This blog post contains exercises, stretches and strategies to help fix a Hip Flexor injury.

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The Hip Flexors are a group of muscles which are involved with flexion of the hip.

(Think of the movement of hip flexion as the knee being lifted up towards the chest.)

There are many muscles in the hip which are considered a “hip flexor”… all of which can potentially get injured!

An injury to the hip flexors may involve a Strain, Partial/Full thickness Tear, Ruptures, Tendinopathy or Contusion.

List of Hip Flexors

• Psoas
• Iliacus
• Rectus Femoris
• Sartorius
• Tensor Fasciae Latae
• Pectineus
• Anterior portion of Gluteus Medius/Minimus
• Anterior portion of Adductors

(The amount of involvement of each muscle during hip flexion is generally based on the position and movement of the hip.)

Causes:

Quick and/or forceful movements of the hip whilst the hip flexors are active.

For example: Running/Sprinting, Kicking, Pushing an object with your foot

Symptoms

• Pain when lifting the leg
• Weakness when lifting leg
• Painful to touch

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Hip Flexor Injury Test

Here a few ways to determine if your Hip Flexor is injured.

a) Where is Hip Flexor pain felt?

Front of the hip.

If there is pain when you press into the structures at the front of the hip, this suggests that there may be an injury to the Hip Flexors.

b) Manual Muscle Test (Hip Flexed)

Instructions:

• Sit down on a chair.
• Lift your knee towards your chest.
• Place your hand on top of the knee.
• Push your knee firmly into your hand.
• Hold this contraction for 2-3 seconds.

Results: If this test causes pain in the front of the hip, this suggests that you may have injured the hip flexors.

c) Manual Muscle Test (Different Hip Position)

Instruction:

• Lie down on the floor.
• Keep your leg completely straight.
• Lift your leg slightly.
• Get someone (or yourself) to apply a downward pressure on top of your knee of the leg that is lifted.
• Attempt to lift your leg against the downward pressure.

Results: If this test causes pain in the front of the hip, this suggests that you may have injured the hip flexors.

d) Pain on Stretch

Instructions:

• Assume the lunge position with the target leg at the back.
• Lunge forwards.
• Tuck your tail bone underneath you.
• Push your hips forwards.

Results: If performing this stretch causes pain at the front of the hip (back leg), this suggests you may have a Hip Flexor injury.

e) Get a Scan

A MRI and/or an ultrasound scan to the hip can be used to determine if you have any abnormalities in the Hip Flexors.

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How To Fix a Hip Flexor Injury

STEP 1: Reduce Aggravating Activities
STEP 2: Decrease Inflammation
STEP 3: Releases
STEP 4: Hip Flexor Stretches
STEP 5: Isometric Exercises
STEP 6: Strengthening Exercises
STEP 7: Strengthen the Core

STEP 1: Reduce Exposure to aggravating activities

Modify, Reduce Exposure to or Completely stop any activity/movement/position that aggravates your hip flexor injury.

Failure to comply with this first step will likely result in frequent exacerbations in the symptoms and make the suggested exercises outlined in this blog post less effective.

Common aggravating activities/movements:

• Walking/Running
• Getting in/out of the car
• Moving in bed
• Stairs
• Kicking

KEEP IN MIND – Do not completely stop using your hip! This can result in more stiffness and weakness in the long term.

As a general rule: Use your hips as much as you comfortably can without significantly aggravating the pain.

STEP 2: Reduce Inflammation

A significant amount of inflammation can make the hip flexors very sensitive and painful.

This may limit the ability to perform the suggested exercises on this blog post.

Here are some simple ways to reduce inflammation:

a) Anti-Inflammatory Gel

Apply an anti-inflammatory gel to the front of the hip.

Do this 3 times per day.

b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.

Note: Please consult your Primary Care Provider before taking any medication.

c) Cold Therapy

Apply an ice pack to the front of your hip for at least 10-15 minutes.

Do this 3-5 times per day.

Note: Do not apply the ice pack directly to the skin as you may develop an irritation on the skin.

d) Try Natural Products

It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.

(To be honest – I am not 100% how effective this is! … But it might be worth a shot.)

e) Cortisone Injection

The cortisone injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.

Talk to your Primary Care Provider to see if the cortisone injection is appropriate for your shoulder injury.

STEP 3: Releases

Releasing the hip flexor muscles can help reduce tension in the region.

Note: There are sensitive structures (such as nerves and arteries) in the front of the hip. DO NOT press into areas that cause significant pain, tingling and/or numbness down the leg.

(To help you be more specific, it is recommended that you know exactly WHICH hip flexor muscle is injured.)

If you are not confident in performing the following releases by yourself, make sure to see a healthcare professional.

a) Hip Flexor Release

Instructions:

• Sit down on a chair.
• Keep your leg completely relaxed.
• Locate the specific Hip Flexor muscle that you are targeting
• Place your finger tips into this muscle.
• Apply a firm amount of pressure.
• Continue for 1 minute.

Alternatively – you can lie on top of a foam roller or massage ball:

STEP 4: Stretches for Hip Flexor injury

The following hip flexor stretches can help reduce tightness in the muscles in the front of the hip.

Note: If your symptoms get worse during or after performing these hip flexor stretches, you may need to consider skipping the stretches for now.

In some cases – stretching may lengthen an already lengthened hip flexor muscle which can lead to more pain.

(You can gradually implement the stretches at a later date when your hip can tolerate it.)

Here are 3 variations of stretches that target the Hip Flexors:

a) Stretch to the Front Hip

Instructions:

• Assume a kneeling lunge position.
  • Use a pillow underneath the knee.
• Keep your pelvis facing forwards throughout the stretch.
• Tilt your pelvis backwards.
  • “Tuck the tailbone underneath you.”
• Drive the hips forwards.
• Lunge forwards.
• Aim to feel a stretch at the front of the hip.
• Hold for 30 seconds.

b) Stretch to the Front/Outer Hip

Instructions:

• Assume a lunge position with your hands on your hips.
  • (The leg at the back will be the side that is stretched.)
• Have both feet in line with each other.
• Keep your pelvis facing forwards at all times.
• Tilt your pelvis backwards and push your hips forwards.
• Lunge forwards.
• Push your hips out towards the side of the back leg.
• Aim to feel a stretch on the outer side of the front of the hip.
• Hold for 30 seconds.

For more stretches, see post: Tensor Fasciae Latae Stretches.

c) Stretch to the Front/Lower Hip

Instructions:

• Stand up and hold onto something for balance.
• Bend your knee backwards.
• Hold onto your ankle and pull your foot towards your buttock.
• Keep your knees together and aligned with one another.
• Push your hips forwards.
• Aim to feel a stretch at the front of the thigh region.
• Hold for 30 seconds.

STEP 5: Hip Flexor Isometric Exercises

An isometric exercise involves the contraction of a muscle without movement of the hip joint.

This type of exercise is a great place to start when there is pain present in the hip flexor.

With the following exercises, aim to apply as much force as possible without causing any pain.

a) Flexed Hip

Instructions:

• Lie down on the floor with your hip and knee bent at 90 degrees.
• Place your hand on top of the knee.
• Without moving your hand, push your knee into your hand.
• Hold this contraction for 30 seconds.
• Repeat 3 times.

b) Neutral Hip

Instructions:

• Stand in front of a wall.
• Make sure that tip of your toes are in contact with the base of the wall.
• Keep your leg completely straightened.
• Push your foot into the wall.
• Hold this contraction for 30 seconds.
• Repeat 3 times.

c) Extended Hip

Instructions:

• Assume a lunge position.
  • (The leg at the back will be side that will be targeted.)
• Push the foot of the leg at the back into the ground.
• Hold this position for 30 seconds.
• Repeat 3 times.

STEP 6: Hip Flexor Strengthening Exercises

Strengthening the hip flexors will build resilience in the muscles. This will help the muscles tolerate more stress/load.

a) Straight Leg Raise

Instructions:

• Lie down on the floor.
• Lock your leg straight.
• Lift your leg to ~30 degrees.
• Aim to feel the contraction at the front of your hip and thigh.
• Hold for 5 seconds.
• Repeat 30 times.
• Progression: Add an ankle weight or tie a resistance band between ankles.

b) Straight Leg Raise (Hip Extended)

Instructions:

• Lie down on the floor.
• Hold your knee towards the chest.
• Lock the other leg in a straightened position.
  • (This is the side that will be targeted.)
• Lift your leg to ~30 degrees.
• Aim to feel the contraction at the front of your hip and thigh.
• Hold for 5 seconds.
• Repeat 20 times.
• Progression: Add an ankle weight.

c) Straight Leg Lift (Sitting)

Instructions:

• Long sit on the floor with the support of your hands behind you.
• Keep your leg straight throughout this exercise.
• Without moving your pelvis, lift up your leg as high as possible.
• Hold for 5 seconds.
• Repeat 10-20 times.
• Note: If this exercise is difficult, lean your torso slightly backwards.

d) Knee Lift (Sitting)

Instructions:

• Sit up right on the edge of a chair.
• Lift your knee as high as possible without causing any pain.
• Do not lean backwards.
• Aim to feel a contraction in the front of the hips
• Hold for 5 seconds.
• Repeat 10-30 times.
• (If you find it difficult to lift the weight of your leg, you can use your hands to provide some assistance.)
• Progression: Wrap a resistance band between your ankles.

e) Knee Lift (Standing)

Instructions:

• Stand upright.
• Place your foot onto a block at knee height.
• Lift your knee as high as possible without causing any pain.
• Do not lean backwards as you lift your knee up.
• Aim to feel a contraction in the front of your hip.
• Hold for 5 seconds.
• Repeat 10-30 times.
• If you find it difficult to lift the weight of your leg, you can use your hands to provide some assistance.
• Progression: Wrap a resistance band between your ankles.

e) Lunge with Foot Drive

Instructions:

• Assume the lunge position.
• Lunge forwards.
• Tuck your tail bone underneath you.
• Push your hip forwards.
• Aim to feel a pulling sensation at the front of the back hip.
• Push the foot of the back leg into the ground as hard as you comfortably can tolerate.
• Perform a lunge.
• Repeat 20 times.

f) Strengthening with Resistance Bands

Instructions:

• Tie a resistance band to a stationary object at floor height.
• Loop the other end of the resistance band around your ankle.
• Face away from the anchor point.
• Step forwards to increase tension on the band.
• Stand up right.
• Hold onto something for balance.
• Lock your knee straight.
• Allow your leg to be pulled backwards.
• Pull your leg forwards.
• Perform 30 repetitions.

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Depending on your goals and level of activity, you may also benefit from exercises that implement speed, change in direction, acceleration/deceleration, explosive movements, kicking etc.

The exercises suggested on this blog post serve as a starting pointing when initially addressing the hip flexor strain.

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STEP 7: Strengthen the core

In addition to performing specific exercises for the hip flexors, I would also suggest that you learn how to engage your core muscles.

“The Core” is a group of muscles that are responsible for the stability of the spine and pelvis.

By engaging these muscles, I believe that it can help take excessive pressure off the hip flexors (… and thus reduce the chance of having an injury).

Recommendation: Engage your core muscles before and during any activation of the hip flexors.

How to engage the Core:

• Lie on your back with your knees bent and feet on the floor.
• Tilt your pelvis backwards to help flatten your lower back onto the floor.
• Take a deep breath in through your nose and slowly exhale ALL of the air out through your mouth.
• As you reach the point where you have completely emptied out your lungs, notice how your lower ribs and lower back sink towards the ground.
• Maintain this lowered rib position throughout this breathing exercise by gently engaging your abdominal muscles.
  • Draw your belly button in.
  • Take note of the contraction in your abdominal region. This is what I refer to as activating the core!
• Take a deep breath in.
  • Aim to expand the entire circumference of your rib cage.
  • (Think about the movement as a balloon being inflated.)
• Breathe out all the air out of you lungs.
  • Allow the lower ribs sink to the floor as you do this.
• Continue this diaphragmatic breathing for 3-5 repetitions.

Common Questions

Have a question? Let me know in the comment section!

a) How long does Hip Flexor pain take to heal?

The recovery time of a hip flexor strain really depends on multiple factors such as the severity of the injury, strength of the tendon, past injuries to the area etc.

As a (very) rough guideline:

• 2-6 weeks for a strain
• 6-12 weeks for a partial thickness tear
• 12+ weeks for a full thickness tear

b) Exercises to avoid with a hip flexor strain

Generally speaking – any exercises or movement that causes pain to the Hip Flexors should be modified or completely avoided.

Movements which require quick hip movements are higher risk. Kicking, jumping, running, deep lunges etc.

b) Other possible injuries to the front of the hip

If you have performed all of the suggested exercises on this blog post and still experience pain at the front of the hip, it is possible that you may have a:

• Abdominal Hernia
• Appendicitis
• Osteoarthritis
• Hip Impingement
• Abdominal strain
• Groin strain
• Labral tear

Please see a health professional to determine if you have any of the conditions mentioned above.

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Conclusion

The term “Hip Flexors” refers to a group of muscles that help flex the hip.

To get the most out of this blog post, it is important that you know exactly which hip flexor that you have injured.

Perform the suggested exercises, stretches and strategies to help fix your Hip Flexor injury.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical Disclaimer.