Hip flexor pain

Hip flexor pain can be caused by a variety of problems from poor movement patterns to an actual hip flexor strain

Muscle Strain

Hip flexor strains most commonly occur due to a sudden contraction of the hip flexor muscles (particularly in a position of stretch). They often occur during sprinting or kicking activities. This is particularly so during explosive acceleration or when a footballer performs a long kick, particularly following an inadequate warm-up.

Patients usually feel a sudden sharp pain or pulling sensation in the front of the hip or groin at the time of injury. In minor strains, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue the activity. Patients with a severe hip flexor strain may also be unable to walk without limping.

Patients with this condition usually experience pain when lifting the knee towards the chest (especially against resistance) or during activities such as running, kicking or going upstairs. It is also common for patients to experience pain or stiffness after these activities with rest.

A hip flexor strain is an injury characterized by tearing of one or more of the hip flexor muscles and typically causes pain in the front of the hip or groin. The group of muscles at the front of the hip are called the hip flexors. The most commonly involved muscle in a hip flexor strain is the iliopsoas  The hip flexors are responsible for moving the knee towards the chest (i.e. bending the hip) during activity and are particularly active when sprinting or kicking. Whenever the hip flexors contract or are put under stretch, tension is placed through the hip flexor muscle fibres. When this tension is excessive due to too much repetition or high force, the hip flexor muscle fibres may tear. When this occurs, the condition is known as a hip flexor strain. Tears to the hip flexors can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture involving a sudden episode of severe pain and significant disability.


Poor movement control can also cause hip flexor pain. This is often noticed with hip flexor squats. When squats are performed incorrectly, hip flexor pain can occur due to weakness in the posterior gluteal muscles and tightness in the anterior hip flexor muscles. The inability to stay upright during a deep squat shows both a lack of gluteal (buttock) strength and tightness in the anterior hip flexors.

A test for glut strength is to lie face down with your top half on a table, then lift one leg up to parallel with your body. Then get a friend to press down on your thigh and if you can’t keep your leg up then you have weak gluts.
A test for tight hip flexors is to lie on your back on the table and let your legs drop over the edge. Then hug one knee and let the other leg drop down, if your knee is not lower than the table then your hip flexor is tight. This is known as the Thomas test.

Both a hip flexor strain and hip pain from poor movement patterns can be treated very effectively with physiotherapy.

Physiotherapy for hip flexor pain

  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • joint mobilization (especially the lower back and hip)
  • stretches
  • dry needling
  • anti-inflammatory advice
  • ice or heat treatment
  • progressive exercises to improve hip strength and flexibility
  • education
  • biomechanical correction and return to sport programme


Contact Information

To book an initial consultation with one of our expert physiotherapists, please contact us on 0207 6030040 or email us at info@kenphysio.com.