Hip Flexor Strain

The hip flexors are the muscles at the front of the hip that lift your thigh. A strain is a stretch or partial tear in one of these muscles or its tendon, and it can make climbing stairs, getting out of a car, and walking briskly uncomfortable. Strains are graded by how much of the muscle has torn, from a few fibers in a grade 1 strain to a complete rupture in a grade 3. They are common in athletes who sprint, kick, or change direction quickly. Most heal with rest and a structured rehabilitation program, and most people return to their prior level of activity.

Common symptoms include:

• Sharp or pulling pain at the front of the hip or deep in the groin crease
• Pain that increases when lifting the knee, climbing stairs, or sprinting
• Pain that began during a single explosive movement and may worsen over the following hours
• Pain again when standing after sitting for a long period
• Bruising along the front of the thigh with a larger tear

The diagnosis starts with a physical examination: pain at the front of the hip near the groin that increases when the leg is raised against resistance, sometimes with swelling or bruising. An MRI is used when more detail is needed to grade the tear and locate it. In adolescents, an X-ray checks whether a fragment of bone has been pulled from the growth plate.

The large majority of strains heal without surgery:

• Rest and ice in the first day or two to control swelling and pain
• Activity changes, avoiding sprinting and kicking while the muscle heals
• Physical therapy with progressive stretching and strengthening, including eccentric exercise, guided by return-to-sport criteria
• A short course of anti-inflammatory medication for early pain and swelling

Surgery is rarely required. It is considered when a complete rupture has pulled a bone fragment from its attachment with significant displacement, particularly in a young active patient.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Hip Strains — AAOS OrthoInfo