When Groin Pain Is Actually a Hip Problem
Published by Dr Oliver Khoo at Sunday, July 12, 2026
Groin pain is often blamed on a muscle strain, sports injury, or overuse. While these are common causes, persistent groin pain can sometimes be a sign that the real problem lies within the hip joint itself. Because the hip sits deep within the pelvis, pain from the joint is frequently felt in the groin rather than over the outside of the hip. This can make diagnosis challenging and may delay appropriate treatment.
Understanding when groin pain is actually a hip problem can help you seek the right assessment sooner, reduce unnecessary investigations, and begin effective treatment before symptoms worsen.
The hip is a ball-and-socket joint located deep within the pelvis. Many of the nerves supplying the hip also supply the groin, causing pain to be "referred" to the front of the hip or inner thigh rather than directly over the joint itself.
This means someone with a hip condition may never experience what they consider "hip pain". Instead, they may notice:
This referral pattern is one of the reasons hip conditions are commonly mistaken for groin strains, hernias or even lower back problems.
Several hip disorders commonly cause groin pain.
Hip osteoarthritis is one of the most common causes of groin pain in adults over 50.
Typical symptoms include:
Pain usually develops gradually and worsens over months or years.
FAI occurs when the bones of the hip do not fit together perfectly, causing abnormal contact during movement.
People often experience:
FAI commonly affects younger and active adults.
The labrum is a ring of cartilage around the hip socket that helps stabilise the joint.
A torn labrum may cause:
Labral tears are often associated with FAI.
Hip dysplasia occurs when the hip socket does not fully cover the femoral head.
Symptoms may include:
Athletes, runners and individuals with reduced bone density can develop stress fractures of the femoral neck.
Warning signs include:
Stress fractures require prompt assessment to avoid serious complications.
Although every patient is different, several features increase the likelihood that the hip joint is responsible for groin pain.
These include:
Pain that extends towards the thigh or knee can also originate from the hip, even when the knee itself is completely normal.
Not all groin pain originates from the hip. Other possible causes include:
Because the causes overlap significantly, a thorough clinical assessment is essential.
A detailed history and physical examination remain the foundation of diagnosis.
Some commonly used clinical tests include:
The Flexion, ADduction and Internal Rotation (FADIR) test places the hip into a position that commonly reproduces pain from:
Pain during this manoeuvre increases suspicion of intra-articular hip pathology, although it is not diagnostic on its own.
The Flexion, ABduction and External Rotation (FABER) test helps assess:
Pain in the groin during the test often suggests hip involvement.
Loss of internal rotation is one of the earliest signs of many hip disorders, particularly osteoarthritis and FAI.
Doctors compare movement between both hips while assessing pain and stiffness.
Rolling the leg gently inwards and outwards while the patient lies relaxed may reproduce pain originating from the hip joint.
Observing how someone walks can reveal:
No single clinical test confirms a diagnosis. Instead, clinicians interpret the findings alongside the patient's history and imaging results.
Imaging helps confirm the diagnosis and identify the underlying cause.
Weight-bearing pelvic and hip X-rays are usually the first imaging study.
They can reveal:
X-rays remain an important first-line investigation for many hip conditions.
MRI provides detailed images of soft tissues.
It is particularly useful for detecting:
MRI is often recommended when X-rays appear normal but symptoms persist.
CT scans provide excellent detail of bone anatomy.
They may be used for:
Ultrasound is useful for evaluating:
However, ultrasound has limited ability to assess structures deep inside the hip joint.
Occasional muscle soreness after exercise usually improves with rest.
However, you should arrange an assessment if you experience:
Urgent assessment is recommended if groin pain follows a fall or is associated with an inability to bear weight, severe pain or fever.
Successful treatment starts with identifying the correct source of pain.
Management may include:
Early diagnosis often provides more treatment options and may help prevent progressive joint damage.
Many people spend months treating what they believe is a groin strain when the underlying issue is actually inside the hip joint.
Persistent groin pain should never be ignored, particularly when it affects walking, sitting, sport or everyday activities. A careful history, physical examination and appropriate imaging usually identify the true source of pain and guide the most effective treatment plan.
Yes. Hip osteoarthritis commonly presents as deep groin pain, particularly during walking, climbing stairs or standing after sitting for long periods. Many patients do not initially notice pain over the side of the hip.
Muscle strains usually improve with rest over several weeks and are often tender to touch. Hip-related pain is typically deeper, associated with stiffness, reduced movement, and discomfort during activities such as putting on shoes, getting into a car or twisting. A clinical examination is the best way to distinguish between the two.
Not always. X-rays are excellent for detecting arthritis, hip shape abnormalities and many bone problems. However, conditions such as labral tears, early stress fractures and cartilage injuries often require an MRI for diagnosis.
Yes. Some lumbar spine conditions can refer pain into the groin. Because symptoms can overlap, your doctor will assess both the spine and hip before determining the most likely source.
If your groin pain persists despite rest, limits your daily activities, causes a limp, or is associated with reduced hip movement, an assessment by an orthopaedic specialist can help establish the diagnosis and discuss appropriate treatment options.