February 12, 2025
The hip flexors are a group of 5 muscle groups (iliacus, psoas, pectineus, rectus femoris and sartorius). They are powerful muscles that help bring the knee closer to the chest and enable activities like sprinting, kicking and jumping.
Did you know hip flexor pathology is estimated to affect up to 30% of the sport-specific population. Most of these injuries do well conservatively but often take significant time to rehabilitate. Physio Wali explains the signs and symptoms and the best way to manage hip flexor-related pain, but let's start with How do you know if you have injured your hip flexors?
- Pain at the front of your hip
- Tight sensation at the front of the hip
- Tight/sore low back
- Difficulty lifting knee to chest
- Sharp pain with walking, jogging, running or sprinting
- A sudden increase in load with sprinting or kicking resulting in a gradual increase in anterior hip pain
Hip flexor-related pain can be a result of muscle tears, tendon pathology or an inflamed bursae. Hip flexor strains (pulled muscle) are microscopic tears that can occur when the demands imposed on it are greater than the muscle’s capacity. Often patients will describe the pain as deep tension that feels very tight. It is the job of your OHL Physiotherapist to differentiate between these different structures with our battery of clinical tests, and we will end our consult sharing your injury story.
A common mistake in managing this anterior hip tension is stretching the hip flexors without strengthening these muscles.
Stretching the hip flexors is important if there is true tightness in the hip flexor muscle. This can be assessed by having your physiotherapist test the flexibility of your hip flexors via the Thomas test. Subsequently, appropriate soft tissue techniques and stretches may be applied and administered.
Once hip flexor tightness is ruled out, you are usually dealing with an increase in muscle tone. Often as a result of the hip flexors and associated lumbopelvic muscles being weak and consistently overworked (3).
How can you rehabilitate hip-flexor pain (HFP)?
Acute phase:
- After the acute inflammatory and painful phase, it's time to return to gentle movement with the goal being to return to walking and sitting comfortably. It is important to not over-exert the hip flexors during the acute phase to allow the muscle and tissue enough time to heal.
- Administering of gentle hip flexor stretching to help maintain the mobility of the hip flexors and the hip joint. Your OHL Physio can help you balance the right amount of stretching (and in the best positions) in your consultation.
- Once a full pain-free range of motion is achieved, you can start introducing some gentle exercises to load the hip flexor muscles and tendons. It’s time to get those muscle working!
- It is important to continue strengthening the surrounding muscles such as the glutes, core, hip adductors and abductors to maintain strength around the pelvis as the hip flexors are healing.
Middle to late phase:
- It is important to start loading up the tissue through this phase to increase the tissue capacity of the hip flexor muscle and tendon so it can tolerate the demands of walking, running, jumping and sprinting.
- A strength program 2-3 times a week in addition to two cardio sessions (light jogging, biking, rowing) is important for a successful return to play. It is important to note that effective strengthening can take place in the presence of some pain, but, again, our OHL Physio will help you understand the level you can push each particular movement as you practice each movement together in your consultation.
- Below are some great exercises to help strengthen your hip flexors through the mid-late stage rehabilitation of HFP.
1. GHD eccentric crunch: Great exercise to strengthen and help with the mobility of the psoas muscle.
2. Supine hip flexion off bench using a kettle bell
3. Standing hip march with band
4. Supine hip flexor march
Final thoughts:
Depending on the degree of strain and pain, HFP can be debilitating and may require lengthy rehabilitation. It is important to go through all phases of rehabilitation from early protection to early mobilisation, optimal loading and gradual return to sport or activity. Completing all phases will give you the best chance of a successful return to activity. Our expert team of physiotherapists at the Optimal Health Lab are trained to diagnose HFP and implement an appropriate rehabilitation program to get you back to achieving your goals. Book today to get out of pain ASAP!
