Your Hip Pain Professional will assess your pubic pain and examine all the contributing factors. Advice and management approach will be determined by each individuals contributing factors — for example, previous trauma, pregnancy, level of conditioning and athletic involvement. Pain around the hip and pelvis may also be related to soft tissues Figure 2. Soft tissues are non-bony structures that connect, support, or surround other structures and include:.
There are many muscles located in this region that support and move the hip and pelvis. The adductor muscles of the groin sit on the inner side of the thigh, between the pelvis and the knee Figure 2. The abdominal muscles extend from the ribcage down to the pelvis, supporting the spine and allow the trunk to curl up forwards or to the side.
They also help control the position of the pelvis. There are also another 3 layers of abdominal muscles external oblique, superficially, internal oblique beneath and transversus abdominis deepest that wrap around your body like a corset. At the front, they join into a big ligament that runs across the groin — the inguinal ligament Figure 2.
Traumatic injury resulting in a rapid onset of pain, is usually associated with sporting actions such as:.
A single cause for more longstanding groin pain can however be much more difficult to establish. One of the main reasons for this is the large amount of interconnection between the soft tissues around the pubic region.
Magnetic Resonance Imaging MRI scans of someone who has had groin pain for more than 3 months will often reveal a variety or combination of findings, and you may receive a diagnosis of:. In the region where the abdominal muscles join onto the pelvis and the inguinal ligament Figure 2. A hernia is where the pressure of the bowel against the weakened area can cause the appearance of a bump, as the bowel pushes into the area. More severe hernias are easily visible, but most of the time inguinal hernias are small and only picked up on ultrasound scans.
Although relatively more rare than soft tissue or joint problems, bony problems such as a fracture, stress fracture or very rarely, infection or tumour within the bone may cause pain in the groin and the inside of the thigh. The most likely bone-related issues associated with pain in the groin region, are fractures or stress fractures of the femur or front of the pelvis pubic ramus Figure 3.
The most common fractures around the hip and pelvis include a fracture of the neck of the femur common in older women with osteoporosis , or fractures through the pelvis related to large traumas or where stress fractures have not been attended to early enough.
Stress fractures may occur in a number of sites around the hip and pelvis. Sites that are most likely to be associated with groin pain are the top of the thighbone neck of the femur and the bones at the front of the pelvis the pubic ramus Figure 3.
Pain related to the bones could be felt anywhere around the hip or pelvis region depending on the bone affected and the cause of the bone pain. Click on our Pain Locator Map to review the areas you feel pain and learn more about the bones that may be related to pain in each area. Pain experienced around the hip and pelvis sometimes has nothing to do with problems in this area.
There are two main ways this might occur:. Referred pain is pain felt in a part of the body other than its actual source. However, this area of the spinal cord also receives information from structures in the hip and pelvis. The brain is unable to distinguish where the information came from, the back, the hip or the pelvis so you might feel pain in any one or a combination of these areas Figure 4.
Radicular pain is pain associated with irritation of the nerve roots as they exit the spine. Most commonly this is associated with inflammation or compression from the nearby disc. The nerve roots that exit at each level of the spine give rise to sensation indifferent areas of the skin, called dermatomes Figure 4.
The nerve roots that exit at each level of the spine give rise to sensation in different areas of the skin, called dermatomes Figure 4. When a nerve root is irritated at the spine, pain may be felt in the area of skin that the nerve root supplies. If the pain in your hip is due to a problem in the back, you can spend valuable time and money getting unnecessary treatment on the wrong area and this might delay an important diagnosis and your recovery.
The nervous system Figure 5. It is through this system that we feel, move and control our bodily functions. Nerve roots leave the spinal cord via the intervertebral foramina holes or spaces between the vertebrae and join together from various levels of the spine to travel as cord-like structures, called nerves, to their destinations. Some peripheral nerves travel only a short distance and others all the way from the lower back to the foot.
Along their journey they run between and through muscles and fibrous tunnels. While radicular pain arises from a problem as the nerve root exits the spine, nerve-related pain may develop due to a problem along the pathway of a peripheral nerve, outside the spine. Neuralgia felt around the hip and pelvis may develop in many ways including excessive compression or stretch of the nerve. This may be caused by a sudden, acute mechanism, for example a fall or blow to the area resulting in compression, or the leg being caught and wrenched, resulting in stretch.
Alternatively, the onset may be subtle, with a gradual onset associated with sustained postures or repetitive movements that cause cumulative nerve irritation.
Nerves will also be influenced by the health of the tissues they run through or alongside. For example, high muscle tension or tendinopathy may over time result in irritation of neighbouring nerves.
Nerve related symptoms are usually experienced differently from pain associated with muscle and joint problems. Peripheral nerve irritability may result in:. Be aware that some nerves may cross through and supply more than one region around the hip and pelvis. Additionally, some areas of skin may have several nerves that serve the area. This sometimes makes accurate diagnosis tricky.
Your hip pain professional will help to identify the cause of your pain. Irritation or damage to the ilioinguinal, iliohypogastric and genitofemoral nerves may occur as they travel through the muscles of the back and abdomen.
Most commonly, symptoms may arise following some sort of abdominal or groin surgery, such as hernia repair. The nerves may be damaged at the time of surgery or become entrapped in the scar tissue or mesh used for hernia repair.
Endometriosis may also sometimes affect these nerves. The symptoms are usually pain, with or without tingling or numbness in the area of nerve supply Figure 5. The iliohypogastric and ilioinguinal nerves also provide some motor supply the ability to make the muscles contract and work to the abdominal muscles, so there may be some weakness of the abdominals experienced in conjunction with the nerve irritation.
People with obturator neuralgia may experience pain, tingling or numbness in its area of skin supply Figure 5. If there is an adductor strain, there may have weakness or pain during this test. The physician may order an x-ray because sometimes the bone where the muscles and tendons attach may break off avulsion causing pain. An MRI may be ordered which may show swelling and a collection will blood around the site of injury.
A referral to physical therapy to help strengthen the core muscles should be considered by the physician. This exercise program would usually begin with stretching before the strengthening phase. Surgery is generally not needed for adductor or groin strains.
However, there is a different category of adductors injury called core muscle injury or athletic pubalgia which may need surgery. Some studies have shown that a good adductor and core muscle strengthening program may reduce the extent of adductor strain injuries, but not necessarily prevent them.
Return to play will depend on the extent of injury. This information will help your doctor diagnose the problem. They will then perform a physical examination of the groin area along with other tests, if necessary. Your doctor will insert one finger into the scrotum the sac that contains the testicles and ask you to cough.
Coughing raises the pressure in the abdomen and pushes your intestines into the hernia opening. X-rays and ultrasounds can help your healthcare provider see if a bone fracture, testicular mass, or ovarian cyst is causing the groin pain.
This type of blood test can help determine if an infection is present. The treatment for your groin pain will depend on the underlying cause. You can often treat minor strains at home, but more severe groin pain may require medical treatment. If your groin pain is the result of a strain, treatment at home is probably your best option.
Resting and taking a break from physical activity for two to three weeks will allow your strain to heal naturally. Pain medications, including acetaminophen Tylenol , may be taken to manage your pain and discomfort. Applying ice packs for 20 minutes a few times per day can help as well. If a broken bone or fracture is the cause of your groin pain, surgery may be required to repair the bone.
You may also need surgery if an inguinal hernia is the underlying cause of your symptoms. If home care methods do not work for your strain injury, your doctor might prescribe medications that reduce inflammation to help relieve your symptoms. If this does not work and you have recurring strain injuries, they might advise you to go to physical therapy. Talk to your doctor about your symptoms if you have moderate to severe pain in your groin or testicles for more than a few days.
These symptoms could be signs of a more serious condition, such as a testicular infection, testicular torsion twisted testicle , or testicular cancer. You should also seek emergency medical care if you have severe testicular pain that occurs suddenly. There are a few steps that you can take to avoid groin pain.
For athletes, gentle stretching is a way to help prevent injury. Doing a slow, steady warm-up before physical activity can help reduce your risk of a groin injury, especially if you do it consistently.
Maintaining a healthy weight and being careful when lifting heavy objects can help prevent hernias. Hip and groin pain is caused by a problem with the bones or other structures in or around the hip joint. Learn more here.
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