Hip Flexor Tendinopathy – Symptoms, Causes, and Treatment Options

Overview of Hip Flexor Tendinopathy

Hip flexor tendinopathy is an overuse injury that affects the tendons connecting the hip flexor muscles to the pelvis and upper thigh bone. Tendons are tough connective tissues that attach muscle to bone, and when they are repeatedly strained, tiny tears and inflammation can develop. Over time, this can lead to stiffness, pain, and reduced hip mobility.

This condition is commonly seen in athletes who perform repetitive hip movements, such as runners, soccer players, and dancers. However, anyone can develop hip flexor tendinopathy, especially if their daily activities or work involve prolonged sitting, heavy lifting, or sudden changes in activity levels.

How common is hip flexor tendinopathy?

The exact prevalence is not well documented, but tendinopathies account for a significant percentage of musculoskeletal complaints in both athletes and the general population. According to a systematic review, tendinopathies affect up to 30% of athletes across various sports (Maffulli, N., Longo, U.G., Denaro, V., 2010, Clinical Sports Medicine, doi:10.1016/j.csm.2010.06.003). Hip-related tendon pain is less common than Achilles or rotator cuff tendinopathy, but it is a growing issue as more people take up high-intensity exercise.

Impact on daily life

Hip flexor tendinopathy can interfere with many aspects of life:

• Work: Sitting for long periods, standing, or lifting can all worsen hip pain, making office jobs or manual labor difficult.
• Sport & exercise: Running, squatting, or even light jogging may trigger sharp pain, reducing performance and motivation.
• Sleep: Pain often increases when lying on the affected side or after long days of activity, disturbing rest.
• Relationships & mental health: Ongoing pain can limit social activities, reduce participation in hobbies, and lead to frustration, stress, or low mood.

By understanding what hip flexor tendinopathy is and how it impacts you, you can take steps toward effective treatment and prevention.

What are the main symptoms of Hip Flexor Tendinopathy?

Hip flexor tendinopathy symptoms usually build up gradually, but in some cases they can appear after a sudden movement or injury. Recognizing these symptoms early can help you avoid worsening the condition.

Common symptoms you may notice

• Front hip or groin pain: The hallmark symptom is aching or sharp pain at the front of the hip.
• Stiffness: The hip may feel tight, especially after long periods of sitting or first thing in the morning.
• Pain with movement: Climbing stairs, kicking, running, or even lifting your knee can trigger pain.
• Tenderness: Pressing on the front of the hip often produces soreness.
• Reduced range of motion: Some people notice difficulty fully extending or flexing the hip.

Severity and daily impact

• Mild cases may feel like a dull ache during or after exercise.
• Moderate cases often include pain during daily tasks like walking or standing.
• Severe cases can make even simple movements, such as getting out of a chair, feel sharp and disabling.

How it affects your life

• Work: Sitting for long hours can increase stiffness and discomfort, while standing jobs may worsen fatigue and pain.
• Sport: High-impact activities like running or soccer may feel impossible; even low-impact exercise such as yoga can aggravate symptoms.
• Sleep: Lying on the affected side or shifting during sleep often triggers pain, leading to restless nights.
• Mood: Chronic pain can lead to irritability, stress, or reduced motivation to exercise.

Red flag signs

While hip flexor tendinopathy is generally not dangerous, you should seek medical care if you notice:

• Sudden, severe hip pain after a fall or accident.
• Inability to bear weight on the leg.
• Swelling, redness, or warmth around the hip (possible infection or fracture).
• Numbness or tingling in the leg (possible nerve involvement).

Reference:
Reiman, M.P., Bolgla, L.A., & Loudon, J.K. (2012). A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiotherapy Theory and Practice, 28(4), 257–268. https://doi.org/10.3109/09593985.2011.604981

Causes and Risk Factors for Hip Flexor Tendinopathy

Hip flexor tendinopathy develops when the tendons in the front of your hip are overloaded or stressed beyond their capacity to heal. Understanding the causes can help with both treatment and prevention.

Biomechanical causes

• Repetitive stress: Running, sprinting, cycling, and kicking can strain the hip flexor tendons.
• Sudden increase in activity: Rapidly increasing training load, intensity, or frequency raises injury risk.
• Muscle imbalances: Weak glutes or tight hamstrings can place extra stress on the hip flexors.
• Poor movement patterns: Over-striding while running or poor posture during exercise can worsen tendon strain.

Lifestyle and occupational risk factors

• Age: Tendons lose elasticity with age, making them more vulnerable.
• Posture: Prolonged sitting shortens the hip flexors, leading to stiffness and higher risk.
• Occupation: Jobs requiring heavy lifting, climbing, or long hours of sitting increase strain.
• Pregnancy: Hormonal changes and increased pelvic stress can overload the hip flexors.
• Obesity: Extra body weight increases stress on hip structures.

Comparison with other conditions

Hip flexor tendinopathy can be mistaken for:

• Hip labral tears: These cause clicking or locking in the hip, which is less common in tendinopathy.
• Hip bursitis: Usually involves more lateral (outer hip) pain.
• Hernias: Groin pain may mimic tendon pain but comes from a different cause.

Why prevention matters

If untreated, hip flexor tendinopathy can become chronic, making recovery longer and more difficult. Prevention strategies include gradual increases in training, maintaining balanced strength across hip muscles, and taking regular breaks from sitting.

Reference:
Rees, J.D., Maffulli, N., & Cook, J. (2009). Management of tendinopathy. The American Journal of Sports Medicine, 37(9), 1855–1867. https://doi.org/10.1177/0363546508324283

Diagnosis, Recovery, and Management of Hip Flexor Tendinopathy

Hip flexor tendinopathy can feel confusing and frustrating, especially when pain interferes with work, exercise, and sleep. This section explains how the condition is diagnosed, what you can expect during the recovery process, and evidence-based strategies to manage and prevent flare-ups.

How is Hip Flexor Tendinopathy Diagnosed?

Hip flexor tendinopathy is diagnosed through a combination of physical examination, movement testing, and sometimes imaging. The goal of diagnosis is to confirm that the hip flexor tendon is the source of pain and to rule out other conditions such as hip bursitis, labral tears, or hernias.

What do doctors check during a physical exam?

During your first visit, a healthcare provider will take a detailed history of your symptoms. They’ll ask questions like:

• When did the pain start?
• What activities make it worse or better?
• Do you feel stiffness, weakness, or sharp pain with certain movements?

A physical exam may include:

• Palpation: Pressing gently on the front of your hip to check for tenderness.
• Strength tests: Lifting your knee against resistance to see if pain increases.
• Flexibility tests: Stretching the hip flexor to look for tightness or reduced range of motion.
• Functional tests: Movements like walking, squatting, or stair climbing to evaluate how symptoms affect daily activity.

These tests help determine if the hip flexor tendon is inflamed or damaged.

When is imaging used?

Most cases of hip flexor tendinopathy can be diagnosed without imaging. However, your doctor may order tests if symptoms are unclear, severe, or not improving:

• Ultrasound: Shows tendon structure and can identify thickening or small tears.
• MRI (Magnetic Resonance Imaging): Used if a more detailed look at soft tissues is needed, especially to rule out labral tears or other hip injuries.
• X-ray: Not useful for tendon issues but may be done to exclude fractures or arthritis.

How do clinicians find the root cause?

Diagnosis goes beyond confirming tendon pain. A thorough evaluation considers:

• Biomechanics: How you walk, run, or move may reveal imbalances.
• Muscle strength: Weak glutes or core muscles often contribute to hip flexor overload.
• Lifestyle factors: Sitting posture, training errors, or occupational stress may explain why the tendon is struggling to heal.

By identifying both the immediate source of pain and the underlying drivers, a healthcare provider can build a more effective treatment plan.

Reference:
Hölmich, P., Thorborg, K., Dehlendorff, C., Krogsgaard, K., & Gluud, C. (2014). Incidence and clinical presentation of groin injuries in sub-elite male soccer. British Journal of Sports Medicine, 48(16), 1245–1250. https://doi.org/10.1136/bjsports-2013-092627

Recovery Timeline for Hip Flexor Tendinopathy

Recovery from hip flexor tendinopathy depends on the severity of the injury, how long symptoms have been present, and how well you follow treatment guidelines.

How long does hip flexor tendinopathy take to heal?

• Mild cases: 4–6 weeks with consistent rest, activity modification, and exercises.
• Moderate cases: 8–12 weeks, often requiring structured rehab.
• Severe or chronic cases: 3–6 months or longer, especially if tendon degeneration is advanced.

Decision pathway for recovery

• If symptoms are mild: You may improve with rest, stretching, and gradual return to activity.
• If symptoms are moderate: Structured physical therapy and progressive strengthening are usually required.
• If symptoms are severe or chronic: A longer rehabilitation process may include advanced therapies (e.g., shockwave, injections) in addition to exercise.

Factors that influence prognosis

• Positive factors: Early diagnosis, consistent rehab, good posture, and balanced strength training.
• Negative factors: Ignoring symptoms, returning to sport too early, poor ergonomics, or coexisting conditions such as arthritis.

Return to work and sport

• Work: Most people with sedentary jobs can continue working with modifications (e.g., standing breaks, ergonomic seating). Manual laborers may need temporary restrictions.
• Sport: Athletes often return once they can perform pain-free movements, usually after completing strength and mobility goals in rehab.
• Long-term outlook: With proper care, most people recover fully. However, recurrence is common if underlying risk factors (like weak glutes or poor posture) are not addressed.

Lifestyle impact of recovery

Recovery requires patience and consistency. Some people find that the biggest challenge is managing frustration and adapting their lifestyle while healing. Building in low-impact activities (swimming, cycling) can help maintain fitness without overloading the tendon.

Reference:
Silbernagel, K.G., & Crossley, K.M. (2015). A proposed return-to-sport program for patients with midportion Achilles tendinopathy: rationale and implementation. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 876–886. https://doi.org/10.2519/jospt.2015.5885

How to Manage Hip Flexor Tendinopathy

Managing hip flexor tendinopathy involves reducing strain on the tendon while gradually restoring strength, flexibility, and function.

Key management strategies

• Posture and ergonomics: Avoid prolonged sitting with hips flexed; adjust chairs and desks to reduce stress.
• Activity modification: Temporarily reduce running, sprinting, or kicking sports. Replace with lower-impact activities.
• Core and glute strength: Strengthening surrounding muscles reduces overload on the hip flexors.
• Flexibility training: Gentle stretching of the hip flexors and hamstrings helps maintain mobility.
• Load management: Gradually increase activity levels instead of making sudden jumps.

Self-help & relief tips (step-by-step)

1. Rest: Avoid high-impact activities for at least a few weeks.
2. Ice: Apply cold packs to the front of your hip for 15 minutes after activity.
3. Gentle stretch: Perform a hip flexor stretch (kneeling lunge) for 20–30 seconds, 2–3 times daily.
4. Strengthen support muscles: Add glute bridges, planks, and side-lying leg lifts to your routine.
5. Modify sitting posture: Keep hips slightly above knees; stand up every 30–45 minutes.
6. Return to activity slowly: Start with low-intensity exercise and progress when pain-free.

Each of these steps reduces load on the tendon and supports gradual healing.

Therapy and lifestyle support

• Physical therapy: Provides tailored exercise plans, manual therapy, and monitoring.
• Coaching and habit formation: Helps maintain consistency with rehab exercises.
• Lifestyle optimization: Adequate sleep, balanced nutrition, and stress reduction all promote tendon healing.
• Community and social supports: Group exercise classes or rehab groups can increase motivation.

Comparison with similar conditions

Hip flexor tendinopathy management differs from bursitis or labral tears because the primary focus is on progressive loading and tendon repair, rather than reducing inflammation alone.

Multidisciplinary Coordinated Care for Hip Flexor Tendinopathy at CARESPACE

At CARESPACE, hip flexor tendinopathy is treated through a coordinated, multidisciplinary approach that addresses both the physical and mental sides of recovery. Instead of focusing on a single therapy, our team works together to create a personalized plan that supports your body, mind, and lifestyle so you can heal faster and reduce your risk of recurrence.

How does CARESPACE treat Hip Flexor Tendinopathy differently?

CARESPACE uses a team-based model of care that brings together physiotherapists, chiropractors, massage therapists, kinesiologists, psychotherapists, nutritionists, and other specialists. This means you don’t just get symptom relief—you get a whole-body, long-term solution.

In a standard care model, you might only see one type of provider, such as a physiotherapist or a chiropractor. While helpful, that approach can leave out key factors that influence recovery, such as stress, sleep, nutrition, and mental health. At CARESPACE, we coordinate across multiple disciplines to give you a more complete path to recovery.

For example:

• A physiotherapist designs a personalized exercise program to restore hip strength and flexibility.
• A massage therapist reduces muscle tension and improves circulation to support tendon healing.
• A psychotherapist helps you cope with the stress and frustration of living with chronic pain.
• A nutritionist ensures your body has the right fuel to support tissue repair.
• A fitness coach or kinesiologist guides safe return-to-sport and long-term injury prevention.

This coordinated plan ensures you are supported at every stage of recovery.

Why does a team approach help Hip Flexor Tendinopathy recover faster?

A team approach helps you heal faster because it tackles both the root causes of pain and the lifestyle factors that slow recovery. Hip flexor tendinopathy is not just about the tendon—it’s also about muscle imbalances, poor posture, training errors, stress, and even sleep.

Acute phase (pain relief and protection)

In the early stages, your care team works to reduce pain and protect the tendon. This may include:

• Chiropractic adjustments to improve hip and pelvic alignment.
• Massage therapy to relieve tension in surrounding muscles.
• Acupuncture to reduce pain sensitivity and promote circulation.
• Psychotherapy or coaching to help manage pain-related anxiety and insomnia.

Subacute phase (rehab and strength rebuilding)

As symptoms improve, the focus shifts to restoring function. Your team may add:

• Physiotherapy exercises to gradually load the tendon and improve resilience.
• Kinesiology or fitness training to retrain movement patterns and build hip stability.
• Nutrition support to optimize healing and reduce systemic inflammation.

Maintenance phase (prevention and long-term health)

Once pain is under control, the goal is to keep it from coming back. This may involve:

• Core and glute strengthening programs to reduce strain on the hip flexors.
• Lifestyle coaching to build sustainable exercise and posture habits.
• Ongoing counselling if pain-related stress or sleep disruption continues.

How does CARESPACE support both body and mind in Hip Flexor Tendinopathy?

Living with hip pain can take a toll on your mental health as much as your physical health. At CARESPACE, we recognize that conditions like hip flexor tendinopathy often lead to stress, poor sleep, and frustration with daily limitations.

That’s why our care plans often combine physical therapies with mental health support:

• Psychotherapy helps you manage pain-related stress, anxiety, or low mood.
• Mental performance coaching builds resilience and coping strategies.
• Sleep strategies and relaxation training improve rest and recovery.
• Nutritional counselling supports mood stability and energy balance.

This mind-body connection means you recover not just physically but also emotionally, leading to stronger long-term outcomes.

Why is coordinated care better than isolated treatment?

Coordinated care reduces confusion, speeds up recovery, and lowers the chance of relapse. Instead of managing multiple providers on your own, CARESPACE integrates all your care in one plan.

Key advantages of coordinated care at CARESPACE

• Efficiency: Each provider shares notes and progress updates, so you don’t have to repeat your story.
• Personalization: Plans are tailored to your unique body, lifestyle, and goals.
• Prevention of recurrence: By addressing strength, posture, nutrition, and stress together, your risk of future injury goes down.
• Whole-person support: Physical pain, emotional well-being, and daily function are treated at the same time.

For example, someone with hip flexor tendinopathy who sits long hours for work may start with physiotherapy to relieve tendon strain. At the same time, they could receive ergonomic coaching, massage therapy for tightness, and psychotherapy for stress linked to chronic pain. This team-based approach is much more effective than seeing one provider in isolation.

Putting it all together: The CARESPACE advantage

At CARESPACE, hip flexor tendinopathy care is evidence-based, natural, and multidisciplinary. You’re not treated as just a set of symptoms—you’re supported as a whole person. From the acute stage of pain relief to long-term maintenance and prevention, our coordinated care model ensures every angle of recovery is covered.

This is the CARESPACE difference: a team working together for your recovery, resilience, and future health.

Related Conditions, FAQs, and Disclaimer for Hip Flexor Tendinopathy

Hip flexor tendinopathy shares symptoms with several other hip and groin conditions. Knowing what else might cause similar pain helps you and your provider find the right path to recovery. Below, we cover related conditions, answer frequently asked questions, and provide an important disclaimer about medical guidance.

Related Conditions for Hip Flexor Tendinopathy

Hip flexor tendinopathy can mimic or overlap with other conditions that cause hip and groin pain. This is why careful diagnosis is important.

Common related conditions:

• Hip bursitis: Inflammation of the fluid-filled sacs on the outside of the hip, usually causing outer hip pain rather than front hip pain.
• Groin strain: A muscle injury that often occurs suddenly during sports, while hip flexor tendinopathy tends to build up gradually.
• Labral tear: A tear in the cartilage inside the hip joint that may cause clicking or locking in addition to pain.
• Osteoarthritis: Joint degeneration that causes stiffness and pain, often affecting older adults.
• Hernia: Groin pain that can feel similar to tendon pain but comes from a bulge of tissue through the abdominal wall.

Because these conditions share symptoms, a thorough exam is needed to tell them apart. 

Looking for information on a different condition? Visit our full Conditions List.