Soccer Injury Spotlight: Acute Hip Flexor Strains

Power to advance the leg while sprinting and force generation when striking the ball is produced by the hip flexor muscle groups. 

When these muscles are overloaded, it can result in a hip flexor injury, which can mean time away from soccer for rehab and recovery if the injury is not recognized and treated. 


Muscle strains are one of the most common injuries among soccer players. Strains can occur to muscles of the hip, groin, thigh, and lower leg. A 1-3 grading system is used when diagnosing these injuries to help clarify the severity and determine the best path for rehab and recovery. Moderate to severe strains can lead to a complete tear or even an avulsion fracture.  

  • Grade 1 (Mild): Described as overstretching with small tears of the muscle fibers, which causes some localized pain to the front of the hip with minimal loss of function (<5%). This localized pain is aggravated by movement with mild swelling and bruising to the front of the hip and thigh.
  • Grade 2 (Moderate): Described as overstretching with larger tears of the muscle fibers, which cause localized pain to the front of the hip with greater loss of function (between 5-50%). This localized pain is aggravated by movement and marked by difficulty standing and walking. There can be a moderate level of swelling and bruising to the front of the hip and thigh. 
  • Grade 3 (Severe): Described as a complete tear or rupture of the muscle fibers or tendon resulting in severe pain and loss of function (>50%). Movement aggravates the injury, causing pain and the inability to walk without a limp. An increase in swelling and bruising in the front of the hip and thigh is also common. 


  • Sudden stress to the muscle or tendon during activity such as; running, sprinting, kicking, a change in direction, or a collision with an opposing player 
  • Tight or inflexible muscles
  • Muscle strength imbalances
  • Immature skeletal growth


  • Sudden pain with activity such as sprinting, kicking, or change in direction
  • Localized pain and/or tenderness in the front of the hip or thigh
  • Painful muscle contraction of the hip or thigh
  • Difficulty pulling the knee up to the chest
  • Swelling and bruising 
  • Pain and difficulty walking, running, and when during sport 


  • Begin with active rest from 2-3 up to 10 days for mild strains
  • Seek advice and evaluation by a medical professional if:
    • The athlete is unable to bear weight or walk without a limp, have sharp or stabbing pain with movement and activity
    • The athlete has difficulty sleeping due to pain
  • Apply an ice pack for 10-20 minutes 3-5 times per day for pain and swelling 
  • Complete physical therapy to restore strength and flexibility before returning to full activity
  • Perform modified strength and conditioning programs


  • Yearly physical exams
  • Well-fitting cleats and guards
  • Train on well-maintained field surfaces
  • Eat well and stay well-hydrated 
  • Maintain proper training and techniques 
  • Maintain fitness through in-season programs, off-season programs, and pre-season injury prevention programs such as FIFA 11+.
  • Properly warm up to 10 min with jogging, light stretching, dynamic movements, ball passes, and ball dribbling drills. 
  • Prevent overuse by incorporating periods of complete rest during the year
  • Play different sports throughout the year and avoid sport specialization 
  • Participate in a comprehensive off-season training program 

Click here to learn more about our Sports Medicine specialty and for a list of our Sports Medicine physicians. If you have questions or want to learn more ways to stay healthy, active and strong, consider connecting with one of our Certified Athletic Trainers through our Sports Medicine Hotline

Sources: Grassi A, Quaglia A, Canata GL, Zaffagnini S. An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. 2016;4(1):39-46. Published 2016 Jun 13. doi:10.11138/jts/2016.4.1.039;;