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”).[1]

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).[2] 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

Symptoms and diagnosis of psoas tendinopathy

Typical pain and its triggers

The pain is located in the groin crease or at the front of the hip, triggered by active hip flexion against resistance: climbing stairs, lifting the knee, sprinting or kicking a ball. An audible or palpable snap at the front of the hip is sometimes associated, particularly when moving from a flexed to an extended position.

How symptoms progress without treatment

Without treatment, the pain tends to settle in gradually: it first appears at the end of exertion, then within the first few minutes, with a risk of affecting your stride and the quality of your sporting movement.

Differential diagnosis

Several types of hip and groin pain can look like psoas tendinopathy:

• Hip impingement, triggered more by flexion combined with internal rotation in a squatting position
• Psoas muscle strain, an acute muscle injury occurring after a specific movement (sprint, kick), to be distinguished from this tendinopathy which develops gradually from overload
• Adductor muscle strain, with pain that’s more medial, on the inner side of the thigh

Causes and risk factors

Psoas tendinopathy develops from repeated overload of the tendon, without any specific injury being identifiable.

Biomechanical and personal factors

• A too-rapid increase in training volume or intensity
• Prolonged sitting that keeps the psoas in a shortened position
• A lack of flexibility in the hip flexors
• A deficit in psoas strength or endurance relative to the sporting load placed on it

Which sports contribute to psoas tendinopathy?

All sports that heavily demand repeated hip flexion are particularly linked to this injury:

• Football (striking, running)
• Rugby (kicking, sprinting)
• Intensive cycling (prolonged flexed position)
• Trail running and running with a large hip flexion range
• CrossFit (explosive hip flexion movements)

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

“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.

Expected recovery timeline for psoas tendinopathy

Clear improvement is generally seen within a few weeks with appropriate treatment, by first managing the load before progressively resuming repeated hip flexion movements.

Preventing recurrence

Once the pain is under control, a few measures help stop it coming back:

• Progress in stages with training volume and intensity
• Limit time spent sitting for long periods, or take regular breaks to stretch the hip flexors
• Keep up a regular hip flexor flexibility routine
• Continue regular strengthening of the psoas and pelvic chain, even after recovery

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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