Pilates guide
Pilates works the hip flexors from both sides: it strengthens them, stretches the front of the hip, and builds the glutes and trunk that share the load. That matters, because feeling "tight" isn't always about short muscles, and in trials strengthening improved range of movement as much as stretching. No trial has tested Pilates for tight or painful hip flexors, so this guide uses the stretching and strengthening trials.
This guide explains the hip flexor muscles, what sitting does (less than you might think), whether tight hip flexors cause back pain or a tilted pelvis, how to stretch and strengthen them well, why they ache in some Pilates moves, and when hip or groin pain needs a physiotherapist or GP. It ends with a 25-minute class with 3D demos.
Common hip flexor tests are unreliable unless the pelvis is held still. People who sat a lot and moved little had about 6 degrees less hip extension in one study, but that's a link, not proof that sitting shortens the muscles.
Back pain wasn't linked with hip flexor range once body weight was taken into account, and people with back pain don't stand with more pelvic tilt. Trunk endurance and hip strength had stronger links.
Twice-daily hip flexor stretching for 10 weeks increased hip extension in older adults, and stride length in those who started stiff. But stretching didn't change pelvic or spinal posture in 23 studies.
Strength training improved range as much as stretching in 11 trials, 6 weeks of band training raised hip flexor strength by 17%, and weak hip flexors predicted declining mobility in older adults.
Tuck your pelvis under in the kneeling stretch, keep it mild, and hold 20 to 30 seconds: gains level off at about 4 minutes a session and 10 minutes a week.
Strains happen when kicking, sprinting or changing direction. Start with gentle marches and bridges, and stretch once loading is pain-free. A pop with bruising or weakness lifting your knee needs checking within days.
The main hip flexor is the iliopsoas: the psoas major, from the sides of the lower spine, and the iliacus, from the inside of the pelvis, sharing a tendon to the inner thigh bone. The rectus femoris, the one thigh (quadriceps) muscle that crosses the hip, helps and also straightens the knee. Sartorius and tensor fasciae latae help too.
They lift the knee towards the chest when you climb stairs, walk, sprint or kick, and with the legs held down they curl the trunk up in the second half of a sit-up. The psoas helps hold the lower spine upright when you sit tall and steadies it sideways. Contrary to popular claims, it "cannot have major affects to 'control lordosis'", the curve of the lower back.
In 433 older adults, weak hip flexors were the main predictor of declining mobility over a year, and in a small study, strengthening them improved step length and walking speed.
The modified Thomas test (lying at the end of a bed hugging one knee) caught a real shortfall in hip extension only about a third of the time unless the pelvis was held still, and pass or fail scoring agreed poorly between testers. With careful methods, reliability is better.
People who sat more than 7 hours a day and were inactive had 6.1 degrees less hip extension than active people who sat little. In another study, body weight, not back pain, predicted hip flexor range. Nobody has followed people over time to show that sitting shortens the muscles.
The feeling of tightness can come from stiffness, a sensitive area, or muscles working hard to hold you steady, as well as from length (our reading). That's one reason strengthening and gentle stretching both help.
No trial has tested Pilates for tight or painful hip flexors; the trials below tested stretching and strengthening programmes, mostly small and short.
Across 77 studies, stretch training increased range of movement by a moderate to large amount, with static and contract-relax stretching beating bouncing or swinging stretches. Across 189 studies, static stretching gains levelled off at about 4 minutes a session and 10 minutes a week, and people who started stiffer gained more.
In 96 older adults, stretching twice a day for 10 weeks increased hip extension a little (from about 6 to 8 degrees). With supervision, it increased stride length and walking hip extension in those who started stiff, and walking speed and stride length in frail older adults. Hip and ankle stretching for 8 weeks increased walking speed in 40 older adults.
Active and passive hip flexor stretching increased hip extension equally over 6 weeks in 33 people. In 40 professional footballers with back pain and stiff hips, 8 weeks of dynamic stretching improved hip range and pain, and some of the gain faded after 4 weeks off.
In 11 trials with 452 people, strength training and stretching improved range of movement equally. In 39 dance students, end-range hip flexor strengthening and gentle stretching (3 out of 10) improved usable, active range more than moderate to hard stretching.
Band hip flexor training 3 times a week for 6 weeks raised strength by 17% in 33 adults. Strengthening improved walking speed and step length in a small study, and sprint and shuttle times in active adults. The hip flexors work hardest between about 30 and 60 degrees of hip bend, as in straight-leg raises.
In 14 women aged about 62, 12 weeks of mat Pilates raised hip flexor and extensor strength (no control group). Nine months of Pilates didn't change the size of the iliopsoas or glutes in 12 women, so its benefits are probably in control rather than muscle size. We found no trial of Pilates for tight or painful hip flexors.
Across 23 studies, stretching didn't change spinal or pelvic posture, and 20 stretching researchers agreed that stretch training doesn't "improve posture" or prevent injuries on its own. One session of hip flexor stretching reduced pelvic tilt by about 1 degree straight afterwards.
In 118 adults, back pain wasn't linked with hip flexor range once body weight was taken into account. In 600 adults, iliopsoas length, the lower-back curve and pelvic tilt weren't linked with back pain, while back muscle endurance and hip flexor, inner thigh and tummy strength were. Links between hip range and back pain are very low quality, and hip flexor length wasn't among the measures that predicted back pain in long-term studies.
People with back pain stand with no more lower-back curve or pelvic tilt than people without it (43 studies). Most pain-free young adults tilt forwards a little, and the shape of the pelvis alone changes the measured angle. Hip extension range was unrelated to pelvic tilt or the lower-back curve.
Programmes aimed at a tilted pelvis changed it by under 2 degrees, with very low-quality evidence. Our Pilates for anterior pelvic tilt guide covers this in full.
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The hundred with straight legs, the roll-up, the double-leg stretch, double-leg lowers and the teaser all ask the hip flexors to work hard. Sit-ups worked the psoas at 15% to 35% of its maximum against under 10% in curl-ups, and leg raises peak around 30 to 60 degrees of hip bend.
Bend your knees to a tabletop, keep your feet lower or on the floor, keep your head down, roll up with your knees bent or using a strap, and build up the tummy work first (teachers' methods, our suggestion).
An ache that settles within a day is usually overload. Pain on resisted hip flexion or on stretching, with tenderness in the groin, fits iliopsoas-related groin pain, which needs a physiotherapist. A pop with bruising or weakness needs checking within days.
Hip flexor injuries make up about a third of sudden groin injuries in male athletes: the rectus femoris mostly when kicking or sprinting, the iliacus and psoas when changing direction. In women's football, inner thigh injuries were the commonest groin injury, then the iliopsoas and rectus femoris.
In athletes and people without a hip replacement, exercise-based treatment helped 77% to 100% of people with iliopsoas-related groin pain, though the studies were low quality.
The NHS advises avoiding strenuous exercise such as running for up to 8 weeks after a strain. Start with gentle marches, knee folds and bridges, add band work, and add stretching once loading is pain-free. Our hip flexor pain guide has the staged plan.
Our 25-minute class 2 or 3 times a week for 6 to 10 weeks (our editorial starting point, from the stretching trials' 10 weeks and the strength trials' 6 to 8). On other days, a kneeling stretch with your pelvis tucked, 2 to 4 holds of 20 to 30 seconds each side; there's little extra gain beyond about 10 minutes a week.
Our tight hip flexors routine is strength-led, with a band and lunges. The Pilates class adds trunk control, breathing and balanced work for both sides; either is a good choice.
Pelvic tilt into bridge, 6 slow reps, and dead bug heel taps, 6 each side (our beginner class); knee folds, 2 sets of 5 to 10 each side (the move's page); single-leg circles, 5 each way, each leg, other knee bent (the move's page).
Standing march, 10 each side with a low knee, and band hip flexion, 3 sets building from 15 to 8 hard reps over the weeks (our hip flexor pain guide, from the Thorborg trial); straight-leg raises, 8 each leg (our knee pain class); single-leg stretch, 6 each side (our beginner class); dead bug, 6 each side to start (our editorial starting point).
Kneeling hip flexor stretch with your pelvis tucked, 2 to 3 holds of 30 seconds each side, mild (our hip flexor pain guide); standing and face-down strap stretches, 20 to 30 seconds, 2 to 4 times each side (the moves' pages); single-leg kick, 6 to 8 each leg (the move's page); couch stretch, 2 holds of 30 seconds each side, later (our editorial starting point).
3D demoHalf-kneeling hip flexor stretchBeginner · No equipment
3D demoStanding hip flexor stretch (split stance)Beginner · No equipment
3D demoFace-down quad and hip flexor stretch with a strapIntermediate · Other / check instructions
3D demoSingle-leg kick (Pilates one leg kick)Beginner · No equipment
3D demoCouch stretchIntermediate · A wallGlute bridge, 2 sets of 10 (our hip flexor pain guide); shoulder bridge, 3 to 5 kicks each leg, swimming, 2 to 3 sets of 20 to 30 seconds, and knee hover, 3 holds of 15 to 30 seconds (the moves' pages); clamshells, 10 each side (our knee pain class); bird dog, 5 each side (our beginner class).
These load the hip flexors most. Use bent knees and keep your head down until your trunk can hold your pelvis still.
Follow your surgical team's precautions: ask before bending the hip past a right angle, and after a front (anterior) approach replacement, leave out kneeling and lunge stretches while your team restricts taking the leg behind you.
Keep stretches mild and in the middle of your range, and favour the strengthening moves: the NHS says not to overextend your joints just because you can.
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Use the standing or face-down strap stretch instead of kneeling or the couch stretch, and keep your pelvis tucked in any lunge.
Our 25-minute Pilates class controls, strengthens and stretches the front of the hip and trains the back of it. The tight hip flexors routine is the strength-led alternative with a band; the hip release and anterior pelvic tilt routines add stretches and pelvic control; the glute class trains hip extension.
A 25-minute Pilates class for the hip flexors: pelvic control, hip flexor strength, the glutes and back of the hip, and a gentle pelvis-tucked stretch.
25 minBeginner16 movesA band, An anchor pointHips that feel tight: a tucked hip flexor stretch, then band knee drives, leg raises, dead bugs, bridges and lunges. Strength through range loosens hips too.
15 minBeginner8 movesA band, An anchor pointStiff hips and glutes: a few minutes of rolling the glutes and thighs, two stretches while the extra range lasts, then strength work to keep it. About 15 minutes.
15 minBeginner7 movesA foam rollerA 20-minute routine for anterior pelvic tilt: hip-flexor stretches, pelvic tilts, glute bridges, dead bugs, bird dogs and planks, for hip range and strength.
20 minBeginner10 movesA wallA 25-minute Pilates class for your glutes: bridges, the side kick series, face-down kicks and standing work at a wall, with a band to make it harder.
25 minBeginner16 movesA wall, A bandA 20-minute Pilates class for hip pain: bridges, outer-hip holds, standing leg work and balance, without deep bends, crossed legs or lying on the sore side.
20 minBeginner14 movesA band, A wallThese match our hip and groin pain guides. In the US, call 911 where this page says 999.
Ask for an urgent GP appointment or get help from NHS 111 if you have severe hip pain that started suddenly but you've not had a fall or injured your hip, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a high temperature can be a joint infection.
Same day: a teenager with sudden pain at the front or top of the hip bone after a sprint, kick or jump, often with a pop. A piece of growth plate can pull off the pelvis (an avulsion fracture), and it needs an X-ray the same day.
Get help from NHS 111 if you have a hernia (a lump in the groin or tummy) and pain in or around it, a bloated tummy, you feel sick or are being sick, you're vomiting blood or your vomit looks like coffee grounds, you're constipated, you have a high temperature or feel hot, cold or shivery, or you've suddenly become confused.
A pop or sudden sharp pain at the front of the hip or top of the thigh during a lunge, kick or sprint, then a large bruise, a dent, or real weakness lifting your knee: get it assessed within days. Most hip flexor strains settle with rehab, but a torn or pulled-off tendon may need a scan to plan treatment (our suggestion).
A lump in the groin, upper thigh or tummy, especially one that appears when you cough or strain and goes when you lie down: see a GP, as it may be a true hernia. A femoral hernia (a small lump at the top of the thigh, mainly in women over 50, though it can happen to anyone) needs treating in hospital.
Same day, and stop running now: groin or front-of-hip pain in a runner, sometimes felt in the thigh or knee, that builds with running, hurts with every step or at night, or hurts when the hip is turned to the end of its range. Keep weight off the leg, using crutches if you have them, and get an urgent GP appointment or help from NHS 111 the same day: a stress fracture of the hip (femoral neck) needs urgent imaging.
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Hip pain that stops normal activities or disturbs sleep, keeps getting worse or keeps coming back, or has not improved after 2 weeks of looking after it at home.
In many areas you can refer yourself to NHS physiotherapy.
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Call 999 if:
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
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One study found about 6 degrees less hip extension in people who sat a lot and moved little. That's a link, and no study shows sitting shortens the muscles over time.
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Back pain wasn't linked with hip flexor range once body weight was considered, or with iliopsoas length in 600 adults.
Hip extension range was unrelated to pelvic tilt, most pain-free adults tilt forward a little, and stretching doesn't change posture.
Strengthening improves range as much as stretching, and weak hip flexors predict declining mobility as you get older.
We found no evidence for it. The psoas bends the hip and steadies the spine, and months of Pilates didn't change its size. Gentle stretching and slow breathing can feel good, which is reason enough.
Gentle stretching improved usable range more than hard stretching in dancers, and gains level off at about 4 minutes a session.
It can be: Pilates trains hip flexor control and strength, stretches the front of the hip and strengthens the glutes and trunk. No trial has tested Pilates for tight or painful hip flexors, but mat Pilates raised hip flexor strength in older women, and programmes that stretch and strengthen improve range.
A kneeling hip flexor stretch with your pelvis tucked under, the single-leg kick, and strengthening moves such as the knee fold, dead bug and single-leg stretch, with bridges for the back of the hip. Our 25-minute class puts them together.
One study found people who sat a lot and moved little had about 6 degrees less hip extension. That's a link, not proof that sitting shortens the muscles. Breaking up sitting, stretching and strengthening all help range.
The evidence doesn't show that: back pain wasn't linked with hip flexor range once body weight was considered, or with iliopsoas length in 600 adults. Trunk endurance and hip strength had stronger links.
Both. Strength training improves range as much as stretching, and weak hip flexors matter for walking and stairs as you get older. Gentle stretching suits most people.
Moves like the hundred, roll-up and double-leg lowers load the hip flexors heavily, especially before your tummy can hold your pelvis still. Bend your knees, keep your feet lower and your head down, and build up. Sharp pain, a pop or bruising needs checking.
20 to 30 seconds, 2 to 4 times each side, at least 2 days a week. Gains level off at about 4 minutes a session and 10 minutes a week, and gentle stretching works as well as hard.
Not really: hip flexor length doesn't track pelvic tilt, and stretching doesn't change standing posture. Pilates builds strength and control; our anterior pelvic tilt guide covers this.
Yes, gently: start with marches, knee folds and bridges, and leave stretches until loading is pain-free. The NHS advises avoiding strenuous exercise such as running for up to 8 weeks after a strain. See someone within days for a pop with bruising or weakness lifting your knee.
The reformer offers supported lunges and leg work, but no trial has compared it with mat work for the hip flexors. Either works if it includes strengthening and a stretch with your pelvis tucked.
The psoas is the deepest hip flexor, running from the lower spine to the thigh bone; it lifts the leg and steadies the spine. There's no good evidence that it stores tension or emotions. Stretching and breathing can feel good, and strengthening matters too.
Common tests, like lying at the end of a bed hugging one knee, are unreliable unless the pelvis is held still. If your hip moves comfortably and doesn't hurt, you don't need to chase a number.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
