Hip Flexor Pain: What Is It and How Can I Treat It?

Hip flexor pain is most often caused by iliopsoas syndrome, which is an overuse problem that causes anterior hip pain (pain in the front of the hip). You may have experienced hip flexor pain at some point in your life, chances are this was caused over time, slowly becoming a problem over weeks and weeks. 

Whether the sensation is painful, or simply uncomfortable, it is a sign that there are complications in your movement patterns caused by muscular imbalances or improper movement. Distinguishing between muscular imbalances causing pain that are due to compensation and tight hip flexors is important as well, as it can outline the course of treatment. 

What is the hip flexor? 

The hip flexor, or iliopsoas is a group of muscles that sit along the front of the hip. The hip flexors have two functions. They can raise your thigh (called hip flexion) and they can be used to stabilise the pelvis/low back. This muscle group is ‘turned on’ during activities while lying on our back, sitting and standing. 

The muscles are activated when the leg is pulled upwards, which includes movements such as walking, running, and even standing, as well as other forms of exercise like squats or lunges. They are important in almost all leg movements.

Difference between tight hip flexors and hip flexor pain

People often associate hip pain or discomfort with having tight hip flexors; stretching the hip flexors constantly but getting no relief in pain. However, it is sometimes a result of having muscular imbalances—especially at the glutes—that cause compensation in the hip flexors. A lot of times we haven’t learnt to activate the glute and hamstring muscles properly and that causes hip flexor pain.

However, the importance of maintaining flexibility, in all aspects of the body, and especially the hip flexors because of our poor sitting habits cannot be understated. Read more about the importance of flexibility here.  

What causes hip flexor pain (iliopsoas syndrome)? 

Muscular Imbalances / Compensation of the Hip Flexors

Moving with proper biomechanics and muscular activation is key to treating and preventing hip flexor pain. Hip flexor pain is an overuse injury. This means that over time due to poor movement patterns the hip flexors compensate for other muscle groups that aren’t working efficiently. 

Furthermore, when other muscles aren’t activating properly, their load defaults to the hip flexors. The hip flexors aren’t designed to facilitate this load and the stress can cause pain if the improper movement is carried on over time.

The muscles that are the cause for this are the hamstrings, glutes, and core. As mentioned above, the hip flexor muscles are responsible for stabilisation as well as hip flexion. 

The hamstrings are responsible for knee flexion and the complex motion of the gait and glutes are responsible for hip extension. Consequently, when these muscles aren’t activated properly during movement, the hip flexors are the only other major muscle at the hip, so they compensate for tasks that they are not designed for, causing hip flexor pain or iliopsoas syndrome. A weak core can also cause compensation. 

The hip flexors are responsible in part for stabilising the spine during movement, a function shared by the core (however, the core is much more efficient at this—the hip flexors play a small supplementary role). The hips are the only other muscle apart from the core that connects the hips to the spine. 

Thus, when the hip flexors have to compensate for a weak or inactive core they will perform disparate movements—hip stabilisation and hip flexion—and undergo a motion they’re meant to perform a supplementary role in; the stress of which, causes pain.

4 ways to prevent and treat hip flexor pain

There are a number of tips and tricks that you can incorporate into your everyday life to help strengthen your hip flexors and prevent pain.

1. Mobility

Stretching the hip flexors improves mobility at the hip. Reducing mobility problems can improve activation of the muscles, correct biomechanical issues, and reduce compensation of the hip flexors.

The best way to do this is the half kneeling stretch. Perform this by kneeling down, then putting one leg forward bending at a 90 degree angle at the knee as if in a lunge while keeping the back leg with the knee against the ground. At this point, squeeze the glutes and you should feel a stretch in the leg that has the knee against the ground.

Recommended sets/reps: 10 reps for 10-second holds.

Foam rolling also releases tightness or stiffness in the muscles, improving mobility. This can be hard to perform with a foam roller, so using a baseball, tennis ball or another spherical object to lie underneath could be an alternative. Otherwise, remedial massage/hands-on physiotherapy may be a better option.

2. Activating the glutes:

Activating the glutes is important to ensure proper movement and so the hip flexor muscles aren’t compensating for weakness. A key exercise to activate the glutes is the side plank clamshell.

To perform this lay on your right side, with your legs bent and a resistance band loop around your knees. Keep your right elbow and right knee in contact with the ground as you raise your hips and hold them in a side plank position. 

While maintaining this side plank, rotate your left leg open against the band resistance. Holding it for two seconds before lowering it back down. A cue used often with patients is to imagine your legs are a clamshell opening and closing.

Recommended sets/reps: 2 sets of 15 reps on each side

3. Strengthening the core:

Strengthening the core will ensure the hip flexors aren’t compensating to stabilise the spine.

Perform a plank by getting in a push up position, with your feet extended. From there, you can stay in this position until you can progress to your forearms. Ensure you don’t drop your hips too low or raise them too high as this reduces the activation of the core and makes it easier on yourself. You want to maintain a straight body from shoulders to hips and to feet.

Recommended sets/reps: 3 sets of 60-second holds

4. Strengthening the hips: 

Once you have strengthened the core, performing isometric hip flexion will strengthen the hip flexors.

Lay on your back with your knees bent and feet up in the air at a 90-degree angle. Place a small resistance band loop around your feet then straighten one of your legs. Make sure your other leg remains in a bent position. Hold the extended leg for 3-5 seconds before returning to the start position. 

This exercise creates an isometric contraction (activation without joint movement) of the hip flexors in order to maintain the top leg from moving. Isometric contractions can be a great way to strengthen injured tissues without pushing them into pain during the early phase of the healing process.

Recommended sets/reps: 2-3 sets of 10 kicks with a 3-5 second hold.

Treat your hip flexor pain at City Physio Adelaide 

If you are suffering from persistent hip flexor pain, it is important to be proactive and see a physiotherapist. Here at City Physiotherapy in Adelaide, South Australia, we are committed to helping you be the best version of yourself. Your wellbeing is our number one priority. 

We can assess you to determine if your pain is a result of an injury, muscle tightness, or muscle weakness. 

Some of our treatments for hip flexors include:

• Remedial massage gives you immediate relief from pain and stiffness in your hip, working best when combined with other remedial techniques. 
• We will assess you and devise an exercise plan if your muscles need it. There are a number of exercises and/or stretches that help increase flexibility of and strengthen hip flexor muscles. 
• We offer pilates classes for rehabilitation, if you are rehabilitating from a hip flexor injury, offering a safe and therapeutic option. 
• Dry needling can also be an effective method to reduce pain and inflammation in the hip flexor muscles. All of the physiotherapists at City Physio have completed post-graduate training in advanced neuromuscular trigger point dry needling treatment.

There are a number of signs that you may have tightness in your hip flexors, or that they are weak. We personalise a recovery plan and tailor treatments to you and your body. Whether you have an injury, tightness, weakness, or a combination of all in your hips, we are committed to you. 

Book online today for an assessment on your hip flexors from one of our qualified physiotherapists. Start your journey to recovery and wellness with City Physiotherapy Adelaide. 

Sources 

https://squatuniversity.com/2017/10/07/fixing-hip-flexor-pain/

Ingber RS. Iliopsoas myofascial dysfunction: a treatable cause of “failed” low back syndrome. Arch Phy Med Rehabil. 1989;70(5):382-386

White SG, Sahrmann SA. A movement system balance approach to management of musculoskeletal pain.

In: Grant R, eds. Physical Therapy of the Cervical and Thoracic Spine. New York, NY: Churchill Livingstone Inc; 1994:339-357

Paolini, J. Review of myofascial release as an effective massage therapy technique. Athletic Therapy Today. 2009; 14(5):30-34

Grenier SG & McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabil. 2007; 88:54-62

Gardner-Morse MG & Stokes IAF. The effects of abdominal muscle coactivation on lumbar spine stability. Spine. 1998;23(1):86-92

Johnston CA, Lindsay DM, Wiley JP. Treatment of iliopsoas syndrome with a hip rotation strengthening program: a retrospective case series. J Orthop Sports Phys Ther. 1999;29(4):218-224

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