What we are talking about
The hip is a deep, very stable joint surrounded by big muscles. That is exactly why its pain gets referred elsewhere: people with a hip problem often point to the groin, and it is not unusual for the first symptom to be in the knee.
Different situations end up in here: the osteoarthritis that stiffens movement and gives groin pain, the groin pain of people who play change-of-direction sports, the trochanteric pain that hurts on the side when you lie on it, the impingement that flares in a deep squat.
There is a common thread: almost all of them respond to strength and control work for the glutes and the deep muscles. This is an area where well-dosed exercise gives a lot, and where resting alone gives very little.
When it makes sense to get seen
What we hear most often:
- Groin pain when you stand up from a chair or put your socks on
- Pain on the side that wakes you when you sleep on it
- Groin or pubic pain after playing or running
- The hip has stiffened and limits you in everyday movements
- A noise or a click in the hip that worries you
- Knee pain with nothing wrong with the knee
What can be done remotely, and what cannot
The hip is assessed largely by observing movement and by asking the right questions about when and where it hurts.
What can be done remotely
- Working out where the pain really is and what sets it off
- Watching you stand up from a chair, step up, stand on one leg
- Building the strength programme for the glutes and deep muscles, which is the core of it
- Correcting the technique of the movements that light up your symptom
- Adapting your sport rather than suspending it completely
What cannot
- Impingement tests and passive mobilisations, which are done by hand
- Manual therapy and soft-tissue work
- Injections and ultrasound scanning
Groin pain that comes on suddenly after trauma, or in someone with osteoporosis, should be assessed by a doctor before starting any exercise.
Frequently asked questions
Why does the hip hurt at night?
If the pain is on the side and worse lying on it, it is usually not the joint but the gluteal tendons over the greater trochanter, compressed by your body weight. Changing how you arrange yourself in bed often brings relief within the first few nights.
Can I still exercise with hip osteoarthritis?
Not only can you: it is the first thing the guidelines recommend. Exercise and load management come before any other option, and they do not «wear out» the joint. What needs tuning is the type and the amount.
Does groin pain get better with rest?
Usually not. It settles while you are still and comes back as soon as you start again, because the cause is a deficit of strength and control that rest does not correct. The path is progressive strengthening and a gradual return to sporting movements.
Is a clicking hip dangerous?
Almost never. A tendon flicking over a bony prominence makes a noise and in the great majority of cases is harmless. It only becomes interesting if it hurts or comes with giving way.
