Thigh pain can cause you to have difficulty walking, running, or climbing stairs. Sometimes the pain can occur after trauma or an injury. Other times, it may begin for no apparent reason.
Have you ever suffered from thigh pain and automatically assumed you must have pulled a muscle in your quadriceps? The thigh is one of those areas that most people think they know, when in fact it can be one of the trickier areas of the musculoskeletal system to pin down a cause for pain. Unfortunately, musculoskeletal physios see all too often patients who have been self treating a “quad strain” or something similar for months when the pain is actually from something completely different.
Thankfully, with proper diagnosis from a sports specialist physio most causes of thigh pain are very treatable and unlikely to continue once the source of the pain has been dealt with.
This article discusses the common causes of thigh pain along with potential treatments. Take note of the signs and symptoms that indicate when you should see a doctor. In rare cases, thigh pain can be a sign of a life-threatening condition.
Enabling us to stand up and move our legs, and by extension, to move our entire bodies, our thighs are heavily used in the course of our day-to-day lives. It is therefore quite common to experience pain in your thighs, and this can have a number of causes. Your thighs are made up of one bone (the femur) and many muscles, tendons, ligaments, nerves and blood vessels, which are all potential sources of thigh pain.
What Is Thigh Pain?
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Thigh pain is any type of pain or discomfort affecting the area stretching from the pelvis to the knee. Your thighs provide structural support and enable movement, and are made up of bones, muscles, tendons, ligaments, nerves, and blood vessels.
Thigh muscles provide motion and tendons anchor your thigh muscles to the bones of the pelvis and lower leg. Ligaments hold the thigh bone (femur) together with the pelvis and the lower leg bones to create the hip and knee joints. Nerves control sensation and movement, and blood vessels ensure continuous blood circulation to and from the thighs. Any of the structures of the thighs are subject to injury, infection, diseases, or other conditions that can produce pain.
Thigh pain can develop suddenly or gradually. Thigh pain may feel dull and achy, throbbing, piercing, or tingling. You may also experience paresthesias, pain-like sensations often described as pins and needles, prickling, or burning. Thigh pain may be simply irritating and uncomfortable or be so debilitating that you cannot put weight on your leg or walk.
Thigh pain can be caused by a very wide variety of conditions, including normal growth and aging. Thigh pain caused by a minor muscle strain or contusion may be controlled with home treatments, such as rest, ice, elevation of the leg, and pain relievers.
Types Of Thigh Pain
We can identify various types of thigh pain. For example, you might feel thigh pain in different places – in the front or back of your thigh, in your inner or outer thighs, or just under your buttock or next to your groin. The pain could be diffuse, or confined to a very specific area. Thigh pain may also be accompanied by various other symptoms (e.g. pins and needles, burning or electric shock sensations, swollen legs, coldness, loss of sensation) and/or pain in other parts of your body.
Thigh pain can be the result of an injury, come on during strenuous activity and either stop – or persist – at rest. It can even occur without any exertion at all. Finally, it may affect either one or both thighs.
Pain At The Back Of The Thigh
Hamstring strain – this is the most common cause of pain at the back the thigh. Symptoms include a sudden sharp pain which occurred whilst sprinting or performing high kick type activities.
Cramp – is a sudden and often painful involuntary contraction of the hamstring muscle. You will have difficulty straightening the leg for a while but cramp usually wears off.
Upper hamstring/buttock pain
Hamstring tendon strain – is a tear of a hamstring tendon as it attaches to the pelvis
Hamstring Avulsion strain – this occurs when the tendon tears taking a small piece of done with it. This is more common in younger athletes (14-18-year-olds) and older people who may have had a history of chronic hamstring tendinitis. If an avulsion strain should always be suspected and professional medical advice sought.
Hamstring origin tendonitis – is inflammation of the hamstring tendon as it attaches to the ischial tuberosity at the top of the back of the thigh. It may occur following a hamstring tendon strain which has failed to heal properly.
Iscioglutial bursitis – is inflammation of the bursa that lies between the bottom of the pelvis (Ischial tuberosity) and the tendon of a hamstring muscle. Symptoms are identical to hamstring origin tendonitis.
Referred hamstring pain – is caused by an injury or problem elsewhere such as the lower back, sacroiliac joints or muscles of the buttocks. Symptoms include pain which may be sudden onset but is usually gradual onset where no specific point of injury can be identified.
Posterior compartment syndrome – occurs when the muscle swells up too big for the sheath that surrounds it causing pressure and pain. Symptoms include a dull pain in the back of the thigh, cramp, and weakness. It is caused either by overuse as might be seen in endurance runners or repeated trauma from recurrent hamstring strains. Surgery is thought to be the most effective form of treatment.
Front thigh pain
Thigh strain – (quadriceps strain) is a tear of one of the quadriceps muscles and a common cause of sudden onset pain at the front of the thigh. Sudden sharp pain is felt at the front of the thigh and depending on severity, swelling and bruising may develop.
Thigh contusion – also known as a dead leg or charley horse is caused by a direct blow or impact to the thigh, crushing the muscle tissue against the thigh bone (femur). If contusions are not treated properly with cold therapy, compression and rest then Myositis ossificans may occur which is a more serious chronic condition causing bone growth within the muscle.
Inner thigh pain/groin pain
Groin strain – is probably the most common cause of pain on the inside of the thigh. This is a tear of one of the adductor muscles. Sudden sharp pain is felt, usually whilst sprinting or turning sharply. Depending on how bad the strain is there may be swelling and bruising.
Groin inflammation – is an overuse injury. Tendons of the adductor muscles become inflamed and sore.
Inguinal hernia – occurs when part of the internal tissue which can be fat, muscle or intestine bulge through a weakness in the overlying abdominal wall.
Gilmore’s groin – is a complex muscular-tendinous dislocation of the lower abdomen.
Upper thigh pain
Upper thigh pain refers to pain at the top of the quadriceps muscles/front of the hip.
Rectus femoris tendon strain – is a tear of the tendon of the rectus femoris at the point it attaches to the pelvis at the front of the hip. Sudden sharp pain is felt at the very top of the muscle where it attaches to the pelvis with localized swelling at the point of injury. Occasionally the tendon may tear pulling a piece of bone with it, called an avulsion strain.
Rectus femoris tendonitis – or tendinopathy is inflammation (or degeneration) of the rectus femoris tendon at front of the hip. Symptoms include a gradual onset of pain and tenderness at the front of the hip, or it may develop following a tendon strain or avulsion strain which has failed to heal properly.
Fractures
Femur stress fracture – is caused by prolonged overuse. The main symptom of a femur stress fracture is a dull ache deep in the general area of the thigh. There is likely to be a pain when a bending force is applied to the femur, known as the hang test.
Femur fracture – is a serious injury, more likely to be caused by road traffic accidents or similar. The femur is the bone which takes longest to heal. This is due to it’s poor natural blood supply.
What Other Symptoms Might Occur With Thigh Pain?
Thigh pain can develop along with other symptoms, which vary depending on the underlying disease, disorder or condition. Additional symptoms can involve other body systems or areas, such as the cardiovascular and neurological systems. Other symptoms that may accompany thigh pain include:
Bleeding
Bruising, laceration or abrasion
Burning or prickling feeling
Change in gait such as limping
Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)
Joint pain
Muscle spasms
Reduced range of motion
Swelling
Tingling, pain, or other abnormal sensations in the toes
Symptoms that might indicate a serious or life-threatening condition
In some cases, thigh pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as deep vein thrombosis, which is a blood clot in the leg that can travel to the lungs and cause a life-threatening pulmonary embolism. Other serious conditions include a fracture or infection. Seek immediate medical care (call 911) if you, or someone you are with, have other serious symptoms, with or without thigh pain, including:
Change in consciousness or alertness such as fainting
Chest pain
Difficulty breathing, wheezing, or shortness of breath
Discolored, unusually pale, or cold leg
Inability to walk or put weight on your leg
Popping sound at time of injury
Red, warm and swollen calf or leg
Severe pain
Severe swelling or deformity of the knee, thigh or hip
Causes Of Thigh Pain
Thigh pain can be due to a problem with your bones, muscles, blood vessels or nerves. Bone-related pain could be caused by a fractured femur, or a condition such as osteoporosis (brittle bones), for example. Muscle pain could be due to a cramp, a pulled or strained muscle, or tendinitis. Blood-vessel related pain could be caused by venous insufficiency or phlebitis or thrombosis, for example.
When it comes to nerve pain, the cause could be sciatica or cruralgia, which is sometimes called ‘front sciatica’ as it has similar symptoms.
Pinched Spinal Nerve
Both herniated lumbar discs and low back arthritis may pinch on the nerves that exit your spinal column and travel down your thigh, resulting in thigh pain.1
Symptoms of a pinched nerve may include:
- Pain in the front or back of your thigh
- Numbness or tingling in your thigh
- Weakness in your thigh muscles
- Difficulty sitting or rising from sitting
Pinched nerves typically cause thigh pain that changes depending on your spine’s position, so this can be a clue to your doctor that your low back is actually causing your thigh pain.
Trauma And Injury-Related Causes Of Thigh Pain
Thigh pain may be caused by injuries and other trauma including:
Bone fracture (broken bone) or dislocation, especially of the hip or thigh bone (femur)
Groin pull or strain
Laceration, abrasion or contusion of the thigh
Ligament sprains and tears, especially of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knees, which ensure leg and knee stability. Sprains and tears may cause pain or discomfort in the thigh area near the joint.
Meniscus tear (tear in the shock-absorbing cartilage of the knee)
Muscle cramp (charley horse), commonly caused by dehydration or overuse
Strained or pulled thigh muscles, such as a hamstring or quadriceps muscle strain
Tendinitis (inflammation or irritation of tendons due to overuse or injury)
Spinal Stenosis
Spinal stenosis is considered a degenerative condition because it worsens over time. Most people who have it are over the age of 40. The condition occurs when your spinal nerves are compressed by the bones in your spine. Often, this is simply a result of daily wear and tear experienced over the course of your life.2
Symptoms of spinal stenosis include:
- Pain in both thighs and legs
- Feelings of numbness or heaviness in your thighs
The pain from spinal stenosis is typically felt in both legs at the same time. Symptoms are made worse with standing and walking, and almost immediately relieved with sitting.
Infectious Causes Of Thigh Pain
Thigh pain can be caused by various infections including:
Cellulitis (invasive infection of the skin and surrounding tissues)
Infection of a wound or sore
Infection of the knee or hip, which can lead to septic arthritis and cause pain in the joint that radiates to the thigh area
Osteomyelitis (bone infection)
Neurological Causes Of Thigh Pain
Thigh pain can be caused by neurological conditions that cause inflammation, entrapment, compression, or damage to the nerves including:
Peripheral neuropathy (disorder that causes damage and dysfunction of nerves that lie outside your brain and spinal cord) and diabetic neuropathy (neuropathy caused by long-term diabetes)
Piriformis syndrome (buttock muscle compressing or irritating the sciatic nerve that causes pain, tingling or numbness down the leg)
Sciatica (compression, injury or inflammation of the sciatic nerve that causes burning or shooting pain running from the buttocks down the back of the leg)
Quadriceps or Hamstring Tendonitis
Overuse and repeated stress to your thigh muscles may cause inflammation in your tendons. This condition is known as tendonitis.
Symptoms of quad or hamstring tendonitis include:
Pain in the front or back of your thigh, usually near your knee or hip
Difficulty walking or climbing stairs due to pain
A feeling of weak muscles in the front or back of your thigh
Symptoms usually last for four to six weeks and slowly get better with gentle exercises such as walking, leg raises, wall squats, and the Nordic hamstring stretch.
Iliotibial Band Friction Syndrome
Your iliotibial band is a thick piece of tissue and fascia (connective tissue densely packed with nerves) that runs down the outer side of your thigh. Sometimes it can become irritated with overuse or repeated stress. This is a common running injury known as iliotibial band friction syndrome (ITBS).
Symptoms of ITBS include:
Pain on the outside part of your thigh near your hip or knee
A feeling of tightness near your hip or knee
Difficulty walking or running
The pain from ITBS usually gets worse with increased activity and better with rest. Many people benefit from physical therapy to learn stretches and strengthening exercises for ITBS.
Stroke
Sometimes, a cerebral vascular accident (CVA), also known as a stroke, can cause abrupt pain in your thigh. This is usually accompanied by numbness, tingling, and muscle weakness that begins suddenly.5
A stroke is a medical emergency; if you suspect you have had a stroke, go to your local emergency department right away.
Blood Clot
A blood clot in your lower leg or thigh may cause thigh pain along with warmth, swelling, and redness.6 Some people experience a cramping sensation similar to a Charley horse.
A blood clot needs to be diagnosed and managed immediately—if the clot moves from your vein, it can travel to your lungs and may result in a fatal pulmonary embolism.
Why Can Diagnosing Thigh Pain Be Difficult?
Thigh pain commonly occurs due to sporting injuries, injuries at work and day to day overuse, but is also a prime culprit for receiving referred pain from other, sometimes not so obvious areas in the body. Due to the thigh’s proximity to the groin, pelvis and role in ITB function, it is common for thigh pain to be referred from those areas, but it is also the prime ground for receiving pain from other conditions such as:
Sciatica type symptoms – your femoral nerve can refer pain to the front of your thigh
Hip joint conditions such as arthritis
Meralgia Paresthetica – when the lateral femoral cutaneous nerve becomes impinged
Lower back pain
Vascular problems such as a deep venous thrombosis
And rarely; a fracture to the femur bone
The first step in treating your thigh pain is to have your doctor accurately diagnose it. When visiting your doctor, they will likely ask about the nature of your pain, how it started, and how it behaves. Questions you may be asked include:
- Is the pain constant or does it come and go?
- Does the pain change with certain movements or positions?
- How long has your pain been bothering you?
- Did the pain begin after trauma? Or is there no apparent reason for it?
Your doctor may palpate (examine by touch) your thigh and check the surrounding joints and muscles. In addition, they will likely test your strength and watch you walk and move about. Various tests may be done to diagnose your thigh pain.
Diagnostic Tests
- X-ray: This test examines the bones of your thigh, knee, or hip to look for fractures or arthritis as a cause of your pain.
- Electromyographic (EMG) test: The EMG shows your doctor how the nerves of your thigh are functioning. It can also show if a pinched nerve or loss of nerve function may be causing your thigh pain.
- Magnetic resonance imaging (MRI): An MRI shows pictures of the soft tissue around your thigh. It may be used to look for muscle or tendon tears.
- Ultrasound: An ultrasound test may be used to visualize arteries and veins around your thigh. This can be used to check for a blood clot.
Your doctor should be able to diagnose your thigh pain once the clinical examination and diagnostic testing is complete. From there, they will move forward with your treatment.
Treatment
Treatment for your thigh pain is based on an accurate diagnosis of your condition. In some cases, you will be able to treat your thigh pain at home. However, some causes of thigh pain are an emergency.
If your pain is caused by a stroke or blood clot, you need to get medical attention right away. Treatment for a stroke involves a team of medical professionals. A blood clot requires anti-embolism care and management with blood thinning medication.
Thankfully, most thigh pain is not caused by a life-threatening problem and can be managed quite successfully. There are various things you can do to treat your thigh pain, depending on the cause of your pain and the severity of your condition.
Exercise
Exercise has been proven to help thigh pain that involves your muscles, bones, ligaments, tendons, and nerves. This is known as your musculoskeletal system.
If your pain is coming from your back, lumbar stretches and strengthening exercises may be done to relieve pressure from spinal nerves. Exercises that correct your posture may also be helpful.
Thigh pain from a quad or hamstring strain responds well to stretching and strengthening exercises.3 Your local physical therapist can help determine the best stretches for your thigh pain.
Exercise can also help you maintain an appropriate weight and body mass index. This may relieve your symptoms and prevent thigh and leg pain from coming back.
Medication
Your doctor may prescribe an anti-inflammatory if the cause of your pain is an inflammatory condition such as tendonitis or an acute strain.
For mild symptoms, over-the-counter Advil (ibuprofen) or an anti-inflammatory cream like Aspercreme may be recommended.
While it won’t help with inflammation, Tylenol (acetaminophen) may be used to treat discomfort.
For severe pain, a prescription-strength anti-inflammatory and/or pain reliever may be used.
