Psoas syndrome: causes, symptoms, and how to find relief

A deep ache in the front of your hip or groin that just won’t go away can be frustrating — especially when it’s hard to pinpoint exactly what’s causing it. If you've noticed pain after sitting for long periods, climbing stairs, or lifting your knee, your psoas muscle may be contributing.

Your psoas (pronounced “so-az”) is one of your primary hip flexor muscles. It connects your lower spine to the top of your thigh and plays an important role in everyday movements like walking, going up and down stairs, standing up, and getting in and out of a car.

But you don’t have to just deal with discomfort from psoas syndrome. It often responds well to movement-based treatments — targeted exercises can improve strength, mobility, and flexibility so your hips become more comfortable and resilient over time.

Learn more about psoas syndrome, including what causes it, symptoms, plus how to treat it with targeted exercises recommended by Hinge Health physical therapists.

What is psoas syndrome?

Psoas syndrome is a condition involving irritation or dysfunction of one or both psoas muscles. These muscles help flex your hips and stabilize your spine, so they're working almost anytime you walk, climb stairs, stand up, or lift your leg.

“We see it fairly often, especially in people who spend a lot of time sitting or whose activities involve repeated hip flexion,” says Matthew Turner, a physical therapist at Hinge Health.

Because symptoms can overlap with other causes of hip or lower back pain, such as a hip flexor strain, psoas syndrome isn't always easy to recognize. Fortunately, the treatments are often very similar and focus on restoring movement and strength.

Symptoms of psoas syndrome

Psoas syndrome can feel different from person to person, but it often causes a deep ache in the front of the hip, groin, or lower back. Symptoms may include:

• Groin pain

• Pain or stiffness when you stand up

• Trouble standing fully upright

• A snapping or clicking sensation in your groin when you raise your knee

• Pain that gets worse when you are in one position for a while, whether it’s sitting, standing or walking

• Discomfort that radiates down the front of your thigh towards your knee

Causes of psoas syndrome

Your psoas muscles are resilient and capable of handling high-intensity exercises and deep stretches. Psoas syndrome usually develops when these muscles are asked to do more than they're prepared for — or when they stay in the same position for long periods. Common contributors include:

• Prolonged sitting. “Spending hours sitting keeps your hips flexed, which can leave the psoas feeling stiff and less prepared for movement afterward,” Dr. Turner says.

• Repetitive hip flexion. You put a lot of demand on your psoas muscles when you run, cycle, play soccer, or do certain forms of dance. If these muscles don’t get enough recovery, or they aren’t conditioned for these activities, they can become irritated from overuse, says Dr. Turner. 

• Doing too much too soon. Increasing running mileage, cycling distance, or workout intensity too quickly can overload the psoas before it's had time to adapt.

• Muscle imbalances. If nearby muscles, such as your glutes (butt muscles) and core are weak or tight, your psoas muscles may have to pick up the slack, which can create a strength imbalance across your trunk and lower body, says Dr. Turner. 

• Previous injury or surgery. A previous hip or back injury — or surgery — can temporarily change how you move, placing extra demand on the psoas while your body adapts.

How movement can help psoas syndrome

When your hip hurts, it's understandable to want to stretch it constantly — or avoid using it altogether. In reality, the psoas responds best to a combination of mobility and strengthening exercises.

Targeted movement improves blood flow, reduces stiffness, and helps your muscles better tolerate everyday activities. “The goal isn't just to calm symptoms,” says Dr. Turner. “It’s to strengthen your psoas and the muscles around them so they can handle the demands of daily life more comfortably.”

Exercise therapy can also strengthen your core, glutes, and other hip muscles so your psoas muscles don’t have to do all the work on their own.

These exercises offer a mix of mobility and strengthening movements to help your hips move more comfortably. The hip flexor stretches improve flexibility, while bridges, bent-over hip extensions, and bird dog strengthen the muscles that support your hips and pelvis. The glute stretch helps improve overall hip mobility. Practiced consistently, these movements can reduce muscle stiffness, increase strength, and help you perform daily activities with more ease.

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.

Treatments for psoas syndrome

Most people with psoas syndrome improve with conservative care. The goal isn't to stop moving — it's to gradually build strength, improve mobility, and help your hips better tolerate everyday activities. Here are the treatments Hinge Health physical therapists recommend:

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help increase hip mobility and strength, which can ease pressure off your psoas muscles as they heal. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Gentle movement — walking, light cycling, swimming — helps rehab your psoas muscles by increasing blood flow to the area and improving both their strength and stability. “Physical activity also prevents you from being sedentary, which keeps your psoas muscles in a tight, flexed position,” says Dr. Turner.  

• Apply heat or ice. Ice can help reduce inflammation and numb pain, whereas heat can help improve circulation and prevent muscle and joint stiffness. “Heat also often feels good if your muscles feel very tight or sore,” says Dr. Turner. Consider trying both methods, or stick to the one that provides the most relief. 

• Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have hip and groin pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.

• Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.

• Explore complementary treatments. Talk to your provider if you’re interested in trying alternative approaches for psoas syndrome relief. Certain therapies, such as massage and acupuncture can help ease symptoms.

• Try TENS therapy. TENS, or transcutaneous electrical stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with psoas syndrome. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.”

Tips to manage psoas syndrome

Small changes to your daily routine can reduce stress on your hips and help prevent symptoms from returning. Here are a few habits worth trying:

• Take movement snacks. Staying in a sitting position for extended periods of time can make your psoas and surrounding hip muscles sore and tight. Consider getting up to move at least once every hour or so to promote blood flow to tender areas. An easy way to fit in a movement snack? “I always recommend drinking a lot of water throughout the day, because that means you’ll naturally get up to go to the bathroom and refill your water bottle,” says Dr. Turner.

• Warm up before exercise. Before engaging in any physical activity, it’s a good idea to warm up your muscles with dynamic movements, such as standing march, bird dog, and kneeling hip flexor stretch. 

• Pace your activities. Modify activities that trigger pain. If standing or walking for long periods aggravates symptoms, break up activity into shorter sessions. “Find your movement sweet spot,” says Dr. Turner, or the level of activity that feels like you’re putting in work without straining yourself or hurting sore muscles.

• Strengthen the muscles around your hips. Strong glutes, core muscles, and hip stabilizers help share the workload, so your psoas doesn't have to do it all. A physical therapist can identify which muscles could benefit from a little extra attention.

• Adjust your sleep position. Consider placing a pillow between your knees if you’re a side sleeper, or place one under your knees if you sleep on your back. Both of these positions allow your psoas to relax as you rest.

When to see a doctor

Psoas syndrome often improves on its own with simple at-home treatments. But if your psoas pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider, either your primary care physician, or an orthopedic or sports medicine specialist. It's also a good idea to get care if you have:

• Pain that follows a sudden traumatic injury or fall

• Numbness, tingling, or weakness in the leg

• Fever or unexplained weight loss alongside hip or back pain

• Difficulty with basic daily tasks like getting dressed or walking

PT tip: Balance stretching with strength work

“Stretching is important and often provides immediate relief when you have tense muscles,” says Dr. Turner. But muscles can also be tight from weakness. “Lasting relief usually comes from strengthening your hips, glutes, and core so your psoas doesn't have to work so hard every day.”

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

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.

References 

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2. Tufo, A., Desai, G. J., & Cox, W. J. (2012). Psoas Syndrome: A Frequently Missed Diagnosis. The Journal of the American Osteopathic Association, 112(8), 522. doi:10.7556/jaoa.2012.112.8.522

3. Lakkadsha, T. M., Qureshi, M. I., Kovela, R. K., Saifee, S. S., & Lalwani, S. S. (2022). Efficacy of Single Stretching Session of Iliopsoas Using Proprioceptive Neuromuscular Facilitation Versus Muscle Energy Technique on Low Back Pain in Patients With Lumbar Hyper-Lordosis. Cureus, 14(8). doi:10.7759/cureus.27916

4. Anderson, C. N. (2016). Iliopsoas. Clinics in Sports Medicine, 35(3), 419–433. doi:10.1016/j.csm.2016.02.009

5. Siccardi, M. A., Tariq, M. A., & Valle, C. (2020). Anatomy, Bony Pelvis and Lower Limb, Psoas Major. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535418/