Hip Pain
Deep groin, side, or buttock pain that limits training and daily life.
What it is
An umbrella term covering hip impingement, gluteal tendinopathy, labral irritation, and hip osteoarthritis. Each is managed differently, and all are assessed thoroughly.
Common symptoms
- Groin, lateral hip, or deep buttock pain
- Painful with running, sitting, or single-leg loading
- Stiffness rotating the hip
Why it happens: root cause
Hip joint capacity and glute control vs. the demands you're placing on them. When load on a tissue chronically exceeds its capacity, pain shows up. My job is to close that gap, by lowering load, raising capacity, or both, so the tissue stops being overwhelmed.
A closer look
'Hip pain' is an umbrella, gluteal tendinopathy (lateral hip), hip impingement/FAI and labral irritation (groin or front), and hip osteoarthritis each present and are managed differently. Step one is figuring out which one you're actually dealing with.
What causes it (LOAD > CAPACITY = PAIN)
- Glute and hip-rotator strength/control deficits relative to demand
- Rapid changes in training or sitting load
- Hip mobility restrictions
- Running mechanics
- Compression for tendinopathy (crossing legs, side-sleeping)
Why it keeps coming back
- Strength and control not fully restored
- Returning to volume too soon
- Continuing compressive positions
Why rest, stretching, and passive care aren't enough
Rest and stretching calm it but don't build hip capacity. For gluteal tendinopathy, stretching and compression often make it worse. Loading and position management are the fix.
Conditions that can mimic this
A thorough assessment (and Clarius MSK when useful) localizes the source. Femoral-neck stress injury needs prompt medical attention, I screen for it.
How I treat it
How the ADAPT Method treats your Hip Pain
- A
Assess
Differential exam, hip impingement, gluteal tendinopathy, labral irritation, OA each look different, plus a running, sitting, and training history. Clarius MSK ultrasound is used when it sharpens the diagnosis (e.g., gluteal tendinopathy).
- D
Decrease Pain
Modify aggravating positions and loads, then layer Focused Shockwave (ESWT), Radial Pressure Wave (EPAT), and EMTT over the hip joint, gluteal tendons, and surrounding tissue to calm the irritated structure and accelerate healing.
- A
Activate
Restore hip internal rotation, extension, and capsular mobility with FRC-style work, and reactivate the deep stabilizers.
- P
Progress
Progressive hip loading (hinge, lunge, single-leg) appropriate to the diagnosis; gluteal tendinopathy especially needs heavy-slow loading.
- T
Transfer
Return-to-running or sport plan with Running Analysis where it applies, plus a hip-strength minimum that holds the gains.
ADAPT closes the gap between LOAD and CAPACITY, lowering what's stressing the tissue while building what the tissue can handle.
FAQ
Why is hip pain so hard to diagnose?+
Multiple structures sit in a small space, joint, labrum, gluteal tendons, deep rotators, bursa. A thorough exam (and selective ultrasound) usually sorts it within one visit.
Do I need an MRI?+
Sometimes, and especially for suspected labral or intra-articular issues. I don't order it unless it'll change the plan.
Should I stop running?+
Usually no. I modify volume and any specific aggravators (hills, speed, cross-slope sidewalks) rather than fully rest.
Does shockwave help hip pain?+
Yes for the right diagnoses, gluteal tendinopathy responds well to Focused Shockwave, and EMTT has RCT evidence in hip OA. I pick the tool by the tissue.
Will I need a hip replacement?+
Not unless conservative care has been given a real shot and quality of life is genuinely limited. Many 'pre-arthritic' hips do beautifully with strength and mobility work.
What about cortisone?+
It can offer short-term relief in joint or bursal pain, but repeated injections without addressing capacity rarely change the long arc. I use it as scaffolding, if at all.
Do I need an MRI?+
Usually no, at least not first. Most musculoskeletal issues are diagnosed by history and exam. I use Clarius MSK diagnostic ultrasound in-office when it actually changes the plan: confirming a tendon issue, ruling between two diagnoses, or guiding treatment. I refer for MRI when red flags or surgical questions warrant it.
How long does it take to improve?+
Most cases see meaningful change in 6–10 weeks; tendinopathies remodel over months.
Do you take insurance?+
Form & Function is a cash-based (self-pay) practice; I don't bill insurance directly. That lets me spend more time with you and build your plan around what you actually need, not what an insurer will approve. Fees are discussed up front. On request I can provide a detailed receipt (superbill) you may submit to your insurance for possible out-of-network reimbursement, though reimbursement isn't guaranteed.
What happens at the first visit?+
I sit down and talk through your history, training, and what you've already tried. Then I go through a hands-on movement and strength assessment, look at the painful area (and the joints above and below), and use Clarius MSK ultrasound in-office when it sharpens the diagnosis. You leave with a working diagnosis and a written plan, not a vague 'come back next week.'
Book your evaluation.
An honest assessment is the first step in the ADAPT method, and the fastest path to a real plan.