Symptoms and causes of weak hip flexors and how to treat them

Article featured on MedicalNewsToday, medically reviewed by Gregory Minnis, DPT — Written by Lois Zoppi on February 27, 2021

Weak hip flexors can cause the surrounding muscles to overcompensate, which can cause pain and difficulty walking. Treatment for weak hip flexors includes physical therapy and exercises.

The hip flexors are muscles that connect the lower back to the hips, groin, and thigh bone. This muscle group includes the psoas muscle, which helps push the top of the leg upward.

The hip flexors stabilize the lower spine. They play a major role in walking, postural alignment, joint mobility, flexibility, and balance.

This article explains what symptoms and risks can come with weak hip flexors and how a person can strengthen them.

Symptoms

The symptoms of weak hip flexors can affect a range of different areas in the body.

General symptoms may include:

  • changes in gait and posture
  • knee pain
  • hip pain
  • back pain

These symptoms occur because the joints try to compensate for weak hip flexors, which leads to them overworking.

Pain in the hip flexor area may be the result of a hip flexor strain. This is different from weak hip flexor muscles, although weakness can cause a strain to occur.

Difficulty when walking

The psoas muscle is responsible for swinging the leg forward while walking. If this muscle is weak, a person may have to exert more energy and rely on other muscles — the rectus femoris muscle in the thigh and the hamstrings. These muscles may overcompensate during walking, which might put excess strain on them and cause discomfort.

A person may also find climbing stairs difficult as it may be hard to lift the leg.

Gait

Stiff knee gait is when a person walks with limited knee flexion, or bend, in the knee. Weakness in the hip flexors can lead to a stiff knee gait.

A 2016 study involving 47 people with severe hip arthritis revealed a correlation between hip flexor strength and gait. Participants in the study with the strongest hip abductors and hip flexors had a better gait than those with weaker muscles in that area.

However, other factors in the study that led to better gait were lower pain levels and better quality of life. Scientists concluded that muscle strength does play a moderate role in improving gait.

Posture

A person may experience lower back pain if they have a weak hip flexor, as the hip flexor is an important spinal stabilizer.

According to a recent article weakness in the hip flexors can make it difficult for a person to maintain a straight posture. Weak hip flexors can also cause the pelvis to tilt, which can affect posture and cause lower back pain.

Risks

Weakness in the hip flexors could result in injury, as well as the symptoms above. An injury could occur to the spine, legs, and knees if they have to overcompensate for weakness in the hip flexor muscles.

What causes weak hip flexors?

There are many different possible causes of weak hip flexors. These include:

Lack of exercise

Not partaking in regular physical activity can lead to weak hip flexors. Underuse of the hip muscles can cause the muscle to degenerate and become weak, which is known as muscle atrophy.

Sitting for long periods

Staying seated for extended periods can cause weakness in the psoas muscle. This is because the muscle does not work as hard as if the person were standing.

Osteoarthritis

Osteoarthritis in the hip can also cause weak hip flexors. It can also cause weakness in the knees, hamstrings, and buttock muscles.

Lateral transpsoas surgery

Lateral transpsoas surgery, a type of operation on the spine, can often leave a weakness in some hip flexor muscles.

Cerebral palsy

According to an article in the Journal of Ultrasound Medicine, people with cerebral palsy may experience weakness in the hip muscles. Cerebral palsy can also increase the risk of hips coming out of joint during childhood.

Tight or weak hip flexors?

Weak hip flexors are not the same as tight hip flexors. Sitting for prolonged periods could cause the hip flexors to become tight, as well as weak. Symptoms that come with tight hip flexors include lower back pain and hip pain.

How to test for weak hip flexors

A person can see whether they have weak hip flexors using resistance tests and simple exercises.

Seated knee raise

a person is performing a seated knee raise
  1. Sit in a chair and lift one leg, keeping it bent.
  2. A second person must push down on the knee while the seated person pushes against them.

A person with weak hip flexors will not be able to resist the added pressure on the leg.

Lying knee raise

a person is performing a lying knee raise

Lie down flat on the back, bringing one leg to the chest, using the hands.

If it is difficult to keep the leg up close to the chest after letting go of it, a weak hip flexor may be the culprit.

How to strengthen weak hip flexors

Exercises can be useful to prevent or strengthen weakness in the hip flexor muscles. Some people also find stretching useful for tight hip flexors.

The following exercises could help reduce weakness in the hip flexors:

Ankle weights

  1. While sitting down in a chair, attach ankle weights to the ankles.
  2. Slowly lift and lower the leg to strengthen the psoas muscle.

Doing this exercise from a standing position can also be effective.

Mountain climbers with floor sliders

This exercise uses sliders, which are small discs that a person can place underneath the feet to slide them across the floor without friction.

The mountain climber pose involves the following:

  1. Assume a plank position.
  2. Place a slider underneath the ball of each foot.
  3. Bring the knees up to the chest one by one, moving the slider along the floor.
  4. Repeat.
a person is performing sliding mountain climbers

Lunges

a person is performing a lunge
  1. Stand with the legs hip-width apart.
  2. Step forward with one leg.
  3. Slowly bend the knee until it reaches a 90-degree angle. The rear knee should be parallel to the floor.
  4. Return to a standing position by lifting the front knee
  5. Repeat.

Wall psoas hold

  1. Stand with the legs hip-width apart.
  2. Bend the knee and lift the leg so that it is level with the hips.
  3. Balance on the other foot and hold for 30 seconds.
  4. Slowly lower the leg.
  5. Repeat on the other side.
a person is performing a wall psoas hold

Skater squats

  1. Stand with the legs hip-width apart.
  2. Bend at the knees and keep the buttocks parallel to the ground, with the back straight.
  3. Come back up to a standing position and stand on one leg.
  4. Lift the opposite leg to the side with the foot pointed forward.
  5. Repeat on alternate sides.
a person is performing a skater squat

Resistance band training

A 2016 study on 33 people involved one group carrying out strengthening exercises using an elastic resistance band for three 10-minute periods each week for 6 weeks. They progressed the repetitions of the exercises they were doing over the 6 weeks. The control group did not carry out these strength exercises.

The scientists concluded that using exercise bands in this context can significantly strengthen the hip flexors.

a person is exercising with a resistance band

The following is an example of an exercise that uses an elastic exercise band to strengthen the hip flexors:

  1. Place the band around both ankles.
  2. Stand with the feet hip-width apart, and the knees slightly bent.
  3. Take a diagonal step, about 2 or 3 feet long.
  4. Continue for 20 steps.

Summary

Underuse of the muscles or sitting down for extended periods can cause weak hip flexors. Conditions such as and osteoarthritis can also cause weakness in this muscle group.

A person with weak hip flexors may experience lower back or hip pain and may have difficulty doing certain activities, such as walking or climbing stairs.

Weak hip flexors can affect a person’s posture and the way they walk.

To remedy weak hip flexors, a person can try a range of strengthening exercises that target the hip flexors.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.