GROIN PAIN AFTER Total Hip Replacement- Hip Tightness after THR

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IMHO this happens far more often than is recognized by the doctors and physical therapists. If you have groin pain after a THR investigate if it is your psoas muscle and Iliopsoas Tendinitis. Your physical therapist should be able to easily find your psoas muscle and push down and you will recognize that is where the pain is coming from.

AFTER TWO WEEKS- If you CAN do this,

Lay flat on your back on the bed with your shoes off

Keeping your heel in contact with the bed, bend your knee and drag your foot up towards your butt

But CAN'T do this

Lay flat on the bed with your shoes off

Keeping your leg straight (don't bend the knee)

Raise your foot up off the mattress (you are using your hip muscles for this)

AND your groin hurts like HELL in certain situations, but not all situations, you probably have iliopsoas tendonitis.

You need to pay attention and be VERY careful. Think of tendonitis as little small rips into the tendon. What you need to do is rest the tendon and don't do anything to make the tears bigger (deeper). You want to not aggravate it, let it rest and let those little rips heal up.

Most people think that they simply need to exercize or stretch more, and in fact this is the opposite of what you should do, doing that only makes it worse and can result in a permenet condition as scar tissue will form over the rips.  Trust me on this I had tendonitis in my IT Band that I ignored, kept on working, that tuned into a perment condition (Tendonosis). It actually disabled me, so I am rather an expert on Tendonitis.

During your hip replacement they have to manipulate your leg and move it into positions it is not used to, this can pull that psoas muscle/tendon. OR your prosthesis is to big, or placed wrong and you will have this conditon until they go in and fix that.

Since I previously had Tendonosis I recognized the pain and symptons immediately. It was confirmed by my physical therapist. What I did was not exercize at all for 3 - 4 weeks. That is the amount of time it took for that iliopsoas tendonitis to heal back up. Only after that was healed up did I take up exercizing again, my physical therapist simply gave me leg massages during this time.

I found I had to lay down on the sofa not sit in a chair, as sitting in a living room chair was just a bad position for that tendon, so I layed around until it healed. What was very odd is that sitting in the chair wasn't that much of a problem initially, but when I got up from the chair it hurt. The good news, it did heal up just fine and I have had no further issues with it.

Google -  iliopsoas tendonitis after hip replacement

There is one woman on here I was able to help. Her prosthesis was digging into the tendon, her doctors did a surgery and did something (not sure what) and that fixed it. I know she did not have to have her prosthesis removed or changed out, instead they did something with the tendon instead.

Another woman I was able to help, she was doing great after her THR, about a month/ 5 weeks after her THR she was stepping off a pier to get into a boat and that is where she injured her iliopsoas tendonitis. Of course she was "stretching" and exercizing thinking that would help, which it did not, she followed my advice, simply rested the tendon by not doing anything that aggravates it and in about 3 to 4 weeks she was fine also.

If you have pain in your groin it is either nerve damage or the iliopsoas tendonitis. Nerve damage will travel down to your foot, Iliopsoas Tendinitis will stay sore in your groin area.

I am not a big fan of rigerous exercize right after surgery anyway. Think about it, they cut off the top of your leg bone and shove a stick in it. It simply takes time for that stick to get knitted back into the leg bone. I was forced to not exercize because of the iliopsoas tendonitis and at 4 weeks I started. In a matter of one week I went from using a walker/trolly to walking completely on my own with nothing. I just focused on keeping my back very straight and not bending over, in other words being very attentive to keeping good posture. I am more of a fan of , don't push yourself, let the bones heal up, when the bones are good and strong you will be able to get back into the swing of things very quickly. Good Luck to you.


Here is Shaye's reply to me---------------

Interesting that you say 'as sitting in a living room chair was just a bad position for that tendon' as I find sitting on an upright dining chair doesn't feel good after about 10 minutes. Driving is easier as I can tilt the seat back. In the article I read it said experiencing the pain getting out of a car was a sure sign this was the problem but so far I've only done the 'knees together and swivel' like we did when we wore mini skirts haha!! Next time I get in the car I'll try it the way I did it before I ever had a hipproblem.

Hi again Shayes

An update- I wentto my physio last week with info I'd printed off the internet re iliopsoas tendon weakness/inflammation. Now I know it's always difficult to see a 'medic' with info you've gleaned yourself but I've never been backwards in coming forwards - if you know what I mean! After a bit of discussion he got me on the couch and started prodding around the groin area - where I have most pain. he found a few very tender areas. he admitted it looked as if my iliac muscle was inflamed. One of the exercises he'd given me was all wrong for this and was making it worse!!!

He showed me how to massage it myself, which I've been doing for 5 minutes twice a day and it's soooo much better already.

According to the internet this is quite rare but it usually shows up later rather than sooner - I'm 15 weeks post op. However, when I talked to my brother about it he said he had the same thing 7 months post op!! One of the classic signs is pain getting into or out of a car- when you put one leg in/out first. I just can't do that, it's too painful.

And then my reply back-------

FWIW it will take about 3 to 4 weeks to have that Psoas muscle/tendons heal. IF after about 2 months it doesn't get any better you will most likely need a small surgery. I went from tendonitis to tendonosis (and you can look up tendonosis) of my IT band. Thankfully the THR totally fixed that, and that was a huge relief as my IT Band tendonosis caused me more pain than my bad hip. Please please take very good care of your psoas muscle so that it does nto beocme permenent. I didn't with my IT band and I suffered for 3 years, I was basically handicapped because of it.

My phyical therapist is the one who about 2 weeks in after my surgery told me it was my psoas muscle, he went and felt for it. He knew. When we had our THR they are moving that leg around in positions it never normally goes when they are dislocating the hip, this is what causes Iliopsoas Tendinitis. If you think of it this way it kind of makes sense doesn't it? Lay down rather than sit, lay around for a month and hope like Hell it heals.  If you have to get into and out of a car, wear pants and lift your leg by pulling up on your pants with your arms so as not to aggravate that muscle. Don't do anything that aggravates that muscle, pray that it heals. If after 2 months it never does heal go back to the orthopedic surgeon and ask for a small surgery to repair. Trust me you do NOT want to suffer with tendonosis all your life, it will handicap you. It is orthepedic surgeon who treat your tendons also. tendons and bones work together so that kind of makes sense to me.

5 likes, 103 replies

103 Replies

  • Posted

    I couldn't do the leg lifting before my op. I was told I had a degenerative Labrial Tear made worse by osteoarthritis. I was told they can only repair these tears in younger people.

    Is that something completely different? I can now lift my leg a lot more with a feeling of stiffness but my groin is painful from time to time. Put this down to general bit wary and concerned. What you had sounds awful


    • Posted

      Do you get groin pain getting in/out of a car -putting one leg in first? If so that's a classic symptom of this. Don't stretch it!! You need specific exercises to let this heal.

      How long post op are you?

    • Posted

      I'm 7 weeks post op and not driving yet but when I get in the passenger side I still sit on the seat first then bring legs in together.

      Before my op I had to lift my leg in and out of the car. Getting in and out was very painful indeed

      Did you mean classic symptom of Labrial Tear or tendonosis



    • Posted

      I mean classic signs of there being a problem with your iliac/psoas muscle.


    • Posted

      Thanks Martha. I'm seeing my specialist tomorrow for my first check since my op. I will tell him about this pain in my groin and see what he says.


    • Posted

      Yes i do have pain when getting in and out of the car. I am 5 months post op
    • Posted

      Hi Susan please use plastic bag on the seat when getting in and out of the car.

      I had groin pain too. rest in bed as much as you can. you will get better.

  • Posted

    Hi Jodi-France,  This is what  I had but mine was aggravated by lifting a heavy case.. before that it was fine.... Mine was sorted slightly by cortisone injection (4th March) as inflammation woudl not go down....   It improved but is coming back again.... Actually when you think they tell you to sit in upright chairs and not "slouch" after op.... I gave up as it was so uncomfortable sitting like that and ended up resting lying flat on my sofa or on bed.    Anyway, I see my consultant again 7th May as follow up to injection and YES better than pre jab but still not 100% .. stll have that groin "tightness" tendons just not stretching out as they shld....
    • Posted

      Ask to see a physio and get him/her to show you in your groin where to massage - actually you'll know because it hurts!! I've only been doing 5 minutes twice a day for 4 days and already it's so much better.biggrin
    • Posted

      Hi Martha, I have been seeing a physio weekly from 6 weeks post op, until I had the jab, apart from a few weeks when I was out of country in Oct/Nov and then over Xmas break etc.   So we know exactly where the issue is. All was going really well until I lifteed that damn case 17th Nov. When I limped into her treatment room... Oh NO!!! what have you done...  So she was the one that said go to GP this needs more than physio.   From horse injuries etc I knew what muscle injury can do and how long it can take to heal and repair....  Saw surgeon after New Year... we agreed hip itslef was fine and it was muscles and tendons problem....I wanted an injection into psoas muscles AND groin adductor, but surgeon said once psoas inflammation is alleviated the "pressure" on  adductors that had been compensating for psoas and having to work harder than they shd will lessen as psoas will be able to function.. so no need for jab in groin...  He's the expert but I think I shld have had groin area as well and I will hammer on that when I see him 7th May.  My hip joint itself is brilliant...My horse has been "out at rest" since last June..I had to top riding last March 2014 but I actually got on a friends horse 2 weeks ago (smaller than mine) for first time since last March and getting on and sitting there pain free and going for a walk and trot..pain free and getting off without having help was AMAZING... so now I can bring my mare in .. oh boy is she in for a shock! ..WORK??!!!... and both of us can start getting fit again... probably have missed out on this season - endurance riding - but next season.....
  • Posted

    Hi Jodi-France .... Thank you for sharing !!! This very problem has lead me to this forum .... except that this groin pain is in my non-operated leg and started way before surgery - I had Physical Therapy prior surgery, thinking it would be good to get fit, you know .... I felt really good and that is why I did it .... welll, I am ot sure if I can blame the therapist, but after 2 sessions the pain in my groin started - I was doing fine on the excercise bike and was put on leg-press machine and other leg-muscle strengthening machines - Sure my muscles felt sore but this was evolving in stabbing pain - I went in 3x a week - I told therapist but he said it is to be expected and will get better - well .... it got worse and worse - I stopped going there - then got massages ... that didn't help except that it felt good ... it was so bad that I saw my GP 3-4 times and each time he prescribed another painkiller - didn't help --- I was told just to get the surgery done ...I was worried about this so-called supporting leg and how it would be after surgery ... I am 6 weeks post-op now and one week on this forum - my operated hip/leg is doing great (stiffness and some discomfort and all that but all normal apparently) however, the groin pain is not .... 

    It is excaclt how you describe it - lifting the leg is so darn painful - getting up rom sitting position to standing ditto - even pulling my leg up while l laying flat on my back ...

    I read some of the articles and am confused - I could not find anything about resting  - only excercises one should do .... 

     between the hard rock and deep blue sea so to speak ....

    Oh, I was able to convince my PT that I am not ready to go on machines but she insists ...

    I don;t know what to do ..... 

    • Posted

      Hi Renee

      I was diagnosed with a degenerative Labral Tear. Exactly same symptoms as described in this thread and I started with it after an over enthusiastic PT

      It was in my bad hip so my recent hip replacement has taken care of it thank goodness. Worst pain and so difficult getting in and out of car. Osteopath helped while waiting for op. She used something called Rock Tape on me.

      Google it, it seems that it can be repaired in younger people.


    • Posted

      Hey thanks for that tip on Rocktape.

      My husband hurt his lower back, I think I would like to try it on him and see how it works. thx

    • Posted

      Glad that was useful. It comes in some very pretty colours!
    • Posted

      I would certainly not go by top description of what defines psoas pain...I have just had a psoas tendonotomy after TRHR as have a ton of people on the iliopsoas release board...Please check in there to get a full idea of scope.
    • Posted

      I saw that discussion and think it is probably the best discussion on this board. Could you please post a link to that discussion as a reply to my comment here? I think it will be really helpful for everyone who is experiencing groin pain to read it.

      Psoas muscle or Iliopsoas tendon pain is as I have described. Not saying it doesn't manifest itself in other ways as well, but I have described it very well. I know I had it and thankfully I had an excellent physical therapist who diagnosed it immediately and I rested it it and it did heal up. But the pain is as I described it. Now what causes it? Bad cup placement, oversized cup, a movenet, like stepping off a pier onto a floating boat 3 months after the surgery can do it too, or simple delayed reaction to having your leg manipulated during the surgery, that is what mine was, manipulation of the leg during surgery.

      It would be so great if you would post that link to the tendon release surgery as a reply so people can see it in this thread. When you Google "Groin Pain after Total Hip Replacement" My thread comes up second in Google so a lot of people are coming here, would be so kind of you to post the link to the release surgery. I would but I don't remember the title to the thread.

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