Hip and groin pain

Pain on the outside of the hip – lateral hip pain

There are two quite common causes of pain on the outside of the hip, where you may feel it lying on your side (we call this the trochanter). They are Gluteus Medius Tendinopathy and Trochanteric Bursitis.

Trochanteric  Bursitis

This is inflammation of the fluid-filled sac that lies between the prominent bony lump (the greater trochanter) and the overlying muscles. It usually occurs either in sportspeople or in active people later in life as the body’s ability to repair slows down.  

It causes pain on the outside of the hip which can spread down the outside of the thigh. The area is often tender to touch and terrible to lie on at night. It is made worse by running sports, stair climbing and crossing the legs. When it is bad even a long walk can be hard.

I can usually get the diagnosis from listening to you and carrying out a gentle examination.  An ultrasound scan or MRI may be useful to confirm things, and to rule out other problems.

Treatment is physiotherapy, and if it is being stubborn then a steroid injection can help. Very rarely a little operation is needed.

I have suffered from this condition when marathon running and successfully treated it with activity modification, changes to footwear and some very specific exercises.

Gluteus medius tendinopathy / tendonitis

This is inflammation and tearing of one of the tendons of the big buttock muscles (gluteus medius) where it joins onto the thighbone. It is one of the most common causes of pain on the outside of the hip, particularly in sportspeople, but also in elderly people where the body’s capacity for repair slows down. I see this a lot in runners and cyclists and have had it a bit myself. Typically, pain builds up and up through a session, or throughout the day, and it’s often at its best in the mornings. 

The diagnosis is often obvious following an examination and listening to your story but sometimes we would get an MRI scan or ultrasound to confirm it. 

Fortunately, there are really good treatment options in the form of physiotherapy, shockwave therapy and rarely injection therapy. Surgery is not required for this condition. For runners, a fatigued gait analysis can be really interesting (basically a slow-motion video of how you run when you are really tired!).

Groin Pain – pain at the front of the hip

There are a few common causes of pain at the front of the hip (we call this groin pain). These include Labral tears, sports hernias, and stress fractures, as well as the beginnings of hip arthritis.

Torn hip cartilage – acetabular labral tear

The ball and socket joint of the hip has a cartilage rim around the socket to make it deeper, we call this the labrum. This can get torn and can be a potent cause of groin pain. It is more common after an injury in young adults who do sport. There is often pain with twisting and sometimes some clicking and catching sensations felt within the front of the hip. It can be a stinging pain. The pain never really settles, but it worse with twisting.

I can usually make the diagnosis by listening to your story, then I will carefully examine you and probably arrange a special sort of MRI scan. I have this myself, but I am trying to ignore it!

If you do have a torn hip cartilage it can be treated with keyhole hip surgery to either stitch it back together or trim away the dead pieces. This is not an operation I do myself, so if this does turn out to be the diagnosis, I will refer you on to the right person. 

Sports hernias / groin strain (Gilmore’s groin)

Hernias in the groin are usually due to muscle tears in the region. They are common in kicking sports and can be really problematic. There is often an injury that starts things off. There may be a deep-seated ache in the groin worse with kicking, striding and straining.  

Unlike the sort of hernias that are common in older men, there is usually not a lump or bulge, but there may be pain coughing. Some people get a bit embarrassed about having this looked at, but don’t worry – you are in good company and a lot of professional footballers get this.

By carefully listening to your problems and examining the area I can usually make the diagnosis, and an ultrasound scan will usually confirm this. Hernia type problems tend to be dealt with by general surgeons so if this is what is causing your groin pain then I’ll refer you on to one of my colleagues who is excellent at dealing with this problem. 

Stress fractures of the hip

Stress fractures can occur in the hip (the femoral neck) or the pelvis (in the pubic rami) and are more common in endurance runners. They usually start with pain after sport, then often with pain at night, eventually there can be pain with sport. It’s quite typical that whilst you are running the pain does not trouble you too much in the beginning, this is probably the endorphins masking it.

The bones around the hip are incredibly strong, but they can still fracture from the repetitive impact of running. I tend to see stress fractures when people are increasing their weekly amount of sport rapidly and the body can’t strengthen up quickly enough to compensate. I see a few of these every marathon season and I see them in military recruits as well as ordinary day to day people.  

Sometimes the problem can have been brought on because of training errors, and sometimes there can be factors in the shape of your body (biomechanics) that make some people more likely to have stress fractures than others. Weight can also be an issue as can bone health, diet, hormones and sleep.

Femoral neck stress fractures can be really serious and there are plenty of videos on the internet of people’s legs literally breaking during marathons when they have ignored the pain and tried to carry on. This is an important reason why you should take groin pain associated with sports seriously. If we can pick up a stress fracture before it completely snaps then the treatment is fairly straight forward, but once it has snapped major surgery may be the only option. 

By carefully listening to your story about your pain and your sport I can usually tell whether this is a possibility. A gentle clinical examination helps narrow down the options and probably the best test to look for stress fractures and stress reactions is an MRI scan. Importantly, a normal x-ray does not completely rule out an impending stress fracture.