Psoas muscle strain: understanding your hip pain and getting back to activity

What is a psoas muscle strain?

Psoas anatomy

The psoas is a deep muscle that connects the lumbar spine to the femur, passing in front of the hip joint. As the main hip flexor, it’s heavily stressed during sprinting and explosive leg-flexion efforts, which exposes it to muscle strains during intense efforts or forced movements.

Why does this muscle get injured?

A psoas strain most often occurs during an explosive hip-flexion effort, such as a sprint, a kick, or a sudden start, particularly in athletes who haven’t warmed up sufficiently. Too rapid an increase in training intensity or a lack of flexibility in the muscle also raise the risk.

Symptoms and diagnosis of a psoas strain

Typical pain and what triggers it

The pain is triggered by active hip flexion against resistance: sprinting, kicking, or taking the stairs quickly. It’s felt at the front of the hip or in the lower abdomen, sometimes fairly diffusely since the psoas is a deep muscle. Sharp pain, sometimes with a “pulling” or “popping” sensation followed by stiffness, is typical of higher grades.

Differential diagnosis

Other hip or groin pain can resemble this injury:

• Psoas tendinopathy, which develops gradually rather than appearing suddenly
• Hip impingement, worth considering if the pain is deeper and triggered by flexion combined with rotation
• Adductor muscle strain, usually located on the inner thigh

Causes and risk factors

A psoas strain most often occurs during an explosive movement on a muscle that isn’t sufficiently prepared.

Risk factors

• Insufficient warm-up before an explosive effort
• Muscle fatigue toward the end of a match or training session
• Too rapid an increase in training intensity
• A lack of flexibility in the psoas
• A previous psoas strain, a risk factor for recurrence

Which sports contribute to psoas muscle strains?

Any sport with explosive hip-flexion efforts exposes this muscle:

• Athletics (sprinting, hurdles)
• Football (striking, running)
• Martial arts (kicking)
• Dance
• Intensive cycling
• Sports with repeated explosive starts

Treating a psoas muscle strain in rehab with a sports physio

The goal of treatment is to allow the muscle to heal under good conditions, then progressively restore its strength to prevent any recurrence.

1. 1Protection and relative rest of the area
2. 2Gentle hip mobility
3. 3Light isometric contractions
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Pelvic chain work
7. 7Reintroducing sport-specific movements
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

“A poorly managed muscle injury is the best way to get hurt twice in the same place.”

Progressive strengthening, the cornerstone of treatment

Strengthening the psoas must be introduced progressively, starting with pain-free isometric contractions before moving to concentric then eccentric work, with a very gradual reintroduction of explosive efforts.

In brief

• Isometric then progressive concentric strengthening
• Eccentric strengthening to prevent recurrence
• Associated hip mobility
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Prolonged total rest isn’t recommended: it causes loss of muscle mass and strength, which increases the risk of recurrence. It’s better to temporarily adapt your activity, avoiding explosive hip-flexion efforts, while quickly starting active, progressive rehab.

When should you see a specialist for a psoas strain?

If you feel sudden pain accompanied by a “pop” or an inability to flex your hip, prompt medical attention is needed to rule out a more severe injury.

Recovery time for a psoas strain

A simple strain (grade 1) can resolve in one to two weeks, while a partial tear (grade 2) generally requires four to six weeks of progressive rehab. A complete tear (grade 3), which is rarer, can take several months and needs specialist medical input.

Preventing re-injury

The psoas is particularly prone to recurrence if you return too quickly. Several measures reduce this risk:

• Carry eccentric strengthening all the way through before a full return
• Keep up a specific warm-up including dynamic hip flexion before every session
• Adapt load progression in training
• Work on psoas flexibility outside of painful phases
• Don’t return to competition before strength and mobility criteria are validated

The HOPP care programmes to treat your psoas strain and get back to sport

To heal durably, this muscle strain requires a progressive, well-dosed return to explosive loading. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your hip is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

Join the HOPP support programme designed by sports physios.

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