Hip Pain
Pain in the front, side, or back of the hip from joint, muscle, or tendon dysfunction.
Hip pain can originate from the joint itself (femoroacetabular impingement, labral pathology, osteoarthritis), the surrounding soft tissues (gluteal tendinopathy, greater trochanteric pain syndrome, hip flexor tendinopathy), or be referred from the lumbar spine or SI joint. Greater trochanteric pain syndrome alone has an estimated prevalence of 10–25% in the general population (Segal et al.), and is now recognized as predominantly a gluteus medius/minimus tendinopathy rather than simple bursitis.
Pain in the front of the groin or deep in the hip often points to the joint or labrum and is reproduced with deep flexion and rotation (squatting, getting in and out of a car). Pain on the lateral hip with side-lying or stair climbing typically reflects gluteal tendinopathy. Posterior hip pain frequently has SI joint or deep external rotator (piriformis) involvement. Stiffness after sitting and reduced internal rotation are common across most hip pathologies.
Joint-driven hip pain is most common in active adults aged 20–50 (impingement, labral) and again after 50 (osteoarthritis). Lateral hip pain disproportionately affects women between 40 and 65. Runners, cyclists, soccer players, hockey players, and lifters with limited hip mobility are at higher risk for impingement and flexor tendinopathy.
A combined, root-cause approach.
Recent RCTs (LEAP trial, BMJ 2018) demonstrate that education plus targeted exercise outperforms corticosteroid injection at 12 months for gluteal tendinopathy. We assess the joint and the entire kinetic chain, mobilize restricted hip and pelvic motion, release tight hip flexors, TFL, and deep rotators with ART and dry needling, and progressively load the glutes and deep stabilizers to keep the femoral head centered in the socket.
- Hip adjustments and mobilizations
- ART for hip flexors and glutes
- Dry needling
- Hip stability rehab