Persistent groin pain is one of the most commonly misdiagnosed complaints in active adults. It is frequently attributed to a muscle strain, a hernia or a generic soft tissue injury, and patients often spend months in physiotherapy treating the wrong structure before the real source of the problem is identified. In many cases, the source is inside the hip joint itself.
Why groin pain is difficult to diagnose
The groin is a complex anatomical region with multiple potential pain sources in close proximity. Structures that can refer pain to the groin include the hip joint, the adductor muscles, the pubic symphysis, the inguinal region, the lumbar spine and the abdominal wall. Without a systematic assessment that considers all of these, it is easy to treat the wrong source.
The hip joint, in particular, is a common and frequently overlooked cause of groin pain. Because the hip sits deep within the pelvis and its pain referral patterns overlap with muscular and abdominal sources, hip pathology can be missed for months or even years in active patients who continue to train through their symptoms.
Hip conditions that cause groin pain
Several hip conditions commonly present as groin pain in active adults and adolescents.
Femoroacetabular impingement (FAI) is one of the most common. When the bones of the hip make abnormal contact during movement, the result is often a deep ache or sharp pain felt in the groin, particularly with sitting, squatting, kicking or deep hip flexion. Many patients with FAI initially present to physiotherapy or sports medicine with a groin or adductor complaint.
Hip dysplasia, in which the socket does not fully cover the femoral head, causes abnormal loading at the rim of the socket that frequently presents as groin pain in adolescents and young adults. It is particularly common in active females and is often not identified until a specialist hip assessment is performed.
Labral tears produce a characteristic deep groin pain, often with a catching or clicking sensation, that is worse with prolonged sitting and activities involving hip flexion. Labral tears can occur from impingement, dysplasia or trauma, and rarely resolve fully without treatment of the underlying cause.
Osteitis pubis causes pain at the front of the pelvis and in the inner groin, and is common in kicking sports. It frequently occurs alongside hip impingement, and treating only the pubic joint without assessing the hip often produces temporary rather than lasting relief.
When to seek a specialist assessment
Groin pain that has persisted for more than six to eight weeks despite physiotherapy, that is consistently reproduced by specific hip movements such as flexion and internal rotation, or that is associated with a clicking or catching sensation in the hip, warrants a specialist orthopaedic assessment. A thorough clinical examination combined with the right imaging can identify the source of pain accurately and direct treatment appropriately.
The earlier the underlying cause is identified, the better the outcome. Conditions such as FAI and dysplasia cause progressive cartilage damage over time, and treatment is most effective before that damage becomes irreversible.
What assessment involves
Mr Balakumar assesses groin pain with a detailed history, a clinical examination of the hip, pelvis and surrounding structures, and a specific set of standardised X-ray views. MRI is often ordered to assess the labrum, cartilage and soft tissues. In selected patients, a cortisone injection into the hip joint under ultrasound guidance is both therapeutic and diagnostic. If the injection significantly reduces the pain, it confirms the hip joint as the primary source.
Treatment depends on the specific diagnosis and may range from a structured physiotherapy programme and load modification through to hip arthroscopy or, in cases of significant structural abnormality, a joint preservation procedure such as periacetabular osteotomy.
