Understanding Hip And Groin Pain

Understanding Hip And Groin Pain

No matter what the underlying cause of hip pain is, it can easily become a big problem, adding a great deal of discomfort. Both elderly and young people suffer from hip pain, which can drastically affect every aspect of daily life. When hip pain is combined with the discomfort of osteoarthritis, discomfort from a strained muscle, groin pain, discomfort in the lower back, knee pain, bursitis, or other conditions like femoroacetabular impingement, the affected person is going to require a comprehensive course of therapy.


Every person’s hip joint contains a special receptacle known as the acetabulum, which is further subdivided into the pubic, ilium, and ischium bones. The acetabulum is a kind of socket which connects to the tip of the leg bone via a piece of connecting tissue called the labrum. The labrum is circular in shape, and functions much like a shock absorber, helping to protect and increase stability in the hip. In everyone’s hip there are also two specialized muscles, known as flexor and extensor muscles, that run across the hip joint. These connect to the muscles in the leg and are how a person is able to bend and straighten their knees. In addition, two other muscles known as abductors and adductors connect the pelvic bone to the pubis, adding greater stability to the hip. It is when all of these interconnected muscles work properly that a person is able to walk and perform other movements. The hip also contains two tendons known as rotators, which make sure that the leg can twist and bend as we move. It is only when all of the various parts of the hip are understood that identifying and treating sources of hip discomfort can be properly treated.

Diagnosing Hip and Groin Pain

While no discomfort is welcomed by a person suffering from hip or groin pain, the official definition of this is when a person experiences stiffness in the region in the morning, or cannot rotate their hips by more than 15 degrees without experiencing discomfort.

Discomfort in the hip and groin area can occur in anyone, but some people are particularly prone to this discomfort:

  • Adults over 50 years old
  • People with a hip developmental disorder
  • Anyone who has previously suffered an injury to the hip

Understanding the Pain

It is common for many people who experience discomfort in the hip to also feel pain in the groin, knee, leg, and ankle. Many people who suffer from hip discomfort in combination with other forms of pain are between the ages of 20 and 40, and have spent years participating in athletic or other physically strenuous activities. Patients who experience pain only in the hips are generally between 50 and 80 years old. While sometimes the pain in the hip or groin area is described as piercing or sharp, in other cases it may feel more like a pinched or numb feeling. In some cases, a person may feel or hear an audible clicking noise as they walk, which probably indicates that there is some dysplasia of their hip. Only after a careful analysis of the complete anatomy of the hip can a medical professional identify the cause and source of the discomfort.

Treatment Options

Treatment for these conditions begins with a course of education, learning how to modify and adjust the way they perform everyday activities. Certain exercises and stretches are also effective for minimizing discomfort and improving flexibility, endurance, and strength. Obese people who suffer from hip discomfort can also greatly benefit by reducing their weight, as well as learning other techniques for reducing the amount of stress load that they place on the joint.

Doctors can also provide what is called manual therapy, or the use of special hands-on techniques for loosening and relaxing the hip muscles and tendons. This is a great way to reduce the amount of pain in the area, and help increase the mobility and flexibility of the hip.

A variety of physical therapy options are also available, including what are known as assisting devices, like walkers, crutches, and canes. Used properly, these devices will help a person suffering from discomfort regain their mobility while reducing the amount of weight and stress that they are placing on their hip.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


Explore more advanced diagnostic tools available only at NYDNRehab:


Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.


At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:


Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment


Hip joint stability test using DLEST methodology with C.A.R.E.N.


3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation


Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility


Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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