Groin Pain

[Lisa]

I've been experiencing pain in my left and right groin when I stand from a sitting position. Running makes it worse. An MRI showed that I have arthritis in both hips. The pain feels like a nerve. It's not sore muscles. Sometimes I can't stand up straight or walk for a minute and then I slowly work it out. I have an appt. with a spine specialist this month. I don't want to be told that I shouldn't run. I'm a runner. I want to run. Do you know what this pain might be? The right side started 13 years ago and now the left side has started and it's a lot worse. I just became a runner 2.5 years ago and I'm 41 years old. Help!

[Gene Zeitler]

Groin pain can have several different causes. Given your history this is something that needs to be evaluated. I would be more than happy to see you or you can see an orthopedist. The reason I am recommending an evaluation is because the possible causes of your pain are varied and the treatment options are very different and I don’t want you to jump to conclusions based on some of the information that I discuss below. Outlined below are some of the possible causes of your pain. Please note that these are potential options are based on the information you have provided and it is not an exhaustive list. In order to accurately diagnose the cause of your pain your need to schedule an appointment with a professional.

Usually groin pain is caused by an over-stretch or strain to the muscles that run from the inside of the femur (upper leg bone) and attach to the pubic symphysis (the region where both of your pubic bones meet). These muscles include the pectineus, gracilis, adductor brevis, adductor longus and adductor magnus. Usually when someone strains their groin muscle they can associate it with a specific event such as running with high intensity and getting sudden intense pain or making a misstep and getting pain. Generally a groin strain will heal over time unless the muscle has a tear that is getting chronically re-torn or if the tear is too extensive to heal on its own. To aide in the healing process I will use manual therapy techniques to help breakdown the damage tissue and stimulate the remodeling process on the muscle and tendon. Applying Kinesio tape to the muscle helps to prevent chronic re-injury to the muscle by mildly limiting range of motion of the muscle and joint. It can also decrease inflammation by allowing improved removal of edema. Neuromuscular stimulation to the tissue with specific exercises can improve and reeducate damaged nerve receptors in the tissue while also increasing strength of the muscle.

My concern, however, is the duration of your injury and the fact that the MRI showed degeneration of your hip. Like I said above groin strains usually heal with time and your pain is long in duration. When was the MRI taken and to what extent is the degeneration? Also, were x-rays performed on the hip. When looking at hip degenerative changes it is sometimes more effective to have an x-ray than an MRI. You are definitely young to have hip degenerative changes, but I would want an x-ray to rule out a condition called congenital hip dysplasia. This is a condition someone is born with in which the hip joint is shallow and causes premature degenerative changes. If the hip pain is being caused by moderate to severe degenerative changes to the hip than running would not be a recommended form of exercise. Running is a high impact exercise which would cause further progression of the degeneration and exacerbate your problem. If the pain is caused by degeneration a guided injection to the hip can help alleviate the pain. I will often work to lengthen the hip muscles which decreases the compression on the hip joint and can decrease the hip pain. Strengthening the hip muscles can also help decrease the pain.

Femoroacetabular Impingement (FAI) of the hip joint can cause groin pain and is diagnosed with x-ray or MRI of the hip. The hip is a ball and socket joint. The femoral head is the ball which sits in the socket called the acetabulum. In FAI the socket or acetabulum reaches too far around the femoral head and when the individual flexes the hip the acetabulum impinges on the femur causing pain. FAI can also be caused by a deformity of the femoral head. Treatment for FAI often consists of decreasing activity, increasing hip strength and possible hip injections. If this fails surgery may be necessary.

Degenerative changes to the low back can also refer pain to the groin. The spinal surgeon will be able to diagnose this with x-rays and offer some orthopedic options for treatment. I usually recommend manipulation or mobilization to the joints, myofascial release to the muscles and strengthening the core muscles with a specific core strengthening routine.

There are also several non-musculoskeletal causes of groin pain such as kidney stones and an inguinal hernia. Again re-emphasizing the importance of having an evaluation. I hope this helps and please get an evaluation.

[Lisa Davis]

Thank you so much for your response. I see the spine specialist next week. I pray that I can get some answers.

[Lisa Davis]

Where are you located?

[Gene Zeitler]

Your welcome. Good luck. I am in Newtown and in Ridgefield. Gene

[Lisa]

I just realized I didn't answer a couple of your questions. I had two MRIs done in December 2009 - lumbar and pelvic. As to the degree of the degeneration, I don't know how to answer that. I had a linear tear and several mild buldging discs in my lumbar spine and arthritis in both hips. You have made more since to me than any of the doctors I've seen so far. The Pain Management Doctor thinks I have facet disease and fibromyalgia. Not sold on the fibro. It could very well be something I was born with and didn't start causing problems until I was 27. When I was a baby, the doctor put me in shoes mounted to a bar because my feet turned outward. My mom had to carry me around like that. Maybe it was a hip problem. Sorry, thinking out loud. I've been trying to diagnose myself because the doctors just want to throw drugs at me. That's not what I want. I don't like taking drugs. I'm in SC but willing to travel to CT if I need to. I'll see how it goes with the Spine Institute next week. Thanks again!