Hip Pain

Hip pain covers a lot of ground, and where you feel it is the most useful clue you can bring in. Pain in the groin, deep aching in the buttock, and a sharp tenderness on the outside of the hip are three different problems with three different treatments, even though people describe all of them as “my hip”.

The hip is a deep ball-and-socket joint surrounded by some of the largest muscles in the body, with tendons, bursae and the lower back all in close company. That means the joint itself is only one of several candidates, and sorting out which is involved is what makes treatment work.

What causes hip pain

Outer hip pain is most often gluteal tendon irritation, sometimes with the bursa over the bone involved as well. It’s typically tender to touch, worse lying on that side, and worse on stairs or standing on one leg. See bursitis for more on that pattern.

Groin pain more often points to the hip joint itself, whether that’s early arthritic change, a labral irritation or a hip that’s simply stiff and being asked to move beyond what it currently does. Groin pain from a sudden movement is more likely a groin strain.

Buttock and back-of-hip pain frequently refers from the lower back rather than originating in the hip, which is why the assessment always includes the spine. Deep buttock pain that travels down the leg suggests nerve involvement, covered under sciatica.

Across all three, weakness or poor control through the gluteal muscles is a common thread, because those muscles are what stops the hip collapsing inward every time you take a step.

When to see a physiotherapist

Hip pain that’s lasted more than a couple of weeks, that’s changing how you walk, or that’s stopping you sleeping is worth assessing, since a limp or an altered gait starts loading the other hip, the knees and the back.

Some hip pain needs urgent medical assessment instead: an inability to weight-bear after a fall, an obvious deformity, or hip pain with a fever and feeling unwell. If you contact the clinic with any of these, you’ll be told the same thing and helped to get seen.

Physiotherapy treatment for hip pain

Andrew’s assessment tests the hip joint’s own movement, the tendons around it, the strength and control of your glutes, and what your lower back is contributing, before anything is treated. Treatment typically combines:

• Manual therapy and soft tissue work to restore movement in a stiff joint and settle the tissue around an irritated tendon.
• Exercise rehabilitation, graded so the tendon or joint is loaded enough to adapt without being flared, which is the part that determines whether the improvement holds.
• Shockwave therapy where a gluteal tendon has been irritated for a long time and hasn’t responded to loading alone.
• Load and position advice, including sleeping position, stairs, and how long you’re standing on one hip.

What to expect

Andrew will tell you which structure he thinks is irritated and why, and what that means for how it’s likely to respond. Tendon-related hip pain takes longer than most people expect, because a tendon changes with consistent loading over weeks rather than with treatment alone, and he’ll be specific about that timeline rather than vague.