Do you have pain in front of your hip with lifting your leg, sprinting, kicking, changing directions, with your leg straight behind you, or simply sitting for a while? It is quite possible you have a hip flexor strain. A hip flexor strain can be a real pain, however, they tend to do really well given the right education, proper exercise prescription, and time. In this article, you’ll learn what exactly is a hip flexor strain, what hip flexor strain rehab entails, and the fundamentals of how to manage a hip flexor strain!

 

What Is A Hip Flexor Strain?how to manage a hip flexor strain the prehab guys

First, we need to start with identifying what exactly are the hip flexor muscles. Typically the hip flexors are referred to as a group of muscles including the iliacus, psoas major, psoas minor, and rectus femoris. However, it is important to note there are more muscles that also slightly contribute to flexing the hip. As you can see the sartorius muscle above crosses the hip as well. So what is a hip flexor strain?

 

 Hip Flexor Strain Rehab At Your Fingertips!

hip rehab program hip flexor strain the prehab guys

Are you currently dealing with a hip flexor strain? If so, we have a solution for you! Get started with our program today! 

 

How To Manage A Hip Flexor Strain: How Do I Know If I Had An Injury?

how to manage a hip flexor strain the prehab guys

A muscle strain is typically referred to as a pulled muscle. There are microscopic tears that occur within the muscle tissue itself as a result of overstretching or the demand imposed on the muscle is greater than it’s capacity. As defined by Weir et al. 2015, experts agreed that iliopsoas-related groin pain is more likely if there is pain on resisted hip flexion AND/OR pain on stretching the hip flexors. Refer to the image above to get an idea of where hip flexor related pain can be located compared to other sources of pain.

 

POLICE Principle

With any soft tissue-related injury, we are big advocates of the P.O.L.I.C.E principle. What does POLICE stand for?

  • Protection

 

  • Optimal Loading

 

  • Ice

 

  • Compression

 

  • Elevation

 

In layman’s terms, you want to protect the hip right after an acute hip flexor strain. This means that if you injured your hip playing soccer, it may be best to take a break from playing soccer and not over-exert your hip for a short period of time. When it is appropriate, you want to optimally load the tissue involved. This is the tricky part, which we will cover throughout the article. You can ice the area immediately after the injury to reduce secondary cell damage within the first 48 hours. You can also use ice if you desire after the first couple of days to help with managing pain and discomfort in the sub-acute phase, however, there is mixed evidence to support if it improves swelling (which is the common belief.) You can learn more about the real effects of icing here. On the other hand, compression has better evidence to support its effect on swelling, but it can be challenging to compress this area. Elevation is another option to help with swelling and managing symptoms in an attempt to get the injured tissue above heart level.

READ: THE TRUTH ABOUT ‘RICE’ AND ICING INJURIES 

truth about rice and icing injuries the prehab guys

 

Early Phase Rehab

After the immediate strain settles down and you can tolerate the pain and discomfort, it’s time to get moving! Gentle motion and physical activity are appropriate, the goal is to get back to your normal routine and be able to tolerate simple things like walking, sitting, stairs, etc. Sometimes sitting for long periods of time with your hip in flexion (knee at hip height), can be discomforting, thus you may want to limit how long you do this and mix up how you work. For example, if you have to sit for your job, sit for a time limit you can tolerate followed by using a standing desk and changing between the two positions throughout the day. Read more about how to optimize your understanding of posture, which is discussed in one of our previous blog posts HERE!

In the early phase of hip flexor strain rehab, you don’t want to overexert the tissue (this is where protection is important). The easiest way to think about it is to imagine there is a scab on your muscle you can’t see, in order to let the scab heal you have to protect it. Overexerting the muscle could lead to picking the scab off and restarting the healing process all over again. Below you will find exercises that we have separated into mobility and strengthening to optimally load the tissue without overdoing it.

Standing Hip Flexor Stretch With Pelvic Tilts

There is debate regarding if you should stretch after a hip flexor strain. The challenge is with soft tissue injuries, the body wants to lay down scar tissue rather than new muscle tissue, which can limit the hip’s range of motion. In practice, I like to promote gentle, relative pain-free stretching just to keep things moving and to limit stiffness or loss of range of motion. You have to think about a soccer player with a hip flexor strain, getting into terminal hip extension with sprinting, kicking, and other motions are essential for the sport. That is why I like this stretch and the one below as early rehab hip flexor strain stretches, but remember – start easy and keep it relatively pain-free. It is not necessary to push through substantial pain and/or discomfort at this time, remember the scab analogy!

 

Secrets To Unlocking Your Hip Flexors

 

 Hip Strengthening Exercises

Why strengthen the glutes with a hip flexor strain? Well during the early phase of hip flexor strain rehab we have to protect the tissue involved, thus we are not going to program a ton of hip flexor exercises just yet. However, we want to maintain strength and physical capacity, so we need to strengthen other muscles around the hip. Also, as we strengthen the glutes we will be moving through hip extension range of motion, which can promote reciprocal inhibition of the hip flexors to get them to relax and lengthen. This can be beneficial for those that feel perceived tightness and muscle guarding of their hip flexors.

Bridge Hold

Sample Hip Flexor Rehab Program Exercise

 

Quadruped Hip Extension With Knee Bent (Donkey Kicks)

 

Prehab Membership The Prehab Guys

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

Middle Phase of Hip Flexor Strain Concepts

What is next in regards to how to manage a hip flexor strain? Once you’re able to tolerate the early phase hip flexor strain rehab exercises without any issue for a week or two, it is time to progress optimal loading of the tissue. For the average person, optimal loading during rehab can be based on the Rate of Perceived Exertion (RPE) as well as recovery time. An easy way to measure RPE is using a scale from 0-10, 0 being no difficulty at all and 10 being the most difficult thing ever. In rehab, RPE should range from 5-7/10 in the early phase and can work towards 6-8/10 once in the middle phase as long as there is no significant pain or discomfort.

RPE pairs nicely with recovery, meaning how long it takes for your body to return to baseline after training. If you performed the early phase hip flexor strain rehab exercises and your hip bothered you for 3 days after, you’re likely over-exerting the tissue as that recovery period is too long. However, if you performed the same exercises and felt fully recovered in a day you may be ready to move on and increase the challenge of the exercises. Below you will find hip flexor strain rehab exercises focused on progressive overloading of the tissue.

 

Late Phase of Hip Flexor Strain Rehab

The same rules apply, think about your RPE and recovery with the mid-phase hip flexor strain rehab exercises. At this point, you shouldn’t have any pain with activities of daily living or at rest. If you’re an athlete, you may be back to jogging or getting back into your normal workouts. Now it is a matter of getting your hip’s capacity back to or greater than 100% to minimize the risk of this happening again. Below you will find exercises that should be programmed into your workouts, before/after your training sessions, and moving forward to [P]Rehab your hip.

World’s Greatest Stretch

Sample Hip Flexor Rehab Program Exercise

 

Standing Psoas March With Band

 

Closing Thoughts

A hip flexor strain can be a nagging nuisance that provides challenges when attempting to overcome this particular injury. Depending on the degree of the strain, one may have to spend longer periods of time within the certain phases of rehabilitation in order to optimize his or her outcomes. Although it may be difficult to cope with this injury, it definitely is one that has a good prognosis with appropriate care! You will take a systematic progression from early protection and rest, followed by early mobility, optimal loading, and ultimately functional specific exercises to get you back to your functional goals. This progression of rehabbing from the proliferative phase through the maturation phase can be further understood in our tissue healing blog!

 

Take Control of Your Hip Flexor Issues

hip rehab program hip flexor strain the prehab guys

It’s all in the hips! Okay, maybe not ALL but in most activities the hips are the main driver of movement. The surrounding hip musculature provides stability and force production for walking, lunging, single-leg stance, and squatting patterns. It’s a unique design that requires mobility, stability, strength, and power. If mobility and stability become compromised discomfort becomes the result. In this program you learn to take control and earn back meaningful activity by improving hip mobility, stability, and strength, or a better way to put it: function!

 

REFERENCES

  1. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768-774.

 

About The Author

Craig Lindell, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Content Officer

craig lindell the prehab guysCraig is a South Jersey native & Penn State Kinesiology Alumni. When the opportunity came, Craig packed his bags and drove to California to pursue his Doctorate in Physical Therapy from the University of Southern California. With [P]rehab, Craig oversees all digital content creation and multi-channel publication that reaches millions of people on a weekly basis. As a PT, Craig has a wide array of experience from working with various neurological conditions to working with collegiate & professional athletes across the Big Five in North American sports. Experiencing physical therapy first-hand as a soccer player in high school, Craig has a passion & special interest in adolescent athletic development working with young athletes to overcome injuries. In his spare time, Craig enjoys exercising, playing golfing, hiking, traveling, watching Philly sports, and spending quality time with his family.

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.

About the author : Craig Lindell PT, DPT, CSCS

14 Comments

  1. Cheryl Palen February 28, 2021 at 4:53 pm

    Thank you for these exercises. I have self-diagnosed and will try these before I go in to see a specialist!

    • Sherif Elnaggar March 1, 2021 at 7:26 am

      Of course! Thank you for your support!

  2. Jake Gold March 17, 2021 at 11:36 am

    Hi Cheryl, I just self diagnosed myself with a hip flexor strain, I’m wondering how you’re feeling a little over 2 weeks since this comment? I’m an athlete and would love to see someone else’s timeline of recovering from this.

  3. Louise McGill June 9, 2021 at 7:54 am

    Thank your for these great videos– I am doing the exercises while waiting to get in to see my physiotherapist. I have injured my hip flexor from running.

    • Sherif Elnaggar June 9, 2021 at 11:49 am

      You are most welcome! Thank you for your positive comments and we hope you have a speedy recovery!!

      • Don June 8, 2022 at 4:09 am

        Thanks for this information and videos. I’m a senior and former triathlete who recently jumped back into cardio and strength training. I believe over doing it on the spin bike was the root cause of my hip flexor strain. Having ignored it and continuing workouts for a couple of months I’ve been seeing a PT who has been treating me weekly and prescribed many of the same stretches you perform in your videos. Unfortunately I don’t seem to be getting better and the pain now is radiating down my thigh to just below my knee. Not sure what to do at this point and considering a visit to an Ortho to determine just how bad this year is. Just wondering (hoping) that you can make a recommendation.

        • Team [P]rehab June 11, 2022 at 9:59 am

          Hi Don!

          emailing you to gain some more information from you so we can help get you going in the right direction.

          Best,

          Team [P]rehab

  4. Ben Foster August 23, 2021 at 1:27 am

    An amazing article.
    Since COVID happened, I had taken up running and had encountered this issue when the running volume started to increase.
    I was unaware of what the problem was and because of lockdown I had delayed seeing a physio, simply resting and staying off running. When the injury reoccured I had managed to get it checked out by a physio. The diagnosis was it was an overuse injury and that I had weak hip flexors that couldn’t cope with the running load.
    Having come across this article, I am confident I can practise different variations of hip flexor strengthening exercises and be able to eventually enjoy running again!

    Thanks so much for this.

    • Prehab August 23, 2021 at 4:43 am

      Thank you so much for reading our article and your positive feedback. We are glad that this has been helpful to you and we wish you a speedy, healthy recovery! All the best!

  5. Ioana January 9, 2022 at 1:27 am

    This article is helping me tremendously.
    Thank you for it!

    • Team [P]rehab January 9, 2022 at 10:21 am

      You are most welcome, we are so glad this has been helpful to you!!

      All The Best,

      Team [P]rehab

  6. Miriam Davis February 7, 2022 at 9:06 am

    This sounds exactly like my problem. I had purchased the HIP prehab program before fully understanding what I was dealing with. Should I begin that program, or follow this as I do believe it’s hip flexor pain that I’m dealing with.

    • Team [P]rehab February 9, 2022 at 2:51 am

      Hi Miriam!

      We are sorry to hear your hip has been bothering you. At this time, we recommend that you begin the Hip Program, as this program is going to optimize your entire hip region’s health, with an integration of step-by-step education, self assessments, thoughtful progressions, and will also integrate movements from other body regions which contribute to a healthy hip, including the core and low back! The program you are beginning is meant to treat the ENTIRE you, not just the root of your pain, which is why so many people have had success with our programs. I hope this helps answer your question, and please feel free to contact us at info@theprehabguys.com if you have any other questions, comments, or concerns! We are eager to hear about your recovery process.

      All The Best,

      Team [P]rehab

  7. Miriam Davis February 7, 2022 at 9:08 am

    After reading this, I believe this is exactly the kind of problem I’m dealing with on my left side. Prior to reading this I had purchased the HIP Prehab program. I’m now wondering if I should follow through with that, or follow what’s laid out in this article. Any thoughts?

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