Hip & groin pain

Identifying the cause of pain in the hip and groin area can be difficult.

There are many structures in the area and it is common for more than one structure to give pain at the same time.

Some are musculoskeletal (MSK) in origin e.g. hip joint, muscles and spine. However pain may also be referred from other structures in the region such as the ovaries or kidneys.

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 GP.

What can I do myself to get better – now and in the future

Hip pain often gets better on its own. It can be self-managed by

  • Relative rest, avoiding the cause while staying as active as possible
  • Over-the-counter painkillers, such as paracetamol and ibuprofen.
  • Exercise, maintaining strength and active range of movement is important. Visit the Arthritis UK website for more information
When should I see my doctor?
  • If you have severe pain, tingling, or numbness in the arm or fingers, or if your limb feels cold, after an injury, or if you think you may have broken your arm (for example it is severely swollen or appears to be deformed).
  • If the joint becomes hot, red, swollen and tender, and/or you feel feverish so you should see your doctor straight away.
Common Causes of hip and groin pain

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 eight million people in the UK.

  • Osteoarthritis of the hip (OA Hip) may cause pain, stiffness and grating or grinding sensation when the joint moves. Pain which originates in the hip or groin can also sometimes radiate down to the knee.
  • Greater Trochanteric Pain Syndrome (Lateral Hip Pain, Trochanteric Bursitis)
    • This causes pain at the outside (lateral) hip. It is usually caused when the tendons of the gluteal muscles (buttock) are overloaded.
  • Adductor Tendinopathy – This condition gives pain in the crotch at the top of the inner thigh.
  • Hip Impingement is not common. It tends to cause pain in the groin region, when moving the hip into certain positions. Those affected are often younger than those getting OA hip. It is diagnosed on clinical history and appropriate examination.
  • 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 causes of hip pain
  • Muscle strains –particularly hamstring in the buttock and hip flexor injuries in the groin and front of the thigh
    • These are usually sudden in onset and related to an obvious cause eg kicking a football or overstretching
    • If there is a tear, bruising may be apparent. A minor injury may take 2 weeks, moderate 4-6 weeks but severe can last 2-3 months. It may be worth obtaining physio advice if more severe or not settling
    • Usually responds well to rest, painkillers and cold packs followed by gradual strengthening and rehabilitation before return to activity
  • Sportman’s Hernia (Gilmours groin) – Footballers may have heard of this condition which has affected many premiership players. It causes a pain in the groin when stretching or kicking. There is often discomfort coughing which may alert you to the fact that it may not be a simple muscle strain. Diagnosis is by examination of the groin area by a suitably knowledgeable clinician. It 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 are a regular exerciser, especially if you run regularly, be aware of the possibility of a stress fracture as a 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 during a run. As it progresses the pain will appear earlier in the run. It can affect the hip, femur or pelvis. Pain disappears with rest only to recur on subsequent activity. It is an important diagnosis as if the stress fracture develops into a fully blown fracture there can be significant longer term effects. If you are suspicious, rest and see your GP 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, worse on coughing or straining. If it 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.