Arthritis might be your first thought when you’re experiencing chronic pain at the front of your hip, but the truth is, there are many different issues that could be causing that hip pain. The ultimate goal, of course, is to fix the pain, but eliminating the pain once and for all involves also fixing the problem that is causing it…not just applying a temporary solution for pain relief. Today we’re going to explore the hip and 5 possible causes for pain specifically in the front of the hip as well as cover ways you can test for each. Watch Dr. Centeno’s video below, and then we’ll summarize the causes layer by layer starting at the very first layer, the skin.
1. The L2 Spinal Nerve and the Skin
The L2 spinal nerve branches from the lumbar spine in the lower back and into the front of the hip. If the L2 nerve becomes irritated due to an issue in the spine, pain can be referred down the nerve branch and present at the front of the hip. Wouldn’t you have back pain? Not necessarily. You may have back pain, slight back discomfort, or even no back pain at all when a nerve becomes irritated at the spinal level.
One sign that the L2 nerve may be the problem is that the skin at the front of the hip where there is pain will feel different from the skin over the opposite hip. You can test skin sensation on both sides by using touch, pinprick, and hot or cold stimulation.
2. The ASIS and the Quadriceps Muscles
The anterior superior iliac spine (ASIS) is located on the iliac bone on both sides of the hip; it’s the bony projection you can feel at the front of the hips. In addition, the quadriceps muscles in the thigh attach here. This would be the next layer of concern when searching for the cause of pain at the front of the hip.
If there is a problem with the quadriceps muscles, these muscles and the ASIS will feel tender when pressure is applied.
3. The Adductor and Iliopsoas Muscles
Moving to the next layer, we have two muscles (the psoas and iliacus) that make up the iliopsoas muscle. These muscles bridge the hip, pelvis, and spine. Beneath the iliopsoas are the adductor muscles and an iliopsoas bursa. A bursa is a pouch filled with fluid. Its purpose is to minimize friction as structures move and provide a cushion between those structures, including the many ligaments that support the hip.
If the pain at the front of your hip is due to one of these muscles, when you put pressure directly over the hip joint or the adductor or iliopsoas muscles, it will be very tender in these areas.
4. The Hip Joint Itself
Focusing down to the deepest hip layer, you have issues that involve the hip joint itself, including the hip labrum, the protective lip around the joint. A labrum tear or arthritis in the joint could cause pain in the front of the hip. Additional symptoms may include pain or clicking with walking and decreased range of motion in the hip.
If you the hip joint or labrum are the problem, if you lift your leg or sit cross-legged on the floor, you will feel pain in the hip joint. You can also check your range of motion by comparing the affected hip to the opposite hip while putting on your shoes for example. The affected hip will have less range of motion when performing this or similar moves.
5. The SI Joint
The sacroiliac (SI) joint is located where the tailbone (the sacrum) and the back of the hip (the iliac) meet. A problem in the SI joint can present as pain at the front of the hip. How can a structure at the back of the hip affect the front? The SI joint is part of a joint system called the pelvic ring, which has one joint at the front of the pelvis and two at the back. These joints absorb forces as they travel from the leg and into the spine.
If the SI joint is the cause of pain at the front of your hip, an additional sign will likely also be pain at the back of the hip.
Chronic pain at the front of the hip doesn’t automatically mean arthritis. As you’ve learned, it can be any number of issues affecting a variety of structures in the hip or even in the spine or leg muscles. Temporarily relieving the pain won’t fix the problem; the goal is to find and fix the problem using regenerative-medicine solutions. Fixing the problem, in most cases, should tackle the pain once and for all.