Owing to the outstanding sensing properties, especially high sensitivity and large stretchability, flexible piezoresistive strain sensors are advantageous for achieving intelligent sensing and have become a popular topic in the field of civil structural health monitoring (SHM). To explore advanced flexible strain sensors for civil SHM, this paper summarizes the recent research progress, achievements and challenges in flexible piezoresistive strain sensors. First, four common piezoresistive mechanisms are introduced theoretically. Sensor materials, including conductive materials, flexible substrates and electrodes, are explained in detail. Second, essential sensing parameters are interpreted and then followed by specific explanations of improvement strategies for the sensor performance in terms of each parameter. Third, applications of flexible piezoresistive strain sensors in the deformation measurement and damage detection of steel structures, concrete structures and fiber-reinforced composite structures are presented. Existing challenges and prospects in the practical application and large-scale production of flexible strain sensors are also reported. Last but not least, strategies for the selection of piezoresistive sensors for civil SHM are explained.