Buttock, hip and groin pain is often connected or might be pain referred from another area, such as the lower back. The hip and groin area is one of the most challenging areas of the body to treat by sports injury specialists. This is because there are a large number of possible structures that can be injured and cause pain in this area, and also because most of the structures are very deep within the groin area (including the hip joint).
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Pain in the buttocks is often gradual onset and may be referred by injuries or conditions in the lower back, hips, or thigh. One of the most common causes of buttock pain is Sacroiliac joint pain. The Sacroiliac joint is located at the bottom and just to the side of the back and can become inflamed and painful. Symptoms can be either a sharp pain or an ache in the lower back which can spread to the buttocks. SI joint pain also can be caused by a traumatic impact, poor biomechanics, inflammatory disease or from hormonal changes, such as pregnancy.
Piriformis syndrome occurs when the sciatic nerve becomes impinged or compressed by a tight Piriformis muscle, causing pain in the buttocks which may radiate down the leg. Injuries causing pain under the buttocks (at the top of the hamstrings) often have similar symptoms. Hamstring origin tendinopathy which is inflammation or degeneration of the tendon, and Ischiogluteal bursitis which is inflammation of the bursa (small sack of fluid) which sits between tendon and bone, will cause gradual onset buttock pain. Hamstring origin tendon strain or avulsion strain may result in acute or sudden onset pain under the buttocks.
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Hip pain or hip joint pain often develops gradually and can be from a number of causes. Labral tears and Osteoarthritis are more common, especially in older athletes who have been highly active in their 20's and 30's. A labral tear is a tear to the cartilage lining of the hip joint. A common cause, particularly in athletes who have done repetitive movements which abduct the hip (move out sideways) such as hurdling, breaststroke swimming, or horse riding is 'cam impingement' where abnormal bone growth at the neck of the femur pinches or impinges on the joint lining. Osteoarthritis of the hip is 'wear and tear' or degeneration of the hip joint, in particular, the hard, tough cartilage at the ends of bones causing progressively worse hip pain, reduced mobility and joint stiffness.
Perthes' disease affects children, most commonly boys aged between four and ten years old, with symptoms of tiredness, hip and groin pain. Medical help is needed to diagnose this condition as early as possible to try to prevent and limit any future problems.
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The most common cause of pain in the groin is an acute Groin strain, and this is frequently seen in twisting and turning sports, such as American football, rugby, and soccer. Symptoms include
A Hernia occurs when an internal part of the body (such as the intestine), pushes through a weakness in the overlying muscle wall, causing pain which increases with exercise and even when coughing. The two most common types of hernia are
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Hip and groin pain in Children
Hip and groin pain in children should always be checked out as soon as possible with a qualified medical professional as sometimes what seems a relatively mild condition could turn out to be very serious with long-term implications.
There are a number of hip/groin conditions that present in the hip and groin area. The most common is Perthes' disease which usually presents itself between the ages of four and eight years of age, although it can also occasionally occur in younger (toddlers) or older children (teenagers).
Parents/guardians should note that if a child complains of stiffness and reduced movement (ROM) in the hip area then Perthes’ must be suspected. If severe, the child may even walk with a noticeable limp and the affected leg may appear shorter than the other leg.
Hip and groin pain are especially difficult to diagnose in young children and adolescents because like adults, there are a number of different structures in the hip area that can result in pain. Children often find it difficult to explain pain and where it is and therefore their pains are often put down to 'growing pains' and this is not true. If in any doubt it is recommended that parents/guardians seek advice from a medical professional who ideally specializes in paediatrics (the study of children). It should be noted that incorrect or missed diagnoses of hip conditions in children can have catastrophic consequences in their later life.
Without a doubt, severe hip/groin pain experienced by children should always receive urgent medical attention. Apparently minor conditions such as a pulled muscle or tendon strain can cause similar types of pain to a stress fracture, so a professional opinion is vital. Stress fractures in children are medical emergencies, so a correct diagnosis is crucial in children experiencing severe pain.
When should I see a doctor?
- Severe pain in or around the hip or groin area, especially during walking.
- A “giving way” feeling in the hip during walking or going up/downstairs.
- Altered sensation in the leg – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia).
- Unable to complete your normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.
In the first instance, if you have followed the P.R.I.C.E. principles and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Another warning sign is if your hip “gives way” whilst walking and once again, you should consult your doctor or visit A&E.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your knee, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.