Hip Pain

Where the hip meets the whole body

The hip is the link between your trunk and your legs. It bears your full body weight with every step, and it has to balance mobility with stability in a way that few other joints are asked to do. When the hip isn't working right, you feel it in your groin, your buttock, your thigh, and often in your low back and knee.

What makes hip pain tricky is that "hip pain" can mean a lot of different things depending on who's saying it. Pain in the side of the hip is a different problem than pain in the groin, which is different from pain deep in the buttock. The location tells us a lot about what's going on.

Common causes

Femoroacetabular impingement (FAI). This is a mechanical problem. The shape of the femoral head or the acetabulum causes abnormal contact during certain movements, particularly deep flexion and internal rotation. It causes groin pain, especially with sitting, squatting, or getting in and out of a car. It's common in young active adults and athletes.

Hip osteoarthritis. Cartilage loss in the hip joint causes stiffness, groin pain, and a progressive loss of range of motion. Unlike FAI, osteoarthritis tends to develop gradually in people over 50, though it can occur earlier, especially after injury or in the setting of impingement.

Greater trochanteric pain syndrome. This is the modern name for what was often called trochanteric bursitis. Pain on the outside of the hip, over the bony prominence you can feel, that's often worse lying on that side, climbing stairs, or walking long distances. The gluteal tendons are usually the primary issue, not just the bursa.

Sacroiliac joint dysfunction. The SI joint sits right behind the hip and can produce pain in the buttock, the posterior hip, and even down the leg. It's a common mimicker of hip pathology and lumbar radiculopathy. Pregnancy, pelvic asymmetry, and prolonged sitting all predispose to SI joint problems.

Labral tears. The labrum is a ring of cartilage that deepens the hip socket and helps with stability. Tears can cause catching, clicking, or a deep ache in the groin. They often occur in combination with FAI and may or may not be symptomatic. Imaging alone doesn't tell the full story.

Referred pain from the lumbar spine. Nerve roots exiting the lumbar spine supply sensation and motor control to the hip and thigh. A disc herniation or foraminal stenosis at L2, L3, or L4 can produce anterior thigh and groin pain that feels exactly like hip joint pathology. I always check the spine when evaluating hip pain.

How we approach it

I want to know where the pain is, what provokes it, and what the exam shows. A thorough hip exam combined with an assessment of the lumbar spine, pelvis, and SI joints usually narrows it down. Motion analysis helps us see the dynamic picture, how you actually move under load, not just on a table.

OMM addresses the pelvic mechanics, the lumbar spine, and the soft tissue restrictions that are contributing to abnormal hip loading. When we need to target the joint itself or a specific bursa or tendon, ultrasound-guided injections give us precision. For chronic gluteal tendinopathy, shockwave therapy has strong evidence.

If the exam raises concern about the joint itself, we'll get imaging and discuss the full range of options, including when surgery may be the right call.

When to seek care

If your hip pain limits your walking, if it wakes you at night, if it's been present more than a few weeks, or if you're having trouble with stairs, getting dressed, or getting in and out of your car, it's time to come in. Hip pain that's changing your gait is also changing how your knees, back, and ankles are loaded. The longer it goes, the more secondary problems develop.

What you can do right now

Strengthen your glutes. Weak hip abductors, particularly the gluteus medius, are involved in almost every hip pain pattern I see. Clamshells, side-lying leg lifts, and single-leg bridges are a good starting point.

Avoid prolonged sitting with your hips flexed below 90 degrees. Deep couches and low car seats keep the hip in a position that aggravates impingement and flexor tightness. Sit higher when you can.

Gentle hip circles and figure-four stretches can relieve tension, but avoid aggressive stretching into pain. The hip responds better to gradual loading than to forcing range of motion.