kicking. In dance and gymnastics, the hip flexors are specifically used in hip flexion, turnout and controlled leg elevation.
Evaluating Hip Flexor Pain
Hip flexor pain can originate from the muscle itself or from nearby structures that refer pain to the front of the hip or groin. Because many of these conditions feel similar, imaging and a focused physical exam are often needed to distinguish them.
A sports medicine evaluation begins with a detailed history, including activity level, recent changes in training, and associated symptoms.
A focused physical examination assesses hip range of motion, strength, flexibility, and provocative maneuvers. Imaging such as X-ray, musculoskeletal ultrasound, or MRI may be used when the diagnosis is unclear, symptoms persist, or more serious pathology is suspected.
Differential Diagnosis of Anterior Hip Pain
Muscle strain or overload
This is one of the most common causes, particularly in athletes, dancers, runners, and individuals who suddenly increase activity level. Pain often develops after activity and is worse with resisted hip flexion or stretching the muscle.
Iliopsoas tendinopathy or bursitis
Inflammation or degeneration of the iliopsoas tendon or irritation of the iliopsoas bursa can cause deep anterior hip or groin pain. Patients may notice snapping or clicking in the hip, especially when moving from flexion to extension.
Femoroacetabular impingement and labral pathology
Structural abnormalities of the hip joint can place increased stress on surrounding soft tissues, including the hip flexors. Pain is often activity related and may be associated with clicking, catching, or a feeling of giving way.
Referred pain from the lumbar spine
Lumbar disc disease, facet joint arthritis, or nerve irritation can refer pain to the front of the hip or groin. In these cases, hip imaging may be normal, and symptoms may be associated with back pain, stiffness, or neurologic symptoms.
Referred pain from the hip joint
The hip joint can refer pain to the front of the hip. Arthritis can be seen on an Xray of the hip.
Stress fracture or bony pathology
In athletes or individuals with risk factors such as low bone density or nutritional deficiency, pain in the hip flexor region may reflect a stress injury to the pelvis or femoral neck. This is an important diagnosis not to miss, as continued activity can worsen the injury.
Sports hernia or core muscle injury
Pain from the lower abdominal or pelvic musculature can mimic hip flexor pain and is often felt deep in the groin. Symptoms may worsen with cutting, sprinting, or rotational movements.
Treatment Options
Treatment depends on the underlying cause but often includes a combination of targeted physical therapy, addressing contributing biomechanical factors activity modification, and depending on diagnosis, orthobiologics. Physical therapy focuses on restoring normal hip mobility,
improving core and gluteal strength, correcting movement patterns, and gradually returning patients to activity. In addition, anti-inflammatory medications or ultrasound-guided injections may be appropriate. Surgery is rarely needed and is reserved for specific structural conditions that do not respond to conservative care.
Prevention Strategies
Preventing hip flexor pain involves more than stretching alone. Key strategies include maintaining balanced strength between the hip flexors, gluteal muscles, and core, avoiding prolonged sitting without movement breaks, progressing activity and training gradually, and addressing flexibility deficits appropriately. Proper warm-up before exercise and attention to running or sport-specific mechanics can also reduce risk.
When to Seek a Medical Evaluation
Patients should seek medical evaluation if hip flexor pain is severe, worsening, associated with limping, night pain, or inability to bear weight, or if it does not improve with rest and conservative measures. Early assessment can prevent chronic symptoms and allow for a faster, safer return to activity.
Although hip flexor pain is common, it is not always simple. A thoughtful evaluation and individualized treatment plan can relieve pain, restore function, and help prevent future injury.
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