Groin pain

Please could anyone help with this patients of mine.

38 year old male.
18 month history of left groin pain. Was playing alot of football and keen on fitness work.
Agg. kicking, walking, running, aerobics.


Affected side Objective.

Weak Glut med and max.
Favours TFL in side lying abduction.
tight piriformis referred pain into medial proximal thigh EOR
Balance eyes closed (R) 15 secs (L) 3 secs
Sat on gym ball eyes closed (L) leg raised balance 20 secs. (R) raised (therefore balancing through left leg) = unable to balance.
Symphisis pubis palpation = tender left side no referred pain
Ab crunch with arms out to left (obliques) = Weak and reduced ROM compared with right
Positive Hip impingement test ie. pain on hip flexion and adduction.

Any thoughts?

It could be a labral tear or perhaps lig teres?

An MR arthrograph might be useful for diagnosis is hip Xrays appear normal...

It could be neurogenic referred pain... Palpate his lumbar spine and look for unilateral stiffness at L1 or 2 on PA.