You Keep Straining Your Groin. What If Your Hip Is Actually the Problem?

September 22, 2026

Reviewed by: Drew Burleson, M.D.

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KEY TAKEAWAYS

• Recurring groin pain isn’t always a groin strain. In some cases, the true source of pain is femoroacetabular impingement (FAI), a structural problem within the hip joint.
• FAI can closely mimic a muscle injury. Because symptoms often overlap with a traditional groin strain, the condition may go undiagnosed without a thorough evaluation.
• The right imaging can make the difference. Specialized hip X-rays can reveal cam or pincer lesions that may not be obvious on standard imaging.
• Early diagnosis can help active patients stay active. Identifying and treating FAI may relieve pain, restore function, and help preserve the natural hip joint for the future.

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Recurring groin pain is not always a muscle strain. According to Dr. Drew Burleson, some patients with repeated “groin strains” actually have femoroacetabular impingement (FAI), a structural hip condition that can cause similar symptoms and often requires specialized X-rays to diagnose. Identifying the true source of pain can help active patients return to the activities they enjoy while protecting the long-term health of their hip.

You rest. You go to physical therapy. You get back to running or playing sports. Then the pain returns.

If you’ve been treated for multiple groin strains but the pain keeps coming back, the problem may not be the groin at all. In some cases, recurring groin pain is caused by femoroacetabular impingement (FAI), a structural issue within the hip joint that can closely mimic a muscle strain.

According to Drew Burleson, MD, of Beacon Orthopaedics & Sports Medicine, FAI is an under-recognized cause of groin pain, particularly in younger, active patients.

“There is an under diagnosed problem,” Dr. Burleson says. “You see a lot in active people where they have groin pain and they are repeatedly going to the doctor and they‘re told they have repeated groin strains.”

For some patients, the actual problem is femoroacetabular impingement, or FAI, a condition caused by an abnormal fit between the ball and socket of the hip.

Could It Be Hip Impingement?

You may benefit from a hip evaluation if you have:
• Recurrent groin pain
• Pain with running, cutting, or sports activities
• Pain after prolonged sitting
• Limited hip motion or stiffness
• Symptoms that return despite physical therapy
• Multiple diagnoses of a “groin strain” without lasting improvement

When a Groin Strain May Actually Be Coming From the Hip

A traditional groin strain involves an injury to the muscles or tendons around the groin. FAI is different. The problem originates in the hip joint, but the pain is often felt in the groin.

The hip is a ball-and-socket joint. With FAI, the shape of the ball, the socket, or both can create abnormal contact within the joint. One common form involves extra bone on the ball of the hip, known as a cam lesion.

Dr. Burleson compares it to a children’s toy.

“Think about it like a round peg in a round hole,” he says. “In this problem, the round peg is more of an oval.”

As the hip moves, that abnormal shape can cause the ball and socket to repeatedly contact each other, potentially damaging the cartilage and labrum, the ring of tissue that surrounds the hip socket.

“It’s not necessarily a muscular injury,” Dr. Burleson says. “It’s more of a structural problem that is actually causing the groin pain.”

Why FAI Can Be Mistaken for a Groin Strain

The symptoms can look remarkably similar. Both conditions can cause pain in the front of the hip or groin, particularly with running, sports, repeated hip flexion, or prolonged sitting. That overlap can make an accurate diagnosis difficult.

“If either injury occurs in isolation, the initial treatment is generally the same, physical therapy, regardless of whether it is a groin strain or hip impingement,” Dr. Burleson says.

The distinction becomes more important when the problem keeps returning.

“If you keep having repeated problems and you can’t necessarily do the stuff you want to do, you can’t run, you can’t play sports, and it’s impacting not only your physical activity but also normal day-to-day life, that’s when you really want to differentiate between recurrent groin strains and a deeper problem with the hip joint.”

When Should You Have Your Hip Evaluated?

If groin pain improves with treatment and stays away, an extensive evaluation may not be necessary.

But if the pain repeatedly returns or does not improve with rest, anti-inflammatory medication, and physical therapy, Dr. Burleson recommends considering an orthopedic evaluation.

The evaluation may be simpler than many patients expect.

“A lot of the time, we can figure out what’s going on with just X-rays, a physical exam and a history,” he says.

Why the Right X-Ray Matters

Specialized hip X-ray views allow physicians to see the femoral head and socket from different angles, making subtle bone abnormalities easier to identify. The abnormal bone associated with a cam lesion may not always be obvious on routine imaging.

“The people who don’t see this problem often don’t get those X-rays, so they don’t see it,” Dr. Burleson says. “And it just means they don’t make the correct diagnosis.”

Because an X-ray is a two-dimensional image, the position of the hip during imaging can significantly affect what is visible.

Dr. Burleson compares it to looking at a mountain from different angles. From one perspective, its height may be difficult to appreciate. Change the angle, and the shape becomes much more obvious. That is why obtaining the appropriate imaging can be an important step when evaluating persistent groin or hip pain.

How Is Hip Impingement Treated?

Treatment depends on the patient and severity of the problem. In many cases, the initial approach includes physical therapy, activity modification, and other nonoperative measures.

When those treatments do not provide adequate relief, hip arthroscopy may be considered. During this minimally invasive procedure, the surgeon can evaluate and repair a torn labrum while also addressing the abnormal bone causing the impingement.

Dr. Burleson compares the labrum to a gasket around the hip socket.

“The labrum acts like a bumper or shock absorber and creates a suction seal around the hip socket,” he explains.

The surgeon can also reshape excess bone to restore a more normal contour to the femoral head and improve the mechanics of the joint.

Why Recognizing the Problem Can Matter

FAI is not limited to older adults. Dr. Burleson commonly sees the condition in teenagers and adults in their 20s, 30s, and 40s, particularly those who are active and otherwise have healthy hip joints.

Hip arthroscopy for FAI is often considered a hip preservation procedure because it addresses the underlying mechanics while preserving the patient’s natural hip joint. The abnormal contact associated with FAI can damage the labrum and cartilage over time and may increase the risk of developing hip arthritis in some patients.

“For young active people, this is a way to alleviate hip pain, get you back to doing the activities that you want to do while at the same time preserving your native hip joint,” Dr. Burleson says.

What Is Recovery Like?

Hip arthroscopy is typically performed as an outpatient procedure. Patients generally have three small incisions and use crutches for approximately two to four weeks. Dr. Burleson says many patients are doing well with normal daily activities by four to six weeks.

Athletes are typically able to return to competitive sports by approximately three months, although the timeline can vary depending on the procedure, the demands of the sport, and the individual’s recovery.

Persistent Groin Pain Deserves a Closer Look

Not every groin strain is a hip problem. But if the same pain keeps returning despite rest, physical therapy, and activity modification, it may be worth asking whether the hip itself is contributing to the symptoms.

Dr. Burleson frequently sees patients who have been treated repeatedly for groin pain without identifying the underlying cause.

“I hear this story all the time,” he says. “They’ve been told there’s really nothing to do about this.”

A careful history, physical examination, and appropriate X-ray views may reveal a structural problem that has gone undiagnosed. For athletes and active adults, identifying the true source of recurring groin pain can be the first step toward returning to the activities they enjoy while helping protect the long-term health of the hip.

If your groin pain keeps returning despite rest, therapy, and activity modification, an evaluation by a Beacon hip specialist like Dr. Burleson may help determine whether the source of the pain is actually coming from the hip joint.