Hip Flexor Pain and Iliopsoas Pain (Hip and/or Groin Pain)

In this blog we explore the muscles which sit at the front of the hip (hip flexors). We take a look at what these muscles do, and we take a look at hip flexor/iliopsoas related hip & groin pain.

Hip Flexor Pain May Be Related To Which Muscles and What Do They Do?

The muscles that sit at the front of the hip are called the hip flexors and act to lift your knee towards your chest (flexion). It is these muscles that can be involved with hip flexor pain. The main hip flexor, the iliopsoas muscle is made up of two parts – the psoas muscle that starts at the lumbar spine, and the iliacus that starts from the inside of the pelvis. They come together in the pelvis and run forwards over the front of the pelvis, deep across the front of the hip and join onto the upper thigh bone (femur). The iliopsoas muscle provides important support for the front of the hip joint, the sacroiliac joint of the pelvis and the lower back (lumbar spine). It is also a powerhouse for moving your legs forward in walking, running and stairclimbing.  

A number of other longer, more superficial (closer to the surface) hip flexor muscles run from the pelvis and down into the thigh and connect below the knee – the Sartorius, Rectus Femoris and Tensor Fascia Lata (TFL) muscles. These muscles help the iliopsoas muscle with lifting the thigh, but their effect also extends across the knee.  

Hip Flexor or Iliopsoas Related Hip & Groin Pain 

Tears or strains may occur within the hip flexor muscles; where the muscles and tendons join (musculotendinous junction); or within the tendons.  Traumatic injury resulting in rapid onset of pain is usually associated with sporting actions such as: 

  • kicking 
  • sprinting, particularly rapid acceleration 
  • changing direction at speed.  

Changes in tendon health often evolve more slowly, related to your body’s natural make-up (e.g. bony shape, hypermobility) or postural, movement, or athletic training habits.  

The iliopsoas tendon that joins the iliopsoas muscle to the femur (thigh bone) sits deep at the front of the hip and is separated from the hip joint by a large bursa (iliopectineal or iliopsoas bursa). This bursa reduces friction and helps the tendon slide freely across the front of the hip.  The tendon and/or the bursa may become involved and you may receive a diagnosis of: 

  • iliopsoas tendinopathy – a painful iliopsoas tendon 
  • anterior snapping hip – snapping of the iliopsoas tendon which can sometimes become painful 
  • iliopsoas bursitis – inflammation or thickening of the iliopsoas bursa 
  • iliopsoas impingement – impingement or compression of the iliopsoas tendon against the underlying bone 

The hip flexors muscles, and particularly the iliopsoas muscle, have become incorrectly demonised in the popular media for being the source of many problems. These are generally thought to be related to the muscles becoming overly active and tight. There is unfortunately much misinformation on the internet regarding the hip flexors and poor advice regarding management of true hip flexor issues.  

Many people are stretching the hip flexors and placing high loads on the front of the hip unnecessarily, often worsening their problem.  

Kirsty McNabDr. Alison Grimaldi


This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.

Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

Visit our Pain Locator Map to learn more about soft tissue related pain in different regions around the hip and pelvis. 

Hip Pain Locator Map

How a Hip Pain Professional Can Help:

Your Hip Pain Professional can: 

  • assess the hip flexors and decide whether stretching will help or aggravate the problem 
  • provide important advice about sporting activities, for example: 
    • advice re ‘how much is too much’ 
    • allowing adequate recovery between sessions 
    • temporary reduction in activity levels may be required 
    • rest from particular actions that place highest load across the hip flexors and pelvis  
  • provide or send you for rehabilitation to optimise function of these muscles 

Check Out More You Can Read on this Area at HipPainHelp:

Anterior Hip Pain: scroll down and read more about the front (anterior) of the hip joint and how different structures can be involved in pain at the front of the hip.

Groin Pain: scroll down and read more about the groin region and the hip joint and how they can be involved in hip pain that sometimes can be confused as pain at the front of the hip.

Femoroacetabular Impingement Syndrome (FAIS) – what is it and what are the causesLearn about the differences between FAI and FAIS, and what might be the cause of this condition. This is another condition that may result in pain at the front of the hip.

Causes, Affects & Exercises for Lordosis to Reduce Hip and Back Pain: Learn how tilting the pelvis forward may affect your hip flexor muscles

What is the Best Good Posture for Hip Pain Relief: Is there any one good posture that could best help with hip pain relief is not such an easy question to answer!

Don’t miss our next blog……

Our next blog will be looking at hip flexor strains – injuries to the muscles that lift the thigh up towards the chest.  Which muscles are most likely to be affected, and how are htey most likely to be injured.  This is a great blog to help you understand what might be the source of pain if one of the muscles at the front of your hip is injured.. Check out our next blog to find out more!

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