Pain in the groin or deep in the front of the hip, often described as pinching rather than aching.
Worse after sitting for a long time — at a desk, in a car, in a cinema.
Worse getting out of a car, which is frequently the single most painful movement.
Pain on squatting, on lunging, or bringing the knee towards the chest.
The C-sign: you instinctively cup the side of your hip with your hand to show where it hurts.
Clicking, catching or a brief sense of the hip locking.
Stiffness turning the hip inwards, noticed when crossing your legs or putting on socks.
Pain referred to the buttock or the front of the thigh, though not usually below the knee.
Why it happens
A cam deformity: extra bone where the ball meets the neck of the thigh bone, so it is not perfectly round.
A pincer deformity: the socket rim is slightly too prominent and over-covers the ball.
Most often a combination of both, present since the hip finished growing.
Sports played through adolescence that load the hip in deep flexion — football, cricket, hockey, martial arts, dance, gymnastics.
Prolonged deep sitting or squatting, which repeatedly brings the two prominences together.
Occasionally, a labral tear from a single significant twisting injury.
Slightly shallow socket coverage in some patients, which needs distinguishing from impingement because the treatment differs.
See someone sooner if…
Groin pain has not settled after three months of treatment for a presumed muscle strain.
The hip is catching, clicking or briefly locking.
You cannot weight-bear after an injury, which needs urgent assessment.
Pain is waking you at night.
You are a young adult with progressive groin pain and stiffness, since early diagnosis meaningfully widens your options.
The diagnosis that takes years to arrive
A young adult presents with groin pain. It is worse after sitting, worse getting out of the car, and worse squatting. They are told it is a groin strain, then a hip flexor problem, then possibly a hernia, then perhaps something coming from the back. They have physiotherapy for the adductors, an ultrasound of the groin, and eventually an MRI of the lumbar spine.
Two or three years later, someone examines the hip specifically for impingement, and finds it in thirty seconds. This is one of the most commonly and lengthily misdiagnosed conditions in musculoskeletal medicine, and it matters, because the cartilage is taking damage throughout.
What the labrum does and why its tear matters
The labrum is a ring of tough cartilage around the socket rim. Beyond adding depth, it forms a suction seal that keeps a thin pressurised layer of fluid over the cartilage surfaces. That fluid layer is what allows the hip to bear several times your body weight with negligible friction.
Tear the labrum and the seal is broken. The fluid layer is lost, friction rises, and the cartilage begins to wear at the rim. That is the mechanism by which impingement in a twenty-five-year-old becomes arthritis in a forty-five-year-old — and the reason for treating it as a mechanical problem worth correcting rather than pain to be managed.
Things it is commonly confused with
Condition
How it differs
Adductor or groin strain
Tender to press on the muscle itself, hurts on resisted squeezing, settles within weeks with rest
Sportsman's hernia
Pain on coughing, sneezing or sitting up, tender lower down in the abdominal wall
Hip flexor tendinopathy
Pain on resisted lifting of the knee, tender over the front of the hip rather than deep in the groin
Referred pain from the spine
Associated back pain, changes with spinal movement, may cause pins and needles below the knee
Hip arthritis
Older patient, morning stiffness, narrowed joint space on X-ray
Hip dysplasia
Shallow socket rather than a prominent rim; needs a socket-repositioning operation, not a keyhole one
Stress fracture of the femoral neck
Athlete with a recent increase in training load, pain on weight-bearing, needs urgent imaging
Groin pain has several causes, and they respond to very different treatment.
Non-surgical treatment comes first, and often works
Not every impinging hip needs an operation. A proper programme — three to six months, targeting the deep hip rotators, the glutes and trunk control, combined with genuinely modifying the positions that pinch — settles symptoms in a substantial proportion of patients.
Where it does not work, and where imaging confirms a clear impingement shape with a labral tear and healthy cartilage, arthroscopy becomes a reasonable option. The order matters: rehabilitation first, surgery for those it does not help.
How it is diagnosed
Examination is decisive: bringing the hip into flexion with inward rotation reproduces the pain in a positive impingement test, and range of internal rotation is usually reduced.
X-rays in specific views, which show a cam or pincer shape and — critically — whether the joint space is preserved.
MRI, ideally with contrast in the joint, which shows the labral tear and the state of the cartilage.
CT with three-dimensional reconstruction, where surgery is planned, to map exactly where the bone needs reshaping.
A diagnostic injection of local anaesthetic into the joint, which is genuinely useful — if it abolishes the pain, the hip is confirmed as the source.
First, without surgery
What to try before an operation
This list comes first on purpose. For most people reading this page, it is the whole treatment — and where it is not, having genuinely worked through it makes the decision to operate a much clearer one.
Three to six months of targeted rehabilitation for the deep hip rotators, gluteal muscles and trunk control.
Modifying the positions that pinch: raising your chair, avoiding low sofas and deep squats, adjusting your car seat.
Changing how you sit at work, since prolonged deep hip flexion is often the largest single aggravating factor.
Adjusting training load and technique in sport rather than stopping entirely.
Anti-inflammatory medication for flares.
An intra-articular injection, which serves both to relieve symptoms and to confirm the hip as the source of pain.
Manual therapy for the surrounding muscles, which are usually tight and contributing.
Reassessment at three months, since a hip not improving with good rehabilitation needs a different plan.
If surgery is needed
And when it genuinely is
Each option below says when it applies, not just what it is. If your situation does not match, that is a good reason to ask more questions.
Three years of 'groin strain' turned out to be a torn labrum
“I had physiotherapy for my groin, an ultrasound for a hernia and an MRI of my back. Nobody examined my hip. The pain was always worst after a long day at my desk and getting out of the car, which turned out to be the clue. The examination took about a minute and I finally had an answer.”
Priya S., 29 · Software engineer
Vesu · 11 months after treatment
Outcome. Hip arthroscopy with labral repair and reshaping of a cam deformity. Off crutches at three weeks, pain-free at desk work by two months, back to running at five months.
A consultation means your imaging on the screen, a plain explanation of what is actually wrong, and an honest opinion on whether you need surgery — including when the answer is no.