CSA Physio Blog

Groin and hip pain? It’s rarely “tight hip flexors”!

Posted on: June 6th, 2018 by Jeffrey Begg

Groin and hip pain

You’ve got that nagging pain in the front of your hip.  It’s sort of in the groin region, but a bit more in front.  When you sit, it’s basically somewhere along the fold your skin makes between your leg and your lower belly.  It’s been there for months, really, when you think about it.  Maybe on and off for years. 

In my practice, I hear this a lot: “I was told it’s because I have tight hip flexors”.   I’m afraid more often than not folks are being treated for the wrong thing and continuing to suffer in frustration.  Getting the right treatment starts with the right diagnosis.

What is the right diagnosis? 

A 2008 study in the British Journal of Sports Medicine looked at 218 athletes with longstanding groin pain.  More than 70% of the time, the underlying injury was to the actual hip joint or the bones of the pelvis (ie: not the muscles.)  Only 7% of the time were the hip flexors involved.  Maybe that’s why stretching and massaging your hip flexors was not working.

When I started my practice twenty years ago most people with groin pain went to their doctor for a diagnosis and for x-rays / MRIs.  Nowadays physiotherapists do both, and diagnosing and treating this type of hip pain takes up a good deal of my practice.  I’ll take a thorough history of your condition, then examine you, and I may send you for x-rays or other advanced imaging if needed.  Then we’ll come up with a diagnosis.

Hip & groin pain in 20-40 year olds.

Biking shouldn't hurt!

Your diagnosis will depend a lot on your age and your activity level.  For example, if you’re 25 to 40, it’s more likely that the hip bones or cartilage (the ‘labrum’) have been over-strained through either excessive activity, or a less-than-ideal bone structure that you inherited from your parents.  If this is the case, I’ll give you some advice about the specific activities you should avoid, and some specific exercises that will help your hip move better with less strain.

Hip & groin pain in 40-60 year olds.

If you’re 40 to 60, there’s a better chance that your hip has become quite stiff and weak.  The exercises you might need to do can vary from ball-and-socket hip mobilizations to hip rotational strengthening and standing, weight-bearing hip balance and control exercises.  Everyone is different.  Maybe you’ve already googled “the 5 best hip exercises”, as if everyone with hip pain will get better with the same approach.  If you’re reading this, chances are you’ve tried that, and it didn’t work.

Often times we’ll start with 3-6 weeks of treatment, a lot of it being done at home on your own. My approach is based on the principle of “the least amount of treatment required to get you better”.  Sometimes, it’s really as simple a 3 exercises done daily for 4 weeks.  In cases that remain symptomatic, I sometimes suggest a cortisone injection, or occasionally a series of regenerative medicine injections.  Rarely, I’ll need to refer you to a surgeon for another opinion. 

In any event, don’t let your hip hold you back.  The longer you leave it, the more you’re missing out on a fun, active life!


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