Our hip flexors aren’t very well understood and often ignored when we exercise. However, if it weren’t for the hip flexors, we would not be able to sit down. The hip flexors form a very important group of muscles allowing us to bend at the waist. These muscles are found deep within our abdominal area and are some of the strongest muscles in our body, ultimately providing our core support and improving our knee strengthening.
The hip flexors are activated the most when sprinting or kicking. Therefore, it makes sense that athletes — especially soccer players, football players and runners — are prone to issues with their hip flexors.
Hip Flexor Function — and Why The Hip Flexor Is Important
The hip flexors are a group of muscles in the pelvic region and upper thighs that help drive up the knees and keep the pelvis and thighs aligned, which is a key running tip for beginners and can help prevent knee problems. But you don’t have to be a runner or athlete to need healthy hip flexors.
To gain a better understanding of the hip flexors and why we need them, let’s talk a little anatomy. Flexion is a joint movement that decreases the angle between the bones that converge at the joint and is typically initiated by a muscle contraction.
A muscle that flexes that joint is called a flexor. The muscles that make up the hip flexors are collectively known as the iliopsoas or inner hip muscles. Without the iliopsoas muscles, kicking, running, sprinting and even sitting would not be possible.
Common Causes of Hip Flexor Injuries
A hip flexor strain occurs when one or more of the hip flexor muscles becomes stretched or torn. Hip flexors allow you to bend your knee and flex your hip. Sudden movements, such as sprinting, kicking and changing direction while running or moving, can stretch and tear the hip flexors. It can also happen if you are simply in a hurry.
The hip flexor is one of the most common running injuries. As reported by Runner’s World, Reed Ferber, PhD, looked at 283 studies that examined running-related injuries and concluded that there were connections between weak hip stabilization muscles and running injuries. (1)
Ferber, the director at the Running Injury Clinic in association with the University of Calgary, describes the kinetic chain that makes up a human body on the run. He notes that typical mechanics are for the foot to collapse inwards, also known as pronation. This then causes the lower leg to internally rotate, leading to the upper leg that also internally rotates.
As you can see, all of these functions are connected making the hips and core area an integral part of bodily movements. Research out of the University of Wisconsin, Milwaukee reported by Jennifer Earl, PhD, ATC, prescribed a hip-strengthening program to a group of healthy female runners for eight weeks. In addition to showing a predictable increase in hip strength at the end of the program, the runners also exhibited significantly less pronation. Most impressive, the participants experienced 57 percent less pronation at the ankle joint.
Mike Smith, who coaches the distance squad at Kansas State, as well as Olympian Christian Smith, says that this is one of the problem areas he focuses on with runners. “We often see poor hip strength coinciding with poor overall strength,” he says. As such, Smith’s runners spend lots of time on what many people consider supplemental exercises, but which Smith, co-creator of runningdvds.com, sees as fundamental for any runner wanting to consistently train injury-free.
Hips are often called ball-and-socket joints because the ball-like top of your thigh bone moves within a cup-like space in your pelvis. Your hips are very stable, so when they are healthy, it takes great force to hurt them. However, athletes, anyone who engages in sports-related activities, runners, people who do martial arts, play football, soccer and hockey, etc. are more likely to have an injury relating to the hip flexor.
There are some specific factors that can lead to hip flexor strain such as weak muscles, not warming up before a workout, stiff muscles, overtraining, trauma or falls. Typical types of hip injuries include strains, bursitis, dislocations and fractures.
Certain diseases also lead to hip injuries or problems. Osteoarthritis can cause pain and limited motion and osteoporosis of the hip can cause weak bones that break easily. Both of these are more common in older adults.
There are quite a few alternative names that may be familiar to you, such as a pulled hip flexor, hip flexor injury, hip flexor tear, iliopsoas strain, strained iliopsoas muscle, torn iliopsoas muscle and psoas strain.
What to Expect & What To Do About a Hip Flexor Injury
If you encounter a hip flexor strain, you will feel it in the front area where your thigh meets your hip. Depending on how bad the strain is, you may notice sensations such as a mild pain and pulling in the front of the hip, cramping and/or sharp pains. It may be hard to walk without limping. Severe pain, spasms, bruising and swelling may become evident and you may need to use crutches for a severe strain.
If you notice pain similar to what I have described, follow these steps for the first few days or weeks after your injury and see your doctor.
- Stop any activity that causes pain.
- Ice the area for 20 minutes every 3 to 4 hours for 2 to 3 days. Do not apply ice directly to your skin. Wrap the ice in a clean cloth first.
- Consider a combination of essential oils for pain, such as found in this DIY homemade muscle rub.
- If the pain is not severe, you may want to try to exercises I have described below to help stretch and strengthen the area.
- If pain or bulging occurs, or there is no improvement after two weeks of these recommendations, see your sports medicine doctor or physical therapist to better evaluate your specific problem and if any pain persists, see your doctor immediately.
While I always recommend trying natural remedies first, make sure you talk with your healthcare provider before using any pain medicines, especially if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. (2)
Reducing the Risk of Hip Flexor Injuries Caused by Tight Hip Flexors
You may be wondering how to distinguish if a pain is associated with the hip flexor. Hip flexor pain is usually felt in the upper groin region where the thigh meets the pelvis. If you notice a pain in this area, it is important to take steps to help prevent an injury or further increase an injury in the hip flexors.
Hip injuries are most often preventable because they are due to lack of strength and flexibility in the hip flexor muscles. Because of the stress placed upon this region of the body, it is critical that you take good care of it. When you are less flexible, it can prevent you from moving around as much as you normally would leading to more stiffness and even pain. We all know that the less you move, the harder it is easy to stay active. This is all part of good health and maintaining strong hip flexors.
When you sit too much, you can cause shortening of this muscle group. Common reports of injuries occur from those that sit all day and then have a sudden burst of activity, even as simple as being in a hurry or running to catch a cab or a plane, because it causes an unexpected lengthening of the hip flexor muscles. This is why it is important to maintain strength and flexibility in the hip flexors.
Hip flexors also support many other areas of the body. A study was conducted of sixty-eight high school cross country runners (47 girls, 21 boys) in which isometric strength tests of the hip abductors, knee extensors and flexors were performed with a handheld dynamometer. Runners were prospectively followed during the 2014 interscholastic cross country season for occurrences of anterior knee pain (AKP) and shin injury as they examined risk relationships between strength values and occurrence of AKP and shin injury.
While hip and knee muscle strength was not significantly associated with shin injury, it was associated with knee injury. The high school cross country runners with weaker hip abductor, knee extensor and flexor muscle strength had a higher incidence of AKP — therefore increasing hip and knee muscle strength may reduce the likelihood of AKP in high school cross country runners. (3)
A 2015 study reported by the Clinical Physiology and Functional Imaging journal showed that both static stretching and dynamic stretching imposed benefits of strengthening and flexibility of the hip flexor muscles, which can lead to subsequent performance enhancements.
Fourteen highly trained subjects were tested before and following separate sessions of eight repetitions of 30 seconds of both static and dynamic hip flexion stretches with the goal of testing the hip flexor range of motion (ROM), isokinetic leg flexion torque and power of the stretched and contralateral limbs. The stretched limb had a 6.3 percent ROM increase with dynamic stretching at 10 min. The non-stretched hip flexors experienced ROM increases with static stretches of 5.7 percent, whereas dynamic stretches showed up to 8.4 percent increase in range of motion. (4)
The Benefits of Stretching Your Hip Flexors
1. Better Performance for Athletes
Runner’s World reports that weakness in the hip flexors can contribute to slower running times, improper form, and, according to a recent review presented at the annual meeting of the American College of Sports Medicine, a host of lower-leg running injuries. (5)
“The body has the capacity to compensate for weak hip flexors, but the strategies to do that can lead to muscle imbalances and injury,” says Gregory Holtzman, PT, DPT, associate professor of physical therapy at Washington University and director of the university’s Running Clinic, who recommends performing strengthening exercises three or four days a week.
2. Less Risk of Injury and Better Range of Motion
If the hip muscles are strong, they will provide you with the support you need and ultimately help prevent injuries, especially if you are an athlete or an aging adult. And because this muscle group provides so much of your core stabilization, you need them to be strong for simple functions of daily life, too.
If the muscles in the hip joint area are too tight, it can affect your range of motion. It is important to keep the soft tissue around your hip loose. To improve flexibility, you can massage the iliotibial bands located on the outside of your upper thigh, your hip adductors located in your inner thigh and your hamstring muscles.
To do this, do foam roller exercises or use a small ball like a baseball, golf ball or tennis ball to massage these areas. Apply moderate pressure and roll the roller or ball up, down and at various angles over the muscle or ligament, but be gentle at the sensitive spots. This combined with some of the stretches and exercises below should help increase your range of motion in any activity. (6)
3. Walk Longer, Stand Longer and Improve Balance
Are you someone that worries about long walks, even if to the car? The hip flexor is a major stabilizer of the lower body, so if your hip flexor is too weak, you’ll suffer from poor balance and postural problems.
You may have problems with your hip joints and frequent misalignments in your lumbar spine. You’ll have trouble standing and walking for long periods of time, and you may have problems with your gait. Consider beginning a walking to lose weight program as well as a strengthening program for your hips to help prevent these concerns and to give you better quality of life.
4. Better Support for Your Back
The hips help drive us forward and stabilize our landing while preventing excess side-to-side motion that could strain the back. If your hip flexors are overdeveloped, tight, stiff or short, you’ll likely suffer from lower back pain. You could experience a limited range of motion in the lower back because tight hip flexors pull your pelvis into an unnatural forward tilt, which in turn pulls your lumbar spine out of alignment, causing lower back pain.
Best Stretches & Strengthening Exercises for Hip Flexors
Your sports medicine doctor may recommend exercises to help stretch and strengthen your hip flexors so that you prevent injury. These exercises are not just for those that are injured. The best way to think about it is to prevent the injury in the first place by performing these exercises as part of your weekly, or even daily routine, especially if you are susceptible to hip related injuries.
However, if you have encountered a hip injury, swimming may be a great way to exercise and strengthen your core while your are in the resting phase of healing. Eventually, you can begin to work at home or at the gym using some of these exercises here.
For a severe strain, you may want to see a physical therapist (PT). The therapist will work with you to help stretch and strengthen your hip flexor muscles and other muscles that surround and support that area and guide you in increasing your activity level so you can return to your former activities.
Hip Flexor Stretches
Front Hip Flexor Stretch: Place your left knee on the ground and your right knee up with your foot on the ground at a 90 degree angle. Place your hands on your right thigh. Lean your hips forward to create a stretch in the front hip area. Hold for 5 seconds and repeat 5 times. Then do the other side.
Quad Stretch and Hip Strengthener: Lie on your back with knees bent and feet flat on the floor. Feet should be somewhat close to your butt. Lift your hips towards the ceiling and hold for 3–5 seconds while squeezing your butt and tightening your abs. Release. Repeat 10 times.
Seated Butterfly Stretch: Sit on the floor with your back straight, shoulders down, abs engaged. Press the soles of the feet together in front of you, with your knees bent to the sides. Try to pull your heels towards you while relaxing your knees towards the floor. Do not push your thighs down to the floor with your hands, but rather use your thigh and core muscles to try to push them down. Breathe deeply and hold for 10-20 seconds.
Supine Hip Flexor Stretch: Lie on your back on the floor. Bring your left knee towards you to the point of being able to reach behind your left thigh. Gently pull your leg towards you for an increased stretch. Breathe deeply, hold for 3–5 seconds and release. Repeat on the other side for a total of 5 per side.
Hip Flexor Strengthening Workout
Reverse Lunge: Stand with your feet shoulder-width apart. You may want to hold onto a chair while performing this exercise. Take a step backwards with your right foot and lower into a lunge. Push through your left heel to stand. Immediately lower back into a lunge. Focus on a strong core and keep the upper body as upright as possible. Do three sets of 12 reps on each side.
Advanced: Reverse Lunge with Knee Drive: Perform the same movement as above; however, when you push through your left heel, drive your right knee up until it’s parallel to the floor. Return to standing position and repeat.
Seated Hip Flexion: Sit in a chair or on a bench with good posture. Raise your right knee up toward your chest, making sure that your thigh does not roll in or out. Pause, then slowly lower your knee to start. If at first, you can only lift a little, don’t worry; over time, you will be able to lift a bit higher. Do three sets of 12 reps on each side.
High Knees: While standing on your left leg, raise your right knee as high as you can, then repeat with the other leg like a slow march in place. Do this for 30 seconds three times.
Advanced: High Knees Run: The movement is the same as above, but quickly alternating legs as if running with high knees. Do this for 30 to 60 seconds five times.
Single-Leg Knee Lift: While standing on your right leg, lift your left knee until your thigh is parallel to the floor. Hold for 10 seconds. A trick to help with balance is to stare at a spot that is a few feet in front of you that is not moving. Keep abdominals tight. Do three sets of 10 reps on each side.
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