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 GLUTS
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 gluts.” 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 gluts. Weakness in the gluts 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.
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!
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.