When people have pain in the front of the hip, they often assume it’s just the same arthritis Grandma or Grandpa had, but pain in the front of the hip can actually be caused by a number of different issues. In order to fix it, we have to first find out what might be damaged or hurt that’s causing the pain. As you’ll see in the brief video above, to do that we examine the hip, layer by layer. We start on the surface of the hip at the skin layer.
At the skin layer, the L2 spinal nerve is what we are looking at. This nerve branches off the lumbar spine in your back and supplies the front of the hip. If there is a problem in your lumbar spine, this can refer to the hip and cause pain in the front of the hip. Even if you feel no pain in your lumbar spine, this can still be the source of your hip pain.
If the L2 spinal nerve is the culprit, the skin over the front of the hip on the affected side will feel different from the skin the other side. You can test it to see if it feels different by using touch, pinprick, and hot or cold stimulation.
Quadriceps Muscles and the ASIS
The next layer down would be the ASIS, which is the place where the quadriceps and other muscles attach. It sits right at the front of the hip. If it’s the quadriceps muscles that are causing the problem, then the ASIS as well as the quadriceps muscles will be tender.
Iliopsoas and Adductor Muscles
Down a bit deeper, in the next layer, we see the iliacus and psoas muscles, together known as the iliopsoas. These muscles bridge the pelvis/spine and the hip. Below these rest the adductor muscles. At this layer there is also an iliopsoas bursa, which is simply a fluid-filled pouch that serves as a cushion between moving parts to minimize friction, and a whole bunch of ligaments around the hip.
If it’s the iliopsoas or adductor muscle causing pain in the front of the hip, it should be very tender if you put pressure right over the hip joint itself or just around those muscle areas.
Hip Joint or Labrum
At the deepest layer, you have issues in the hip joint itself and the labrum, which is the lip around the hip joint. Pain in the front of the hip could be due to hip arthritis or a tear in the labrum, and symptoms could include decreased range of motion or clicking with pain when you walk. You can also test this layer: lift your leg, as if you were getting out of a car, or sit Indian style. If the hip or labrum is the culprit, these movements will hurt in the joint. Testing the range of motion is also easy. Just look at how much the affected hip is able to move while putting on your socks or shoes, for example, versus the other side.
The sacroiliac (SI) joint can also refer pain to the front of the hip. The SI joint is where the sacrum, or the tailbone, and the back of the hip come together. It’s part of a joint system that makes up what’s called pelvic ring, consisting of one joint in the front and two in the back. These joints allow forces to travel from the leg to the spine. So if the problem is due to the SI joint, in addition to having pain in the front of the hip, you’ll often have pain in the back of the hip as well.
The upshot? The hip is complex, and pain in the front of the hip alone can be caused by irritation or damage to one of a number of different structures. The key to figuring out how to fix it is to first figure out what’s causing the problem. From there we can seek regenerative-medicine solutions to tackle the pain once and for all.