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Understanding Hip Flexor Pain

Updated: Nov 19, 2023

Hip flexor pain can be a common issue affecting a variety of individuals. Often pain is felt in the hip or groin and can be made worse by certain movements such as kicking, changing direction, lunging or bringing the knee towards the chest. In this piece we will explore the anatomy, causes, symptoms and treatment options for hip flexor pain, offering useful insight to help keep your hips healthy and pain-free.


Hip Flexor Anatomy


The hip flexor region is a complex area, with various anatomical structures that make up the anterior hip and lumbopelvic complex region. The following structures may cause hip flexor pain:

  1. Iliopsoas Muscle: Compromising of the iliacus and psoas major muscles, the iliopsoas is important for postural stability, trunk and hip flexion. The iliacus originates from the pelvis, while the psoas major originates form the lumbar spine.

  2. Rectus Femoris Muscle: Part of the quadriceps group, this muscle crosses both the knee and hip joints, playing an important role in hip flexion and knee extension. It is important in activities that combine both of these movements such as squatting and kicking.

  3. Sartorius Muscle: The longest muscle in the body, the sartorius assists in hip flexion, abduction and external rotation.

  4. Tensor Fasciae Latae (TFL) Muscle: Located on the lateral hip, the TFL aids in hip flexion, abduction, and internal rotation. It arises from the iliac crest and inserts into the iliotibial (IT) band.

  5. Pectineus: A small but important muscle that contributes to hip flexion and adduction.

  6. Hip Joint & Surrounding Ligaments: The hip joint, a ball-and-socket joint, allows for various movements, including flexion, extension, abduction, adduction, and rotation. Various ligaments and capsular structures provide stability to the joint.

  7. Hip Nerve Structures: Various nerves, such as the iliohypogastric, genitofemoral, inguinal nerve and other femoral nerve branches, can contribute to anterior hip pain.

hip flexor anatomy

Fig 1: Hip Flexor Anatomy - Physiopedia


What are the Causes of Hip Flexor Pain?


Understanding the root causes of hip flexor pain is essential. Common factors include:

  1. Muscle Strains: Rapid actions like sprinting and kicking can strain the hip flexor muscles, particularly the rectus femoris.

  2. Muscle Tightness & Posture: Prolonged sitting, often related to occupation, may lead to tightness in the anterior chain.

  3. Overuse or Repetitive Stress: Activities involving repetitive hip flexion, such as cycling or running, can result in irritation and tendinopathies.

  4. Trauma or Injury: Direct trauma, such as a fall or sports-related collision, can cause anterior hip pain.

  5. Referral Pain: Hip flexor pain may sometimes be secondary to an underlying cause, such as lower back issues.

What Different Structures Can Cause Hip Flexor Pain?


Diagnosing hip flexor pain may be complex as it can often be a secondary symptom rather than the primary source of pain. Further, it is not uncommon to have multiple structures involved with hip & groin pain. Consider these potential different casues:

  1. Hip Joint Pathology: Conditions like osteoarthritis, labral tears, and femoroacetabular impingement (FAI) can mimic hip flexor pain.

  2. Lumbar Spine Pathology: Nerve impingement or disc herniations in the lower back can refer pain to the hip flexor area.

  3. Inguinal Related Groin Pain: An inguinal hernia in some cases can cause pain in the groin area, resembling hip flexor pain.

  4. Bone Stress Injuries: Stress responses in the pubic region or femoral neck can refer pain to the hip flexors and adductor muscles.


Common Signs & Symptoms?


Various signs and symptoms may be present depending on the root cause of hip flexor pain. Some of the common signs and symptoms include:

  • Ache pain or discomfort in the groin/hip region, which may be worsened with prolonged sitting

  • Tenderness to touch

  • Muscle weakness during certain activities

  • Reduced range of motion, particularly during functional tasks such as lunging, running, and kicking

  • Changes in gait due to pain and reduced range of motion


Treatment - The Road to Recovery from Hip Flexor Pain


Effective treatment depends on the signs, symptoms, and causative factors. It may involve:

  1. Rest and Activity Modification: Reducing or modifying activities that exacerbate hip flexor pain to alleviate strain.

  2. Physical Therapy & Treatment: Customized treatment plans involving stretching, strengthening, manual therapy, dry needling, and rehabilitation. Biomechanical analysis helps address contributing factors and loading strategies whilst a comprehensive rehabilitation program can address areas of weakness and reduced function.

hip flexor pain rehabilitation treatment

To Finish


Understanding the complexity of the hip flexor region and the potential causes of pain is the first step to effective management. Physiotherapy plays a pivotal role in diagnosing, treating, and preventing hip flexor pain, ensuring you can lead a pain-free, active life.


If you're experiencing hip flexor pain, don't hesitate to reach out and inquire online or book today for an in-depth physiotherapy consultation. Your journey to recovery begins here 🌟💪






References

  1. Falvey, É. C., King, E., Kinsella, S., & Franklyn-Miller, A. (2015). Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients—clinical findings, MRI findings and patient-reported outcome measures at baseline. British Journal of Sports Medicine, 50(7), 423–430. https://doi.org/10.1136/bjsports-2015-094912

  2. Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D. R., Khan, K. M., … Tyler, T. F. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. 49(12), 768–774. https://doi.org/10.1136/bjsports-2015-094869

  3. Wadsworth, D. J., & Weinrauch, P. C. (2019). THE ROLE of a BIKE FIT in CYCLISTS with HIP PAIN. A CLINICAL COMMENTARY. 14(3), 468–486. https://doi.org/10.26603/ijspt20190468

  4. Laumonerie, P., Dalmas, Y., Tibbo, M. E., Robert, S., Durant, T., Caste, T., … Chaynes, P. (2021). Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature. 22(5), 1149–1157. https://doi.org/10.1093/pm/pnab061

  5. Kemp, J. L., Grimaldi, A., Heerey, J. J., Jones, D. R., Scholes, M., Lawrenson, P. R., … King, M. D. (2019). Current trends in sport and exercise hip conditions: Intra-articular and extra-articular hip pain, with detailed focus on femoroacetabular impingement (FAI) syndrome. 33(1), 66–87. https://doi.org/10.1016/j.berh.2019.02.006

  6. Hip Biomechanics During a Single-Leg Squat: 5 Key Differences Between People With Femoroacetabular Impingement Syndrome and Those Without Hip Pain | Journal of Orthopaedic & Sports Physical Therapy. (2019). Retrieved June 1, 2023, from Journal of Orthopaedic & Sports Physical Therapy website: https://www.jospt.org/doi/full/10.2519/jospt.2019.8356

  7. Serner, A., Weir, A., Tol, J. L., Thorborg, K., Roemer, F. W., Guermazi, A., … Per Hölmich. (2018). Characteristics of acute groin injuries in the adductor muscles: A detailed MRI study in athletes. 28(2), 667–676. https://doi.org/10.1111/sms.12936


Disclaimer: This blog is for informational purposes and should not be considered a substitute for professional medical advice. Please consult with our qualified healthcare providers for personalised recommendations related to your specific condition and needs.

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