Eric Tannenbaum, MD

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Hip Flexor & Groin Strains

Groin and hip flexor strains respond best to progressive strengthening of the inner thigh, hip flexors and core. A well-known trial found that an active strengthening program returned far more athletes to sport than passive treatments alone. Progress steadily, but avoid sprinting and kicking until strength has returned.

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Use this program for

  • Adductor (inner thigh) strains
  • Adductor-related groin pain in athletes
  • Hip flexor strains

Before you start

  • Check with Dr. Tannenbaum or your physical therapist that this program fits your condition.
  • Warm up with 5 minutes of easy movement.
  • Move slowly and with control. Quality matters more than speed.
  • Use the pain guide below to decide how hard to push.
0 to 3 out of 10Safe. Keep going.
4 to 5 out of 10Acceptable if it settles by the next morning. Otherwise ease off.
Above 5, or worse the next dayToo much. Reduce the reps, range or weight.

Phase 1: Gentle loading

Weeks 0 to 2

Start loading the muscle gently.

1Ball squeeze

  1. Lie on your back with knees bent and a ball or pillow between your knees.
  2. Squeeze the knees together at a moderate effort.
  3. Hold, then relax.

5 to 10 repetitions, hold 10 to 30 seconds, once or twice a day

Pain during the squeeze should stay mild, 3 out of 10 or less.

2Bridge

  1. Lie on your back with knees bent and feet flat.
  2. Tighten your stomach and squeeze your buttocks.
  3. Lift your hips until your body is in a straight line from shoulders to knees, then lower slowly.

3 sets of 10 to 15, hold 2 to 3 seconds at the top, once a day

Progress to a single-leg bridge when 15 feel easy.

Phase 2: Strengthen

Weeks 2 to 6

Build strength in the inner thigh and hip flexors.

3Side-lying inner-thigh lift

  1. Lie on the sore side with the top leg bent and its foot on the floor in front of you.
  2. Keep the bottom leg straight.
  3. Lift the bottom leg a few inches off the floor, then lower slowly.

3 sets of 10 to 15, once a day

Keep the toes pointing forward.

4Standing march with a band

  1. Loop a band around one ankle and anchor it low behind you.
  2. Stand tall holding a counter if needed.
  3. Lift the knee up toward your chest against the band, then lower slowly.

3 sets of 10 to 12 each side, every other day

Start without a band if this is painful.

5Side plank from the knees

  1. Lie on your side propped on your elbow, knees bent.
  2. Lift your hips so your body is in a straight line from shoulder to knees.
  3. Hold without letting the hips sag.

3 to 5 repetitions, hold 15 to 30 seconds each side

Progress to straight legs when 30 seconds feels easy.

Phase 3: Return to sport

Weeks 6 and beyond

Build strength and control for running and cutting.

6Side steps with a band

  1. Place a band around your ankles or just above the knees.
  2. Bend your knees slightly and stand with feet hip-width apart.
  3. Step sideways, keeping tension on the band, then step the other way.

3 sets of 10 to 15 steps each direction, once a day

Keep your toes pointing forward and your trunk still.

7Slow split squat

  1. Stand in a long stride with the sore leg in front.
  2. Lower straight down over 3 seconds until the back knee nears the floor.
  3. Rise over 3 seconds.

3 to 4 sets of 6 to 10, every other day

Add a backpack or dumbbells as it gets easier. Slow and heavy builds tendon strength.

Avoid for now

  • Sprinting, kicking and quick changes of direction until cleared
  • Aggressive stretching early on
  • Playing through sharp groin pain

When to move ahead

Advance when the current exercises cause pain of 3 out of 10 or less. Your therapist may add the Copenhagen adductor exercise as an advanced step.

Stop and call our office at (812) 376-9353 if you have

  • Pain that is getting worse week to week, or severe pain at night
  • New numbness, tingling or weakness
  • Significant swelling, redness, warmth or fever
  • A joint that locks, gives way or will not move
The research behind this program
  1. Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999;353(9151):439–443.
  2. Harøy J, Clarsen B, Wiger EG, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2019;53(3):150–157.

Need more help?

Work with our physical therapists

Our physical therapists at the SIO Physical Therapy & MRI building, 745 Schnier Street in Columbus, work alongside Dr. Tannenbaum and can tailor this program to you.

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