Hip and groin pain are often confused due to the hip joint’s deep location and complex anatomy. While hip bursitis is frequently associated with pain on the outer side of the hip, it can also cause groin pain. This anterior discomfort involves anatomical structures and compensatory movement patterns beyond the inflamed bursa.
Understanding Hip Bursitis
Bursae are small, fluid-filled sacs that function as cushions, reducing friction between bones, tendons, and muscles. When one of these sacs becomes inflamed, the condition is known as bursitis. In the hip region, two main bursae are typically involved. The most common type is trochanteric bursitis, involving the bursa located over the greater trochanter, the bony prominence on the side of the upper thigh bone. This inflammation typically causes pain directly on the outside of the hip, which may spread down the outer thigh, often worsening with direct pressure, such as lying on the affected side at night.
The second type, iliopsoas bursitis, is located on the inside of the hip near the groin. Inflammation of this bursa is less common than trochanteric bursitis, but it directly causes pain in the groin area. Even the more common trochanteric bursitis on the lateral hip can lead to pain felt in the anterior hip and groin region.
The Connection: How Pain Refers to the Groin
Pain originating from the lateral hip can be perceived in the groin due to referred pain. The hip joint and surrounding structures share nerve pathways, making it difficult for the brain to pinpoint the exact origin of the discomfort. Nerves supplying the lateral hip also contribute to sensation in the anterior thigh and groin, which can confuse the pain signal.
Furthermore, inflammation of the lateral trochanteric bursa can lead to dysfunction in surrounding musculature, such as the gluteal muscles and the tensor fascia lata (TFL). Tightness or irritation in these structures places increased strain on the anterior hip capsule and hip flexor tendons. This strain results in anterior discomfort perceived as groin pain.
This pain can also result from altered movement patterns. To avoid the sharp pain on the outside of the hip, a person may unconsciously change their walking or standing posture. These compensatory movements overload the hip flexor muscles and anterior joint structures, creating secondary inflammation and pain deep in the groin.
Differentiating Groin Pain
While hip bursitis can lead to groin pain, several other conditions are more commonly linked to anterior hip discomfort. Accurately identifying the source of pain is necessary because management strategies vary significantly. Pain deep in the groin, particularly with certain movements, should prompt consideration of pathologies affecting the hip joint itself.
Hip osteoarthritis is a common cause of deep, aching pain felt primarily in the groin, sometimes radiating down the thigh. Unlike bursitis, osteoarthritis typically involves stiffness, reduced range of motion, and pain that is worse in the morning or after periods of rest. A labral tear, which involves the ring of cartilage lining the hip socket, also often causes a deep, constant ache in the groin. This condition may also involve a clicking, locking, or catching sensation within the joint during movement.
Another common cause of groin pain is a hip flexor strain, an injury to the muscles at the front of the hip. This pain is usually sharp and sudden, often occurring during activity like running or kicking. In contrast, bursitis pain is often more gradual in onset and is particularly exacerbated by direct pressure or prolonged standing and walking. The defining symptom of trochanteric bursitis is localized tenderness when pressure is applied directly over the bony prominence on the side of the hip.
Managing Bursitis and Related Pain
Conservative treatments are the initial approach for managing trochanteric bursitis and its related pain. Activity modification is a primary step, which involves avoiding activities that worsen symptoms, such as repetitive hip movements or lying on the affected side. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce both pain and inflammation.
Physical therapy is a core component of recovery, focusing on stretching the iliotibial band and hip flexors, as well as strengthening the abductor muscles that stabilize the hip. These exercises help correct underlying biomechanical issues that may have contributed to the bursa irritation. For cases that do not respond sufficiently to initial measures, a corticosteroid injection directly into the bursa can provide targeted relief from inflammation and pain.