Hip and groin pain

There are many structures in the hip and groin area and it is common for more than one component to give pain at the same time. You may feel it in several areas such as with the lower back, hip and groin pain. 

Some pain is musculoskeletal (MSK) in origin. These include the hip joint, muscles and spine. However, pain may also be referred from other parts of the body, such as the ovaries or kidneys (pain from a kidney stone may be felt in the lower back and hips, for example). Non-musculoskeletal refers to parts of the body that are not made of muscle or bone.  

The MSK structures will normally give pain on movement while the non-MSK structures will tend to have other non-movement related symptoms such as abdominal pain, temperature and so on. If the pain is constant or you have any doubt, speak to your doctor. 

The main cause of hip pain in adults is osteoarthritis. Osteoarthritis of the hip is the most common form of joint disease, and affects approximately 8 million people in the UK.

However, it is just one of the many different conditions that can cause of hip and groin pain. These are the most common hip pain causes:

• Osteoarthritis of the hip, which may also be referred to as OA Hip, may cause hip joint pain, stiffness and grating or grinding sensation in the ball and socket joint of the hip when you move. You may experience hip clicking and groin pain at the same time. Pain, which originates in the hip or groin, can also sometimes radiate down to the knee. Sometimes you may experience lower back and hip pain.
  
  
• Greater Trochanteric Pain Syndrome, which is also called Lateral Hip Pain or Trochanteric Bursitis. This causes pain at the outside (lateral) part of the hip. It is usually caused when the tendons of the buttock (gluteal muscles) are overloaded.
  
  
• Adductor Tendinopathy is a condition that gives pain in the crotch at the top of the inner thigh.
  
  
• Hip Impingement (femoroacetabular impingement) is a rare condition. It tends to cause pain in the groin region, when moving the hip into certain positions, although the pain may radiate giving you leg pain. Those affected are often younger than those who have osteoarthritis of the hip. Hip impingement is diagnosed on clinical history and appropriate examination. You may have hip pain at night if you lie on your side.
  
  
• Ischial (Sitting Bone) Bursitis Pain. This uncommon condition causes pain in the buttock. The site of the pain is such that it is more painful when sitting on the affected part. It is usually triggered by an increase in weight-bearing activity, such as running or lunging.

Other common causes of hip pain include:

Muscle strains

These commonly occur in the hamstring in the buttock or are the result of injuries to the hip flexor muscles in the groin and front of the thigh. Symptoms of hip flexor pain can be a sudden and sharp pain in the hip or pelvis.

These are usually sudden in onset and related to an obvious cause, such as kicking a football or overstretching. If there is a tear, bruising may also be apparent. You may experience hip pain when walking or doing normal activities.

A minor injury may take two weeks to heal. If the strain is moderate then expect a four to six-week recovery period, while a severe strain can last for two to three months.

In the case of a severe strain or pain that doesn’t settle then it may be worth seeking advice from a physiotherapist. Strains usually respond well to rest, painkillers and cold packs.

Gradual strengthening exercises will help your rehabilitation and return to normal activity levels.

Sportman’s Hernia (Gilmore's Groin)

Footballer fans may have heard of this condition, which has affected many premier league players. It causes groin pain when walking, stretching or kicking. There is often discomfort when coughing.

Diagnosis is by examination of the groin area by a clinician. The condition may settle with relative rest including a lot of walking.

Occasionally, surgery is required. The American Academy of Orthopaedic Surgeons’ website provides more detailed information.

Stress fracture around the hip

If you exercise regularly, especially if you are a runner, then a hip fracture may be the cause of pain in the groin. Typically it is associated with gradual onset of pain as duration of weight-bearing activity increases.

Often it will come on while you are running. It can affect the hip, femur or pelvis. Pain disappears with rest only to recur on subsequent activity.

It is an important diagnosis because if the stress fracture develops into a fully blown fracture there can be significant long-term effects. If you have hip pain when running and you think it may be a stress fracture then you should see a doctor as soon as possible.

Hernias and other causes of hip and groin pain

A hernia is caused by a weakness in the anterior abdominal wall. You may notice a swelling, which is worse on coughing or straining.

If the hernia becomes continuously painful you should see a clinician. However, in most instances it will be ‘niggly’ and you can see someone at your leisure.

If your groin/hip pain is associated with other features involving waterworks, bowels or you are unwell or have a temperature, you should seek medical advice.

Hip pain often gets better on its own accord. Until the body heals itself, pain can be self-managed using these techniques:

• Relative rest. Avoid straining the cause of the pain while staying as active as possible.
  
  
• Painkillers. Paracetamol and anti-inflammatory medication, such as ibuprofen, from your local pharmacist can help with reducing pain and swelling associated with the pain.
  
  
• Exercise. Maintaining strength and active range of movement is important. Hip pain exercises can be beneficial in relieving symptoms. Visit the Arthritis UK website for more information.
• Apply ice or heat packs. Place them on the injured area for short periods of time. These can help to reduce the swelling, inflammation and pain.
  
  
• Apply a compression wrapping. This can help to control swelling.
  
  
• Physical therapy. Stretching exercises may help improve the symptoms and is usually an key part of hip pain treatment. A physical therapist will be able to give you a course of exercises to help you recover from groin and hip problems. The exercises will be tailored to working out a specific group of muscles.