How to Tell if You Tore (or Pulled) Your Hip Flexor

What are the hip flexors?

The hip flexors are the muscles that lift your thigh toward your body, such as when you climb stairs, sprint or kick a ball. Cleveland Clinic describes them as the muscles where your thigh meets your hip, running across the bottom of the abdomen and down the front of the hip.

A strain is a tear in muscle fibers. Cleveland Clinic notes that a strained, pulled and torn muscle all describe the same type of injury, graded from 1 (mild) to 3 (severe). Most are mild or moderate and heal without surgery.

Anyone can strain a hip flexor. Cleveland Clinic notes the injury is common in running, hockey, football, soccer and martial arts, and that non-athletes can strain one too, especially when they suddenly push much harder than usual. Overuse, skipping a warm-up, tight muscles and falls are common causes.

What are the signs of a hip flexor strain?

Cleveland Clinic lists the typical symptoms of a hip flexor strain. They usually start during activity, often with a sprint, kick or sudden change of direction.

A mild strain may only ache when you lift the knee or climb stairs. A moderate strain often causes a limp and visible bruising a day or two later. A severe strain can make it hard to lift the leg at all, which is a reason to be examined promptly.

• Pain at the front of the hip or upper thigh, especially when lifting the knee
• A feeling of tightness or pulling
• Trouble walking without a limp
• Weakness in the lower abdomen or hip
• Bruising, swelling or muscle spasms

How can you tell a strain from something deeper?

A strain usually has a clear moment of injury and steadily improves. Cleveland Clinic notes that most people feel better within a week or two and that most strains heal within a few weeks with home care. The sore spot is usually tender to press, and it hurts most when you raise the knee against resistance.

Problems inside the hip joint behave differently. They often have no single moment of injury, hurt deep in the groin rather than in the muscle, and do not keep improving week after week. They may also cause clicking, catching or pain with sitting and pivoting.

Try paying attention to a few simple clues over the first two weeks. Did the pain start at one clear moment? Is it a little better each week? Is the sore spot near the surface and tender to touch? Three yes answers point toward a strain. A no to any of them is a reason to have the hip examined instead of waiting.

Which hip problems are mistaken for a hip flexor strain?

Cleveland Clinic points out that several conditions cause pain similar to a hip flexor strain, including hip impingement, pinched nerves and other muscle strains. These are the look-alikes our team checks for most often in active adults:

• Labral tear: deep groin pain with clicking, catching, or pain sitting and pivoting
• Femoroacetabular impingement (FAI): groin pain with twisting, squatting and deep bending
• Stress fracture: an ache that builds with running and may ache at night
• Early hip arthritis: groin pain and stiffness, worse after sitting or in the morning

Why does it matter if it is not a strain?

A strain heals with time. Some of its look-alikes do not, and a few get worse if you keep training. AAOS OrthoInfo explains that a bone stress injury can progress from a stress reaction to a true fracture if you continue to run through the pain. It also notes that bone stress injuries often appear three to four weeks after starting a new routine or a new season.

Stress fractures at the femoral neck, the top of the thighbone, are a particular concern in distance runners, according to AAOS OrthoInfo. They can cause groin pain that is easy to blame on a tight hip flexor. Labral tears and FAI also tend to linger, since AAOS OrthoInfo notes that ongoing FAI symptoms usually mean the cartilage or labrum is already being damaged.

How should you treat a pulled hip flexor at home?

For a typical mild strain, Cleveland Clinic recommends rest, ice and compression. Ice for 10 to 15 minutes every hour on the first day, then every three to four hours, with a towel between the ice and your skin. Over-the-counter anti-inflammatory medicine can help, though Cleveland Clinic advises not using NSAIDs for more than 10 days in a row without talking to your provider.

Skip running and hard workouts until the pain settles, since returning too soon raises the risk of re-injury. Gentle walking and light stretching are usually fine as long as they do not provoke sharp pain. Ease back into sport gradually once you can lift the knee and walk briskly without pain.

To lower the risk of another strain, Cleveland Clinic suggests warming up and stretching before exercise and building overall flexibility over time. Strengthening the hip and core muscles helps too.

When should a hip flexor injury be checked?

Cleveland Clinic advises seeing a provider if pain continues a few weeks after the injury or symptoms are severe. Get an exam sooner if you felt a pop with sudden sharp pain and weakness, since severe strains can pull the tendon off the bone. Groin pain that keeps a runner from hopping or that aches at night also needs imaging to rule out a stress fracture.

At Dr. Stride Hip & Joint, the exam focuses on finding exactly which structure is hurt. X-rays and, when needed, an MRI can confirm a strain or reveal a labral tear, impingement or stress injury. If your "pulled hip flexor" is not getting better, the Saturday Hip Pain Clinic in Memorial City is a good place to get answers before your next run.

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