Groin and Hip Pain: 8 Possible Causes

Hip and groin pain are common issues that are seen by physiotherapists and doctors in Australia. They can be mistaken for each other as they are closely related. The groin describes the region around the inner thigh to the pelvic folds. On the other hand, hip pain can vary from the inner pelvic folds, the outer sides and the bottom.

According to the Australian Institute of Health and Welfare, Australians over the age of 60 are increasingly diagnosed with hip conditions and undergoing hip surgery.[1] Approximately 10% of people over the age of 40 will experience hip pain.[2] Young and active people will tend to experience more soft tissue injuries, such as groin strains and tendinopathy.

There are many causes of hip pain and groin pain, including the joint, bones, muscles and tendons. As a result, it can be hard to determine which part of the hip and groin might be causing the pain. Consulting a health professional, such as a physiotherapist and/or doctor can help determine an accurate diagnosis.

The 8 causes and treatments of groin and hip pain

1. Osteoarthritis

Osteoarthritis is the most common type of arthritis. Hip osteoarthritis is a condition where the cartilage between the joints begins to wear away. Over time, this can lead to groin and hip pain. Additionally, it can also cause hip stiffness, walking difficulties and swelling. According to the latest report by the Australian Institute of Health and Welfare, it is responsible for over 30000 hip replacement surgeries a year.[1]

Hip Osteoarthritis Treatment

There are many treatments for hip osteoarthritis. However, physiotherapy and rehabilitation is generally the first option for those experiencing this condition. Exercise is particularly important for strengthening the hip muscles and keeping the joint mobile to help prevent the symptoms from worsening. There have even been specific programs that are dedicated to hip osteoarthritis which can reduce the groin and hip pain by up to 36% upon completion.[3]

2. Hip Fracture

Hip fractures are another source of groin and/or hip pain which is usually caused by trauma, such as falling or impact. A hip fracture will typically occur along the top part of the femur (thigh bone). According to the Australian Institute of Health and Welfare, hip fractures are common amongst those over 45, especially in women and those with other conditions (e.g. diabetes, low red blood cells).[4]

Hip Fracture Treatment

According to the latest report by the Australian Institute of Health and Welfare, approximately 93.5% of all hip fractures are treated surgically.[4] Factors that determine whether a hip fracture needs surgery include gender, age, the fracture’s severity and the location of the injury. Physiotherapy and rehabilitation will be required after either a hip fracture or surgery to help restore movement and strength.

3. Hip Impingement

Also known as femoroacetabular impingement, this is a condition where extra bony growth along the hip joint prevents it from moving effectively. As a result, movements such as squatting, bending over and even sitting can lead to groin pain. These types of activities can cause bone-on-bone irritation. Active people in their 20-40s are most likely to experience groin and hip pain with hip impingement.[5] However, not everybody with hip impingement will experience symptoms

Hip Impingement Treatment

In the early stages, hip impingement is usually managed with physiotherapy and rehabilitation. Exercises to keep the muscles strong and joint mobile can help minimise the grinding groin pain that many people experience. Other treatments, such as injection and surgeries may be necessary if symptoms continue to persist.

4. Hip Bursitis

Hip bursitis typically presents as outer hip pain along the greater trochanter (the boney area located at the widest part of the hips). It is a condition where the bursa become inflamed. The bursa are little fluid filled sacs that sit between bone and muscles to limit friction during movement. Middle-aged women are more susceptible to developing hip bursitis.[6]

Hip Bursitis Treatment

Hip bursitis is generally managed with physiotherapy. Your therapist will go through strategies (e.g. positions to avoid, what activities to reduce), exercise and hands on treatment to ease pain (e.g. massage, ultrasound).Other options include taking anti-inflammatory medications, cortisone injections and surgery (as a last resort).

5. Groin Strain

A groin strain refers to an overstretch or tear injury to the adductor muscles (also known as the groin). This most frequently occurs in active individuals who play running and kicking sports, such as Australian Rules Football and soccer. Strains are classified into grade 1, 2 and/or 3 depending on how severe the tear is. Groin pain is often felt shortly after the injury has occurred.

Groin Strain Treatment

Groin strains can be a persisting injury, particularly in high-level athletes due to their level of demand. Physiotherapy is recommended to help with recovery and prevent further re-injury. Rehabilitation and exercise is the gold-standard for managing a groin strain. Other treatments, such as massage, dry needling and electrotherapy can help ease discomfort and pain.

6. Femoral Head Avascular Necrosis

Avascular necrosis is a serious condition where the blood supply to the head of the femur (thigh bone) is stopped. As a result, the bone gradually begins to become arthritic, weaken and even fracture. This can lead to worsening hip pain, stiffness and difficulty walking. There are several causes of avascular necrosis, including excessive alcohol consumption, sickle cell disease, using steroids and childhood hip conditions (e.g., Legg-Calve-Perthes disease).

Femoral Head Avascular Necrosis Treatment

Treatment will generally be determined based on the severity of the condition.[7] Factors such as pain, age and how advanced the condition is will determine the most appropriate course of action. Physiotherapy and medication can be used in conjunction for more milder and/or temporary conditions. However, more advanced circumstances may require surgery.

7. Labral Tear

The hip labrum is a spherical piece of cartilage in the pelvis which helps keep the femur (thigh bone) in the hip joint. With the support of the tendons and ligaments, it almost acts as a vacuum seal to keep the hip joint secure. It also helps absorb shock and produces fluid to lubricate the joint. A tear in the labrum occurs through trauma (e.g. car accidents, slipping on a hard surface) and/or repetitive hip movements (e.g. twisting, rotation). As a result, labral tears can lead to hip pain, stiffness and difficulty walking.

Labral Tear Treatment

Treatments for labral tears will depend on several factors, such as the location of the injury, the amount of pain and the patient’s age. Physiotherapy and rehabilitation is recommended as the first option for treatment. However, more invasive treatment, such as cortisone injections and surgery may be necessary for more severe injuries.

8. Inguinal Hernia

Inguinal hernias is a condition where tissue from the abdomen (such as the intestines) begins to poke out of the wall of the surrounding muscles. Gaps in weak areas along the abdominal muscle wall can cause gaps where this can occur. This can be worsened by activities that lead to increased pressure in the abdomen, including lifting heavy objects or constant coughing. Inguinal hernias lead to symptoms, such as groin pain, bulging areas along the groin and pain when coughing/lifting.

Inguinal Hernia Treatment

Inguinal hernias require a consultation with a doctor and/or surgeon. Treatment may not be required for hernias that have no or little symptoms. However, if the hernia develops and becomes more painful, surgery may be necessary to fix it.

When to See a Physiotherapist

Groin and hip pain are conditions that are regularly seen by physiotherapists. As noted in the possible conditions listed above, most can be managed through a routine of physiotherapy and exercise. However, further investigations may be required to determine the root cause of the pain, such as X-rays, MRIs and ultrasounds.

Physiotherapists also regularly work alongside GPs and orthopaedic specialists in circumstances where further treatment is necessary. For instance, advanced stages of avascular necrosis will often require surgery to prevent the joint from collapsing. However, physiotherapists will then be responsible for looking after the rehabilitation process after the process.

Key takeaways

There are several causes of groin and hip pain. The 8 possible causes listed above are some of the more common reasons. There are a range of injured structures around the hip that can cause this, including cartilage, bone and muscles.

How they are managed will depend on the condition suspected, the severity of the injury and the characteristics of the patients. Although physiotherapy can help with a majority of these conditions, additional support may be required.

If the groin and hip condition is not improving (e.g. persisting osteoarthritis, labral tears) surgery may be required. More severe conditions, such as advanced inguinal hernias and avascular necrosis may need surgery immediately. Physiotherapy will most likely be required after the procedure to restore movement and strength to the hip.