What is it?

The hip flexors are the group of muscles and tendons that cross the hip joint and attach the thigh bone (femur) to the lower spine and pelvis. They assist in lifting and bending the thigh at the waist. A strain of the muscles and tendons is an over-stretch or tearing that can lead to inflammation, pain, and weakness. Like all muscles and tendons, the hip flexors also can be strained. This injury typically occurs with overuse, especially in sports and activities that involve sprinting, jumping, and kicking; these include dance, martial arts, track & field, soccer, and cycling.

Symptoms

The symptoms depend on the severity of the injury and usually present as pain or soreness in the groin or front of the hip. The pain may also be worsened with lifting the thigh or bending at the waist.

The diagnosis can usually be made without obtaining x-rays or magnetic resonance imaging (MRI). The examination of the hip and pelvis typically reveals tenderness over the groin area. In addition, there may also be tightness of the hip flexors and weakness of the gluteal (“butt”) and hamstring muscles.

Treatment

Initial treatment over the first 48 hours of injury consists of rest, periodic ice application (i.e. 15 minutes every several hours), and anti-inflammatory medications (e.g. ibuprofen or naproxen). Rehabilitation exercises should be started to stretch the injured muscles and tendons, as well as gradually build back up strength. During this time, activities should be adjusted or limited to less intense exercises in order to allow the injured tissue to heal; failure to modify activities can lead to further injury.

Injury Prevention

Prevention relies on proper warm-up and stretching. Individuals with tight hip flexors or imbalances in core, gluteal, and hamstring muscle strength may be at higher risk for injury.

Recovery depends on the individual as well as severity of injury and duration of symptoms, with return-to-play ranging from days to weeks. A delay in treatment can lengthen the recovery time, so addressing the problem early with an athletic trainer or doctor is important. The goal for safe return to the sport is resolution of the pain, improvement in mobility, and correction of the muscle weaknesses to prevent reinjury.

AMSSM Member Authors
Jason Brucker, MD and Craig Young, MD

References
Morelli V, Smith V. Groin injuries in athletes. Am Fam Physician. 2001 Oct 15;64(8):1405-1415.
Marcello-Brinker TB, Lowe L, Garber MB, et al. “Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial.” Phys Ther. 2004; 84:800-807.