Why Hip Problems Cause Groin Pain

A deep ache in the groin that will not settle is one of the most common reasons people come to MTP Health thinking they have pulled a muscle. Often the muscle is fine. This hip and groin pain is coming from the hip joint, which sits much closer to the groin than most people expect. Knowing why helps you get the right assessment sooner.

Key Takeaways

• The hip joint sits directly behind the groin crease, so joint irritation is felt in the groin and front of the thigh rather than on the side of the hip.
• Groin pain that builds with sitting, stairs, twisting or getting out of the car points more towards the joint than a muscle strain.
• Hip osteoarthritis is the most common joint cause after 50, while impingement and labral tears are more common in younger, active adults.
• Joint pain can travel down the inner thigh towards the knee because the same nerves supply both areas.
• At MTP Health the physiotherapy and exercise physiology team usually leads treatment, with Dr Donald Cawthorne assessing the joint when surgery may be part of the plan.

Where The Hip Joint Sits

When people point to their hip, they usually touch the bony point on the outside of the pelvis, over the hip bone. The joint is not there.

The hip is a ball and socket joint: the ball at the upper part of the thigh bone sits in the hip socket deep in the front of the pelvis, near the pubic bone and lower abdomen, roughly behind the crease where your leg meets your body, under several layers of muscle. Pain from inside this ball and socket therefore shows up where the joint actually is, which is the groin.

How Joint Pain Reaches The Groin

The lining and capsule of the hip joint are supplied mainly by the obturator and femoral nerves. These nerves also carry sensation from the groin, the groin muscles and the front and inner thigh, up into the upper thigh. When the joint is irritated, the brain cannot tell which part of that territory is the source, so you feel pain in the groin and thigh. This is referred pain, and it is normal for deep joints.

People with hip joint pain often describe it with a cupped hand wrapped from the groin around to the side of the hip. Clinicians call this the C sign, and it is a useful clue that the joint is involved. Some people notice a dull ache in the thigh or knee instead, which is one reason hip conditions are sometimes missed before an assessment at an orthopaedic and physiotherapy clinic on Sydney’s North Shore.

Joint Pain Or Groin Strain

A true groin strain usually has a clear start, often a sprint, kick or sudden change of direction. It is sore when you squeeze your knees together or stretch the inner thigh, and it improves over a few weeks with the right loading. But not all groin pain is muscular.

Hip joint pain behaves differently. It often creeps in without an obvious injury and is aggravated by positions that compress or rotate the joint: long periods of sitting, deep squatting, pivoting, climbing stairs and swinging the leg out of the car.

Reduced movement and difficulty when you move your hip are common. Turning the knee inwards while the hip is bent is often the most provocative movement, and it is one of the tests the MTP Health team uses to separate joint pain from a muscle problem, alongside the rest of the examination findings.

Hip Conditions That Cause Groin Pain

Hip osteoarthritis, or hip arthritis, is the most common joint cause of groin pain in people over 50. As the cartilage thins, the joint becomes stiff and sore, particularly on rotation. Early osteoarthritis often responds well to guided strength work and activity adjustments, and many people manage for years without surgery.

Femoroacetabular impingement, or impingement FAI, is more common in active people in their twenties to forties. Femoroacetabular impingement occurs when extra bone on the ball or the rim of the socket causes abnormal contact and pinches the joint lining in deep bending and rotation, producing groin pain with squats, cycling or sitting low.

A labral tear affects the ring of cartilage, sometimes called the labrum, that seals the socket. It can occur with impingement, a shallow socket or a twisting injury, and typically causes sharp groin pain with catching or clicking. Hip dysplasia, a developmental dysplasia where the socket is shallower than usual, can sit behind both labral tears and early arthritis, particularly in younger women.

Not every ache on the outside of the hip is the joint. Hip bursitis, irritation of the fluid filled sacs that cushion the tendons, sits on the side rather than the groin. Rarely, groin pain over the pubic bone comes from bone itself: a hip stress fracture or, in an older or higher risk person, avascular necrosis, where reduced blood flow means bone tissue in the ball begins to die.

Avascular necrosis affects the femoral head and, in severe cases, needs earlier input. Sudden, severe groin pain that stops you weight bearing can signal a true fracture and is a medical emergency, unlike the gradual pattern of most joint pain, so hip fractures need same-day care.

What An Assessment Involves

Assessment starts with your story: where the pain sits, what sets it off and how it has changed. The examination compares the two hips for range of movement, particularly rotation, and uses specific positions to load the joint, the adductors, the surrounding muscles and other muscles such as the hip flexors separately.

If the picture suggests a joint problem, an X-ray or MRI may be arranged to look at the cartilage, labrum and bone shape, and to rule out a stress fracture or other structures as the underlying cause. Dr Donald Cawthorne reads these findings alongside the examination, because scans on their own do not decide treatment. Many people with changes on imaging have little pain.

Treatment Paths At MTP Health

For most people, treatment begins with the MTP Health physiotherapy and exercise physiology team. A structured physical therapy program builds strength around the hip, restores rotation where it is safe to do so, and adjusts the activities that flare the joint.

Simple measures help alongside it: anti inflammatory medication used short term to reduce pain and reduce inflammation, and weight loss where it lowers the load through the joint. This approach to treating hip pain can settle groin pain from early osteoarthritis, impingement and many labral tears, and it prepares the hip if surgery is needed later.

Where pain continues to limit your life despite a good rehabilitation effort, Dr Cawthorne can discuss hip surgery and further treatment options with you. For younger adults with impingement or a labral tear, hip arthroscopy, a minimally invasive procedure, or another hip preservation procedure may help protect the joint. This arthroscopic surgery works through small incisions. For established osteoarthritis, hip replacement surgery can relieve groin pain and restore movement.

Both carry risks, including infection, blood clots and ongoing symptoms, and both are followed by rehabilitation with the same team that started your care. Surgery is one step in a longer journey, not the whole answer.

When Groin Pain Needs Prompt Review

Most hip related groin pain can be assessed in a routine appointment. Arrange review sooner if groin pain arrives suddenly without an injury, wakes you at night, stops you putting weight through the leg, makes the leg feel weak, or comes with fever or feeling generally unwell. These features can point to less common causes of hip pain, including a condition called avascular necrosis or a stress fracture, and are better checked early.

Frequently Asked Questions (FAQs)

Can a hip joint problem cause pain only in the groin?

Yes. Because the joint sits behind the groin crease and shares its nerve supply with the front of the thigh, the groin is often the only place hip joint pain is felt.

How do I tell hip joint pain from a groin strain?

A strain usually follows a specific movement and is sore when you squeeze your legs together or stretch the inner thigh. Joint pain builds gradually and is worse with sitting, squatting, stairs and turning the leg inwards.

Why does my groin hurt when I sit or get out of the car?

Sitting holds the hip in a bent position that raises pressure inside the joint, and swinging the leg out of a car adds rotation. Both positions squeeze an irritated joint lining or labrum, which is why these movements are such reliable triggers for joint related groin pain.

Does groin pain mean I need a hip replacement?

No. Many people with hip related groin pain improve with a guided strength and movement program and do not need surgery. Hip replacement is considered when osteoarthritis is advanced and pain continues to limit daily life despite a genuine rehabilitation effort.

Can hip joint groin pain travel to the thigh or knee?

It can. The obturator nerve supplies both the hip joint and the inner thigh, so hip conditions can be felt as thigh or knee pain. If your knee scan is clear and the pain has not settled, it is worth having the hip examined.

Conclusion

Groin pain that does not behave like a muscle strain is often the hip joint asking for attention. A careful assessment can separate joint pain from muscle pain, identify the likely cause and set out a plan that starts with rehabilitation and includes Dr Donald Cawthorne when surgery may help. If groin pain is limiting the way you move, book an assessment with MTP Health on (02) 9437 9794.