Hip & Groin Pain

The hip is a ball-and-socket joint consisting of the femur (the ‘ball’), the acetabulum (the ‘socket’ - which sits in our pelvic bone), and many muscles and ligaments. There is also thick cartilage that attaches to the rim of the acetabulum to provide further surface area and stability to the hip, known as the labrum.

When the ball doesn’t move appropriately and fluidly within the socket, FAI can occur. FAI usually presents as a dull ache either in the front, side or back of the hip, restricted hip movement, pain when sitting for a long time, pain with repetitive high impact activities, clicking and/or locking, and giving way

You may experience an FAI for several reasons, including

· Differing bone morphology – the bones may have been shaped in a way that increases the risk of the bones contacting each other disruptively during hip movement

· Decreased hip stability – the muscles of the hip have a large role in maintaining smooth movement of the two bones. Weakness increase the risk of the femoral head gliding onto the labrum and causing the above symptoms

Repetitive physical activity during childhood and adolescence can increase your risk of having FAI as an adult. Similarly, repetitive hip flexion, being a labourer, having hip disorders as child and having a family history of hip disorders can increase the risk of FAI.

The first line of treatment during physiotherapy is to strengthen the appropriate muscles and release structures contributing to any restriction. It is important to see a physiotherapist as soon as possible. If left untreated, there is the risk of increased severity and advanced osteoarthritis in the future.

The hip is a ball-and-socket joint consisting of the femur (the ‘ball’), the acetabulum (the ‘socket’ - which sits in our pelvic bone), and many muscles and ligaments. There is also thick cartilage that attaches to the rim of the acetabulum to provide further surface area and stability to the hip, known as the labrum.

Shear forces such as twisting, pivoting and falling onto the hip can be forceful enough to create a tear in the labrum. This risk is increased especially during a period of high demand e.g. lots of training sessions or competitive matches. Labral tears can also be overuse injuries. For example, conditions such as femoro-acetabular impingement (FAI) can progress and eventually result in degenerative labral tears (see ‘FAI’ tab for more information). Degeneration of the hip joint may also result in degenerative labral tears.

Symptoms of labral tear may include:

· Painful click or lock in the hip

· Feeling of hip instability/”giving way”

· Pain in the groin, buttocks and/or side of hip

Having a degenerative disorder such as osteoarthritis and FAI can increase your risk of sustaining a labral tear. Women are more likely than men to have a tear due to structural differences. Individuals who participate in running and sports with frequent external rotation and hip hyperextension also have this increased risk.

The role of physiotherapy is to facilitate optimal recovery through gradual loading and strengthening. These rehab goals include:

· Educate you about your injury and what activities to avoid

· Assist you in acute injury management, and to minimise pain and swelling

· Protect the injured structure

· Commence early rehabilitation

· Plan out your return to sport an

Osteoarthritis (OA) of the hip is a degenerative joint disease that is characterised by a loss of joint space and articular cartilage, the formation of bony spurs, and sub-chondral cysts. Clinically, those with hip OA present with pain, swelling, a loss of range of motion, morning stiffness, crepitus or “creaking”, and stiffness after prolonged rest. It is more prevalent in older age groups and in obese individuals, usually only affecting people over the age of 40, and is the result of wear and tear over many years. Treatment for hip OA is always conservative to start with. We cannot replace cartilage or reduce the loss of joint space, however we can slow the progression of the disease, and improve symptoms and function by improving range of motion and strength, and leading active low-impact lifestyles. Managing overall load, and activity modification is crucial for optimal recovery.

Recovery from OA symptoms is not always linear. Flare-ups of your symptoms are extremely common. Fortunately, these can be mitigated by having appropriate flare-up strategies ready to go, and with the appropriate treatment flare-ups should happen less frequently and recover quicker.

Plain film X-rays are used to diagnose and monitor the progression of the disease. The goal of physiotherapy is to

• Educate you about your condition

• Reduce pain and improve range of motion

• Build Strength

• Improve function and quality of life

• Avoid surgical intervention if at all possible

The hip joint is controlled by the strong muscles that surround it. There are also bursae (fat pads) in place to help reduce friction between tendon and bone during movement. Greater Trochanteric Pain Syndrome (GTPS) is a term used to describe lateral hip pain (pain at the side of the hip) caused by an aggravation of the gluteal tendons as they wrap around and attach onto the greater trochanter (the prominent bony point on the side of the hip) and the associated irritation and inflammation of the bursa. It is often called “hip bursitis” or “gluteal tendinopathy”, but in actual fact, both conditions usually co-exist with the tendinopathy being the primary pathology and the bursitis secondary to the tendinopathy.

People suffering from GTPS will likely feel a deep ache in the hip, pain when sleeping on their side, pain with prolonged sitting (particularly sitting cross-legged), and pain with weight bearing activities e.g. stair climbing, running, and jumping.

GTPS is usually classed as an overuse injury as the tendon and bursa are pushed above and beyond their capacity. However direct trauma - such as a fall onto the hip joint - may also set off GTPS. Several risk factors that may add to injury include:

· Structural factors such as your individual anatomy e.g. hip joint alignment, bone morphology, leg length discrepancy

· Weak hip muscles, particularly the abductors and extensors

· Weak core

· Flat feet or high arches

Load management is an essential aspect of treatment. It is therefore crucial to identify which movements and activities are particularly aggravating so that they can be monitored and managed accordingly. The goals of physiotherapy are to:

· Educate you about your injury and what activities to avoid

· Assist you in acute injury management, and to minimise pain and swelling

· Protect the injured structure

· Commence early rehabilitation

· Plan out your return to sport and activity

The adductors are the muscles of the inner thigh that are responsible for moving your leg towards the middle of your body. They play a large role in stabilising the hip and pelvis through all ranges of motion, and are powerful movers of the hip. Skating sports, soccer, horse riding and rugby are examples of sports that put a high demand on this muscle group, hence the high prevalence of adductor injuries in these athletes.

An adductor injury can occur either acutely or due to overuse. Symptoms may include sharp pain or dull ache in the groin area, sometimes over the front of the hip, a ‘pull’/’strain’ sensation at the time of injury, pain after moving from a prolonged resting position, and pain when pulling your leg into midline.

Risk factors that may contribute include:

• Weak adductors, and even more so if you have strong hip abductors (the gluteal group)

• Poor core stability

• An inappropriate increase in training load

• Previous groin injury

• Significant leg length difference

The most common causes of adductor related pain are:

• Adductor muscle strains (tearing of the muscle fibres), and

• Adductor tendinopathies (cellular changes in the tendon fibres causing weakness and pain)

Though adductor injuries can present quite similarly in terms of symptoms and deficits, they are treated slightly differently during the first stages of recovery. It should be noted that there may be other injuries that present as groin pain with very similar histories and presentations that may not be adductor-related. Accurate and early is key in ensuring your recovery is optimised. Recovery for these injuries can range from 10 days to 3+ months depending on their severity.

The goals of physiotherapy are to:

• Educate you about your injury

• Assist you in acute injury management, and to minimise pain and swelling

• Protect the injured structure

• Commence early rehabilitation

• Plan out your return to sport and activity

The hip flexors are the muscles at the front of your hip responsible for flexing your hip,. or moving your leg up towards your chest. They are prime movers, and like many other hip muscles, strong hip flexors are essential for good athletic performance (e.g. sprinting, kicking and jumping). Because of their attachments to the spine, the hip flexors also play a large role in core stability, lumbo-pelvic alignment and preventing back pain.

A hip flexor injury can occur either acutely or be due to overuse. Symptoms may include sharp pain or dull ache over the front of the hip, tenderness over the front of the hip, a ‘pull’/’strain’ sensation at the time of injury, pain after moving from a prolonged resting position, and pain when flexing the hip.

Risk factors that may contribute include:

• Weakened hip flexors

• Poor core stability

• Daily prolonged sitting – spending lots of time with the muscle in a shortened, overactive position

• Increasing training load disproportionately

The most common causes of hip flexor pain are:

• Rectus femoris and/or iliopsoas muscle strains (tearing of the muscle fibres)

• Iliopsoas tendinopathies (cellular changes in the tendon fibres causing weakness and pain)

In some cases, other structures may be contributing to symptoms, such as the iliopsoas bursa.

Though these injuries can present quite similarly, they are all treated slightly differently during the first stages of recovery. Ensure that you see a physiotherapist so that your pain is accurately diagnosed and efficiently treated. Recovery for these injuries can range from 10 days to 6+ weeks depending on their severity.

The goals of physiotherapy are to:

• Educate you about your injury

• Assist you in acute injury management, and to minimize pain and swelling

• Protect the injured structure

• Commence early rehabilitation

• Plan out your return to sport and activity