Hip and groin pain when walking is a common complaint due to the complex intersection of the lower spine, pelvis, and leg. Pain can originate directly from the hip joint (a ball-and-socket structure) or from surrounding soft tissues like muscles, tendons, and ligaments. Because the nervous system is interconnected, discomfort felt in the groin or hip may be referred from a problem located elsewhere, most frequently the lower back. Locating the source of the pain is the first step toward effective management.
Common Musculoskeletal Causes of Hip and Groin Pain
Pain felt deep within the groin or at the front of the hip often indicates an issue originating within the hip joint itself (intra-articular pain). One prevalent cause in older adults is hip osteoarthritis, where the protective cartilage wears down. This degeneration leads to bone-on-bone friction during weight-bearing activities like walking, resulting in a deep, persistent ache that worsens with activity and may cause morning stiffness.
A tear in the labrum, the ring of cartilage that suctions the ball into the hip socket, can cause sharp groin pain aggravated by walking or twisting movements. Unlike the dull ache of arthritis, a labral tear may present with mechanical symptoms such as clicking, locking, or catching within the joint. When pain is localized high up on the front of the thigh, a hip flexor strain is a frequent culprit. This injury, often involving the iliopsoas muscle group, causes pain when lifting the knee toward the chest and can lead to a noticeable limp when walking.
Pain felt on the outer side of the hip, which can radiate down the thigh, is associated with Greater Trochanteric Pain Syndrome (GTPS), often referred to as trochanteric bursitis. GTPS involves inflammation of the gluteal tendons or the bursa overlying the greater trochanter, the bony prominence on the side of the hip. This pain worsens when lying on the affected side at night, standing for long periods, or walking up stairs or inclines. While historically called bursitis, the primary issue is often a tendinopathy of the gluteus medius and minimus muscles.
Referred Pain and Non-Joint Related Sources
Groin and hip discomfort can originate outside the hip joint due to referred pain, where the brain interprets signals from one area as coming from another. The lower back, particularly the lumbar spine (L2-L4 nerve roots), is a common source of this radiating pain because the nerves supplying the groin are interconnected with those in the lower spine. Conditions like a herniated disc or facet joint irritation can compress these nerves, causing pain that travels from the back into the hip or groin area.
The sacroiliac (SI) joint, which connects the base of the spine to the pelvis, can also cause pain that mimics a hip problem. Dysfunction in the SI joint, often due to too much or too little movement, causes pain in the buttock that can radiate to the hip, groin, or down the back of the leg. This pain often worsens with transitions like standing up from a seated position or walking.
A hernia is a non-joint cause of groin pain, involving tissue pushing through a weak spot in the abdominal wall. An inguinal hernia, the most common type, presents as a bulge in the groin area and causes pain that increases with straining, coughing, or walking. A “sports hernia,” or athletic pubalgia, involves a tear of the soft tissues in the lower abdomen without the visible bulge, causing severe pain during twisting movements or intense activity.
Immediate Strategies for Managing Acute Discomfort
When a flare-up of hip or groin pain occurs, immediate conservative measures help manage acute discomfort and inflammation. Following the principles of R.I.C.E. (Rest, Ice, Compression, Elevation) is recommended, particularly in the initial 48 to 72 hours following a sudden strain or injury. Applying a cold compress or ice pack wrapped in a towel to the most painful area for 15 to 20 minutes every few hours helps reduce local swelling and numb the pain receptors.
Activity modification is important, requiring a temporary reduction in the duration or intensity of walking to a level that does not provoke pain. If walking is difficult, using a cane or crutch on the side opposite the pain significantly reduces the load placed on the affected hip joint and surrounding muscles. Gentle stretching, such as a piriformis stretch or a modified knee-to-chest position, can provide relief by easing tension in tight muscles around the hip and pelvis.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can manage pain and inflammation, but a healthcare provider should be consulted before starting any new medication. For pain that is muscular or stiff, applying heat after the initial acute phase can increase blood flow to the area, promoting muscle relaxation and flexibility. Avoid activities that involve low chairs or carrying heavy loads, as these actions tend to increase pressure on the hip joint.
Determining When to Seek Professional Evaluation
While many instances of hip and groin pain resolve with simple self-care, certain symptoms warrant a professional evaluation. A doctor’s visit is necessary if the pain is severe and starts suddenly without a clear cause, or if the discomfort is so intense that it prevents you from bearing weight or walking normally. Pain accompanied by systemic signs of infection, such as fever, chills, or noticeable warmth and redness around the joint, requires immediate attention to rule out conditions like septic arthritis.
If the pain followed trauma, such as a fall or accident, or if a visible deformity is present, emergency care is needed to check for a fracture. For chronic pain, a consultation should be scheduled if the discomfort persists without improvement after one to two weeks of home management, or if the pain begins to disrupt sleep. The professional evaluation begins with a physical examination and may proceed to diagnostic imaging, such as X-rays or magnetic resonance imaging (MRI), to visualize the underlying bone and soft tissue structures.