Hip Flexor Strain. Causes, Symptoms and Treatment

Hip Flexor Strain.

A hip flexor strain occurs when one of the hip flexors has been pulled too hard, injured, or torn. Flexors are a set of muscle tissues that are engineered to stretch and move, adding range of motion to the area. The hip flexors connect the upper part of the femur (large leg bone) to the lower back, hip, and groin.

Minor hip flexor wounds are classified as a grade one tear and do not usualy end up causing much long-term damage. Most hip flexor wounds are classified as a second degree strain and involve a small rip or hyper-extension of the associated tissues. If the hip flexors are yanked too, this can result in the muscles losing their connection with the bone. Although this occurs rarely, it is classified as a third degree sprain and may also result in a small break of the bone on top of the muscle sprain.

How Hip Flexor Strains Occur

The hip flexors are the associated groups of special muscle fibers that allow a person to bring their leg and knee up in the direction of their torso. Hip flexors are most often used for vigorous activities like sprinting, kicking, dancing, or bending at the waist. Hip flexor tissues can become wounded through overuse but are more commonly torn when a contraction occurs under pressure or when the leg is straight out and then is forced to hyper extend.

Sports medicine has discovered that hip flexor wounds are often associated with developing hamstring strains due to the fact that tightened or injured hip flexor tissues can add additional pressure on the tissues of the lower leg (commonly known as hamstrings).

Who is Vulnerable to a Hip Flexor Strain

A number of athletes participating in certain vigorous activities are at a higher risk of developing a hip flexor wound. People who are playing soccer, rugby or American football and then receive a strike to the lower extremity or hip while trying to kick a ball can easily develop a hip flexor wound. Another class of sports people that often becomes vulnerable to hip flexor wounds is runners who often rip these muscles at the start of a race. Other vigorous past-times that pose a danger of developing hip flexor wounds include bicycle racing, gymnastics, and martial arts.

Tight, inflexible, or improperly warmed-up hip tissues are always in danger of becoming sprained. Some hip flexor wounds are the result of cumulative stress on the associated muscle tissues as a result of constant kicking, an activity associated with sports like soccer, rugby and football, or engaging in a lot of sprints and quick takeoffs from the starting block.


Hip Flexor Strain Symptoms

Hip flexor wounds are rarely diagnosed in a clinical setting but the common symptoms that accompany this type of injury include:

  • A quick and intense pain in the hip or pelvic right after receiving a hard blow.
  • Muscles clenching or cramping in the upper leg area.
  • Tenderness in the area of the upper leg.
  • A tugging feeling or sensation of loss of strength in the front of the groin.
  • Inability to continue kicking, jumping or sprinting.
  • Inability to move normally without limping.
  • Continual, severe discomfort in the upper leg area.

Symptoms are usually made worse when a person with a hip flexor wounds attempts to lift their knee up and towards their torso, when traveling upstairs, or attempting to run, jump, or kick.

Secondary symptoms of a hip flexor wound include tightness, soreness, and stiffness after long periods of not moving, including when waking up after a long sleep.

Hip Flexor Strain Treatment

Few hip flexor sprains require a trip to the doctor. The standard course of therapy for this type of wound is to rest for a couple of days. The application of ice is recommended, as long as it is not placed directly on naked skin, for periods of 15-25 minutes a day, to be repeated 3-5 times daily for the first two days after the onset of the sprain.

Discomfort and any incidents of localized swelling can be reduced by the use of an over-the-counter pain drug. Some people with a hip flexor wound may find that wearing a compression wrap around the area of the wound helps to reduce discomfort. Full recovery from a hip flexor sprain may take anywhere between one and eight weeks.

More severe cases of a hip flexor wound may require medical intervention. Medical personnel may use X-rays, MRI, or CT scans in order to properly diagnose the presence of a hip flexor wound. In severe cases of pain resulting from a hip flexor wound, it may be required to perform an X-ray to locate any potential bone fractures.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


Please explore more advanced diagnostic option unavailable anywhere else:


Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.


At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:


Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment


Hip joint stability test using DLEST methodology with C.A.R.E.N.


3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation


Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility


Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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