Causes and treatments for hip pain and groin pain

Hip pain doesn’t always stay localised to your hip. It can spread to your groin — the area where your abdomen and top part of your thighs meet — and radiate down to your thighs and knees. While hip pain can occur at any age, it is uncommon in young adults and becomes more frequent with age, especially with conditions such as arthritis and hip impingement. Depending on the underlying cause, it may occur alongside stiffness and reduced range of movement, specifically rotational movements. 

One cause of hip pain that is more common in younger populations, specifically athletes, is a tear in the labrum, a ring of cartilage that sits along the rim of the hip socket. However, labral tears are often dismissed as muscle strain. It is, therefore, important to understand the symptoms of common hip problems, so you can seek help and get appropriate treatment. However, first, it helps to know a little about healthy hip joints. 

The anatomy of your hip joint

Your hip is a ball and socket joint and alongside your knees and ankles, is one of the main load-bearing joints of your body. This means it carries the weight of your body. The ball refers to the top of your thigh bone, which is called the femoral head and in a healthy hip joint is usually spherical. The hip socket is part of your pelvic bone and is called the acetabulum.

Both the ball and socket are lined by a smooth synovial cartilage called articular cartilage. This significantly reduces friction as your hip joints bear the weight of your body and allow smooth movement without pain. On the outside of your hip socket is another structure made of cartilage, the labrum, which forms a ring around the entire rim of the socket.

To further support smooth movement, your hip joints contain a lubricating fluid called synovial fluid. The labrum forms a tight vacuum seal, creating a suction-like effect, which keeps the synovial fluid in place and protects your articular cartilage during movement. The labrum also maintains the stability of your hip joint and plays an especially important role in individuals with hip dysplasia, a condition where the hip joints do not develop properly.

Causes of hip pain

There are many different causes of hip pain and in older adults, the most common cause is osteoarthritis. After a fall in an older adult, sudden hip pain is more likely to be a hip fracture as bones become weaker with age. In younger adults, one of the most common causes of hip pain, as already mentioned, is a labral tear. 

Labral tears

Labral tears are most common in individuals who have a pre-existing structural problem with their hips, such as a femoroacetabular impingement (FAI) or developmental dysplasia of the hip (DDH), which we will discuss later. 

Less commonly, labral tears occur after trauma or due to repetitive activities (eg sports that involve a lot of pivoting, such as football, tennis, golf, or ballet dancing). Left untreated, labral tears can lead to further damage, such as the hip articular cartilage peeling off. Unsurprisingly, this causes further joint damage, which can eventually lead to arthritis. 

Symptoms of a labral tear include sharp, knife-like, groin pain, usually on activity and specifically when squatting, lunging or getting in and out of a low car. As the labral tear worsens you may find it increasingly difficult to walk, stand or sit for long periods of time. 

Pain while sitting, in particular, is a common symptom of labral tears, with many people noticing the pain when sitting in the car or on a flight for a long time. You may also notice a catching sensation or clicking, as well as your hip giving way. Groin pain caused by a labral tear can also radiate to your buttock, the front of your thigh or side of your hip. 

Femoroacetabular impingement (FAI)

FAI occurs when excess bone grows around the ball of your hip joint, when your hip socket is too deep, or a combination of the two. This causes the bones of your hip joint to rub against each other during movement. Over time this leads to joint damage, hip pain, groin pain and reduced range of movement. FAI can also cause labral tears and damage the hip articular cartilage. 

FAI usually affects active adults aged 30–45. However, athletes and dancers may develop symptoms earlier, in their teens or twenties. 

Developmental dysplasia of the hip (DDH)

DDH can be present at birth or develop during childhood. In mild cases, it may only be diagnosed in adulthood as a result of investigating hip pain and/or a labral tear. DDH results in a shallow hip socket, which doesn’t completely cover the ball. This means the ball is prone to partially or completely slipping out of the socket.

Diagnosing a labral tear

If you’re concerned that you may have a labral tear, see your GP. They will ask you about your symptoms and when they started, as well as your medical history. They may perform a physical examination and recommend that you have an imaging test, such as an X-ray, CT scan or MRI scan, to confirm the presence of a labral tear. Often, in subtle hip impingement or hip dysplasia, your X-rays may appear normal. If your symptoms persist despite adequate rest and activity modification, then you should be referred to a hip specialist for diagnosis.

As most labral tears are associated with FAI or DDH, treatment of these underlying conditions is usually needed, in addition to treating the labral tear. 

Treating a labral tear

In the first instance, you will need to rest, modify your activities to avoid things that trigger your hip and/or groin pain, and take anti-inflammatory medications. Once your symptoms have settled, you will need physiotherapy to stretch and strengthen the muscles around your hip. To help you continue with your physiotherapy more effectively, your doctor may give you a steroid injection into your hip joint. This will help reduce your pain but will also help your surgeon assess how much of your pain comes from your hip. 

If the above treatments aren’t enough to resolve your symptoms, surgery may be recommended. Surgery to correct a labral tear is usually performed as a keyhole procedure called a hip arthroscopy. The torn labrum can be removed (debrided) or repaired. Increasingly, labral repair is proving to have better outcomes than debriding. 

If your labral tear is associated with FAI, surgery will also involve removing the excess bone that is causing the impingement. If your labral tear is associated with DDH, surgery will be performed to stabilise your hip joint.