- Hip flexor pain, or psoas syndrome, is usually felt on one side of the lower back, groin, and abdomen as pain, stabbing, tenderness, aching, or pressure.
- The pain and tension are usually most noticeable during movement and exertion, but they vary constantly.
- Prolonged symptoms of hip flexor pain are usually associated with pain in the lower back, pelvis, and hip area localized more on front side of the body.
Hip flexor muscles
The most important of the hip flexor muscles is the iliopsoas muscle, which consists of the iliacus muscle and the psoas major muscle. The hip flexor muscles originate from the lumbar vertebrae and iliac bones and attach to the femur. These muscles help maintain and support posture, flex the hip, and bend the torso forward.
Symptoms of hip flexor pain, i.e., psoas syndrome
Psoas syndrome is mentioned in the literature as a relatively rare primary cause of symptoms.
Hip flexor pain is usually felt in the groin and abdominal area as unilateral pain, stabbing, tenderness, aching, or pressure. It can also radiate and be felt in the lower back, sides, groin, and front of the thighs. As muscle pain, it is usually associated with certain movements, such as hip flexion, i.e., moving the knee toward the chest, or hip extension, i.e., bringing the leg backward. Also, it can cause dull achy pain on lower abdominal area at rest.
The onset of symptoms is usually associated with increased exertion and/or injuries, such as slipping while running, etc. The exact location and intensity of the symptoms usually vary depending on posture and movement. Stress usually aggravates the symptoms, but otherwise the symptoms are often variable, with some days being symptom-free. The symptoms are usually most noticeable in the morning upon waking and rarely interfere with sleep.
Clinical examination findings in psoas syndrome
In the clinicle, hip flexor pain is usually diagnosed by palpation, i.e., feeling with the hands. It is very common that repeating the hip flexor symptom by pressing directly is quite rare due to basic anatomy, where the hip flexors are close to the spine and can only be palpated from the abdominal side. Most commonly, the causes and findings of hip flexor symptoms are concentrated in various other muscle and connective tissue structures in the abdomen and flank area. It is also a good idea to test the muscle strength of the hip flexors, although this is much less accurate for treatment purposes than palpation.
Although hip flexor symptoms are quite rare, I would say that various findings related to the musculoskeletal system in the abdominal area are relatively common and are also associated with most prolonged back and hip pain conditions.
Causes of prolonged hip flexor symptoms
Prolonged symptoms are usually caused by a combination of several factors rather than just one of the factors listed below.
- Increased physiological stress due to previous injuries, premature wear and tear, or functional disorders, especially in the lower back, pelvis, hip, and lower extremities.
- Excessive continuous physical strain related to exercise and sports. In the literature, psoas syndrome is mentioned as a professional ailment among ice hockey players, dancers, high jumpers, and runners.
- Surgery in the abdominal and groin area, such as caesarean sections and inguinal hernia repairs, may predispose to the development of psoas syndrome.
- Hip replacement surgery may predispose to prolonged psoas syndrome.
- Psychological factors, such as anxiety, depression, and/or excessive mental strain, commonly known as stress.
- Lifestyle factors, such as too little or too repetitive exercise, insufficient or poor-quality sleep, and obesity.
- Central sensitization of the pain system.
- Factors, such as lack of support from one’s environment or dissatisfaction with family or work matters.
Symptoms in the abdominal area that intensify without actual activation of the hip flexor muscles, accompanied by various intestinal and abdominal symptoms, should be ruled out as possible organic causes, such as appendicitis, kidney stones, and prostate problems in men, before considering psoas syndrome as the cause of the symptoms.
Treatment and rehabilitation of hip flexor pain and psoas syndrome
Treatment and rehabilitation are tailored to the individual. The treatment of hip flexor pain requires experience with similar cases, as the findings and their correlation with the overall symptom picture are much more subtle than, for example, in the treatment of buttock pain, where the anatomy is easier to palpate, the structures are larger, and there are clearly fewer of them. Most commonly, the treatment of hip flexor pain and symptoms may include manual therapy, individual exercises, and, as the symptoms improve, a gradual increase in the load in movements and other activities that previously caused symptoms. Usually, the crucial link in people’s rehabilitation is accurate and individual assessment of the condition and alleviation of symptoms, which allows people to get back to regular exercise.
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Viimeksi päivitetty 13.10.2025
