Are your Gears Grinding: Hip Flexor Pain or Hip Impingement?

Are your Gears Grinding: Hip Flexor Pain or Hip Impingement? Barefoot Rehabilitation Clinic

09 Jun Are your Gears Grinding: Hip Flexor Pain or Hip Impingement?

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Do you have hip flexor pain or a hip impingement?

Let’s figure it out together.

What is a hip impingement?

Impingement occurs when two bones are not sliding on their normal axes and pinch together.

Picture two gears that are spinning nicely without friction.

good gearsThis is the way your hip joint should work.

Now, imagine that one gear is nudged the slightest bit closer to the other gear.  Can you see how the gears will have more friction between them, moving less smoothly, potentially clunking, as one gear passes the other?


jammed gears

This is what occurs in a hip impingement.

Due to prolonged sitting over years and excess training overusing the quads and underusing the gluteal tissue and hamstring, the posterior hip capsular and adductor magnus become overworked and develop adhesion.

When these tissues are tight, they pull the head of the femur forward in the socket, causing a “pinching” sensation in the front of the joint.

How do you know if you have a hip impingement?

Your pain or stretching will only be present at the end range of hip flexion, either in a squat or passively when lying face up.  If you’re not sure, you can stand up and squat now or have someone check your thigh to chest test.

What is hip flexor pain?

The hip flexors are:

  1. psoas
  2. iliacus
  3. rectus femoris


If those muscles are in pain (for the sake of today’s discussion, we’ll ignore the tendons), you either have:

  1. adhesion
  2. a strain
  3. a tear

How do you know which hip flexor pathology you have?

The key differentiator in hip flexor pain vs. hip impingement is at what range the symptoms are provoked.

  • Impingement: felt at end range hip flexion i.e. squat or the thigh to chest test.
  • Hip Flexor Adhesion: felt at end range hip extension or the lunge stretch test.
  • Hip Flexor Strain or Tear: can be felt at any range, but differentiated by the above two by being symptomatic at neutral i.e. standing and lifting the hip a little as you would when walking.

What about a hernia?

A hernia occurs when your intestines come out through a wall of muscle, usually your abdominal/core muscles.

Hernias can be painful.

How do you know if you have a hernia?

You will be a soft mass in the location of the pain.  The lump can go away when you press on it or lie down.

The hip flexor pathologies or hip impingements will not have a mass present.

If you think you have a hernia, surgery is your primary solution and exercise/strengthening is your secondary solution only after surgery is performed.

How do you fix hip flexor pain or an impingement?

As always, all of the above conditions are caused by overload, or too much water in the damaged tissue’s bucket.

In order of severity, hip flexor pain starts as tight muscles that the body conserves energy from by laying down adhesion (A).  Adhesion is present over months to years before there ever is a more significant pathology.  Eventually, an individual does something that uses the hip flexors more (i.e. sprinting after not doing so in months/years) and either strains (small overload – B) or tears (larger overload – C) the tissue.


Notice the distance of the canyon in B.  The body can cross small chasms and repair them.

Notice the distance of the canyon in C. Only if the tear is significant and the body cannot traverse the canyon-sized ravine is surgery required for a tear.

In all of the above cases, removing the adhesion from the psoas, iliacus, or rectus femoris with manual adhesion release is the sweet-spot solution.  If there is a strain or acute tear, then inflammation is present and time is required in addition to deloading (not using) the muscles.

In hip impingements, the adhesion needs to be removed in the adductor magnus and posterior hip capsule.  If an individual has been active from adolescent years, especially hockey, basketball, or soccer,  or has been involved in significant loading of the hip joint over years, then a CAM/Pincer malformation is a possibility to contribute to the symptoms.  In these instances, extra bone has been laid down as a protective mechanism (this is a form of Osteoarthritis) and pinches the labrum and articular cartilage.

Clinical relevance of a CAM/Pincer malformation can only be determined after adhesion has been removed from the adductor magnus and hip capsule.

See this case study to learn how we resolved Sari’s hip impingements 95%.

Does Impingement Lead to Fast Progression of Hip Osteoarthritis?

Yes, it does.

Especially if you have a CAM malformation or reduced hip internal rotation.

Therefore, as soon as hip flexor pain presents itself, it is best to address it early.

speechbubblesTell us about your hip flexor pain? Who have you seen? Did it work?  How long have you had this problem?  What causes it to get worse or better?

If you know of a friend or family member with hip flexor pain or a hip impingement, please forward this information to them so they can get the help they need.  Fixing your adhesion matters because it improves flexibility, improves function, reduces pain, and restores normal movement to the body so you can enjoy the things you love. Call us at 862.205.4847.

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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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  • Pamela Yesner
    Posted at 02:22h, 11 February Reply

    I have pain on the right side of my hip, that includes limited motion ib my leg , the is,a great deal of pinching where the leg meets the buddolks and my grain hurts , my leg and the ball and socket joint is stilff, i do have scoliosis, and low back herniated disks , i can hardly walk with limiteation , an otho doc ordered epi steroind injection ib my low back and after i got the injection my symptoms got worse im in angony im seeking Pt im 59 years old and im very depressed because im am active person

  • Dr. Chris
    Posted at 13:57h, 12 February Reply

    Hi Pamela, I’m so sorry for your pain and suffering. You’re not alone. I’ve been there. Have you had an arthogram of the hip? That would be helpful. Who is managing all of this pain? Injections get rid of your pain short-term. Injections do not fix any problems you have. Where do you live?

  • tracy brothers
    Posted at 19:20h, 03 March Reply

    Hi Dr. Chris.

    Pamela Yesner’s condition sounds identical to mine. I had an MRA recently and it indicated superior and anterior Pinsing…There is milld Sub chondral sclerosis.. Hyper trophied superior and anterior labrum.
    Probable para labral cyst.
    Degenerative cartilage. The unfortunate part is that my left and good hip is starting to mimic the same symptoms and I am in excruciating pain morning noon and night. In the car sitting is unbearable and hitting a bump causes instability/pain in the hip.

    My mood has changed and I’m depressed. I am due to have surgery for labral tear but truly believe that both hips are in trouble due to extremely tight tendons which are causing tilted hips. I don’t know which surgery is the right option at this point and I am due to see my orthopedic doctor on March 14. I don’t make it that long. Thank you for your time.

    • Dr. Chris
      Posted at 14:44h, 04 March Reply

      Hi Tracy, I’m so sorry for your suffering. First, it sounds like surgery is part of the solution. I’m glad you’re pursuing that option. Not knowing your age, activity level, or history of activity/trauma, if you haven’t tested your hip ranges of motion or had a skilled “adhesion” specialist look at your muscles, I highly recommend doing so. Google “Barefoot Rehab thigh to chest test” and “barefoot rehab lunge stretch test”. If you want to report your numbers here, I can talk you through this.

  • Sue Pokorny
    Posted at 17:55h, 20 March Reply

    Thank you for this article — it’s the most informative one I’ve found! After reading your comparisons, I believe I have a low to moderate strain of the left hop flexor. I can easily pull my knee to my chest, but it is very painful to walk on it when it extends backwards. I started doing nightly 30 minute yoga stretches in hopes of alleviating the pain and it seems to help tremendously. I can walk the next day with just a slight limp which is more preventative than because of sharp pain. I’m hoping that a month without running and doing yoga stretching will help it repair itself. Thank you for the clarification!

    • Dr. Chris
      Posted at 17:57h, 20 March Reply

      Hi Sue – so glad it’s helpful. Another way to think of “limping” is protective weakness. It’s uncommon for this to be caused by a “muscle strain”. If you get a chance, see a specialist who can diagnose your hip. An arthrogram is probably necessary. And yes, “deloading” in the form of rest for a month is necessary too. : )

  • sarah
    Posted at 11:09h, 23 March Reply

    Thanks for this, it’s very much helpful. I have learnt that training our body is very much enough in order to keep us in good health, both physically and emotionally. But we don’t actually realise the danger hidden within our bodies “hip flexors”, which are very much vital for us and play the role of controlling balance, ability to sit, stand and several other activities. It eventually results in digestive problems, circulatory issues, etc. I realised this lately and found out a solution. I followed Mike Westerdal’s training series to loosen my hip flexors. His ten moves really helped me a lot by exactly targeting the hard-to-reach muscles with clear demonstration. I suggest to try this: . Trust me, its worth it.

    • Dr. Chris
      Posted at 10:56h, 12 April Reply

      Glad that it helped you Sarah!

  • Christina S.
    Posted at 18:41h, 26 March Reply

    My dad has osteoarthritis (almost bone on bone) but we think it was caused by an issue with his hip flexor. He told me years ago he injured or strained his hip flexor and had pain and really reduced flexibility. When bending over to tie his shoes he struggled to reach because of his hip area. being so tight.

    He’s only 55 and we are being told he will need a hip replacement but that it’s not good to get it too young. Even though his joint has progressed badly now, and he may eventually need a hip replacement he says a lot or maybe even most of the time the pain is coming from his hip flexor muscle that is near the groin area.

    Should he be addressing his muscles as well? Should they be addressed first? My dad suffered a head injury in 93′ and could never do things that he did before, the only kind of work he’d be capable of is light labor/janitorial type work. But he was never down because he always loved being active and didn’t mind walking/busing everywhere instead of driving. He loves being athletic. And since his hip has gotten bad he’s just not in the best place because he can’t be as independent and mobile.

    Any insight would be greatly appreciated. THANKS!

    • Dr. Chris
      Posted at 10:57h, 12 April Reply

      Hi Christina – I always recommend people get adhesion treatment first. Why? If it works, guess what. No hip replace ment! At least right now. Even if he does get surgery, the adhesion work will help him feel way younger and healthier. Make sure he’s seeing competent doctors who can make sure his symptoms aren’t a disc as well. Because groin and anterior hip can be shooting from a disc.

  • Ashley
    Posted at 19:02h, 13 April Reply

    Hi Dr. Chris,

    I was training for a half marathon about a year go and I began feeling tendonitis of what I thought was my hamstring but I think its my adductor because palpation of the pubic ramus is tender.
    When I run, everytime I hit 1.5 – 3 miles I feel a pinching sensation in the front of my R hip flexor. This causes me not to lift my R leg so high during running and by the time I hit 4 miles I am barely lifting my foot due to the pinching sensation. I have recently began foam rolling and focusing on stretching my R hip flexors consistently. This feeling has been ongoing for > 1 year. I am going to begin focusing on strengthening my gluts and hamstrings. Other than those interventions, do you have anymore wisdom or thoughts?


  • Andre Calma
    Posted at 02:40h, 11 July Reply

    Hi Doctor,
    I’ve recently started lifting weights for two months after having been sedentary for the past 3 years (I am 18 years old). About three weeks ago I noticed some pain in front of both of my hip joints that I believe came from squatting. However, my range of motion was not affected, and I could “asian squat” to full depth without problems. After going light on the squats from then on, the pain has subsided quite a bit and I can squat pain-free, but it comes back when I do the lunge stretch test, or lie down flat on my back and only very slightly raise my legs from the ground and try to hold them there (the rest of the range of motion is painless). While the pain is very mild, I am still concerned due to the length of recovery. Is this a simple muscle strain that I can rest through, or is it possibly something more serious?

    Thank you.

  • Dr. Chris
    Posted at 10:43h, 11 July Reply

    Hi Andrew, hard to say. When you do lunge stretch test, is it front leg or back leg where you feel symptoms? I would take the squatting really slowly and NOT go all the way down yet. Let your body adapt more slowly. GO to just above 90 degrees and keep tempo (or speed) very slow to let tiny little muscles fire. I’d do 2×30 reps of glute bridges to warm up so your femur is pulled into the back of the socket. Work on the proper ankle position too ( It’s definitely NOT a simple muscle strain. So take it slow.

  • Andre Calma
    Posted at 01:02h, 12 July Reply

    I definitely feel it in the back leg rather than the front. Also, going up stairs does not cause pain, and neither does going down stairs as long as it is at a moderate pace. However, if I briskly “hop” down the stairs a step at a time, it does. Also, if I squat all the way down so that my hamstrings touch my calves and then come back up, I hear a subtle cracking noise in the left hip, but no noticeable pain accompanying it. This does not happen if I squat just below parallel and no further, however,

    I’ll take it slow from now on, thank you.

    • Andre Calma
      Posted at 01:40h, 12 July Reply

      I should also mention that I just noticed some kind of flexible lump in my left hip, which I couldn’t tell was there by eye until I felt it. Am I right in assuming this is an inflamed tendon and I have some kind of tendinosis/tendinitis?

  • Dr. Chris
    Posted at 07:28h, 12 July Reply

    Andrew, if you feel in the back leg of lunge stretch test, you likely have some adhesion in your psoas or iliacus. Add going down the stairs quickly, and you have an inflamed hip impingement on front of hip. You probably have some light arthritis in front of hip. If you value longevity, I’d be really care about NOT squatting ass to grass too much unless you got that fixed, Not worth it to keep doing and tax your joints.

  • Teah franklin
    Posted at 01:49h, 12 December Reply

    Hi Dr. Chris, iam 24 years old i started my fitness journey with running on the road not stretching or warming up then i started going to the gym i didnt know how to prepare my body before training, now i have stopped completely dont have money to get it checked out. But my right hip pops when i pull it up then grinds when i turn it to the side. Also pops randomly and when i do things like leg lifts. I also get this sharp pain in my left butt near my tail bone when i over extend my leg back. when i turn around right sometimes it also pops but feel like its connected to my upper left and right butt. My front left hip flexor pops when i do butterflies and my right hip feel like it grinds. I use to have pain down my leg but dont ever since i stopped working out. I would just love how to fix it so i can get back into the gym thank you!

    • Dr. Chris
      Posted at 00:48h, 28 January Reply

      Hi Teah, it’s really hard to fix chronic pain issues without getting a diagnosis and a solution. The solution is often adhesion release. I’d start a plan to be able to save money to get the treatment you need.

  • Oliver Platt
    Posted at 00:50h, 08 April Reply

    Hi Chris,

    Great read, presented in a very clear manner thanks so much! I have been diagnosed with FIA in both hips via an X-ray however, my symptoms are when I stand from a seated position my hips hurt and my lower back like a sharp pain. This also occurs if I’m stood up for a long period of time or if I’m sat for a long period of time. This did occur during heavy boxing training last year so running, weights and boxing etc. do you think this diagnosis is correct? Almost one year later and it’s still there, less severe but still present. I have stopped training a lot and have exercises I have been given from my GP. Be interested to hear your thoughts. Kind regards.

    • Dr. Chris
      Posted at 19:59h, 10 April Reply

      Hi Oliver, based on your symptoms, it sounds like there is the FAI (or hip joint issue) and a low back issue to explain your low back symptoms. That’s the best I can do with this current info and not doing an exam.

  • Oliver Platt
    Posted at 08:46h, 22 April Reply

    Hi Chris, thanks for your reply mate appreciate it. I will continue to do exercises hopefully it will help. Kind regards.

    • Dr. Chris
      Posted at 16:48h, 23 April Reply


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