Why Groin Pain May Mean “Hip Joint Pain”
Hip pain can be confusing — patients often point to the groin, thigh, or deep hip crease when describing discomfort. When pain is felt in the groin, it may indicate an issue within the hip joint itself.
Groin pain can come from several different structures in your hip and pelvic area, not just the hip joint itself. Common causes include:
Hip joint problems (such as arthritis or labral tears)
Muscle and tendon issues (particularly the adductor muscles on the inner thigh)
Core muscle injuries (involving the abdominal wall)
Hip flexor problems (the iliopsoas muscle)
Pubic bone inflammation
Hernias
Lets focus on two commonly seen areas for groin pain related to the hip joint:
Hip osteoarthritis (OA)
Hip labral tears
Understanding the differences helps you know what to expect and when to seek treatment.
Hip Osteoarthritis: When the Hip Joint Wears Down
Hip osteoarthritis is a degenerative condition where the cartilage inside the hip joint gradually thins and breaks down.
Why It Happens
Natural aging
Prior injury or trauma
Genetic factors
Femoroacetabular impingement (FAI)
Repetitive impact sports
Obesity
Occupational factors
Common Symptoms
Deep aching groin pain
Stiffness after sitting
Reduced range of motion
Pain with weight-bearing
Referred pain to the buttock, knee, or even below the knee.
“C-sign” pain where patients place their hand in a C shape over the hip
Most patients describe a dull ache that can flare sharply with certain movements.
Diagnosis of Hip Osteoarthritis
Clinical diagnosis based on history and physical examination is often sufficient to diagnose hip osteoarthritis, particularly in patients over 45 with activity-related pain. X-rays or other imaging may be obtained when the diagnosis is uncertain, to exclude other conditions, or before considering invasive treatments.
1. Detailed Physical Examination
We assess:
Hip rotation
Flexion limitations
Strength deficits
Pain during specific motions
2. X-ray Imaging
X-rays can assist in the diagnosis of hip arthritis and show:
Loss of joint space
Bone spurs
Sclerosis
3. Ultrasound Evaluation
Helpful for identifying secondary issues like inflammation, joint effusion, or bursitis.
4. Diagnostic Injection
An anesthetic injection into the joint can confirm that the pain is originating from inside the hip.
Treatment Options for Hip Osteoarthritis
Managing hip osteoarthritis does not automatically mean giving up activity. In fact, the right plan helps patients stay active longer.
1. Exercise & Physical Therapy
One of the strongest evidence-based treatments.
Therapy focuses on:
Gluteal strength
Core stability
Hip mobility
Gait mechanics
2. Activity Modification
Options include:
Reducing repetitive impact
Adjusting running volume
Switching to low-impact cross-training
3. Medications
Short-term: NSAIDs or acetaminophen for flare-ups.
Long-term use is discouraged due to potential side effects.
4. Ultrasound-Guided Corticosteroid Injection
Provides fast inflammation control. Can relieve pain for weeks to months.
Useful for:
Acute flares
Diagnostic clarity
Enabling physical therapy
5. Ultrasound-Guided Hyalouronic acid injection
“Gel injection” i.e. Synvisc, Euflexxa, Gel-one, etc.
- Improves joint lubrication
- Reduces pain and stiffness
- May provide longer term relief than corticosteroid injection
6. Platelet-Rich Plasma (PRP) Therapy
PRP offers a biologic approach to reducing pain and supporting joint health. Benefits include:
Potentially longer-lasting relief than steroid or Hyalouronic Acid injection
Functional outcomes for mild to moderate OA
7. Weight Optimization & Lifestyle
Even modest weight loss reduces load on the hip.
8. When Surgery Is Considered
Total hip replacement is reserved for:
Severe “bone-on-bone” arthritis
Significant functional limitation
Pain unresponsive to non-surgical care
Hip Labral Tears: When the Hip’s Cushioning Ring Is Injured
The hip labrum is a ring of cartilage that lines the socket, helping seal the joint and provide stability.
How Labral Tears Occur
Femoroacetabular impingement (FAI)
Repetitive pivoting
Running
Trauma
Structural hip variations
Symptoms
Labral tear symptoms can be different from arthritis and often include:
Sharp groin pain
Pain with pivoting or twisting
Clicking, popping, or catching
Pain with prolonged sitting
Feeling of instability
While arthritis pain is often dull and stiff, labral pain is frequently sharp and mechanical.
Diagnosis of Labral Tears
Although hip pabral tears are found in many individuals with his pain, it may not always be the source of the hip pain. Labral tears without a paralabral cyst may not be responsible for hip pain. Labral tears can also occur in individuals without symptoms of a labral tear.
1. Physical Exam
We use specialized maneuvers to reproduce pain or catching.
2. X-rays
Primarily to assess for FAI or other structural abnormalities.
3. MRI Arthrogram
This remains the gold standard for seeing tears in the labrum.
4. Diagnostic Injection
If numbing the joint eliminates pain, it confirms the joint is the source.
Treatment of Labral Tears
Not all labral tears need surgery. Many respond to conservative care.
1. Physical Therapy
Therapy focuses on:
Strengthening the gluteus medius and minimus
Improving hip stability
Core stabilization
Reducing anterior pelvic tilt
Correcting movement patterns
Restoring hip and pelvic mobility
2. Activity Modification
Modified activity in positions that pinch the hip i.e. deep hip flexion, squatting, and pivoting.
3. Anti-Inflammatory Medications
Useful for short term symptom control during early phases.
4. Ultrasound-Guided Injections
Steroid or PRP injections reduce pain.
5. Hip Arthroscopic Surgery
Referral for evaluation for surgery may be recommended for:
Persistent symptoms
Mechanical catching
Instability
Large tears, especially with FAI
When to Seek Treatment
When to Seek Treatment for Groin Pain Thought to be from the Hip Joint
You should be evaluated if groin pain:
Lasts more than 2–3 weeks
Worsens with walking, pivoting, or twisting movements
Causes stiffness, clicking, or catching sensations
Limits your ability to exercise or participate in sports
Disrupts your sleep
Causes severe pain or sudden onset of intense discomfort
Because groin pain has many possible causes, a thorough evaluation is important to identify the specific source of your pain.
Treatment Options
The good news is that most people with groin pain improve with conservative (non-surgical) treatment. Conservative treatment success rates range from 40% to 100% depending on the specific cause. 44-70% of patients with hip-related groin pain improve with conservative treatment alone and avoid surgery. Some patients may eventually need surgical intervention if symptoms persist despite appropriate conservative care.
If you’re dealing with groin pain, we at CCSRM can help you find answers and real solutions.
References
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- Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Herring SA, Kibler WB, Putukian M, et al. Medicine and Science in Sports and Exercise. 2024;56(3):385-401. doi:10.1249/MSS.0000000000003324.
- Groin Pain Syndrome Known as Sports Hernia: A Review. Zuckerbraun BS, Cyr AR, Mauro CS. JAMA Surgery. 2020;155(4):340-348. doi:10.1001/jamasurg.2019.5863.
- Conservative Interventions for Treating Exercise-Related Musculotendinous, Ligamentous and Osseous Groin Pain. Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS. The Cochrane Database of Systematic Reviews. 2013;(6):CD009565. doi:10.1002/14651858.CD009565.pub2.
- Hip Pain in Adults: Evaluation and Differential Diagnosis. Chamberlain R. American Family Physician. 2021;103(2):81-89.
- Effectiveness of Nonoperative Management of Hip Microinstability. Ejnisman L, Elisman K, Safran MR. The American Journal of Sports Medicine. 2022;50(4):1013-1019. doi:10.1177/03635465221075349.
- Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra-Articular Hip Disorders. Hunt D, Prather H, Harris Hayes M, Clohisy JC. PM & R : The Journal of Injury, Function, and Rehabilitation. 2012;4(7):479-87. doi:10.1016/j.pmrj.2012.03.012.
