How to Manage Hip Flexor Strain: Exercises and Tips From Physical Therapists

Learn what causes hip flexor pain and how to prevent and treat it, especially with exercises recommended by physical therapists.

Published Date: Mar 28, 2023

If you’ve experienced hip flexor strain, you’re in good company – it’s one of the most common injuries. Athletes are particularly prone, but anyone can develop a strain, which occurs when one of the hip flexor muscles is stretched too far.

The hip flexors are a group of four muscles along the front of your upper thigh, and they are responsible for helping you to walk, bend over, and stand. They’re some of the strongest muscles in the body and also some of the most used, which can set them up for occasional injury. This may occur as a result of a sudden movement, like changing directions while running or pivoting during sporting activities. But you can also strain hip flexors if you exert yourself and do more than your body is prepared for  — for instance, by lifting too heavy of a package, increasing your running mileage too quickly, or overdoing it with yard work one weekend.

Some hip flexor pain can temporarily affect your daily activities. “A minimal strain might limit how long you can walk, while a moderate strain can limit walking, doing the stairs, and getting out of a chair,” says Maureen Lu, PT, DPT, a physical therapist at Hinge Health. More severe strains can take a little longer to bounce back from, but you can always take steps to help the healing and recovery process along. 

The good news about hip flexor strains is that very few are classified as severe, which occurs when there’s a complete tear in your muscle that may require surgery to repair. “In my almost 18 years as a physical therapist, I’ve never seen a surgical case of a complete flexor tear,” says Dr. Lu. Instead, most hip flexor strains are mild or moderate that can be treated with conservative measures, including at-home exercises from our physical therapists. 

Our Hinge Health Experts

Maureen Lu, PT, DPT
Physical Therapist and Clinical Reviewer
Dr. Lu is a Hinge Health physical therapist and board-certified orthopedic clinical specialist with over 17 years of clinical experience.
Jonathan Lee, MD, MBA
Orthopedic Surgeon and Medical Reviewer
Dr. Lee is a board-certified orthopedic surgeon and an Associate Medical Director at Hinge Health.
Dylan Peterson, PT, DPT
Physical Therapist and Clinical Reviewer
Dr. Peterson is a Hinge Health physical therapist who focuses on developing clinical exercise therapy programs and member education.

Hip Flexor Strain: Hinge Health Perspective

Hip flexor pain — specifically hip flexor strain — is most commonly associated with athletes. Still, the vast majority of us who spend most of our days seated are also susceptible to experiencing it due to tense muscles. “A strong muscle is a supple muscle, so if muscles — and the fibers in them — are more flexible, they’re less likely to become strained,” explains Dr. Lu. 

That’s why being sedentary is the last thing you want to do when treating (or trying to prevent) hip flexor pain. Instead, taking action (literally) with hip exercises that improve strength and mobility in your hips is the key to improving your hip pain and getting back to living your life. As our Hinge Health care team says, movement is medicine

What Is a Hip Flexor Strain?

Hip flexor strain happens when you stretch or tear some of the thousands of fibers in your hip flexor muscles. As scary as that may sound, it’s important to keep in mind that the micro-tearing that occurs with mild to moderate strains is also what happens when we strengthen our muscles (think: the muscle soreness you sometimes feel after doing a new or challenging workout). It’s all part of how our muscles adapt to stress

That adaptation happens on a continuum. If you slowly challenge your muscles and gradually increase the range of motion, load, and speed, micro-tearing can lead to muscle building, explains Dr. Lu. On the opposite end of the continuum, increasing the stress on a muscle really quickly — say, by doing a very challenging workout that your body wasn’t ready for — can result in muscle strain and hip flexor pain. 

Just remember: Your body has the amazing ability to adapt. Doing hip strengthening and flexibility exercises can help you recover from a strain, and it can also make you more resilient to pain and injury in the future. “What our hip flexors can tolerate in terms of load, speed, and motion can be greatly increased over time,” says Dr. Lu. In other words, you can increase the load your muscles can handle so that challenging your body, or moving in new ways, results in muscle building as opposed to muscle strain. 

What Does Hip Flexor Strain Feel Like?

The chief symptom of hip flexor strain is noticeable pain at the front of the hip where it meets your thigh. The pain may be persistent, or you may only notice it when you walk, run, or make certain movements, such as kicking or moving your knee or thigh toward your chest. Other potential symptoms may include:

  • Cramping and muscle spasms. 

  • Difficulty getting out of your chair or up from the ground. This is especially true if you’re getting up quickly because that action requires your hip flexors to elongate from a compressed position quickly, says Dr. Lu.

  • Difficulty climbing stairs or walking up or down sloped surfaces.

  • Lower back pain. “One of the main hip flexors, the psoas, is directly connected to your lower back, so it’s not unusual to experience lumbar pain with hip flexor pain,” says Dr. Lu. Learn more about the connection between hip and back pain.

  • Swelling, inflammation, and bruising. 

  • Instability or weakness in your hip and leg.

What Causes Hip Flexor Strain?

There are many ways you can stretch or injure the fibers of your hip flexor muscles. Some common causes of hip flexor strain include: 

  • Overuse. Overdoing it at work or during physical activity can strain your hip flexors and lead to an overuse injury. This essentially means doing more than your body is ready for, or doing something for longer than your body can handle at that moment. Among athletes, hip flexor pain often affects cyclists, runners, football players, and dancers.  

  • Lack of flexibility. Sometimes, too little activity or spending extended periods of time in one position can cause your muscles to adapt to be less elastic, which makes them more susceptible to strains. “After weeks, months, and years of being less active — say, due to joint pain or limited mobility — it’s a lot easier for something to trigger a hip flexor strain,” says Dr. Lu.

  • Trauma. An acute injury, like a fall or car accident, can strain your hip flexors, especially if you suddenly tense your muscles to brace for impact. 

How to Prevent Hip Flexor Strains

To help keep hip flexors humming along, take a cue from their name. They’re called flexors because their function is to flex the hip. And the more flexible they are when doing that job, the more room your muscle fibers have to stretch before they strain — and the better protected you’ll be from potential injury. 

To keep your hip flexors flexible, try to warm up before exercise, even if you’re walking or doing something less intense than you normally do. Remember, every time you take a step, you’re using your hip flexor muscles.

Another smart move is to avoid sitting for long periods. “Hip flexor pain often starts as hip flexor tightness that goes unchecked,” explains Dr. Lu. “Consistently taking short standing or stretching breaks throughout the day can save you from injury a lot of times by keeping your hip flexors supple.”  

Treatment Options for Hip Flexor Strains

Most hip flexor strains can be treated at home with simple measures, such as the following:

  • Adjust your activity. After an injury, it’s important to work on restoring movement and strength as soon as possible. So while it’s okay to back off from activities that make your symptoms much worse, you should absolutely continue doing other activities that you can tolerate, says Dr. Lu. “Nudging into that pain is a perfectly safe thing to do,” she adds. 

  • Ice and heat. Both ice and heat can be helpful for hip flexor pain. Right after an injury or pain flare, it’s usually better to use ice. Ice eases pain and swelling by constricting blood vessels and decreasing circulation to the area. After this period, when the area tends to feel tight but not painful, it often helps to switch to heat, says Dr. Lu. This loosens up muscle fibers and helps recover your range of motion. 

  • Over-the-counter pain medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for hip flexor pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Exercises to Relieve Hip Flexor Strain

The given exercises from Hinge Health are commonly used to stretch and strengthen the hip flexor muscles. You can also check out more moves that will help you open tight hips, a very common problem that can lead to hip flexor strain, so you can get back to your normal routine – hip, hip, hooray! (Sorry, we had to.) 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Tuck It In

When you do hip flexor stretches, try to tuck your pelvis underneath you, advises Dr. Lu. “Maintaining that tuck will help flatten your lower back, which can help you to really feel the stretch.” 

Learn More About Hinge Health for Hip Pain Relief

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This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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References

  1. Heger, E. & Strong, R. (2021, December 14). 7 doctor-recommended strategies to relieve hip flexor pain at home and when to visit your doctor. Insider. https://www.insider.com/guides/health/treatments/hip-flexor-pain

  2. Hip Flexor Strain. (2022, August 3). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23978-hip-flexor-strain

  3. Alaia, M. J. (2020, July). Hip Strains. Ortho Info—American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-strains/

  4. Nall, R. (2019, March 8). Understanding Hip Flexor Strain. Healthline. https://www.healthline.com/health/hip-flexor-strain#causes

  5. Eckard, T. G., Padua, D. A., Dompier, T. P., Dalton, S. L., Thorborg, K., & Kerr, Z. Y. (2017). Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015. The American Journal of Sports Medicine, 45(12), 2713–2722. doi:10.1177/0363546517716179

  6. How Long Does a Strained Hip Flexor Take to Heal. (2022, August 25). American Hip Institute & Orthopedic Specialists. https://www.americanhipinstitute.com/blog/how-long-does-a-strained-hip-flexor-take-to-heal-32964.html

  7. Four Hip Flexor Stretches to Relieve Tightness, from a PT. (2022, February 2). Hospital for Special Surgery. https://www.hss.edu/article_hip-flexor-stretch.asp