Psoas tendinopathy: understanding your hip pain and getting back to activity

What is psoas tendinopathy?

Psoas anatomy

The psoas is a deep muscle that connects the lumbar spine to the femur, passing in front of the hip joint. It’s the main hip flexor, essential for lifting the leg and for the push-off phase of each stride. Its tendinopathy causes pain at the front of the hip or groin, sometimes accompanied by an audible or palpable snap (“snapping hip”).

Why does this tendon become painful?

Pain appears when the psoas is repeatedly loaded beyond its capacity, particularly during repeated hip flexion movements (running, sprinting, kicking). Too rapid an increase in training volume, prolonged sitting that shortens the muscle, or a lack of flexibility in the hip flexors are common contributing factors.

Which sports contribute to psoas tendinopathy?

Any sport that heavily demands repeated hip flexion carries a particular risk:

• Football (striking, running)
• Athletics (sprinting, hurdles)
• Dance
• Martial arts (kicking)
• Intensive cycling
• Running with a large hip flexion range

Treating psoas tendinopathy in rehab with a sports physio

The goal of treatment is to progressively strengthen the psoas while working on its flexibility, often limited by prolonged sitting postures.

1. 1Reducing pain and managing load
2. 2Hip mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Pelvic chain work
7. 7Correcting sporting technique
8. 8Strengthening under sport-specific load
9. 9Progressive return to your sport
10. 10Return to competition

Why the physio’s initial assessment matters

During the initial assessment, the physiotherapist aims to identify the movements that reproduce the pain (hip flexion, sprinting), any associated snapping sensation, and time spent sitting each day.

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Strengthening and flexibility, the cornerstones of treatment

Progressive strengthening of the psoas, combined with flexibility work for the hip flexors, restores its functional capacity. Comprehensive core and pelvic stability work effectively completes the treatment.

In brief

• Progressive strengthening of the psoas
• Flexibility work for the hip flexors
• Core and pelvic stability
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest is generally not necessary. It’s better to temporarily adapt the repeated hip flexion movements that clearly reproduce the pain, while starting strengthening as soon as possible.

When should you see a specialist for psoas tendinopathy?

If the pain persists for more than four weeks, or if the hip snapping is accompanied by marked, disabling pain, a medical opinion is recommended.

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

This tendinopathy requires progressive strengthening and flexibility work. 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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