What Are the Symptoms of a Torn Psoas Muscle?

A torn psoas muscle typically causes deep pain in the front of the hip or groin that worsens when you try to lift your knee toward your chest, and it can also radiate into the lower back or down the front of the thigh. Because the psoas sits so deep inside the body, connecting your lumbar spine to your thighbone, the symptoms often feel vague and internal rather than sharp and localized. That vagueness is part of what makes psoas injuries tricky to recognize, and why they are frequently confused with hip joint problems, back injuries, or even abdominal conditions.

Where the Pain Shows Up

The psoas major runs from the sides of your lower spine, drops through the pelvis, and attaches near the top of the femur alongside the iliacus muscle. When the muscle or its tendon tears, the pain usually concentrates in the deep groin or the front of the hip. Many people describe it as a deep ache rather than a surface-level soreness, and it can be hard to point to one exact spot. The pain frequently increases with any movement that shortens or loads the muscle: walking uphill, climbing stairs, bringing the knee up toward the chest, or getting out of a car.

Lower back pain can also accompany a psoas tear, particularly on the injured side. The psoas has the ability to stabilize the lumbar spine through compressive loading, and it can generate significant force at the lowest lumbar segments.¹ When the muscle is damaged and can no longer do its stabilizing job, the lumbar spine can feel unsupported, and pain may spread across the low back in a way that mimics a disc problem or facet joint issue.

The Hallmark Symptom: Painful Hip Flexion

If there is one symptom that most reliably points to a psoas injury, it is pain with resisted hip flexion. This means that lifting your thigh against resistance, such as when a clinician pushes down on your knee while you try to raise it, reproduces or intensifies the pain. A scoping review in the orthopaedic literature found that resisted seated hip flexion, along with direct palpation of the iliopsoas tendon and muscle belly, are the most useful clinical tools for determining whether the iliopsoas is the source of pain.² This test is especially valuable because many other hip conditions do not reproduce pain in exactly the same pattern.

You might also notice that the pain eases when you rest with your hip bent, such as sitting in a reclined position, and flares when you stand fully upright or extend your hip backward. That pattern makes sense anatomically: standing tall stretches the psoas, while sitting shortens it and takes the tension off. Some people unconsciously adopt a slightly forward-leaning posture to keep the muscle in a shortened, less painful position.

How Psoas Tears Happen

Psoas injuries are most common in athletes, and the mechanism of injury matters because it shapes both the symptoms and the severity. An MRI-based study of athletes presenting with acute groin pain found that distinct psoas major and iliacus injuries predominantly occurred at the musculotendinous junction, the zone where the muscle fibers transition into the tendon. Psoas and iliacus injuries happened mainly during changes of direction, while injuries to nearby muscles like the rectus femoris occurred during kicking or sprinting.³ This means that if your groin pain started during a cutting movement, a sudden pivot, or a deceleration rather than a straight-ahead sprint, the psoas is a prime suspect.

Outside of sports, psoas tears can result from a forceful or unexpected hip extension, such as slipping on ice with one leg going backward, or from repetitive overuse in activities like ballet, martial arts, or rowing. In older adults, tears occasionally happen with relatively minor force because the tendon has weakened over time.

Mild Strain Versus Partial or Complete Tear

Not all psoas injuries are the same, and the symptoms scale with severity. In a review of nearly 5,000 consecutive hip and pelvis MRI examinations, 33 iliopsoas injuries were identified and classified into muscle strains, partial tendon tears, and complete tendon tears.⁴ That low count out of thousands of scans speaks to how uncommon these injuries are, which also explains why they are frequently missed on initial evaluation.

With a mild strain, you might have a nagging ache in the hip flexor area that limits your performance but does not prevent walking. A partial tear tends to produce sharper pain, noticeable weakness when lifting the leg, and sometimes visible bruising in the groin or inner thigh a few days after the injury. A complete tear is more dramatic: sudden severe pain, an inability to actively flex the hip, and sometimes a palpable gap or bunching of tissue in the groin where the retracted tendon has pulled away. Complete tears are rare, but when they happen, imaging often shows the retracted tendon along with soft tissue swelling or hematoma.⁵

When Nerve Symptoms Appear

One of the more alarming complications of a psoas injury is involvement of the femoral nerve. The femoral nerve runs right alongside the psoas muscle through the pelvis, and swelling, hematoma, or an enlarged bursa in that area can compress it. When femoral nerve compression develops, the symptoms expand well beyond local hip pain. You may notice weakness in the front of the thigh, difficulty extending the knee, decreased sensation over the front of the thigh and inner shin, and sometimes tingling or numbness that precedes the weakness.⁶

This scenario is most commonly reported in people on blood-thinning medications, where even a minor psoas injury can bleed into a sizable hematoma that puts pressure on the nerve.⁷ But it can also occur without anticoagulants. An enlarged iliopsoas bursa, sometimes triggered by inflammation from an injury, has been documented compressing the femoral neurovascular bundle and causing isolated femoral nerve palsy with hip flexor weakness and a groin mass.⁸ If you develop thigh weakness, knee buckling, or patches of numbness after a groin injury, that is a sign to seek medical attention promptly rather than assuming it is a simple muscle pull.

What Else It Could Be

Part of the reason psoas tears are underdiagnosed is that several other conditions produce overlapping symptoms. Hip labral tears are perhaps the most common mimic: they also cause deep groin pain that worsens with hip movement, and the two conditions can even coexist. A case report on psoas tendinitis rehabilitation described a patient whose MRI showed both bilateral labral tears and psoas tendinitis, making it genuinely difficult to determine which structure was driving the symptoms.⁹

Iliopsoas bursitis, where the fluid-filled sac near the tendon becomes inflamed, can feel nearly identical to a muscle or tendon tear. A psoas abscess, though rare, is worth knowing about because it can mimic a muscular injury while actually representing an infection. A psoas abscess may present with features suggestive of other diagnoses including septic hip arthritis and even retrocecal appendicitis.¹⁰ If groin or hip pain is accompanied by fever, night sweats, or unexplained weight loss, an abscess rather than a simple tear should be considered.

Other conditions that land on the differential list include hip osteoarthritis, stress fractures of the femoral neck, inguinal hernias, and referred pain from the lumbar spine. Clinicians often work through these possibilities based on the specific pattern of pain, the mechanism of injury, and whether the resisted hip flexion test isolates the psoas as the pain generator.

How Imaging Confirms the Diagnosis

Because the psoas sits so deep in the body, physical examination alone can raise suspicion but rarely gives a definitive answer. MRI is considered the imaging method of choice for assessing psoas and iliopsoas injuries.¹¹ On MRI, a strained muscle shows a characteristic feathery pattern of fluid signal within the muscle fibers, along with swelling along the fascial planes. Tendon tears, whether partial or complete, are visible as discontinuity of the tendon fibers at or near the insertion point on the lesser trochanter of the femur.⁵

Ultrasound is sometimes used as a first-line option because it is cheaper, widely available, and allows the clinician to watch the muscle move in real time. Its main limitation is that the psoas lies deep, making it harder for the ultrasound beam to provide the same resolution as MRI, especially for detecting subtle partial tears or associated bone injuries. In practice, many clinicians start with X-rays to rule out a fracture, then move to MRI when the clinical picture points toward a soft tissue problem.

Recovery and Rehabilitation

Most psoas strains and partial tears are managed without surgery. The initial phase of treatment usually involves relative rest, meaning you avoid the specific activities that provoke pain rather than going on strict bed rest. Ice, anti-inflammatory medications, and gentle range-of-motion exercises are standard early steps. As pain subsides, rehabilitation shifts toward restoring hip flexor strength, retraining the muscle’s coordination with the surrounding pelvic and core muscles, and gradually returning to full activity.

A retrospective case series of patients treated with a hip rotation strengthening program found that pain and functional improvement occurred in about three-quarters of patients, with most able to return to full activity at follow-up roughly a year after diagnosis.¹² Another case report showed successful resolution of psoas-related hip pain after just six weekly physical therapy sessions that focused on neuromuscular reeducation of the abdomen, pelvic floor, and hip musculature.⁹ The takeaway from the rehabilitation literature is that strengthening the muscles around the hip and pelvis, not just stretching the psoas itself, tends to produce the best outcomes.

For injuries that do not respond to conservative care over several months, surgical options exist. Arthroscopic iliopsoas tenotomy, a procedure where the tendon is partially released through small incisions near the hip joint, can provide reliable pain relief in appropriately selected, refractory cases.¹³ Surgery is generally reserved for people who have tried structured physical therapy for at least three to six months without adequate improvement.

Long-Term Effects of an Untreated or Chronic Psoas Injury

When a psoas tear heals poorly or the muscle remains weakened and atrophied, the consequences can extend well beyond the hip. The psoas plays a stabilizing role for the lumbar spine, and when one side is significantly weaker or smaller than the other, the resulting asymmetry can tilt the pelvis. A case report documented how unilateral psoas muscle atrophy induced chronic pelvic torsion, compromised the sacroiliac and lumbar intervertebral joints, increased lumbar lordosis, and contributed to degenerative changes in the lower spinal segments.¹⁴

This chain reaction helps explain why some people develop persistent low back pain after what seemed like a minor hip flexor injury. The compensatory movement patterns that develop while guarding the injured side can overload the opposite hip, the sacroiliac joint, or the lower lumbar discs. Addressing psoas weakness early in rehabilitation, rather than simply waiting for the pain to fade, is one of the stronger arguments for formal physical therapy rather than a purely rest-based approach.

The Desk-Work Connection

Prolonged sitting is often cited as a contributor to psoas problems, and there is some supporting evidence. A cross-sectional study of desk job workers found that nearly all participants, about 98%, demonstrated iliopsoas muscle tightness, and that the degree of tightness correlated with the curvature of their lumbar spine.¹⁵ While tightness alone is not the same as a tear, a chronically shortened and stiff psoas may be more vulnerable to injury when it is suddenly loaded during exercise or an unexpected movement. If you spend most of your day seated and then jump into high-intensity activity without a proper warm-up that includes hip flexor mobilization, the psoas is working from a disadvantage.

The practical implication is straightforward: regular hip flexor stretching and strengthening can reduce the baseline tightness that makes the psoas more susceptible to strain. This does not need to be elaborate. Standing hip flexor stretches held for 30 seconds on each side, combined with exercises like leg raises or marching drills that actively challenge the psoas through its full range, performed several times a week, address both the tightness and the weakness components. For people recovering from a psoas injury, this kind of routine often becomes a permanent part of their maintenance program to prevent recurrence.