Hip Pain Explained

Hip Pain Explained will teach you about the anatomy of the hips and pelvic area and how many different types of body tissues interact. Each of these tissues is discussed in the tabs listed below: joint, soft tissue, bone, back referred, peripheral nerve and other. It is the interaction of these structures with the central nervous system and brain that result in the feeling of pain.

What is Pain?

Pain is an experience that the brain creates for the purposes of stimulating you to change your behaviour or seek help for a perceived problem with your body. Irritating or potentially damaging stimuli in your body (like high levels of pressure, tension or extremes of temperature) activate sense receptors (danger sensors) in the area. Signals from danger sensors in the body travel through the nervous system to the brain. Here the information is processed and the brain sometimes (but not always) produces a pain experience.

These danger sensors send warning signals to your brain, and your brain then decides whether the signals are dangerous to your health. Your brain uses lots of other stored and real-time information to make this decision, for example:

whether you have had an injury to this area before
whether you know someone who has had problematic pain or injury in this area
whether an injury in this area is likely to impact substantially on your life (ability to work, play sport, stay healthy, interact with family and friends)
what you have read or watched about the problem
what others have said about the problem (friends, relatives, health professionals)
if you are unwell with a cold or flu
if you haven’t slept well
if you are having a good or bad day
if it’s raining or sunny, you are surrounded by harsh noise or calming music, pungent or pleasant smells...

After much scientific study, we now know that pain is not as simple as we once thought. It has been clearly demonstrated many times that:

degree of pain ≠ degree of damage.

Pain is rather a reflection of how dangerous the brain perceives the situation to be and how important it thinks it is for you to do something about it, based on subconscious considerations. The brain truly is amazing!

Persistent or cumulative signals from the danger sensors in your body, will usually trigger a pain experience, but at varying levels for each individual. Danger signals may come from many different structures around the hip and pelvis. The guide below serves as an introduction to these structures.

Pain experienced in the hip, groin and pelvic region may be related to:

the joints of the hip & pelvis – hip joint, sacro-iliac joints, pubic symphysis
the soft tissues – muscles, tendons, bursae & fascia
bones – the femur (thigh bone) or bones of the pelvis
local nerves running through and around the hip & pelvis
musculoskeletal problems elsewhere in the body, such as the lower back (referred pain)
problems with organs, other body systems or health issues masquerading as hip pain

Joint Related

Soft Tissue Related

Bone Related

Back Related

Peripheral Nerve

Other causes

Joint Related

Joint-Related Pain

A joint is formed where two bones are joined together, with varying amounts of movement occurring between them. Pain may be related to the structures involved in the function and support of a joint. The hip joint is the joint most commonly related to pain at the front of the hip (Figure 1.1).

The hip joint is the largest ball and socket joint in the body. The ‘ball’ is the head of the femur (thigh bone). The socket in the pelvis, is called the acetabulum (Figure 1.2).
Both the ball and socket are lined with smooth cartilage which allows the bones to slide against each other easily (Figure 1.2).
The smooth cartilage lining the socket merges into a fringe of a more fibrous cartilage that joins around the edge of the bony socket. This is called the labrum (acetabular labrum) (Figure 1.2). It has a variety of functions, assisting in joint stability and health. The labrum makes the joint deeper and hugs firmly around the head of the femur, providing a suction effect. Both of these features contribute to joint stability. The labrum is also involved in the flow of nutrient-rich joint fluid and trapping fluid between the bones when you land on your foot in walking and running. This provides a cushioning effect for your cartilage and helps maintain joint health.
The ball and socket joint is surrounded by a fibrous capsule, reinforced by a number of ligaments that run between the pelvis and femur (Figure 1.3). These strong ligaments provide stability for the joint but are also flexible, allowing your hip to move in large ranges of motion. There is a large normal variation in how flexible these ligaments are in different people.

Pain Related to the Hip Joint

Changes in joint health:

may occur in association with some conditions such as:
- hip osteoarthritis
- femoroacetabular impingement syndrome (FAIS)
- acetabular dysplasia
- hip instability
- childhood developmental issues of the hip (Congenital dislocation of the hip, Perthes Disease, Slipped Upper Capital Femoral Epiphysis)

DO NOT ALWAYS RESULT IN PAIN (Some level of wear or injury to tissues within the joint is so common in adults, it is thought to be ‘normal’. Identification of changes in joint health on XRays or scans is therefore not considered meaningful unless related to pain or other symptoms)
are poorly correlated with level of pain
most often become painful with one or more of the following factors:
- too much or too little activity
- rapid changes in activity levels
- activities that put large forces across the hip joint (e.g. stretching too far or landing heavily)
- certain sustained or repetitive postures or movement habits that create small changes that add up over time
- high body weight
- other general health factors

Pain related to the hip joint is most commonly experienced at the front of the hip (anterior hip), but may also be felt in the groin, side of the hip (lateral hip) or deep in the buttock. Other things may also cause pain in these areas, so visit our Pain Locator Map to read about different things that may be related to pain in each of these regions.

After a thorough assessment, your Hip Pain Professional will be able to:

tell you whether the hip joint and changes on any XRays or scans, are likely to be related to your pain.
assess for factors that could be contributing to the problem
set a plan to help you:
- reduce your pain
- improve your ability to do everyday activities involved with work and the household
- return to sport or modified activity
- look after your hip joints for the long term, such as through targeted exercise and education around positions, stretches, exercises or activities that may not be ideal for your joint
- refer you for further investigation if required
- provide or refer you for further medical intervention, if appropriate (injections, surgical opinion)

The Pubic Symphysis

The pubic symphysis (Figure 1.5) is the joint where each half of the pelvis joins at the front of the body. The word ͚symphysis simply means – a place where two bones are closely joined. This joint is a flat or plane joint, that includes:

a fibrous disc that sits between the pubic bones, working as a shock absorber
four strong ligaments that support the joint

Only very small movements occur at this joint. For example, some rotation occurs during walking, as one side of the pelvis moves slightly forward and the other slightly back, following the movement of the legs.

Pain Related to the Pubic Symphysis

Pubic Symphysis pain is most commonly associated with injury or excess strain due to:

a major trauma, such as a fall into the splits or a direct impact to the pubic region
increased stretchiness of the joint ligaments during pregnancy – this is a normal response to hormone changes in preparation for childbirth
trauma during childbirth – breech delivery, forceps/vacuum delivery
a gradual build-up of joint stress, such as repetitive movements where the legs move far apart, as may occur in certain sports
large repetitive forces created by the surrounding muscles, particularly the inner thigh muscles. This is most common in field or court sports that involve changing direction at high speed or kicking.

Pain related to the pubic symphysis is most commonly experienced in the groin region and/or directly over the joint. Groin pain that occurs over the pubic symphysis is referred to as Pubic Related Groin Pain. Other problems may also cause pain in the groin region, so visit our Pain Locator Map to read about different things that may be related to pain here.

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.

After a thorough assessment, a Hip Pain Professional will be able to tell you whether changes on your XRays or scans are likely to be related to your pain and what factors could be contributing to the problem. They will also set a plan to help you:

reduce your pain
improve your ability to do everyday activities involved with work and the household
return to sport or modified activity
look after your hip joints for the long term.

The Sacroiliac Joints

The sacroiliac joints (sometimes abbreviated to SIJs or SI joints) are the joints formed between the two bony wings of the pelvis and the tailbone (sacrum) (Figure 1.6).

These joints are designed for stability with extremely little movement capacity. They are flat or plane joints though the surfaces of the joint are not completely flat. They are irregular or bumpy to allow some interlocking of the bones for the stability they need.
They are also surrounded by some of the strongest ligaments in the body. This stable joint structure allows transfer of large forces between the body and the legs during walking, running and jumping.
Some movement occurs in these joints during walking and running, where one leg is moving forward and the other backward, resulting in a small amount of joint rotation.
Movement at the sacroiliac joints will also occur during extremes of hip or back motion, although most scientists agree that the amount of movement that occurs at the sacroiliac joints is very small.

Pain Related to the Sacroiliac Joint

Pain and functional difficulties related to the sacroiliac joint:

most commonly develop during pregnancy or childbirth
may occur after a major trauma, such as a hard fall onto the bottom or a large force through one leg, for example being dragged by one leg after a fall from a horse or water-skis.
may develop over time, related to certain types of repetitive forces.
can develop when there is a problem with the lower back or hip joints, transferring extra load across the sacroiliac joint.

Sacroiliac pain and dysfunction are however, greatly over-diagnosed. While true instability does occur, it is relatively rare and there are many people living unnecessarily in fear, related to a diagnosis of pelvic instability or being told their pelvis keeps moving out of place.

Here are a few facts about the sacroiliac joint that may dispel some of this fear:

The structure of the sacroiliac joint makes it a very stable joint
Asymmetry in the human body is normal
- Differences in tightness of the muscles that join on to either side of the pelvis occur naturally, related to leg or arm dominance, sport and occupation. This asymmetry may cause an appearance of asymmetry in the resting position and movement of the pelvis. This is normal and has not been linked to harm.
- Differences in leg length of up to around 1cm are common and normal. Leg length difference may also produce an appearance of asymmetry in pelvic position in standing.
A click occurring in a joint does not mean it has moved ͚in or out of position. All of us click and pop, some just a little more than others. These are usually normal joint or tendon sounds.

There are also causes for sacroiliac joint pain that are related to other general health conditions. Sacroiliitis refers to an inflammation of the sacroiliac joints associated with a systemic inflammatory disease such as Ankylosing Spondylitis. You can read more about non-musculoskeletal causes of hip and pelvic pain here.

Pain related to the sacroiliac joints is most commonly experienced in the upper buttock region, usually right over the joint, in the area of the dimples at the top of the buttocks. As the pelvis is a ring joined at the front by the pubic symphysis, problems with the sacroiliac joints are sometimes associated with pain in the groin region. There are many other causes for groin pain however, so visit our Pain Locator Map to read about different factors that may be related to pain in each of these regions.

Your Hip Pain Professional will be able to assess your sacroiliac joints to determine if they are likely to be the cause of your pain. If you have sacroiliac joint related pain, you may require:

advice on modifications to activities or positions – e.g. workplace set-up
an exercise program to provide optimal muscle support around the joints
advice regarding short term bracing or taping – only appropriate for short term use and usually only for severe pain and during late stage pregnancy or after trauma
an injection for short term relief of severe pain, while you work on your rehabilitation

The Sacrococcygeal Joint

The sacrococcygeal joint is the joint in the tailbone formed between the sacrum and the coccyx (Figure 1.7).
The coccyx is a small triangular shaped bone made up of 3-5 fused segments. Many ligaments attach to the coccyx helping to provide stability and support for the pelvis, its muscles and contents.

Pain related to the Sacrococcygeal Joint – Coccydynia

Pain relating to the coccyx and sacrococcygeal joint is known as coccydynia (pronounced cox-y-dynia). A sudden onset of coccygeal pain is usually associated with trauma, externally such as from a fall backwards onto the bone, or internally such as in childbirth. Onset can also be gradual, commonly related to sustained pressure from sitting or local muscle forces.

Factors associated with an increased risk of developing coccydynia are:

being overweight
being female – women are 5 times more likely to develop the condition
increased flexibility or mobility of the joint (hypermobility)
reduced flexibility or stiffness of the joint (hypomobility)
variants of coccyx shape
pelvic floor muscle weakness or overactivity
other general health factors (see other causes section): These must be ruled out.

Your Hip Pain Professional can reduce your pain associated with coccydynia by addressing factors such as:

excessive weight bearing on the coccyx due to seating or habitual sitting postures
weakness, spasm or altered activity in the muscles that attach to the coccyx including the gluteus maximus (buttock) and pelvic floor muscles (see the soft tissue section)
altered stress and strain on the structures that attach to the coccyx which may have occurred after trauma or as a gradual build up over time.
providing or referring you for a pain-relieving injection into the area or in very rare cases, to a surgeon.

Soft Tissue Related

Soft Tissue Related Pain

Hip Flexor, Iliopsoas or psoas strain, tendinitis, tendinopathy or impingement

Pain in the front of the hip may also be related to soft tissues (Figure 2.1). Soft tissues are non-bony structures that connect, support, or surround other structures and include:

the muscles, which allow you to move
the tendons, which connect your muscles to the bone
the bursae – small, flat pockets of fluid that help all these things slide and glide against one another, reducing friction. There are bursae are all around the body in places where different structures may rub against one another, for example where a tendon runs around a bone.
the fascia – stretchy, thin, white fibrous tissue. All our muscles are enveloped in fascia, like stretchy stockings that help transfer energy from muscle and movement. Fascia also forms sheaths or tunnels for safe passage of blood vessels and nerves and wraps and supports all our bodily organs.

There are many muscles located in this region that support and move the hip. The muscles that sit at the front of the hip are called the hip flexors (Figure 2.2) and act to lift your knee towards your chest (flexion). The main hip flexor, the iliopsoas muscle is made up of two parts – the psoas muscle that starts at the lumbar spine, and the iliacus that starts from the inside of the pelvis. They come together in the pelvis and run forwards over the front of the pelvis, deep across the front of the hip and join onto the upper thigh bone (femur). The iliopsoas muscle provides important support for the front of the hip joint, the sacroiliac joint of the pelvis and the lower back (lumbar spine). It is also a powerhouse for moving your legs forward in walking, running and stairclimbing.

A number of other longer, more superficial (closer to the surface) hip flexor muscles run from the pelvis and down into the thigh and connect below the knee – the Sartorius, Rectus Femoris and Tensor Fascia Lata (TFL) muscles (Figure 2.3). These muscles help the iliopsoas muscle with lifting the thigh, but their effect also extends across the knee.

Hip Flexor or Iliopsoas Related Pain

Tears or strains may occur within the hip flexor muscles; where the muscles and tendons join (musculotendinous junction); or within the tendons. Traumatic injury resulting in rapid onset of pain is usually associated with sporting actions such as:

kicking
sprinting, particularly rapid acceleration
changing direction at speed.

Changes in tendon health often evolve more slowly, related to your body’s natural make-up (e.g. bony shape, hypermobility) or postural, movement or athletic training habits.

The iliopsoas tendon that joins the iliopsoas muscle to the femur (thigh bone) sits deep at the front of the hip and is separated from the hip joint by a large bursa (iliopectineal or iliopsoas bursa). This bursa reduces friction and helps the tendon slide freely across the front of the hip. The tendon and/or the bursa may become involved and you may receive a diagnosis of:

iliopsoas tendinopathy – a painful iliopsoas tendon
anterior snapping hip – snapping of the iliopsoas tendon which can sometimes become painful
iliopsoas bursitis – inflammation or thickening of the iliopsoas bursa
iliopsoas impingement – impingement or compression of the iliopsoas tendon against the underlying bone

The hip flexors muscles, and particularly the iliopsoas muscle, have become incorrectly demonised in the popular media for being the source of many problems. These are generally thought to be related to the muscles becoming overly active and tight. There is unfortunately much misinformation on the internet regarding the hip flexors and poor advice regarding management of true hip flexor issues.

Many people are stretching the hip flexors and placing high loads on the front of the hip unnecessarily, often worsening their problem.

**Your Hip Pain Professional can:**

assess the hip flexors and decide whether stretching will help or aggravate the problem
provide important advice about sporting activities, for example:
- advice re how much is too much
- allowing adequate recovery between sessions
- temporary reduction in activity levels may be required
- rest from particular actions that place highest load across the hip flexors and pelvis
provide or send you for rehabilitation to optimise function of these muscles

Bone Related

Bone Related Pain

Growing pains (apophysitis), Stress Fracture, Fractured Neck of Femur

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 hip and pelvic pain. In growing children or adolescents, pain may be related to disorders of the growth plates of the femurs or pelvis.

Bone Related Pain in the Front of the Hip

The most likely bone-related issues associated with pain in the anterior hip region, are fractures or stress fractures of the femur or pelvis (pubic ramus), or apophysitis or avulsion fracture of the growth plates at the front of the pelvis (ASIS & AIIS) (Figure 3).

Bone related pain may be due to:

Fracture
Stress fracture
Avulsion fracture
Apophysitis

A fracture:

is the medical term for a broken bone
usually occurs from a traumatic event like a fall, car accident or more severe sporting injury
is more likely to occur in a weakened bone e.g. osteoporosis or genetic diseases like osteogenesis imperfecta

The most common fractures associated with anterior hip pain include a fracture of the neck of the femur (common in older women with osteoporosis) or fractures through the pelvis or the main shaft of the femur related to large trauma.

A stress fracture:

is the medical term used for a fracture that occurs due to a build-up of repetitive stress
is usually related to overuse -an accumulation of repeated small traumas e.g. long-distance running
is more likely to occur with rapid increases in athletic training volume and/or inadequate recovery time
starts as localised swelling in the area of bone exposed to highest stress (you won’t see this at skin level as it is just within the bone)–this may be called a stress reaction or bony stress response
may progress to full fracture if you don’t rest

An avulsion fracture:

is where a small piece of bone is pulled away from the main part of the bone
may occur in adults where a large force across a ligament (joins bone – bone) or tendon (joins muscle to bone), causes a small piece of bone to come away with the ligament or tendon
may occur in children at the bony growth plates (read more in the next section)

Apophysitis:

usually referred to as ‘growing pains’
occurs in adolescents
is due to long bones such as the femur growing more quickly than the muscles, which then tug on the growth zones in the immature pelvis
most commonly occurs at sites where some of the large muscles attach at the front of the pelvis (Figure 3):
- where the sartorius muscle joins to the ASIS (anterior superior iliac spine).
- where the rectus femoris muscle joins to the AIIS (anterior inferior iliac spine).

You can visit the “Soft Tissue Related Pain” tab to view these muscles.

The pain of apophysitis is related to an inflammation of the bony growth centres where these muscles attach. Pain is generally experienced locally at the area of muscle attachment but can radiate around the area as well.

Other growth-related bony issues:

Perthes disease or Legg-Calvé-Perthes Disease – is misshaping of the femoral head related to issues with blood flow to the bone. Most common during ages 4-10 years.
Slipped Capital Femoral Epiphysis or Slipped Upper Femoral Epiphysis-usually a small shift in the growth plate in the neck of the femur that can change the shape of the head and neck of the femur. Most common during ages 8-15 years.

Pain related to the bones could also 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.

Your Hip Pain Professional can:

perform a thorough assessment and let you know if a bone issue may be suspected. In these cases, you may be advised to undertake further imaging or referral to a medical specialist for further advice
provide or refer you for rehabilitation at an appropriate time following bony injury
provide important information about managing sporting activity and recovery in those with bony stress injuries or adolescents with bony ‘growing pains’
address muscular or biomechanical issues that may be contributing to bone-related pain, for example, running style may have an impact.

Back Related

Back Related Hip Pain

Pain experienced around the anterior hip (front) sometimes has nothing to do with problems in this area. Problems in the lower back can result in back pain and/or pain through the hips and down into the legs. There are two main ways this might occur:

Referred pain

Referred pain is pain felt in a part of the body other than its actual source. For example, if there is a problem in the lumbar (lower back) discs or joints, small nerve endings serving these structures generate ‘danger’ messages that are transmitted along small nerve fibres into the spinal cord. 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 4.1).

Referred pain:

is usually a dull, aching or gnawing pain
can expand into a wide area that is difficult to localize
is not related to a problem of the nerve roots in the spine
is not associated with other nerve-related symptoms such as tingling or numbness

Radicular Pain

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 in different areas of the skin, called dermatomes (Figure 4.2). When a nerve root is irritated at the spine, pain may be felt in the area of skin that the nerve root supplies. Referred nerve pain in the front of the hip is usually from higher levels (T12 & L1-3) – within the dashed box on the body chart.

Radicular pain:

is related to a problem of the nerve roots in the spine
is usually accompanied by stabbing or shooting pains
is usually easier to localise than referred pain
may also be associated with an additional or background, deep, dull ache
may be accompanied by other nerve related symptoms such as tingling, itching, burning or numbness

If the pain in the front of 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.

Your Hip Pain Professional can:

provide a skilled assessment
help figure out the actual source of the problem and if you have more than one area contributing to the problem
develop a comprehensive plan to help the problem – If your pain is lumbar-referred or radicular, you may need treatment on your back and not your hip or if you have two problem areas, both will need to be addressed within a comprehensive management plan
recommend further tests or refer you to another specialist if the problem does not appear to be in the musculoskeletal system.

Peripheral Nerve

Peripheral Nerve Related Pain

Femoral, Ilioinguinal, Iliohypogastric & Genitofemoral Neuralgia

The  nervous system  (Figure 5.1) is a complex network of  nerves  and cells that carry messages between the brain and spinal cord and your body. 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. It is these nerves that travel outside the spinal cord that are referred to as “peripheral nerves”. 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. Pain related to a nerve is called “Neuralgia”.

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:

symptoms in the area served by that peripheral nerve (which is different from dermatomal patterns associated with nerve root irritation -radicular pain)
burning pain
odd zings or zaps of pain
tingly sensations or numbness
weakness – only for those nerves that supply muscles, like the femoral nerve

In viewing the individual nerves that may be contributing to your anterior hip pain, be aware that some nerves may cross through and supply more than one region. 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.

Nerves of the Anterior Hip and Groin Regions:

Nerves that supply the front of the hip, groin and thigh (Figure 5.2) include:

the iliohypogastric nerve
the ilioinguinal nerve
the genitofemoral nerve
the obturator nerve
the femoral nerve: the anterior femoral cutaneous nerve

Nerve Related Pain/Neuralgia in the Anterior Hip & Groin Regions

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 5.3). 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.

For Pain Related to Nerves/Neuralgia of the Anterior Hip:

Your Hip Pain Professional can:

Perform specific tests in the clinic to see if nerve involvement is likely
Provide treatments and give you exercises that may improve the health or movement of the nerve
Help improve health of the muscles and tendons beside the nerve (this may be the source of nerve irritation)
Review the position you spend time in and activities you perform daily and provide strategies when performing these tasks that might help protect the nerve, thus reducing your symptoms. This may include changing your sitting or lying posture, or changing stretches or strength exercises that you have been performing that may be contributing to the irritation the nerve
Provide nerve gliding or mobility exercises that can be useful in some situations
Refer you for further tests or to a neurologist, orthopaedic specialist or other pain specialist if required.
In some cases, your hip pain professional may refer you to a pelvic floor physio for further assessment should they consider the pelvic floor muscles are involved.

* Please note: Nerve supply can overlap and be quite variable between individuals. The diagram provided in this section provides an approximate guide only of the nerve supply in this region.

Other causes

Other causes of hip, pelvic & groin pain

There are other processes that may produce pain around the hip and pelvis.

These include:

Systemic/Rheumatological conditions: eg Rheumatoid Arthritis, Polymyalgia, Polyarthralgia
Infective processes: Septic arthritis, Osteomyelitis, Viral Arthritis
Neoplastic processes (cancer)
Vascular issues: Avascular Necrosis, External Iliac Artery Entrapment, varicotic gluteal vessels compressing the sciatic nerve

These conditions are relatively rare compared to musculoskeletal pain, but when present you will need to see a medical practitioner and usually a specialist for that system or problem, for example, a Rheumatologist, Orthopaedic Specialist, Oncologist, Vascular Specialist.

Anterior Hip pain can also be associated with organ problems (ovaries, uterus, bowel, bladder, prostate). One of the most common causes of organ-related pain in females is endometriosis. This occurs when tissue that is similar to the lining of the uterus (womb) grows outside the uterus attaching to other structures such as the pelvic ligaments or the bladder and bowel. This can lead to debilitating pain that may be cyclic, relating to the menstrual cycle. Diagnosis and management of organ related problems will usually require the assistance of a specialist, for example a gynaecologist (female reproductive organs), urologist (bladder and prostate) or gastroenterologist (gut/bowel).

A skilled assessment by a Hip Pain Professional will help clarify if the problem requires further medical attention and whether it is likely to be related to a musculoskeletal problem or not.

Your Hip Pain Professional can:

provide a detailed assessment
assist in determining if the problem is musculoskeletal or not
develop a plan to help if the problem is musculoskeletal
recommend further tests or send you to another specialist if the problem does not appear to be in the musculoskeletal system.

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Hip Pain Explained

What is Pain?

degree of pain ≠ degree of damage.

Pain experienced in the hip, groin and pelvic region may be related to:

Joint-Related Pain

Pain Related to the Hip Joint

The Pubic Symphysis

Pain Related to the Pubic Symphysis

The Sacroiliac Joints

Pain Related to the Sacroiliac Joint

The Sacrococcygeal Joint

Pain related to the Sacrococcygeal Joint – Coccydynia

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