Rectus Femoris Strain (“Hip Flexor Strain”)

The rectus femoris is one of the quadriceps muscles of the thigh. It crosses two joints – the hip and knee. It is commonly injured as the tendon at the front of the hip or in the muscle belly of the thigh. This injury is what many people refer to as a “hip flexor strain.” It is a common injury in sports such as soccer and football. Usually it involves a forceful movement such as immediately starting to sprint or forcefully kicking a ball, especially when the athlete’s foot strikes another player while trying to kick.

These injuries are almost always acute ones. The football player or soccer player will notice immediately that an injury has occurred. With a rectus femoris tendon strain, the athlete will localize the pain to the front of the hip. A sports medicine physician examining the player might notice a defect in this area if a full tear is present, but a full tear is unusual. More frequently, the physician will notice pain or weakness with resisted hip flexion or resisted knee extension. He or she might order x-rays to determine if the athlete pulled a small piece of bone off one of the bones in the hip, as you can occasionally see in young athletes who are not done growing. In high-level athletes especially, the physician might order an MRI of the hip. The MRI will help to confirm which tendon is involved. It can also give a better idea of the extent of injury and how long it might take the athlete to recover and return to sports.

As with most tendon and muscle strains, treatment is almost always nonoperative. Rest from the offending sport and ice to the area can be helpful. As the pain and swelling improve, cardiovascular exercise that does not stress the rectus, such as a stationary bike, can be helpful. As the athlete continues to improve, he or she will start jogging before progressing to a sport-specific rehabilitation program. Working with a sports physical therapist can help tremendously. Return to sports is likely, but it can be difficult to estimate the length of time prior to full recovery. Occasionally the athlete will get back in 1 to 4 weeks, but occasionally it can take 6 to 8 weeks or more.

If you have specific questions about hip flexor strains, please Ask Dr. Geier directly.

44 Responses to Rectus Femoris Strain (“Hip Flexor Strain”)

  1. Hi, very informative article. I have a recurring RF strain near the insertion of the hip joint. It occurred on a free range elliptical last june but has not healed right and not I have chronic tendonitis/tendonosis. It was getting better but I recently tweaked it and its bothering me again. Whats the best thing to heal this thing? I’m really at my witts end. stretching and exercises with no weight load? I donmt want to just rest it because I know it needs blood flow to help healing as well as keep the flexibility there. Much appreciated.

    • I can’t really say in your case without being involved, but working with a physical therapist to recover from the strain and return to exercise and sports can be helpful.

    • Hello Michael P.
      Sounds like I have a very similar issue. Started out as a strained muscle in the middle of my thigh. The strain healed in a couple of weeks but I was left with a chronic tightness in my upper thigh and the side of my upper hip area. I was wondering if you were able to resolve the problem and if so how did you do it?

  2. Dear Doctor, thank you for the informative article. I have been found with an inflammation of the rectus femurs tendon in Jan 2014 after I have experienced strong/ drilling type of pain in my groin coming together with touchable tension in that part of the groin and even fevering. I was given steroids series of shots to reduce the inflammation and irritation of the tendon however until today (May 2014) I am still experiencing strong pain. MRI, X-ray and ultrasounds have been done for me in the hospital. From your experience would you have any advice why I am still in pain and my mobility is very poor? Doctors say that I should be already recovered but I am not. It seems that only irritation may be reduced due to the shots and ibuprofen but the pain is still there although I have retained from all activities. I hope that you could kindly share your opinion. With thanks! Kasia

  3. Hi, What are your own personal thoughts/experiences(if any) regarding the use of Kinesio Tape? I do realize there is virtually no science to support, or negate, the use of it.

  4. I injured my rectus femoris of right leg during soccer game this evening. I’m in great pain, I can light my leg n bend my knees without using my hands to move my right leg. Eg. I can’t straighten my right leg when I’m sitting, can’t lift my right leg to climb onto bed. Is this very serious n need surgery?

    At what degree of rectus femoris injury needs surgery?

    I’m in a country where I won’t want to visit the hospital here thus can forget about the surgery. If need surgery I would hv to fly bk home country for it.

    Pls advise. Thank you.

    • Surgery is rarely needed. If the tendon has pulled off bone and retracted a significant distance could be one instance.

  5. Hi Dr. Geier,
    My daughter 14,is an avid dancer,(15+ hrs weekly) and is having difficulties with her hip flexors. She has been seen by a Sports Med Doctor and he sent her to PT which helped, but continues to battle the pain. (She still does the HF stretches) She is saying that the pain goes from her hip and goes all around the top of her right leg. She wants me to find a doctor that specifically knows dance injuries because she doesn’t feel that the last Sports Doctor really knew the pain she was in. So with that being said, have you helped dancers in the past? She is becoming frustrated and is really being limited on what she loves best. Please let me know your thoughts. With kindest regards, A concerned Dancer Mom! :)

    • Rectus femoris strains can be difficult problems in dancers and other athletes. You might try the AOSSM website and use its Find a Doctor tool to find an orthopaedic surgeon who specializes in dancers in your area.

  6. My 10 year old son felt a pull in his right front thigh (I’m guessing his RF) at tennis practice a few days ago. He said that it only bothers him when he runs. He is scheduled to attend tennis camp tomorrow (Sunday) for a week. I’m certain there will be a lot of running at the camp! Bad idea to let him go? The incident happened on a Thursday, and Friday was a holiday so I was not able to speak or visit our PT. Your thoughts?

    • I can’t give you or him specific medical advice on this website. If an athlete has pain with certain activities, it can be a good idea to rest and avoid those activities for a brief period to try to let the injury heal. Physical therapy and/or seeing an orthopaedic surgeon can help if symptoms continue.

  7. Hi,
    I was working out, trying dead lifts for my first time. Also the way I was working out – I pushed myself to the max. I pulled my hip flexor and it’s been hurting for a couple months now. I want to get back to running. What should I do to heal this asap. Sometimes I’m in pain just from walking.

    • I have found that athletes return to sports and exercise after if they work with a physical therapist for a period of time.

  8. I injured my rectus femoris of right leg during soccer game 5 weeks ago. I was in great pain, I could not lift my leg up and bend my knees without using my hands. I have been advised to have a rest for 4 weeks and I did so. However, when I tried to play soccer and tested it one week ago, I felt a sharp pain and I could carry on playing. At the moment, there is no pain during walking and running.
    Three days ago, MRI was done and confirmed that rectus femoris tendon has pulled off bone 3.5 cm away from hip.

    At what degree of this injury needs surgery? Does the physical therapy will help and how long should it last? which options would you recommend.

    Thank you in advance.

    • I can’t really give you advice, so I would direct that questions to your orthopaedic surgeon. Often tendon avulsions with significant retraction need surgery.

  9. I have been diagnosed with a complete tear of the rectus femoris and and a retraction of 38mm as a result of a fall after hip arthroscopy surgery.
    . My surgeon has said surgery is not required but everything I read on the Internet suggests a complete tear requires surgery. Obviously I’d rather not have surgery… But should I get a second opinion.

    • To be fair, I don’t do those surgeries often, as I tend to perform shoulder and knee surgeries. Many surgeons do feel that complete detachment of the tendon with several centimeters of retraction of the tendon justify surgical repair.

  10. I play soccer and on October 21. I Had a Game and I Was Goalie and I had To Kick the Ball but After The kick I felt This Pain come to my leg and I fell to the floor and After i tried to run it kept hurting.
    I love soccer and i can’t stop playing it without resting my leg…
    Should I Stop and Let it rest??

    • In general, it can be a good idea for an athlete to rest from a sport or activity for a day or two to see if his or her symptoms improve. If they don’t, then seeing a doctor can be helpful.

  11. How bad is a 4 cm. retracted tear of the rectus femoris? I got my MRI results today from my orthopedic surgeon and I was told to see a sports medicine doctor about it. I am a female college soccer player and it has been a little over a month since I tore it. Will more physical therapy be enough for proper healing and strengthening?

    • I think there are different opinions on it if you ask different surgeons. Many feel significant retraction of the tendon is a criteria for surgical repair.

  12. Hello!
    3 years ago I had a complete tear of my rectus femoris muscle. They told me it completely tore off the hip and over time it rolled up into a large mass when I flex my thigh muscles. I never got surgery on this because the doctor told me not to. I questioned his reasoning but since he is in fact a doctor I listened and forgot about it. Now it’s three years later and for about a year I have noticed hip and knee pain on that same leg along with pain where the mass of muscle has settled. What is your opinion on surgery.

    • I can’t really say, but generally those surgeries would be done acutely in patients if they are needed at all. If the tendon retracted and the muscle atrophied over time, it would become a much more complicated surgery. You might consider discussing your concerns with your orthopaedic surgeon.

  13. Hello, Do Rectus femoris injurys cause pain when sitting and can they cause referred pain in the buttock ? Regards

    • I am creating courses on many injuries, so maybe I could create one on these injuries too. Check back here in the coming weeks, as I would post a link at the bottom of this post.

  14. Hi,

    I had a complete rupture of my rectus femoris last Oct 14. Back playing football in Feb 15. Had a massive lump from result of fluid from tear. Physio said lump should go down after a few months. Still not gone, any suggestions?

    Many thanks,
    Niall

    • You might see an orthopaedic surgeon to determine the nature of your injury – muscle, tendon avulsion, etc.

  15. I was at soccer practice and went straight into training without a proper warm-up or stretching. I felt pain immediately in my right quad. I kept on practicing on it for a few days while fighting the pain in my leg. I then went to a massage therapist who suggested I rest my leg until the swelling went down. I rested for 6 days and did’t feel as much pain, so I decided to practice again. I was good for about 2 days and the pain came back. I’ve been off and on with this injury for about 3 weeks now. What would be the best advice for me to return back to normal? Thank you. Debbie (15 years old, TX.)

  16. I took a kickboxing class this past April and I assume that is what strained this tendon. I still feel it when I workout now, and I don’t know if I should stop working out completely until it is completely healed. It still hurts now just as much as it did back in April. What do you think?

    • Sometimes doing exercises that stress the injured area can slow its healing. You might discuss it with your orthopaedic surgeon or physical therapist.

  17. First, thank you for your article! I’ve been reading a lot of articles since my injury and have found this one very informative and helpful.

    I went to my orthopaedic surgeon for my injury 4 weeks after the initial injury and fighting through 1 softball game per week (otherwise resting). Once the pain got to be too much, I caved and went in to see the dr. He ordered X-rays (clear) and MRI immediately. Initial MRI findings (per the radiologist) show “small tear of the proximal myotendinous junction of the rectus femoris muscle” along with fluid collection measuring 6cm in one view. The tendon is intact.

    It has been 3 weeks since my MRI, and my Orthopaedic surgeon has been on vacation, so I finally have my follow up tomorrow. The horrifying pain is gone (and has been gone for 2 weeks), yet if I lift my foot off the floor in order to cross my left leg over my right when sitting or to engage or disengage my parking brake, the pain is there.

    I know you cannot give specific advice, but what I’m wondering is if it is possible for the tear to heal poorly and cause continued chronic pain? I know my right leg and my hamstring and glutes on the left are working harder to compensate for this injury and strength loss since they have that “great workout” faint soreness lately.

    Any advice? I’m anxiously awaiting my follow up tomorrow to get a plan together – at this point I’m just mad at the pain lasting this long!

    Thank you!

    • Chronic weakness and discomfort can result in some patients. Physical therapy often helps them prevent or overcome it. Your surgeon might have more specific advice. I hope it heals well!

  18. I am a retired physician and am often asked for an informal opinion. A friend showed me his thigh today – he had a forced flexion injury of his knee weeks back followed by pain/weakness – he is back to hill running which we do together – he has a lump in his upper thigh with a gap below and I suspect he completely ruptured his rectus femurs muscle distally – he is 70 and not keen on surgery – I have just suggested the usual quads strengthening exercises – any comments/suggestions?

  19. Hello! Thank you for the article. Now I am not really sure if the strain is in my iliopsoas or in my rectus femoris. It happened in the lowest position during squat, just when I jolted; going from eccentric to consentric muscle-work. I felt it pop in my hip! I have long femurs and I use a bit wider than shoulder-stance plus I use a low-bar position on my back during squat. This puts my hips in a really stretched position as I have to really lean forward to keep the bar over the middle-foot.
    Lifting my knee towards my chest gives me discomfort, and also lifting my knee and adducting or abducting my leg is nearly impossible without pain.
    Now, is it an illiopsoas or a rectus femoris injury? Does it matter? And will the procedure/exercises I need to do to recover be the same?

    Thanks

    • I can’t really know without examining you, but a physical therapist can work with a patient with that type of injury to design an exercise program to help him recover and return to exercise or sports.

  20. Thanks for your post
    I have a muscle tear and retraction of 7 cm,and a gap can be seen in the musclotendinous junction of about 1 cm
    3 weeks ago .
    What would that need? A surgery?

  21. Hi.
    Can you advise. As a result of kicking a football 8 weeks ago I have now got atear at the distalrectus femoris musculotendious junction with a gap measuring 7.6 cm. I have no pain and full movement . The doctor tells me that I can live with this but will always have a lump on my leg or have surgery. What is the advantage and disadvantages of each option . What is the recovery time. One doctor stated 2 weeks ! Thanks Barry

    • You should discuss that question with your orthopedic surgeon. Generally many patients do well without surgery, although they can have some weakness and discomfort that persists. Surgery obviously involves the procedure itself and a very long rehab.

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