Hip, thigh, and groin pain

What causes it, and how to get rid of it

Hip pain is one of the most common reasons to see an osteopath.  Our expert osteopaths in Bath have over 30 years of experience in helping people with hip pain get back to leading a pain-free active life.  If you have hip or groin pain then the information below may help you understand what may be the cause and how we can help you get rid of it.

What is causing my hip pain?

The hip and its surrounding muscles are the heavy load bearers of our lives, every time we get up, move and sit back down again they are taking the weight of the body and transferring it to a new position.  When we walk or run, they must cope with the full weight of our bodies while we are balanced on one leg. The hip joint and its surrounding muscles are working their hardest and have the most demands placed on it when we load them in this way (1). It is no surprise then that the hip is subject to a range of problems, most of which are specific to our age (2).  Muscle tears and hernias tend to be in the younger more sporty age groups, hip joint degeneration, such as seen in in osteoarthritis of the hip is mainly seen in people aged fifty or over (3).

The first task in attempting to get rid of pain in the hip is to first work out if the pain is indeed coming from the hip joint or its surrounding muscles.  There are several other parts of the body that can refer pain to the hip, most commonly the low back and the large sacroiliac joints at the base of the spine, but digestive and urinary problems can also produce pain in the hips (3).   A simple test is that if you have to limp due to pain and there is pain in your hip when you stand on one leg then you may have a problem with your hip.  If there is tingling or numbness around the hip and thigh the problem is more likely to be related to your back (3).  In this article we identify the most common causes of hip and thigh pain and the best ways to get rid of them.

Gluteus Medius Strains, Chronic Tendon Problems, and Trochanteric Bursitis – So much in a small space!

The gluteus medius is an extremely strong muscle that lies beneath the gluteus maximus (which gives you the shape of your buttocks), its main function is to provide stability to the body when standing on one leg (1), if it does not function properly then walking and especially running are problematic at best.  Because of its important function, it can be vulnerable to injury.  Due to its location, an injury to the gluteus medius will be felt on the outside of the thigh and possibly down to the outside of the knee and lower leg (4).  In a younger population, it can be due to overuse (increasing exercise too quickly) or trauma (stepping off a high step).  These types of injuries tend to respond well to rest and stretching (5).

A more long-term problem may develop over time by tiny but repeated tears to the tendon of the hip abductors (including the gluteus medius) causing damage to the tendon with a failure in the healing mechanism, this is called a tendinosis (3).   The repeated damage may cause inflammation in the muscles and tendons of the hip and also result in inflammation of a structure called the trochanteric bursa (6).  A bursa is a small fat pad that ensures smooth sliding of muscles over each other to reduce friction, however, due to the nature of its job it exists in a very tightly packed space, which means it can easily be affected by changes in the surrounding structures (5).  The gluteal tendinosis and the trochanteric bursitis were previously seen as two separate conditions but after investigation they are now considered two stages of the same condition (7) and renamed ‘greater trochanteric pain syndrome’ (GTPS).

GTPS is the most common painful problem seen in the hip (3) and is seen more commonly in women, aged 40-60 who may also have osteoarthritis of the knee.  It is also very common in long-distance runners (8).  It is usually described as being a deep ache around the outside of the thigh and bottom of the buttocks, it may be felt lower down towards the outside of the knee but rarely below the knee.  It can be aggravated by lying on the affected side, crossing the legs, standing for long periods, and climbing stairs (9).

If you are unlucky enough to suffer from GTPS the best thing to do in the short term is to rest and avoid the things that make the pain worse (10).   The next thing to do is to get a diagnosis from a professional such as an osteopath so the correct treatment plan can be decided upon.  The most effective way to eliminate the pain from GTPS is to engage in a progressive strength program to improve the power of the muscles around the hip and core (10). At Align Body Clinic we have helped scores of people get rid of their GTPS pain and get back to living a normal life.

Hip Joint Osteoarthritis

Another very common problem that occurs in the hips is osteoarthritis.  The surface of the hip joint is covered by smooth hyaline cartilage, as the hip joint is a weight-bearing joint eventually the cartilage becomes thin and the bone below is exposed causing friction, inflammation, and pain. Due to the problem being one of degeneration, it tends to occur in people aged over 50. The risks can be increased by faulty loading of the hip joint due to poor biomechanics (possibly the influence of surrounding joints), obesity, and previous injuries such as fractures to the pelvis or leg bones (5).  80% of all hip osteoarthritis is secondary to such factors (3).

The pain that hip joints produce tends to be felt in the groin and is worse with movement and better with rest.  It may also feel stiff to start moving and then get better as you move.  An accurate diagnosis is made with a combination of physical examination of the hip, then more definitively by an x-ray (3).

Due to the degenerative nature of the condition a cure is very unlikely, however, several options exist that can eliminate the symptoms and keep the hip functioning well (5).  Conservative treatment based around stretching and massage of the hip and its surrounding muscles is effective alongside advice on appropriate exercise, nutrition and weight loss if necessary (11). If you have a hip with some osteoarthritis and you are diligent in following exercise and lifestyle advice, you can still be active with minimal pain for many years.  If these measures are not effective or the pain is very severe then steroid injections and surgery are recommended (5).  Most people with osteoarthritis of the hip continue to be active if they receive treatment and care from an early stage.  Hip osteoarthritis is one of the most common conditions our expert osteopaths see and we have helped many people with it lead full and active lives.

Iliopsoas Syndrome

The iliopsoas is a very strong muscle that lies deep in the front of the hip, traveling from the vertebrae in your lower back, through the pelvis and attaching to the thigh bone.  Its main role is to flex the hip (12).  Below the iliopsoas tendon, as it crosses the pubic bone lies a bursa, which if irritated can, alongside the tendon become inflamed (13).  The pain from this condition is again felt deep in the front of the groin.  However, unlike osteoarthritis it is much more likely to be experienced in a younger population who are involved in sports such as martial arts, long-distance running, dancing, and gymnastics (5). One difference is that the pain may be felt up into the low back, and a ‘snapping’ sound may be felt while you are walking (10).

Conservative management such as osteopathic treatment can help resolve the problem.  Stretching of the iliopsoas and other muscles of the hip, coupled with mobilisation of the low back and effective exercise and activity advice should relieve the symptoms in under 8 weeks (13, 5).

Hernia (Sports)

A less common reason for pain in the groin is a ‘sports hernias’.  This is where there is a complex tear in the muscular elements of the hip and abdomen that produce a raising of the hip and inward motion.  Because it is usually traumatic it is more commonly seen in a younger age group who are involved in sports that involve repetitive bending backward with twisting at the same time, such as football, hockey, or martial arts.  It is most commonly experienced as a rapid onset of disabling lower back pain with some lower abdomen and groin pain, the pain is mainly aggravated by trying to do a sit-up or trying to twist the trunk while lying down (3).  Rehabilitation options are dependent on the severity of the tear to the muscles.  Usually rest and stopping any activity that may aggravate is the first port of call.  Conservative treatment involving core muscle and hip strengthening should be tried before any surgical option is attempted (2).  If surgery is indicated the good news is that it tends to have a very high success rate (95%) (3).

Meralgia Parathsetica

This is a less common condition that produces tingling, numbness, and pain on the front and outside of the thigh.  The pain is generated due to compression of the lateral femoral cutaneous nerve.  Usually, this is due to mechanical stress on the nerve due to the changes seen in pregnancy, or with obesity, it can also be seen in people who wear heavy work belts such as policemen and builders (3).  Treatment is mainly focused around the correction of the mechanical factors by manual therapy, combined with rest.  If the symptoms persist then surgery can be performed to decompress the nerve.  (2).

Keeping Your Hips in Good Shape

As we have seen in the examples above, many hip complaints can arise from improper mechanics such as a lack of mobility or a lack of strength.  The hip, pelvis, and low back are very closely linked in terms of how they share the load of movement, a change or restriction in one area can have a profound impact on the others (1).  In many instances, hip complaints can be addressed by restoring normal movement to the lower back, pelvis, and hip musculature either through manual treatment from an osteopath or through prescriptive exercise (3).

 

Do you want to know what is causing your pain and if we can help?  Why not take advantage of our new patient assessment introductory offer to get you started towards a tailor made recovery plan for only £19.

Are you in a lot of pain and want to get better as soon as possible?  If so then why not book in for a new patient consultation, with treatment on the day, for £72.

 

 

References

1 – Levangie, P. and Norkin, C. (2005) Joint Structure and Function: A Comprehensive Analysis (4th ed). F. A. Davis, Philadelphia.

2 – Souza, T. (2009).  Differential Diagnosis and Management for the Chiropractor.  4th ed, Jones and Bartlett, Sudbury.

3 – Magee, D. Zachazewski, J. and Quillen, W., 2009. Pathology and Intervention in Musculoskeletal Rehabilitation, Missouri, Elselvier.

4 – Carnes, M, & Vizniak, N. (2011). Conditions Manual. Professional Health Systems, Canada.

5 – Brukner, P. and Khan, K. (2007).  Clinical Sports Medicine (3rd Ed).  McGraw Hill, Sydney.

6 – Ho GWK, Howard TM (2012). Greater trochanteric pain syndrome : more than bursitis and iliotibial tract friction. Current sports medicine reports, 11(5), pp.232-235.

7 – Klauser AS, Martinoli C, Tagliafico A, et al (2013). Greater trochanteric pain syndrome. Seminars in Musculoskeletal Radiology, 17(1), pp.43-48.

8 – Neil A et al (2007). Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical medicine and rehabilitation, 88(8), pp.988-992.

9 – Strauss EJ, Nho SJ, Kelly BT (2010). Greater trochanteric pain syndrome. Sports Medicine Arthroscopy, 18(3), pp.112-119.

10 – Wyss J, Patel A (2012).Therapeutic Programs for Musculoskeletal Disorder: Demos Medical Publishing.

11 – Peter WF,et al; Guideline Steering Committee – Hip and Knee Osteoarthritis. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port. 2011 Jul-Sep;36(3):268-81.

12 – Snell, R. S. (2003).  Snell Clinical Anatomy, 7th Ed.  Lippincott, Williams and Wilkins.  Baltimore.

13 – Johnston, C.A.M., Wiley, J.P., Lindsay D.M., & Wisemand D.A. (1998, April). Iliopsoas bursitis and tendinitis: A review. Sports Med, 25(4), 271-283 (Level of evidence: 1A)

NEW PATIENT CONSULTATION

Book an assessment, diagnosis and first treatment for £72 by using our easy online booking system or by calling 01225 571084.

NEW PATIENT ASSESSMENT

Book your first 45 min assessment & treatment plan for only £19 by using our easy online booking system or by calling 01225 571084.

“Jay has enabled me to get back to cycling and running pain free.  I didn’t think it could happen and it has, I am so grateful!” Heidi R, Bath

WANT TO GET STARTED WITH YOUR RECOVERY?

Call us on 01225 571084 or book your appointment online. Don't forget we offer a new patient initial assessment for just £19 so you can get to know us with no obligation or risk. However if you are in severe pain and want to start treatment sooner, our new patient consultation at £68 will include your first treatment.

Feedback from our Patients

“I have been suffering from muscle aches and spasms for about two years now. I was diagnosed with an underactive thyroid last year and it appears the two problems are related. It has basically been constant pain during that period and I have seen roughly 20-25 specialists from doctors to masseuses. Jay actually understands the issue and has an effective approach to helping to relieve some of the trigger points. His work has moved the pain from a 9 down to a 2 or 3. It has been outstanding and I highly recommend him to anyone with similar problems.”

Caroline Lucas from Bath

“On retirement, I treated myself to Body Alignment sessions to clear some long-standing problems I had with my body – from accidents, work, age etc. I could not be more pleased with the results of Jay’s efforts. I have climbed mountains, taken up sailing and can say I feel better in my body since retirement than for many years before. Many thanks for the exercises, my knee is no longer troublesome. When I reach the top of a hill with no difficulty, I try to remember to thank my lucky stars I made the investment in my future and booked that first appointment. Thank you.”

Anonymous

“Have found the treatment really helped. After a couple of sessions, I had no lower back pain. Jay has a very kind and calm manner and I feel is very good at making you feel at ease.”

Becky Clay from Bath

“I started seeing Jay after I was told to give up on my dream of competing in an IM70.3 this summer. Not only did he make sure I made it to the finish line – but that I crossed it smiling and in a surprisingly impressive time for my age group. My only complaint? I’m totally addicted to tri and already planning next season’s insanity!”

Georgie from Bath

“Yes, I’ve been suffering from a “bad back” for years. Jay has been fantastic in terms of diagnosing my problem, providing a regime to keep my back “under control”, and when the inevitable happens due to my chronic condition he has been amazing in terms of getting me back on my feet again.”

Chris Dance from Bath

“I have had arthritis in my knees for some time, after treatment with Jay over several weeks I am now walking pain-free without a stick at a normal pace, not bad for a 72-year-old. I cannot recommend Jay too highly.”

A B from Bathford

“Jay put me back on my feet after a back injury that had worsened over eighteen months of other treatment. I couldn’t walk, sit or even lie down comfortably, Structural Integration (Rolf Method) was my last hope. Jay’s successful treatment outcome for this hypermobile, fibromyalgic, very unfit older woman was a miraculous feat. Thank you, Jay!”

HB Malvern from Bath

“I was starting to suffer from lower back pain and wanted to get on top of it before it prevented me from working. Seeing Jay was the perfect option – he was knowledgable, thorough and great value for money. The exercises to do at home were easy to understand and have cleared my back pain up a treat. I would definitely recommend going to see him.”

Charlotte Bloom from Bath

“Before seeing Jay I was having “regular” back problems, however, his excellent diagnosis and effective treatment has helped me tremendously”

Chris Dance from Bath

“Jay was recommended to me. Immediate improvement in back pain and mobility after the first treatment. Even better after the second treatment. Good to have a programme to follow at home between appointments.”

Ann Kronenberg from Salisbury

“I had been having treatment on my shoulder by a different commercial practice previously and it had left me in more pain than when I started, probably because of their ‘one size fits all’ solution-based approach. As such, I was a bit nervous going somewhere else and having more treatment, but after a friend highly recommended Jay I went for a consultation. I was put completely at ease and after the first session, it was evident I had made the right choice. Jay asked lots of questions, talked through the problem and what he would do and why. It was clear that he knew what he was doing! I then had maybe 10 or so sessions and given ‘homework’ exercise to do between sessions and my shoulder is back to normal again now. A massive thank you! :)”

Emma Towse from Bristol

“Having been told 10 years ago by shoulder “experts” that nothing could be done to relieve the constant pain I almost gave up on it…one diagnosis and a few treatment sessions with Jay and the pain I’d live with for so long was gone.

Outstanding service, great people and really flexible to my silly work hours, I’ve already recommended ABC to lots of people and intend to refer many more”

George Lewis from Bath

“My son was having an ongoing problem with his shoulder that physio alone did not solve. Jay worked on it over a number of weeks and he is now back to full strength playing rugby.”

Anonymous

“I have seen various Osteopaths over the last few years, with little success. Since being referred to Jay by my PT, my long-standing back condition has dramatically improved and now allows me to enjoy a virtually pain-free existence and a far superior quality of life than before.”

Alan Smith from Bath

“I’ve had back pain on and off for a while, as a professional athlete, it was putting a lot of strain on my career. I got in contact with Jay after a few failed visits at the physio. I’m now back on the road to full-time training thanks to Jay!”

Jessica Lloyd from Bath

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Molly Keel from Bath

“Over 15 years Jay has sorted out a variety of sports injuries and the aftermath of broken bones! I doubt if I would still be caving, running and mountain walking at age 64 if it wasn’t for Jay’s amazing care. Totally brilliant!”

David Lossi from High Littleton

“I was having problems with a rugby injury and struggled to get much movement in my lower back. Jay was able to diagnose potential causes and increase my movement range. the improvement after the first session was huge and in each session since it has continued to improve.”

Laura Mahoney from Bath

“Jay has enabled me to get back to cycling and running pain free. I didn’t think it could happen and it has, I’m so grateful! The treatments and exercises Jay has given mean that I’m now able to maintain my back and knee health with a treatment every few months.”

Heidi Rearden from Bath

“Fantastic, deep, subtle, effective treatment, Jay always gets straight to the relevant areas. Have had sessions many years ago as well as recently, and am delighted how long the benefits lasted. Highly recommend.”

Sophie Carrdus from Bradford on Avon

“100 % difference I can go through a day with no pain and I can play sport again, Jay is a man with magic hands!”

Gavin Savage from Southwick

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Johnny Grace from Bath

“I was suffering from pain in my neck, but after a couple of sessions with Jay the pain has gone, I wished I had gone months before when it first started instead of suffering.”

Lin Levan from Bristol

“Jay is a results-oriented Osteopath who I highly recommend. Whether using his skills for myself or my clients, I can be sure Jay will deliver a significant improvement or complete resolution of an issue or multiple issues. Few Osteopaths in the south-west can deliver, Jay Ruddock does.”

M C from Bath

“The treatment was extremely helpful, Jay gave me exercises that I was able to work on at home and are simple to continue with regularly.”

Elizabeth Passingham from Bath

“Better than I ever thought it could be! Such great progress over a short period of time and I couldn’t be happier with all the work Jay has done to improve my long term…”

Matthew Warman from Bath

“Having suffered acute back pain for over six months and having had treatment previously, Align Body Clinic was suggested to me. Since going to see them and having had approximately 6 treatments, supplemented by an advised stretching regime, I feel almost back to normal. The treatment and consultation advice has provided me with the knowledge that will help me move forward and avoid a reoccurrence. I would have no trouble in recommending Align Body Clinic and would like to thank Jay for getting me back onto the road to recovery – and the badminton court!”

Jonathan Mardon from Bath

“Within just a few treatments my levels of neck and upper back pain greatly dissipated allowing me to sleep and function normally again. Jay Ruddock is highly professional and personable with it. I cannot endorse his skills more highly.”

Peter Higgins from Bath

“After hurting my hip during a hike two years ago, Jay’s significantly reduced the pain and I feel I now have a chance of getting back to normal and walking pain-free for the first time in ages – thanks Jay, I’m definitely glad I came along to the Clinic!”

Sophie J from Bath

NOT SURE WHAT TO EXPECT ON YOUR FIRST VISIT?

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Other Treatments Available at our Clinic

At Align we offer a range of treatments to meet your needs. Find out more below.

Tailored soft tissue massage and stretching techniques to treat the stress, tension and fatigue from occupational, recreational or sporting activity.

A series of treatments to improve the body's relationship with gravity by direct manipulation of collagen fibre or 'fascia'.

A modern, researched based approach based on ancient techniques to provide pain relief either in isolation or alongside osteopathy treatment.

A low cost, no risk assessment with one of our experienced osteopaths. Ideal for those who are not sure or looking for a second opinion.

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