This week’s blog is focused on a commonly treated problem at Life’s Work Physical Therapy: hip pain. When clients describe front of hip pain, pain radiating down the front of the leg, pain in front of the hip joint and pain along the underwear line on the front of the hip joint, physical therapists consider this a primary hip problem. In the cases where pain radiates down the front of the leg, we do a thorough exam to rule out pain generated from the back. Pain in the front of the hip joint is very painful with walking, flexing the hip and getting up from a seated position. It may be accompanied by a click or shifting sensation. It’s important to get it evaluated by a physical therapist sooner rather than later. For tips on finding a good PT in your area, read our recent blog post on How to Find a Good PT.
So, why do hips hurt on the front of the hip joint or as clients often describe along the underwear line? In this blog, I will discuss the most common musculoskeletal causes of pain in the front of the hip. Bear in mind that sometimes these symptoms are caused by hip osteoarthritis that is quite advanced. If you believe this is you, see your primary care doctor to get imaging, referral to PT and to an orthopedic surgeon when appropriate. (This blog will not discuss front of hip pain caused by hip osteoarthritis.)
The diagram on the left is a back view of the hip joint showing the thigh bone (femur) going into the pelvis bone held together by ligaments.
The diagram on the right shows a cross section of the hip. As you can see, the top of the femur is shaped like a ball and the concave cavity of the pelvis is shaped like a socket. Appropriately named, the hip is a ball and socket joint. The round head of the femur spins and moves inside the deep socket of the pelvis. In an ideal world, all the muscles, ligaments and other soft tissue provide symmetric support on all sides of the hip joint so that the ball stays centered in the socket with motion.
When clients come to physical therapy with complaints of pain in the front of the hip, or pain along the underwear line on the front of the hip, we often find imbalance in the muscles, ligaments and other soft tissues that support the hip. In these cases, the femur cannot “park” in the center of the socket and often slips slightly forward. When the hip sits slightly forward, it irritates the front edge of the hip joint and can cause front of hip pain especially with walking, flexing the hip and getting up from a seated position. In physical therapy, we call this Anterior Hip Impingement.
Common Causes of Pain in the Front of the Hip or “Anterior Hip Impingement”
1. THE HYPERACTIVE PSOAS
In the diagram on the left, you are looking at a pelvis, the top of two femurs, the lower back and the bottom ribs. This is a belly side or front view of the body. The large rope-like muscles running adjacent to the lower back and attaching to the inside of the femurs are psoas muscles (pronounced “so-as”). The psoas muscles help lift the leg, as in climbing stairs, and also help you bend forward bringing your trunk toward your knees. Psoas muscles should relax when done working. When it’s hyperactive, it pulls the top of the femur forward making it hard for the femur to stay centered in the socket. With walking and other movements, the femur migrates forward, impinges upon the tissues and creates front of hip pain, or as physical therapists call Anterior Hip Impingement. So, often the number one cause of pain in the front of hip joint are hyperactive psoas muscles. This is treatable in physical therapy.
2. WEAK GLUTES
Gluteal muscles are located on our back sides. There are three main gluteal muscles, the gluteus maximus, the gluteus medius and the gluteus minimus. Collectively, we often refer to them as “the glutes.” As a group, they move the thigh behind the body as in kicking backwards. They also help move the leg to the side and turn the leg inward. Clients with pain at the front of the hip have very strong front of thigh muscles and very weak glutes. Weakness in the glutes leads to altered walking and movement patterns, poor flexibility into hip extension and a more forward position of the head of the femur in the socket. This is highly treatable with a prescribed physical therapy program.
3. POOR POSTURE
In prior blogs, I’ve discussed the importance of posture to prevent spine pain, headaches and ergonomic injuries. Believe it or not, poor posture can lead to front of hip pain as well. Most of us have the tendency to slump forward rounding our back as above on the left. When we stand, walk and even sit in poor posture, it puts unnecessary strain and stress through the muscles and other soft tissues that support the hips. Poor posture is often accompanied by weak gluteals and core and hyperactive psoas. With treatment in physical therapy, we correct the weakness and the hyperactive psoas AND our clients must improve their poor posture for the best long term results.
Front of the hip pain is a very painful and common complaint. If you are suffering from front of the hip pain, get help. If you live in the Portland area, contact us or call 503-295-2585, or visit us at lifesworkpt.com. For those of you living outside the Portland, Oregon area, go to apta.org and click on the “Find a PT” link.
Most clients who have pain on the front of the hip joint get better with physical therapy. If symptoms fail to resolve in physical therapy, other interventions are available through an orthopedic surgeon who specializes in hip injuries.
Thank you for helping me understand the pain I developed at the front of my hip. It began during my recovery from siatica.
I’m so grateful that I stumbled upon this story. I am definitely having pain in the front of my leg at the underwear line. It’s been slow progressive. I’m active at 54, but I’m suffering from osteoporosis arthritis, but never had this problem before. If I hadn’t googled and found this info I still wouldn’t have an idea what could be causing my pain.
Thanks for your comment! We’re so glad to hear this information was helpful to you.
I have pain right under the underwear line but on the very top of the leg. Actually tender to the touch when pressed.
We’re sorry to hear that! We hope you’re getting help with your hip pain.
Best of luck.
My pain is as described in the top front of my hip. It is almost impossible to raise my knee to put on socks or shoes, or to lift my leg (right only) to put on pants. So far, I have no trouble walking. Sitting, my right leg tends to fan out to the outside, and it is uncomfortable to put the knees together. Any thoughts?
We’re sorry to hear you’re experiencing hip pain. Please contact your physical therapist for a complete evaluation.
We wish you the best of luck!
Wow, I’ve had this exact sort of dull/aching pain along my right panty line/hip for about 5 months now. Originally I thought it was internal, had an ultrasound which was all clear, so I was left in the dark… finding this article makes a lot of sense! I started a new office job about 6 months ago, could it be caused by sitting/posture?
Thanks! We’re glad you found it helpful.
This is very helpful. Thank you.
I have pain as described, although the most excruciating pain is when I get up in the morning. I can hardly stand on my right leg. It doesn’t last a long time. I sleep on my back with pillows under my knees.
I do have osteoporosis and osteoarthritis, degenerative disc disease, and fibromyalgia. I am 77.
This helped me make an appointment today.
Thanks for your comment! We’re glad this was helpful.
Im 17 and have had this pain on and off since i hit puberty, today it has occurred again and this was very informative to know why i have pain in the front hip location – my tends to shoot down my leg and also starts making the top outer leg part of my knee ache aswell as usually experiencing pain in a line across my back where the dimples are…. is this normal? Today i dont have my period but im experiencing this pain… this is the pain i experience when i get my period (i dont usually have any other symptoms no cramping etc.)
Hi Loren. We are so happy that this blog post was helpful for your front of hip pain. If you are experiencing pain in your back and hip that is related to your menstrual cycle, you should definitely mention this to your gynecologist. Back and hip pain are common symptoms related to our menstruation however sometimes there is an underlying cause for these symptoms and it could be something that can be helped! A Physical Therapist with experience working on the pelvis can be a helpful part of your team as well–pain related to menstruation often times has an effect on the muscles in and around our pelvis including our back and hip muscles contributing to pain. Talk with your gynecologist and also find an experienced Physical Therapist in your area. If you are local in the Portland area, we have a pelvic health specialist in our clinic. Give us a call at 503-295-2585 to schedule a PT evaluation. If not, then visit Pelvicrehab.com to find a great Physical Therapist!
Wow, Thank you for the informative article. I am having the same issues. I will be contacting my doctor at once to get something rolling on that.
Thank you for posting this clear description of the symptoms and clear discussion of the possible causes. After completing physical therapy for a partial knee replacement (right side) I started riding my bike. As I progressed in strength these symptoms appeared on my left side. Back to physical therapy I guess.
I just don’t see how PT can make this all better? I exercise 4-5 days a week. My hip pain has gotten so bad that I can no longer do jumping lunges, jumping squats, burpees…anything that requires power from my legs. I stretch everyday. I have been working on my posture with my chiropractor. The pain is always there. Sometimes it radiates out to the side causing very tender painful bursitis, and when I’ve been walking funny from the pain for several days my SI joints begin to hurt really bad!
Your telling me PT will make all this go away? It’s far too expensive to experiment with! My husband got PT on his broken thumb one time and we were charged $300.00. Who can afford enough PT to even make a difference?
Thanks for your comment, Roxanne. I’m sorry to hear you’re experiencing this pain! We often counsel patients about the importance of having a good physical therapist on your health care team. When looking for a PT, find one with the designation of FAAOMPT (fellow in orthopedic manual physical therapy), who does hands-on treatment as a standard part of care. You can read more about how to find a good PT in our blog post, “Ask a Physical Therapist: How Do I Find a Good PT I’ll Actually Like?” Best of luck!
I can relate. Oregon drs day we don’t believe in drugs! I’m in excruciating pain in the pantyline like legs is broken there. They say the remedy is a lot of walking when the issue is I can’t stand or walk.
Hi Joseph! Thank you for your comment. Unfortunately, the more you roll or sprain your ankle, the more likely it is to happen again in the future. Ligaments connect bone to bone and when you sprain them they lose some of their stability. Physical therapy can help and I would highly recommend you seek out physical therapy care to keep this from happening again and help you return to pain free walking.
very interesting read indeed! This pain has just started with me but has been very intense. My job has changed recently requiring me to sit for long periods of time. This has made me understand how important it is to KEEP moving. I am 60 and suddenly things seem to deteriorate quickly!
I have hip pain at the underwear line and almost always have a burning radiating pain in the front of my upper thigh and around side to upper buttocks. Especially at night in bed if I lay on my opposite non burning side. I always need to turn and lay on my back to ease some of the pain. At times when I walk I have to put pressure w my fingers on the underwater line where the leg bends to ease pain. I am 46. This has been ongoing now
for at least a few months
We’re sorry to hear you’re experiencing this pain. If you live in the Portland, OR area, we’d be happy to help you! Please contact our office to schedule an initial evaluation.
i too find this article to be very good. thank you.
I was diagnosed with Meralgia Parethetica 3 years ago. I’ve been having cortisone shots every 4-5 months into my hip for the pain. My pain is a burning, stabbing, electric like sensation in my outer thigh & hip. However, I have a click in my hip crease when I do leg lifts and pain at the panty line when I sit. Sitting is particularly painful. The nerve is inflamed (confirmed by ultrasound at injection time). Could I have been diagnosed wrong for MP and instead have a hip issue?
We’re sorry you’re suffering with hip pain. Unfortunately, we can’t speak to your particular situation without evaluating you first. If you live in the Portland, Oregon area we would love to help you! Please contact our office at (503) 295-2585 to schedule an initial evaluation. Or, check out our blog on how to find a good PT in your area: https://lifesworkpt.com/2017/03/how-to-find-a-good-pt/
Best of luck!
Thanks a thousand! … It is exactly what you say, it helps me a lot with this, I recommend it https://bit.ly/30TeuqZ
Great to hear that the content was helpful!
I get this pain when I sit too much and do our books as I hate sitting, hardly ever sit, I am an outdoor person. But I also fell on concrete with my right knee last summer, didn’t break anything, amazing at 72, but that pain is worse now when I sit. So nothing else but to hit the gym in wintertime. I also have a BOSU ball at home and do stretches of my groin on the stair rail. It’s the stuff that ballerinas do. But moist heat from a Battle Creek electric pillow called thermaphore helps the most. You got to buy that pillow ! We also own a deep 6 ft tub that is wonderful to soak in. I do stretches of the frontal hip muscles quite often. Sitting shortens the hip flexors.
Thank you for the tip on the pillow! We will have to check that out. Great takeaway from our post–sitting definitely shortens the hip flexors and the hips can be hard to open up after a whole day of sitting. To add to your hip stretches you’re doing you can also try 360 Degree Breathing. Your hip flexors attach to your segments of your lumbar spine (your lower back) all the way up to your rib cage. They are such long muscles. They also attach to your diaphragm so by doing really great diaphragmatic breaths you can give your hip flexors a little massage! Check out our blog post on How to Perform a 360 Degree Breath and see how it feels. To help with your knee pain with sitting, stretching out your hips can be super helpful, as well as making sure you are getting your knee straight during the day. Read the “Knee Extension Stretch” description in this blog post (https://lifesworkpt.com/2017/10/how-knees-age/) and give it a shot! If your interested in working with a physical therapist give us a call at 503-295-2585 for in-person or telehealth visits.
Hi. I am a 58 year old bricklayer and have had pain with movement for 2-3 years now. About where the front of the legs meet the torso. Especially bad after the hour long drive to and from work. I also have an weird urge to strongly stretch this area upon standing from both lying and seated positions. Really strong urge! It’s like my legs don’t want to go until I do a strong stretch. This problem is bilateral, in the front of my body. Also, up until 2-3 years ago I was an active weight trainer. Back squats, and Zercher style front squats which really seemed to target my quads. Did I damage myself doing these exercises!
Hi Robert, thanks for your comment. Firstly, you did not damage your body by doing those great weightlifting movements. Our bodies are efficient and smart and will work hard to avoid damage even while performing heavy, complex movements. As far as your pain you experience, it is hard to say what exactly is happening without a full evaluation, but it does sound like your psoas muscles are overactive while sitting during your commute. Overactive psoas muscles usually stem from poor trunk stability/core strength causing those muscles to overwork to compensate for weakness elsewhere in your trunk. Check out our blog post “The Core: So much more than just crunches!” to learn how to turn on your core effectively. Also try to adjust your seat in your car to see if you can offload your hip flexors– increase the lumbar support, tilt the seat down or up. Try some different postures to see if it helps give you more support. You should definitely see a Physical Therapist to rule out the possibility of your discomfort stemming from your spine and to lead you through effective exercises. If you are in Oregon, give us a call at (503)295-2585 to set up an in person or virtual visit! Otherwise check out our blog post on How to Find a Good PT or visit aaompt.org.
This exact pain happens to me putting pressure on the underwear line seems to help when I’m walking when it flares up and I’m walking sometimes my leg I’ll just give out it flares up when I’ve done at three or 4 mile walk every day and then I take a breakIt seems to hit Is it from overworking it and possibly osteoarthritis I am not sure but I don’t like it I am 61 years old
Hi Peggy! I wouldn’t like that either! The good thing is that most musculoskeletal pain like you are describing has a root cause that can be treated. I would recommend trying physical therapy. PT can help diagnose what’s going on and start a treatment program to get better. 61 is too young to deal with this kind of pain!
I am female 86 years young ; ) just started 2 days ago with top of the hip sorness ???? I have been pretty active…til covid…had to give up my swimming…now just gently bounce on trampoline to music of Abba…also need a staff to keep my balance when I walk on the beach or uneven trails. ????
Hello! Lower right back pain started during a diverticulitis flare. The pain traveled over to right hip, down the leg front to the knee. Light numbness on leg. I’ve seen a PT and did the stretches for 4 weeks. No improvement. Have a doctor appointment this week.
Hi Tracy! I’m sorry you didn’t get good results from your PT. There are many factors that can influence the kind of pain you describe. If the stretches aren’t the right exercises for your symptoms then no matter how long you do them, it isn’t going to help. I recommend that you try PT again, but look for a physical therapist who specializes in orthopedic manual therapy.