Health condition · Clinically reviewed
The joint, the tissues around it, the muscles, the nerves and the spine can all send pain to the same place. A structured approach separates them - and points to the right treatment.
Written by our editorial team and reviewed by a registered UK clinician before publication.
Checked against NICE, BOA and peer-reviewed musculoskeletal sources you can see at the end.
Reflects modern UK orthopaedic and sports medicine practice, including femoral neck stress fracture pathways.
Key facts
The essentials, in plain English - what actually causes pain in this region, and what a UK clinician looks for first.
What it is
A hub of overlapping problems inside the joint, around it, in the groin muscles, in nerves, or referred from the spine, pelvis or abdomen.
Common intra-articular causes
Hip osteoarthritis, labral tears and femoroacetabular impingement account for the majority of chronic hip pain in adults.
Common groin causes
Adductor strain, iliopsoas problems, sports hernia (athletic pubalgia) and osteitis pubis dominate in active adults.
Paediatric flags
Any limping child with hip or groin pain needs urgent assessment for irritable hip, Perthes, SUFE or septic arthritis.
Critical to catch
A femoral neck stress fracture can look like a groin strain but risks a completed fracture if missed.
How it is worked up
History, structured examination (FADIR, FABER, Trendelenburg), plain X-ray and often an MRI to see labrum, cartilage and bone.
Causes
The most useful way to think about hip and groin pain is by where the problem sits. Each group has its own examination signs, imaging and treatment ladder.
01 · Inside the joint
The classic C-sign, deep-groin pattern. Includes hip osteoarthritis, labral tears, femoroacetabular impingement (FAI), chondral defects, loose bodies, avascular necrosis, synovitis, gout, rheumatoid arthritis and septic arthritis. In children, irritable (transient) synovitis, Perthes disease and SUFE sit here.
02 · Around the joint
Lateral hip pain over the greater trochanter - trochanteric bursitis and gluteal tendinopathy - plus iliopsoas bursitis and tendinopathy, and snapping hip syndrome (internal or external). Very common in runners and post-menopausal women.
03 · Muscles and pubic bone
Adductor strain, hamstring origin injury, rectus femoris injury, iliopsoas strain, osteitis pubis, and sports hernia (athletic pubalgia). Common in football, hockey and rugby - see our guide to hip and groin injuries in sport.
04 · Nerves
Meralgia paraesthetica (lateral cutaneous femoral nerve), lumbar radiculopathy referring into the hip, obturator neuropathy in athletes, and ilioinguinal or genitofemoral nerve entrapment after groin surgery. Burning, numbness or shooting pain points here.
05 · Referred
The lumbar spine and sacroiliac joint often refer into the hip and groin. Intra-abdominal, urological and gynaecological causes - including endometriosis - and an inguinal hernia all present with groin pain that can be mistaken for a musculoskeletal problem.
06 · Bone
Femoral neck stress fracture (critical in runners and servicepeople), osteoporotic fragility fracture in older adults, and rarely primary or metastatic tumour. Our hip fracture guide covers the acute pathway.
07 · Paediatric
A distinct group - developmental dysplasia of the hip (DDH) in infants, Perthes in children, slipped upper femoral epiphysis (SUFE) in adolescents, irritable hip, and septic arthritis at any age. Any limping child with hip, thigh or knee pain needs same-day paediatric specialist assessment.
How the diagnosis is made
The steps a UK GP, sports medicine physician or orthopaedic surgeon will normally follow - so you know what to expect and why.
Phase 1 · Assessing
History, red flags and structured examination
Phase 2 · Confirming
Imaging and specialist review
Phase 3 · Planning
Treatment specific to the cause
Assessing
Onset, mechanism, activity, night pain and where it actually hurts - groin, lateral hip, buttock or back all mean different things.
Assessing
Fever, weight loss, night pain, trauma, cancer history, immunosuppression, cauda equina symptoms and paediatric limp are all checked first.
Assessing
FADIR and FABER for the joint, Trendelenburg for the abductors, straight leg raise for the spine, hop and adductor squeeze for pubic and stress causes.
Confirming
First-line imaging - shows osteoarthritis, cam or pincer morphology, dysplasia, avascular necrosis and most fractures.
Confirming
A specialist musculoskeletal MRI is the test of choice for labral tears, chondral defects, tendinopathy, stress fracture and sports hernia. See our guide to a private MRI scan.
Planning
Ultrasound is useful for bursae, tendon sheaths and guided injections into the hip, iliopsoas or trochanteric bursa.
Planning
Orthopaedic, sports medicine or rheumatology input depending on the pattern - and paediatric orthopaedics for any child.
Typical timeline: a first visit to a confident diagnosis in a few weeks, faster where red flags apply.
Symptoms
Where the pain sits, what it does with movement and load, and the features that shift the diagnosis into a different group.
The classic intra-articular hip pattern - patients cup the hand around the hip in a C. Think osteoarthritis, labral tear or impingement.
Pain over the greater trochanter, worse lying on that side. Usually gluteal tendinopathy or trochanteric bursitis.
Pain along the inner thigh or over the pubic bone, worse with cutting, kicking and squeezing. Adductor strain, osteitis pubis or sports hernia.
Audible or palpable snap - internal (iliopsoas) or external (iliotibial band). Painless snapping rarely needs treatment; painful snapping does.
Numbness or burning over the anterolateral thigh points to meralgia paraesthetica - a lateral cutaneous femoral nerve problem.
Pain from the sacroiliac joint or lumbar spine often refers to the buttock and groin - a careful spinal exam sorts it out.
Any child limping with hip or groin pain needs same-day assessment - Perthes, SUFE and septic arthritis all present this way.
Deep groin pain in a runner, load change, night pain or a positive hop test - a femoral neck stress fracture must be excluded before more running.
Treatment
There is no single treatment for hip and groin pain. Once the cause is clear, the ladder is well established - from load management to targeted surgery.
The foundation for almost every cause - graded loading, strengthening and movement retraining. See our guide to spinal physiotherapy for referred causes.
Short courses of paracetamol and NSAIDs help most soft-tissue and arthritic pain. Not for suspected stress fracture in a runner.
Image-guided injection into the joint, trochanteric bursa or iliopsoas can settle inflammation and help diagnosis. See our steroid injection guide.
Keyhole surgery for labral tears, FAI and loose bodies in the right patient. See our hip arthroscopy guide for who benefits.
The best-evidenced treatment for advanced osteoarthritis of the hip - transforms function and pain. See our hip replacement surgery guide.
Open or laparoscopic repair for athletic pubalgia that has failed structured rehabilitation. See our guide to hip and groin injuries in sport.
Femoral neck stress fracture, osteoporotic fracture or tumour needs urgent orthopaedic care - see our hip fracture guide.
Gout, rheumatoid arthritis, endometriosis and inguinal hernia each have their own pathway - covered in the linked condition guides.
The multidisciplinary team
Complex hip and groin pain often needs several voices in the room - specialist orthopaedic surgery, sports and exercise medicine, rheumatology, musculoskeletal physiotherapy and, where imaging is unclear, specialist musculoskeletal radiology. Paediatric orthopaedics leads for any child.
What this guide is based on
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or specialist knows you and your history and can tell you which parts apply. If in doubt, and especially with any red flag, get seen.
NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).
British Orthopaedic Association (BOA). Standards for adult hip pathology.
British Association of Sport and Exercise Medicine (BASEM). Groin pain in athletes - Doha agreement.
Royal College of Radiologists. iRefer guidelines for hip and pelvis imaging.
British Society for Rheumatology. Guidance on inflammatory arthritis and gout.
Red flags
Most hip and groin pain is manageable, but these patterns are different. Any one of them is a reason to seek same-day medical assessment.
Deep groin pain, night pain, positive hop test or a runner with load change - image urgently and stop loading until cleared.
Acute severe hip pain with fever, refusal to weight-bear and a hot, guarded joint - a surgical emergency at any age.
Same-day assessment - irritable hip, Perthes, SUFE and septic arthritis all present with hip or referred knee pain and a limp.
An overweight adolescent with vague hip, thigh or knee pain and out-toeing gait - urgent orthopaedic review before it displaces further.
Bilateral leg pain with saddle numbness, bladder or bowel changes - a surgical emergency, not a hip problem.
New hip or groin pain with weight loss, night pain or a history of prostate, breast, lung, kidney or thyroid cancer - image for metastasis.
A low-energy fall in an older adult with sudden hip pain and inability to weight-bear - X-ray and admit.
Groin pain in someone on long-term steroids, with sickle cell disease, high alcohol use or after chemotherapy - MRI early.
A lump, bowel or urinary symptoms, or pain that does not fit a musculoskeletal pattern - think inguinal hernia, urological or gynaecological cause.
Living with it
Four principles that make the biggest difference for the majority of adults with hip or groin pain - regardless of the underlying diagnosis.
A quiet reminder
Diagnosis first, then treatment.
Trying every treatment on every problem rarely works. Naming the actual cause is where progress starts.
Most non-traumatic hip and groin pain is a loading problem. Small, boring adjustments to volume, intensity and rest do more than any single treatment.
Glute, adductor and core strength protect the joint and pubic region. A structured programme with a physiotherapist beats generic exercises.
The treatments for a labral tear, a stress fracture and referred spinal pain are completely different. Imaging often earns its keep here.
If pain limits sleep, work or walking despite three months of good rehab, that is a signal to see a specialist - not to push through.
Frequently asked
Quick answers on imaging, stress fractures, sports hernia, the limping child and when replacement surgery becomes the right answer.
No. The hip joint, the tissues around it, the groin muscles, the nerves and the lumbar spine, sacroiliac joint, pelvis and abdomen can all cause pain in the same region. A structured examination is what separates them - not just imaging.
A plain X-ray is usually first - it shows arthritis, dysplasia, cam or pincer shape and most fractures. An MRI is the test of choice for labral tears, chondral defects, tendinopathy, stress fracture and sports hernia. Our private MRI scan guide explains when it is worth it.
In a runner or serviceperson with deep groin pain, night pain, a positive hop test or pain that will not settle, yes - a femoral neck stress fracture must be excluded before more loading. Missed, it can go on to a completed fracture with serious consequences.
A sports hernia, or athletic pubalgia, is a set of injuries to the muscles, tendons and fascia around the pubic bone. There is usually no true hernia. It is common in footballers and ice-hockey players and responds to specific rehabilitation, with surgery for stubborn cases. Our hip and groin injuries in sport guide covers it in detail.
Yes. Children with hip problems - irritable hip, Perthes, SUFE and septic arthritis - very often present with pain in the knee or thigh. Any limping child with hip or referred knee pain needs same-day medical assessment.
For advanced osteoarthritis of the hip that limits sleep, walking and quality of life despite physiotherapy, weight, activity and injection strategies. It is one of the most successful operations in medicine. Our hip replacement surgery guide walks through the decision.
Related content
The commonest cause of chronic hip pain in adults.
Learn moreCartilage rim injury inside the joint.
Learn moreBony shape driving groin pain in younger adults.
Learn moreLateral hip pain and gluteal tendinopathy.
Learn moreRelated treatment option.
Learn moreKeyhole surgery for labral tears and FAI.
Learn moreDetailed imaging of hip, labrum, cartilage and bone.
Learn moreFor bursae, tendons and guided injections.
Learn more