One of the most common problems we see in sport and musculoskeletal (MSK) injury is hip and groin pain. This can pose a challenge to even the most experienced clinician as there are various conditions that may cause either hip or groin pain.
I am going to highlight a few of these conditions and explain the approach that I used in gaining an accurate diagnosis for any patient.
Back or disc issues:
The first thing to note is that hip/groin pain can be due to a back issue when pain is referred from a joint or disc issue in the lower spine. Sometimes the pain may be felt further down the leg or associated with pins and needles or numbness in the leg. At times pain worse on coughing or sneezing may make the pain worse. The Doctor or Physio will be able to test for these problems with careful examination after taking a full history.
The hip joint is a “ball and socket” joint – it is a large stable joint that but can be injured or develop problems over time. In a more elderly population, osteoarthritis (OA) of the hip may develop, although we do sometimes see this in a younger age group (especially if there have been previous problems with the hip). OA may cause groin pain or a feeling of pain deep within the hip joint, it is often worse in impact and loading activities such as running.
Another condition of the hip joint that we may see in younger adults is Femoroacetabular impingement of the hip (FAI). This can happen when an extra bump of bone within the hip irritates the cartilage and may lead to a tear of the cartilage or eventually to OA. There may be a history of locking or catching in the hip joint.
Soft tissue & tendons:
Various problems with soft tissue or tendons may cause hip and groin pain. A common problem is overuse or strain of the psoas muscle and tendon (a hip flexor). This often causes pain to be felt more localised in the front of the hip. Pain may be found when pressing on the area and it can be painful when testing the hip against resistance. Other tendon problems may include adductor injury, more commonly known as a groin strain. Here they may be a history of acute injury turning or twisting in sport or other activity. Sometimes the pain develops gradually overtime.
A hernia may cause pain to be felt in the groin area and sometimes a bump or swelling can be noticed with a true hernia. This is usually quite obvious with increased swelling on standing or coughing. However sometimes it is more subtle and requires careful assessment.
Non specific groin pain:
In sport many people use the terms “ Gilmore`s groin” or “ Sportsman`s hernia” to describe a condition of non-specific groin pain that can occur especially when active in sport and loading the pelvis. Recently there has been a move away from these terms and a better name of “ Inguinal dysfunction” used. The inguinal canal runs along the groin and various issues may arise within this region.
Diagnosis & Treatment:
The above list is by no means exhaustive, there are a number of other conditions may present in addition to those problems.
Careful history and accurate examination by a medical professional is essential to help gain a diagnosis; in addition scans are also often useful. Ultrasound of the groin and hip is very useful and can assess for hernia and tendon issues. MRI scanning and plain X-rays can also be useful if needed.
Depending on the diagnosis; various treatments may be needed. These include: rehabilitation with a Physiotherapist or Osteopath, ultrasound guided injections, shockwave therapy and occasionally surgery.
We have a number of experienced Doctors and Physiotherapists that can assess hip and groin conditions. Careful detective work considering the above conditions is often needed to provide an accurate diagnosis for appropriate management.