Body Area
Hip PainCauses, Patterns & What Chiropractic Can Do
Hip flexor tightness, bursitis, femoroacetabular impingement, and referred pain. Often the pain is not where the problem is.
Book Your First VisitHip pain can come from the hip joint itself, surrounding tendons and muscles, or referred from the lumbar spine. Getting the diagnosis right matters more than starting treatment quickly. A thorough assessment always includes lumbar screening.
Where does hip pain come from?
The hip is a deep ball-and-socket joint designed for load-bearing and large range of motion. Pain "in the hip" can originate from the joint itself (intra-articular), the surrounding muscles and tendons (extra-articular), or referred pain from the lumbar spine, sacroiliac joint, or femoral nerve. These have different patterns, different exam findings, and respond to different treatment approaches.
True hip joint pain typically presents in the groin or anterior thigh, and is reproduced by hip rotation and loading. Lumbar referred pain tends to sit in the posterior hip or buttock, and is reproduced by lumbar movements rather than isolated hip testing. This distinction shapes everything that follows in assessment and treatment. Treating the wrong structure wastes time.
Common causes
- Hip flexor tendinopathy and tightness: very common in desk workers and runners. Prolonged sitting shortens the hip flexors, which may contribute to anterior pelvic tilt and increased lumbar load. Hip flexor pain is typically felt at the front of the hip or groin, and often aches after long periods of sitting or flares when walking upstairs.
- Greater trochanteric pain syndrome: lateral hip pain, previously called trochanteric bursitis. Typically felt on the outside of the hip, often worse when lying on that side at night or getting up from a chair or car seat. Research now identifies the gluteal tendon as the primary source of lateral hip pain in most cases, a shift from the older "trochanteric bursitis" label. This distinction matters because the treatment differs: loading-based rehabilitation and avoiding compressive positions (crossing legs, hip adduction).
- Femoroacetabular impingement (FAI): bony contact between the femoral head and acetabulum during movement. Common in active patients with restricted hip rotation and groin pain. Some cases need imaging and specialist input.
- Sacroiliac joint dysfunction: referring to the posterior hip and buttock. Often confused with hip or lumbar problems. Research suggests manual therapy for the sacroiliac joint (SIJ) shows promise for reducing disability when the SIJ is the primary pain driver, though evidence for pain relief specifically remains less certain.
- Hip osteoarthritis: gradual joint space loss, most common over 50. Conservative management can reduce pain and maintain function, but realistic expectations matter. It cannot reverse structural change.
What helps
Chiropractic care for hip pain includes joint mobilization of the hip itself, lumbar and sacroiliac joint treatment when they're contributing, soft tissue work for hip flexors and gluteal muscles, and rehabilitation exercises targeting hip stability and strength. The specific approach depends on what the assessment finds.
On "bursitis"
The term "trochanteric bursitis" is used loosely in clinical practice. Current research identifies the gluteal tendon as the primary source of lateral hip pain in most cases, a shift from the older "trochanteric bursitis" label. This matters for treatment: tendinopathy responds to progressive loading, while compressive positions (crossing the legs, side-lying directly on the hip) aggravate it. Cortisone injections can reduce pain in the short term, but loading-based rehabilitation produces better global improvement outcomes at one year; differences in pain intensity at long-term follow-up were less pronounced. Some improvement can also occur with time and activity modification alone, though structured rehabilitation produced better global outcomes than a wait-and-see approach in the same trial. For most people, this means starting with controlled, low-load movements that progressively increase rather than rest, which often does not resolve the tendon problem on its own. Evidence from laboratory and animal studies raises significant concerns about long-term tendon tissue health with repeated glucocorticoid injections. If you've already had an injection, that doesn't close the door on rehabilitation.
How I approach hip pain
The first session includes lumbar screening, hip mobility testing, and specific orthopedic tests to identify the structure involved. Some presentations, including labral tears with mechanical catching, significant FAI with structural change on imaging, and hip osteoarthritis requiring joint replacement consideration, benefit from specialist input. I'll let you know if that applies to your situation.
In my clinical experience, hip flexor tightness from desk work often responds well within 4–8 sessions combined with a home stretching and strengthening program. Greater trochanteric pain syndrome typically takes longer because tendinopathy rehabilitation requires gradual progressive loading over weeks. That said, it is not a permanent condition. For most people, meaningful improvement in pain and function is a realistic goal with consistent rehabilitation, though individual responses vary.
If your hip pain has been attributed to wear and tear or bursitis alone, a thorough mechanical assessment may identify additional contributing factors. The distinction between hip and lumbar referred pain is one of the more clinically important things to get right. If you'd like to talk through your situation before booking, get in touch.
When to seek care promptly
See a doctor if you have:
- Hip pain after significant trauma or a fall, especially in older patients (possible fracture)
- Severe groin pain with limited movement and inability to weight-bear
- Hip pain with fever, night sweats, unexplained weight loss, or sudden onset of a severely restricted and painful hip joint
- Sudden onset severe hip pain in a child (may indicate Perthes disease or slipped capital femoral epiphysis)
- Hip pain with a history of cancer or long-term steroid use
- Groin or anterior hip pain in a runner or active patient that worsens with weight-bearing and does not improve with rest (possible stress fracture; requires imaging before loading rehabilitation)
- Hip or groin pain with a history of prolonged corticosteroid use, heavy alcohol use, or prior hip trauma, particularly in younger adults (possible avascular necrosis; requires imaging)
These warrant medical evaluation before conservative treatment. For most gradual-onset hip pain without these features, a chiropractic assessment is an appropriate first step.
Related reading
Common questions
The pattern and location help. True hip joint pain usually presents in the groin or anterior thigh, and is reproduced by hip rotation and loading. Lumbar referred pain tends to be more diffuse, sits in the posterior hip or buttock, and is reproduced by lumbar movements rather than isolated hip tests. I'll run specific tests for both during the assessment. Getting this distinction right is one of the more clinically important parts of managing hip pain. Treating the wrong structure wastes time.
Not before starting conservative care in most cases. Clinical assessment gives a lot of information. Imaging is useful if I suspect FAI with significant structural change, labral pathology that might need arthroscopic intervention, or early hip osteoarthritis that would change the management approach. I'll tell you after assessing you whether I think a scan would genuinely change what we do.
Yes. This is one of the most common presentations in desk workers. Hip flexor shortening from prolonged sitting may contribute to anterior pelvic tilt, which can increase lumbar load and affect how the hip extends during walking and running. Treatment includes soft tissue release, lumbar and hip mobilization, and a targeted stretching and strengthening program. Ergonomic changes to break up sitting time are usually part of the plan too.
The term "trochanteric bursitis" is used loosely, but current research identifies the gluteal tendon as the primary source of lateral hip pain in most cases, not the bursa itself. This distinction matters for treatment: tendinopathy responds to loading-based rehabilitation, while compressive positions (crossing the legs, sitting with the hip adducted) aggravate it. I'll explain the specific pattern that applies to your presentation and what that means for management. If your pain is on the outer hip, worse when lying on that side at night or getting up from a chair or car seat, tendinopathy is the more likely explanation than true bursa inflammation.
In my clinical experience, hip flexor tightness and mild tendinopathy often show meaningful improvement within 4–8 sessions. Greater trochanteric pain syndrome (lateral hip tendinopathy) responds to loading rehabilitation but takes 8–12 weeks to show consistent improvement. For most people, meaningful improvement in pain and function is a realistic goal with consistent rehabilitation, though individual responses vary. Greater trochanteric pain syndrome is not inherently a permanent condition. True FAI or labral pathology typically requires a longer rehabilitation timeline; research documents meaningful short-term improvement with conservative physical therapy, though outcomes in the longer term are variable and some patients ultimately require surgical consultation. I'll give you an honest assessment of what's realistic for your specific situation after the first visit.
References
- Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. doi:10.1136/bmj.k1662
- Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910–922. doi:10.2519/jospt.2015.5829
- Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570–576. doi:10.1016/j.semarthrit.2013.08.006
- Mallets E, Turner A, Durbin J, Bader A, Murray L. Short-term outcomes of conservative treatment for femoroacetabular impingement: a systematic review and meta-analysis. Int J Sports Phys Ther. 2019;14(4):514–524. PMC6670054
- Trager RJ, Baumann AN, Rogers H, et al. Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials. J Man Manip Ther. 2024;32(6):561–572. doi:10.1080/10669817.2024.2316420
Disclaimer
This page is for general information only and does not constitute medical advice. Every person's situation is different. Nothing here should be used as a substitute for assessment and advice from a qualified health professional who can evaluate your specific circumstances.
If you are experiencing severe or rapidly worsening symptoms, loss of bladder or bowel control, progressive weakness, or any symptom that concerns you, seek medical care promptly rather than reading websites.
This page was written with AI assistance and reviewed by Erik Anderson for accuracy. If you find an error, please contact us and we will endeavour to correct it.
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