Hip Pain Relief & Physiotherapy

Three Hip Anatomical Zones

What is femoroacetabular impingement (FAI) and does it always need surgery?

FAI is structural hip anatomy (CAM or Pincer) that mechanically impinges the joint, stressing the labrum and cartilage, causing anterior groin pain and limited flexion. Not all FAI morphologies cause pain, so treatment focuses on movement-pattern correction, hip stability, and load management rather than correcting anatomy, which requires surgery.

FAI is structural hip anatomy (CAM or Pincer) causing mechanical impingement of the hip joint, labral stress, and cartilage damage. Presents with anterior groin pain, hip flexion limitation, and pain with combined flexion+adduction (FABER/FADIR positive).

CAM Morphology: Femoral head-neck junction enlargement. More common in young athletic males. Causes anterior groin pain, restricted flexion ROM.

Pincer Morphology: Acetabular over-coverage. More common in middle-aged females. Causes anterior pain, hip labral degeneration.

What is the difference between gluteal tendinopathy and hip bursitis?

Gluteal tendinopathy is degeneration of the gluteus medius/minimus tendons, causing lateral hip pain worse with side-lying and abduction weakness; it responds to eccentric loading and dry needling. Greater trochanteric bursitis is more acute bursa inflammation responding to anti-inflammatory measures and relative rest. Most lateral hip pain involves both, treated primarily with loading.

Gluteal Tendinopathy: Degeneration of gluteus medius/minimus tendons. Pain lateral hip/buttock, worse with side-lying compression, abduction weakness. Responds well to eccentric loading and dry needling. Does NOT benefit from cortisone injection long-term.

Greater Trochanteric Bursitis: Inflammation of bursa between gluteal tendons and bony prominence. More acute presentation, responds to anti-inflammatory measures and relative rest (1-2 weeks). Often coexists with tendinopathy.

How is hip pain diagnosed with clinical tests?

Hip pathology is classified using objective tests. The FABER and FADIR tests reproduce anterior groin pain and indicate FAI or labral pathology. The Trendelenburg test reveals gluteal weakness through contralateral pelvis drop, and the single-leg hop test assesses hip stability and confidence, flagging when a strengthening phase is needed.

Objective diagnostic procedures to classify hip pathology:

How long does hip pain take to recover with physiotherapy?

Hip recovery follows three phases. Phase 1 (weeks 1-3) reduces pain and restores movement with soft tissue work and dry needling. Phase 2 (weeks 4-8) builds gluteal stability and strength. Phase 3 (weeks 9-12+) restores functional strength and sport-specific training, targeting 90%+ single-leg hop symmetry and pain-free activity.

When can I return to running and sport after hip pain?

You can progress back to running and sport once objective benchmarks are met: 20+ minutes pain-free walking under 2/10, 30+ second single-leg stance without a Trendelenburg sign, hip ROM within 10 degrees of the other side, single-leg hop at 85%+ symmetry, 8+/10 confidence, and good fatigue tolerance.

Objective benchmarks for progression from walking to running to sport:

When should hip pain be checked with imaging or a specialist?

Hip pain warrants imaging or specialist referral when red flags are present: acute trauma from a fall or collision (fracture or dislocation risk), neurological symptoms like leg radiation, numbness, or foot weakness, systemic signs such as fever, night pain, or weight loss, and mechanical locking where the hip catches or gives way.

When to refer for imaging or specialist evaluation:

Dry Needling for Hip Pain & Gluteal Syndrome

Dry needling targets myofascial trigger points and tendinous insertions in hip musculature, particularly the gluteus medius/minimus and hip flexors. Evidence shows 75-85% pain reduction when combined with progressive loading. Most effective for muscle-related (non-labral) hip pain.

Session frequency: 1-2x weekly for 4-6 weeks typically required. Improvement often noted within 2-3 sessions. Deactivated trigger points allow deeper active strengthening work in subsequent phases.

Hip Joint Anatomy & Pathomechanics

The hip is a ball-and-socket joint with remarkable stability but limited ROM in certain planes. The acetabular labrum acts as a sealing ring, improving joint congruency and load distribution. Hip musculature includes:

• Gluteus medius/minimus (hip stabilizers, abduction)
• Hip flexors (iliopsoas, rectus femoris)
• Hip adductors (longus, gracilis, magnus)
• Hip external rotators (piriformis, obturators)
• Hip extensors (gluteus maximus, hamstrings)

Dysfunction in any muscle group alters hip mechanics, increasing labral stress and OA progression. This is why comprehensive hip strengthening is essential for long-term recovery.

Frequently Asked Questions

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