Hip and groin pain

Hip joint structure

Before we delve into the various causes of hip and groin pain, let’s take a quick look at hip anatomy and the structures that surround this important joint.

The hip is a ball-and-socket joint, the largest in the body. It is formed when the ball-like upper end of the thigh bone fits into the acetabulum, a cup-like depression (socket) in the pelvic bone.

The hip joint is designed to allow easy movement of your leg in many directions. Several structures make this possible. Cartilage called the labrum covers the acetabulum (socket) and provides cushioning.

The labrum reduces friction when the hip bones move, for instance when you go for a run. Damage to this cartilage makes hip joint movement painful and limited.

Surrounding muscles, tendons, and ligaments provide stability to the hip joint. They allow you to perform movements with your hip, such as bending and straightening your leg, moving the leg away from and back toward the body, and rotating the hip externally and internally (with your foot pointing outward and inward, respectively).

Fluid-filled sacs called bursae lessen the friction between different structures in the hip joint. Inflammation of a hip bursa can cause pain. Various blood vessels and nerves supply the hip joint.¹ A problem with any of these structures can lead to pain in the hip and groin.

The groin area sits between the lower part of the stomach, the upper inner thigh, and the hip joint. Pain in the groin is a common complaint and can be caused by many different disorders – both in the hip joint itself and the surrounding muscles and tendons.

If sports activities or sudden changes in direction hurt your hip, you’re very likely suffering from a groin injury. Don’t despair. The Injurymap app, the world’s first intelligent rehabilitation app, can start reducing your pain today.

Causes of hip and groin pain

Now that you’re a little more familiar with hip joint anatomy, let’s take a look at some of the causes of pain in the hip and groin. Your symptoms can be the result of a variety of problems. The location of your pain and its characteristics (sharp or dull, constant or intermittent) can provide valuable clues about the cause. In general, problems with the hip joint itself result in pain inside the hip or in the groin. Problems with the surrounding muscles, ligaments, and tendons typically cause pain outside the hip or in the upper thigh or buttock.²

Common causes of hip and groin pain

Hip muscle strains and sprains: Sprains and strains are often the simplest explanation for your hip pain. Hip strains and sprains can happen if you overdo it while exercising. This can injure the soft tissues, such as muscles, tendons, and ligaments, if they are stretched beyond their limits. A hip strain or sprain can cause pain during everyday tasks as well as during sporting activities.

Besides pain, you may experience swelling, limitation of movement, and muscle weakness.³ A home exercise program can relieve your pain and restore range of motion. Specific exercises to strengthen the muscles that support the hip will improve your endurance and flexibility and prevent such injuries in the future.

Tendinitis: Tendons are thick cord-like structures that connect muscles to bones. When tendons become inflamed and irritated, the condition is called tendonitis. Hip pain due to hip tendinitis is typically present on the outer part or front of the hip.⁴ You may also experience symptoms like mild swelling and limited mobility.

Hip tendonitis is common in people who take part in running, swimming, cycling, and other high-intensity sports.⁵ Treatment for hip tendonitis consists of a short period of rest, followed by physical therapy. It is important to stretch and strengthen the hip area with rehab exercises to prevent the problem from recurring.

Bursitis: Bursas are fluid-filled sacs located near large joints. They provide cushioning and allow smooth movement of the joint. When a bursa becomes inflamed and irritated, it is called bursitis. Hip bursitis results in a sharp, intense pain at the point of the hip and outer thigh area.

The hip pain can become a dull ache and spread to a larger area. Hip bursitis pain is usually worse at night, especially when lying on the affected side.⁶

It can also be made worse by climbing stairs, squatting, or sitting for too long, for instance during a long car ride. Physical therapy exercises can increase your hip strength and flexibility and help you recover from hip bursitis.

Osteoarthritis: Osteoarthritis is a painful condition that occurs due to wear-and-tear of the cartilage in joints. It can occur in any joint in the body but is common in large weight-bearing joints like the hip. Hip osteoarthritis occurs when the joint cartilage becomes damaged and frayed.

This results in bone rubbing on bone, leading to symptoms of pain, stiffness, and reduced mobility.⁷ Hip osteoarthritis can make it difficult for you to do your daily tasks and stay active.

Osteoarthritis of the hip gradually worsens over time. The sooner you start treatment, the lesser is its impact on your life. Specific hip exercises can help increase mobility and flexibility and strengthen the muscles of the hip joint, reducing your chances of developing arthritis.

Hip labral tear: The labrum is the cartilage that lines the socket of the hip joint. Injury or gradual erosion of the labrum over time can lead to a tear.⁸ This is common in people who play high-impact sports like football, soccer, and ice hockey.

A hip labral tear can also be the result of arthritic changes in the hip joint. Symptoms of a labral tear include hip pain and stiffness. The pain can be present in the groin and is typically worse with bending, exercising, and playing sports.

There may be a locking of the hip or a clicking sound when you move your hip joint. These symptoms can leave you feeling unsteady on your feet.⁸ Physical therapy exercises for the hip muscles can help relieve your pain.

Less common causes of hip pain

Hip fracture: A hip fracture is a break in one of the bones of the hip joint. It is a serious injury that almost always requires surgical repair, followed by physical therapy rehab.

If you suspect you may have fractured your hip, you should seek immediate medical attention. Hip fracture symptoms include severe pain in the hip or groin, swelling, bruising, inability to put weight on the leg, and inability to walk or get up after a fall. You can reduce your risk of hip fracture by doing exercises to strengthen your hip bones and improve balance.

Inguinal hernia: An inguinal (groin) hernia is a protrusion of soft tissues, such as the intestines, through a weak spot in the abdominal wall.

Symptoms of an inguinal hernia include a bulge in the groin on the side of the pubic bone, which becomes more obvious with coughing, straining, bending, or lifting heavy objects.

People with inguinal hernias often report groin pain and discomfort. The groin pain is described as a burning and aching sensation.¹⁰ You can reduce your risk of developing an inguinal hernia by maintaining healthy body weight and doing specific exercises to strengthen the abdominal muscles.

Sciatica: The sciatic nerve is a large nerve of the lower limb. The term sciatica refers to pain in the path of the sciatic nerve as it makes its way from the lower back, through the hip to the leg, all the way down to the foot.¹¹

Pain radiating from the lower back to the back of the leg is a characteristic symptom of sciatica. The discomfort can be present anywhere in the path of the nerve, including the hip.

Sciatica pain can be a mild ache or a sharp, burning pain, usually affecting only one side of the body. Excess body weight and prolonged sitting are risk factors for sciatica. Physical therapy rehab can help correct your posture, strengthen the muscles of your back and hips, and improve your flexibility to reduce your risk of developing sciatica.

Cancer: In rare cases, hip pain is caused by cancer of the bone or cartilage in the hip joint. Pain in the hip and groin can also occur if cancer spreads to the hip area from other parts of the body, such as the breast, lung, or prostate gland.¹²

Hip pain caused by cancer is usually a dull, achy pain that is made worse by movement and can wake you from sleep.¹² If your hip pain does not improve with conservative treatments and physical therapy exercises, you should see a healthcare provider for further investigation, to rule out a serious cause like cancer.

Avascular necrosis: It is a rare condition in which bone tissue dies due to a lack of blood supply. Avascular necrosis (also called osteonecrosis) can occur following a dislocated joint or broken bone. It is also associated with long-term steroid use and excessive alcohol intake.¹³

Symptoms of late-stage avascular necrosis include hip pain when putting weight on the joint, and later even when lying down. The hip pain develops gradually and is typically centered around the groin, buttock, or thigh.

If you have persistent pain in your hip or groin, you should seek medical attention to rule out a dislocated joint or broken bone that can lead to avascular necrosis.¹³

Causes of groin pain

Pain in the groin can originate from the abdominal muscles, thigh muscles, and hip joints. Most of the time, groin discomfort arises from activities that place pressure on the hip and groin area. Any activity that demands a quick change in direction or shifting of body weight can cause groin pain. Common culprits are football, tennis, running on uneven terrain, and other sports that involve kicking a ball or changing direction abruptly. Other factors that can contribute to the onset of groin pain include:

• General wear and tear of the body as you age
• Damage to the hip joint
• Injuries to the muscle fibers
• Overloading of muscles and tendons in the groin area

These types of injuries can happen with a strong kick of a ball, overstretching to the side, a fall while playing sports, or exercising without warming up. Poor pelvic control or stability, together with weakened muscles in the legs and lower back, can put you at a higher risk of hip and groin problems.

The hip and groin muscles attempt to compensate for this lack of stability and muscle strength. Over time, this can lead to increased pressure on the hip joint, muscles, and tendons. Targeted exercises can increase hip mobility, strength, and balance and protect you from such injuries. Scroll down for a sample of hip exercises from the Injurymap app.

If you have pain radiating from the abdomen or groin, it could be related to your lower abdominal organs or genitals. Check with your doctor before commencing any form of a rehabilitation program to make sure you have a musculoskeletal injury (an injury related to the muscles, joints, tendons, ligaments, etc.) and not a different condition that exercise will not treat.

Symptoms

Depending on the condition that is causing your hip pain, the pain can be present in the thigh, groin, buttocks, front of the hip, or the inner or outer side of the hip joint. The hip pain can be present at rest or with activities like running and stair climbing. The pain may be worse at night or when you lie on the affected side. Other symptoms that commonly accompany hip and groin pain include:^7,8

• Stiffness
• Swelling
• Tenderness
• A crunching or clicking sound
• A locking, clicking, or catching sensation
• Limited mobility (for example, difficulty putting your socks on)

Diagnosis

Doctors diagnose the cause of hip and groin pain based on your description of the pain and what makes your symptoms worse. Your doctor will ask you when your hip pain started, how it affects your everyday activities, and whether the pain is worse at night or with certain activities.

Your doctor will perform a physical examination to see how your hip moves. They may order some tests to confirm the diagnosis, including X-rays, CT scans, and MRI scans. These tests help your doctor find out what might be wrong with your hip and groin. If your doctor suspects your hip pain is related to an infection, they might order some blood tests.¹

When to see a doctor

Most of the time, hip and groin pain can be treated with exercise and other home remedies. However, if self-care treatments do not work, you should see a doctor.