Differentiating hip and groin pain and dysfunction in assessment can be a mine field.
Below are some suggestions of clinical indicators for different areas of discomfort and the tests that are most likely to confirm the true source of the pain.
Hip flexor related pain
– Pain and/or weakness with resisted hip flexion
– Pain and/or weakness with resisted straight leg raise
– Positive thomas test
– Tenderness on palpation
Sacroiliac joint related pain
Need at least two positive tests for SIJ to potentially be source of symptoms:
– Distraction
– Compression
– Thigh thrust
– Sacral thrust
Inguinal related pain
– Pain location in the inguinal canal region
– Tenderness of the inguinal canal
– Pain with coughing and sneezing
– Pain with abdominal contraction
– No palpable inguinal hernia present
– Will often have no pain on resisted hip flexor strength testing → this is often how to differentiate between hip flexor related pain and inguinal related pain
Adductor related pain
– Pain and/or weakness with resisted adduction
– Pain with adductor stretching
– Tenderness on palpation
Pubic related pain
– Presence of pain across pubic region
– Tenderness on palpation of the pubic symphysis and the immediately adjacent bone
Intra articular hip related pain
– Pain with hip ROM → in particular hip flexion and internal rotation
– Pain with FADIR
– Pain with FABER
– Positive Scour test
– Antalgic gait pattern
– Mechanical symptoms such as catching, locking, clicking or giving way.
Greater trochanteric pain syndrome
GTPS encompasses multiple diagnoses including external snapping hip, trochanteric bursitis and gluteus medius and gluteus minimis tendinopathy or tearing and mainly affects women in the 40-60 year old age bracket.
– Presence of pain at the lateral hip, with symptoms potentially radiating to the level of the buttock and lateral thigh
– Pain often worsens with single leg weight bearing activities such as putting on pants or getting in/out of the bath, walking, stair climbing, and/or lying on the affected side.
– Tenderness on palpation specifically on the lateral or posterior aspect of the greater trochanter
– Pain with 30 second single leg stance
– Pain with resisted FADER
– Pain with resisted abduction
– Pain with resisted external rotation test
If your hip or groin are bothering you and you would like to have any of the above tests completed to confirm your area of injury, book an appointment with your physio today.
