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A hip muscle strain, often called a “pulled muscle,” is a stretch or tear of one of the muscles that move the hip. The most common are strains of the hip flexors at the front of the hip, the adductors in the groin and inner thigh, the hamstrings at the back of the thigh, and the abductors on the outside of the hip. Strains are common in soccer, football, hockey, track, basketball and other sports with sprinting, kicking and quick changes of direction, but they can also happen with a slip or a sudden movement at home. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, evaluates and treats hip, groin and hamstring strains in athletes and active adults.

On this page:What it is · Grades · Symptoms · Diagnosis · Treatment · Return to sport · When surgery is needed · Prevention · FAQs · Research
At a glance

  • Most hip muscle strains heal without surgery, using relative rest and a step-by-step exercise program
  • Mild groin strains often allow a return to full training in about 2–4 weeks; severe tears can take 2–3 months or longer1
  • Returning too early raises the risk of a repeat injury
  • Prevention programs such as the Copenhagen adduction exercise and the Nordic hamstring exercise lower injury rates in athletes
  • A complete tear of the hamstring tendons off the “sit bone” is different from a strain and may need surgery

What is a hip muscle strain?

A muscle is attached to bone by a tendon. The area where muscle fibers blend into tendon, called the muscle–tendon junction, is the weakest link and is where most strains happen. Strains usually occur when a muscle is stretched while it is also contracting hard, such as a hamstring during the last part of a sprinting stride or a groin muscle during a kick or a sudden side step.

  • Hip flexor strain (iliopsoas or rectus femoris): pain at the front of the hip, often from sprinting or kicking.
  • Adductor (groin) strain: pain in the inner thigh or groin, common in soccer and hockey.
  • Hamstring strain: pain at the back of the thigh, common in sprinting sports.
  • Abductor strain (gluteus medius and minimus): pain on the outside of the hip. Ongoing outer hip pain in adults may be a tendon problem rather than a strain; see gluteus medius and minimus tears.

Risk factors include a previous strain, muscle tightness or weakness, fatigue, a sudden increase in training and not warming up.

Grades of muscle strain

Strains are often described in three grades:

  • Grade 1 (mild): overstretching with damage to a small number of muscle fibers. There is pain and tightness, but strength and motion are close to normal.
  • Grade 2 (moderate): a partial tear. There is more pain, some weakness, and often swelling or bruising.
  • Grade 3 (severe): a complete or near-complete tear of the muscle or its tendon, with significant weakness and sometimes a gap you can feel.

Several newer MRI-based grading systems give more detail, especially about whether the tendon inside the muscle is involved, which can affect how long recovery takes.

Symptoms

  • A sudden sharp pain, sometimes with a “pop,” during running, kicking or changing direction
  • Pain when you contract or stretch the muscle, such as lifting the knee, squeezing the legs together or bending the knee against resistance
  • Tenderness, swelling or bruising, which may appear a day or two later and spread down the thigh
  • Weakness, limping or difficulty running

In hamstring injuries, a popping sound, bruising, more pain at the time of injury and pain when bending the knee against resistance have been linked to a longer recovery.2

Diagnosis and when to get imaging

Dr. Dold will ask how the injury happened and examine where it is tender, how strong the muscle is and which movements cause pain. Many mild strains can be diagnosed with an exam alone.

Imaging may be recommended when:

  • There was a pop with significant bruising, a large amount of weakness, or a gap or lump in the muscle
  • A hamstring injury happened high up near the buttock, especially with the hip bent and knee straight (such as a water-skiing fall or a slip into the splits), which can tear the tendons off the bone
  • Pain is not improving after a few weeks of rehabilitation
  • The exact severity matters for planning the return of a competitive athlete

X-rays look for a small piece of bone pulled off by the tendon (an avulsion fracture), which is more common in teenagers whose growth plates are still open; see ASIS avulsion. MRI shows the location and size of a muscle or tendon tear. Ultrasound can also be used in some cases. Other causes of groin and hip pain, such as athletic pubalgia (sports hernia) and hip impingement, are also considered.

Treatment

Most hip muscle strains are treated without surgery. Your plan depends on which muscle is injured, the grade and your sport.

  • Early phase (first few days): protect the muscle by limiting painful activities, use ice for comfort, and use crutches for a short time if walking is painful. Complete rest for long periods is generally not needed.
  • Rehabilitation: guided exercises progress from gentle motion and pain-free muscle contractions to strengthening, then running, agility and sport-specific drills. For hamstring strains, programs that include lengthening (eccentric) strengthening, agility and core stability have been shown to restore function and shorten return to play.2
  • Medicines: short-term pain relievers may be recommended by your physician.
  • Injections: platelet-rich plasma (PRP) has been studied for muscle strains, but results have been inconsistent.2 PRP is generally not FDA-approved for this specific use and is often not covered by insurance.

Return to sport

Recovery time varies with the muscle, the grade and the sport. Examples from published studies:

  • Groin (adductor) strains: in a study of 81 male athletes following a criteria-based rehabilitation program, those with mild to moderate injuries returned to full team training at a median of 18 days. Athletes with complete tears (MRI grade 3) took a median of 78 days. The 1-year reinjury rate was 8%.1
  • Hamstring strains: in a randomized trial of elite soccer players summarized in a review, a rehabilitation program that emphasized lengthening exercises led to return to sport in an average of 28 days, compared with 51 days for a conventional program.3

Returning too early is a common reason for a second injury. Nearly one-third of hamstring strains recur within the first year after returning to sport.3 Athletes with groin strains who were pain-free on testing before returning had a lower reinjury rate than those who were not (5% vs. 21%).1 Dr. Dold and your physical therapist will use strength, flexibility and running tests, not just the calendar, to decide when you are ready.

When is surgery needed?

Surgery is rarely needed for a hip muscle strain. The main exception is a complete proximal hamstring avulsion, where the hamstring tendons tear off the sit bone at the bottom of the pelvis. For these injuries, surgical repair has achieved better outcomes than non-surgical treatment in published studies.2 Because the torn tendons can pull away and scar down over time, these injuries should be evaluated promptly. Learn more about proximal hamstring tears and avulsions.

Surgery may also be considered for some complete tendon tears of the adductor or rectus femoris, and for large bone avulsions in young athletes, depending on the size of the tear, the amount of displacement and the patient’s activity level.

Prevention

  • Copenhagen adduction exercise: in a randomized trial of 652 semi-professional soccer players, a program using this single side-plank-style groin exercise (3 times a week in the preseason and once a week during the season) lowered the risk of groin problems by 41%.4
  • Nordic hamstring exercise: a meta-analysis of 15 studies including 8,459 athletes found that programs including this exercise reduced hamstring injuries by up to 51%.5
  • Other steps: a dynamic warm-up, gradual increases in training load, adequate rest between hard sessions and full rehabilitation of any earlier strain.

A physical therapist or athletic trainer can help you start these exercises safely. Individual results vary.

What the research shows

Muscle strains around the hip are among the most studied sports injuries. Here is what the research shows about recovery, rehabilitation and prevention.

Groin (adductor) strains

Partial adductor tears usually return to play within about 1 to 7 weeks with a structured physical therapy program. For long-standing groin pain, an active strengthening program has worked much better than passive treatments in a randomized trial. Even complete tears of the adductor longus tendon often do well without surgery.

Hamstring strains

How you rehabilitate matters. Randomized trials have found that programs emphasizing exercises that load the hamstring in a lengthened position shorten return to play, and criteria-based, progressive programs have lowered reinjury rates. Some strength deficits can persist after an athlete feels ready, which is why return-to-sport decisions should include objective strength and running tests, not pain alone.

MRI and PRP

MRI grading can help estimate recovery time for higher-grade injuries, but it is not needed for most mild strains. Platelet-rich plasma (PRP) injections have shown mixed results: some meta-analyses suggest return to sport may be about a week faster, while a double-blind, placebo-controlled trial in hamstring injuries found no benefit.

Prevention

The Nordic hamstring exercise has roughly halved hamstring injury rates across several sports. For the groin, a simple adductor strengthening program built on the Copenhagen adduction exercise lowered groin problems by about 40% in one large soccer trial, although pooled results across studies are less certain.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Published research on hip arthroscopy, including Post-operative Considerations Following Hip Arthroscopy (JBJS Reviews, 2017) and studies in the American Journal of Sports Medicine; member of the International Society for Hip Arthroscopy (ISHA)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

How long does a pulled groin take to heal?

It depends on the severity. In one study, athletes with mild to moderate adductor strains returned to full team training at a median of 18 days, while complete tears took a median of 78 days.1

How long does a hamstring strain take to heal?

Many hamstring strains take several weeks. In a randomized trial of elite soccer players, an eccentric-focused program led to return to sport in an average of 28 days.3 More severe injuries and injuries involving the tendon can take longer.

Do I need an MRI for a pulled muscle?

Not always. Mild strains are often diagnosed by exam. An MRI is helpful for severe injuries, suspected tendon tears near the sit bone, or pain that is not improving.

Should I use heat or ice?

Ice is commonly used for comfort in the first few days. Gentle movement and a structured exercise program are the most important parts of recovery.

Why do hamstring strains keep coming back?

Returning before strength and flexibility have recovered is a common reason. Nearly one-third of hamstring strains recur within the first year.3 A full rehabilitation program and the Nordic hamstring exercise can help.5

When should I see a doctor for a hip or groin strain?

See a physician if you felt a pop with major bruising or weakness, cannot walk normally, have pain high in the back of the thigh near the buttock, or are not improving after a couple of weeks. See also hip pain.

Do you accept my insurance?

Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Related pages

Research cited on this page

  1. Serner A, Weir A, Tol JL, et al. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthop J Sports Med. 2020;8(1):2325967119897247. PubMed
  2. Rudisill SS, Kucharik MP, Varady NH, et al. Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review. Orthop J Sports Med. 2021;9(11):23259671211053833. PubMed
  3. Erickson LN, Sherry MA. Rehabilitation and return to sport after hamstring strain injury. J Sport Health Sci. 2017;6(3):262-270. PubMed
  4. 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. PubMed
  5. van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. 2019;53(21):1362-1370. PubMed
  6. Farrell SG, Hatem M, Bharam S. Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention. Am J Sports Med. 2023;51(13):3591-3603. PubMed
    A review of 30 studies of acute adductor injuries found partial tears returned to play in about 1–7 weeks with physical therapy; complete adductor longus tears did well with or without surgery.
  7. Thorborg K. Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain. J Athl Train. 2023;58(7-8):589-601. PubMed
    A clinical review outlined exercise and load management for acute and long-standing adductor injuries.
  8. 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):439-43. PubMed
    In a randomized trial of long-standing adductor-related groin pain, an active strengthening program returned far more athletes to sport pain-free than passive physical therapy.
  9. Ishøi L, Sørensen CN, Kaae NM, et al. Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scand J Med Sci Sports. 2016;26(11):1334-1342. PubMed
    A randomized trial found the Copenhagen adduction exercise produced large gains in eccentric adductor strength.
  10. Quintana-Cepedal M, de la Calle O, Diez-Solorzano P, et al. The Copenhagen Adduction Exercise Effect on Sport Performance and Injury Prevention: A Systematic Review With Meta-Analysis. Scand J Med Sci Sports. 2025;35(8):e70119. PubMed
    A 2025 meta-analysis confirmed the Copenhagen adduction exercise increases adductor strength, though its effect on groin injury rates was not statistically significant and evidence quality was very low.
  11. Alsirhani AA, Muaidi QI, Nuhmani S, et al. The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial. Phys Sportsmed. 2024;52(5):497-506. PubMed
    Adding the Copenhagen adduction exercise to rehabilitation improved strength and reduced pain in soccer players with adductor-related groin pain.
  12. Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39(11):2296-303. PubMed
    In a randomized trial of soccer players, eccentric Nordic hamstring training reduced new and recurrent acute hamstring injuries.
  13. Al Attar WSA, Soomro N, Sinclair PJ, et al. Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis. Sports Med. 2017;47(5):907-916. PubMed
    A meta-analysis found injury prevention programs that include the Nordic hamstring exercise lower hamstring injury risk in soccer players.
  14. Biz C, Nicoletti P, Baldin G, et al. Hamstring Strain Injury (HSI) Prevention in Professional and Semi-Professional Football Teams: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(16). PubMed
    A meta-analysis of prevention programs in professional and semi-professional athletes found they substantially reduced hamstring injuries.
  15. Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953-9. PubMed
    In a randomized trial of elite soccer players, a rehabilitation program emphasizing lengthening exercises shortened return to play after acute hamstring injury.
  16. Askling CM, Tengvar M, Tarassova O, et al. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532-9. PubMed
    The same lengthening-exercise approach also shortened return in elite sprinters and jumpers.
  17. Mendiguchia J, Martinez-Ruiz E, Edouard P, et al. A Multifactorial, Criteria-based Progressive Algorithm for Hamstring Injury Treatment. Med Sci Sports Exerc. 2017;49(7):1482-1492. PubMed
    A criteria-based, progressive rehabilitation program led to fewer hamstring reinjuries after return to soccer than a standard program.
  18. Hickey JT, Timmins RG, Maniar N, et al. Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2020;50(2):91-103. PubMed
    Rehabilitation that allowed some discomfort did not speed return to play but better restored hamstring strength than strictly pain-free rehab.
  19. Jankaew A, Chen JC, Chamnongkich S, et al. Therapeutic Exercises and Modalities in Athletes With Acute Hamstring Injuries: A Systematic Review and Meta-analysis. Sports Health. 2023;15(4):497-511. PubMed
    A meta-analysis found progressive loading programs help athletes return to sport on time after hamstring strain.
  20. Abdulridha KH, Maseer MJ, Cuenca-Zaldivar JN, et al. Comparative effectiveness of rehabilitation protocols for hamstring injuries: A systematic review and meta-analysis. J Bodyw Mov Ther. 2025;44:820-832. PubMed
    A 2025 meta-analysis found eccentric lengthening protocols reduced reinjury and shortened return to play compared with conventional programs.
  21. Maniar N, Shield AJ, Williams MD, et al. Hamstring strength and flexibility after hamstring strain injury: a systematic review and meta-analysis. Br J Sports Med. 2016;50(15):909-20. PubMed
    Some hamstring strength deficits resolve within 3–7 weeks after a strain, while others persist past return to play.
  22. Hickey JT, Timmins RG, Maniar N, et al. Criteria for Progressing Rehabilitation and Determining Return-to-Play Clearance Following Hamstring Strain Injury: A Systematic Review. Sports Med. 2017;47(7):1375-1387. PubMed
    A review found return-to-play decisions after hamstring strain often rely on pain and subjective tests, supporting more objective criteria.
  23. Reurink G, Goudswaard GJ, Moen MH, et al. Platelet-rich plasma injections in acute muscle injury. N Engl J Med. 2014;370(26):2546-7. PubMed
    A double-blind, placebo-controlled trial in acute hamstring injuries found no benefit of PRP injection.
  24. Grassi A, Napoli F, Romandini I, et al. Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis. Sports Med. 2018;48(4):971-989. PubMed
    A meta-analysis found PRP shortened return to sport slightly overall, but not in the double-blind or hamstring-only studies.
  25. Sheth U, Dwyer T, Smith I, et al. Does Platelet-Rich Plasma Lead to Earlier Return to Sport When Compared With Conservative Treatment in Acute Muscle Injuries? A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(1):281-288.e1. PubMed
    A meta-analysis of 5 randomized trials suggested PRP may shorten return by a few days in grade 1–2 muscle strains, without raising reinjury risk.
  26. Bensa A, Fattini Fellini G, Boffa A, et al. Platelet-Rich Plasma Accelerates the Return to Sport in Athletes with Acute Muscle Injuries: A Systematic Review and Statistical Fragility Index-Based Meta-Analysis of Randomized Controlled Trials. Sports Med Open. 2026;12(1). PubMed
    A 2026 meta-analysis of 9 randomized trials found PRP gave about a week faster return to sport, with no difference in reinjury.
  27. Hollabaugh WL, Sin A, Walden RL, et al. Outcomes of Activity-Related Lower Extremity Muscle Tears After Application of the British Athletics Muscle Injury Classification: A Systematic Review. Sports Health. 2024;16(5):783-796. PubMed
    The British Athletics Muscle Injury Classification (an MRI grading system) helped predict return-to-play time and reinjury risk.
  28. Beattie CE, Barnett RJ, Williams J, et al. Are return-to-play times longer in lower-limb muscle injuries involving the intramuscular tendon? A systematic review. J Sci Med Sport. 2023;26(11):599-609. PubMed
    Evidence that tendon involvement within the muscle prolongs return to play is mixed; certain MRI features were linked to longer recovery.
  29. Reurink G, Almusa E, Goudswaard GJ, et al. No association between fibrosis on magnetic resonance imaging at return to play and hamstring reinjury risk. Am J Sports Med. 2015;43(5):1228-34. PubMed
    Scar tissue seen on MRI at return to play after hamstring injury was not linked to reinjury.
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Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.