What's actually going on?

The hip is a deep ball-and-socket joint surrounded by powerful muscles. Pain can come from inside the joint (labrum, cartilage), around the joint (tendons, bursae), or from referral patterns (low back, SI joint). Common diagnoses by population:

  • Femoroacetabular impingement (FAI) syndrome — in younger, active populations
  • Gluteal tendinopathy — most common cause of lateral hip pain in middle-aged adults, particularly women
  • Hip osteoarthritis — in older adults
  • Hip labral tear — often coexists with FAI
  • Athletic pubalgia / groin pain — in field-sport athletes
  • Proximal hamstring tendinopathy — deep buttock pain with sitting

What the evidence says

  • The Warwick Agreement on FAI (Griffin et al., BJSM 2016) supports trial of conservative care before considering surgery for many patients.
  • The LEAP trial (Mellor et al., BMJ 2018) on gluteal tendinopathy: education + load outperforms corticosteroid injection at 8 weeks and at 1 year.
  • For hip OA, Cochrane (Fransen et al., 2014) shows land-based exercise reduces pain and improves function.
  • For groin pain in athletes, the Doha agreement categorizes groin pain into specific subtypes, each with targeted approaches.
“Load progressively. The hip is built to handle it.”

The plan

  1. Thorough assessment to identify the specific diagnosis.
  2. Education — particularly important for FAI and gluteal tendinopathy where myths abound.
  3. Progressive loading specific to the diagnosis.
  4. Manual therapy and adjuncts where helpful.
  5. Return-to-sport or daily-activity progression.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Hip pain in active people responds well to assessment-driven loading. Decision about imaging or surgical referral is made when conservative care has had a fair trial.