Hip pain is one of the trickier complaints to sort out. The hip joint sits at the intersection of the spine, pelvis, and leg, which means pain in and around the hip can come from multiple sources. And it doesn’t always feel like what most people expect a hip problem to feel like.
At Dynamic Sports Medicine, we see hip pain in runners, lifters, office workers, and post-surgical patients alike. What they share is that the pain is limiting something they care about, and that a vague diagnosis like “hip impingement” or “hip flexor strain” hasn’t given them a clear path forward. Here is how to think about it more clearly.
The Hip Is Not Just One Structure
When people say “my hip hurts,” they could be describing pain from a dozen different sources. The hip joint itself is a deep ball-and-socket joint surrounded by a labrum, cartilage, ligaments, and a capsule. Around it is an extensive muscular system including the glutes, hip flexors, adductors, external rotators, and the iliotibial band.
Pain in the front of the hip is different from pain on the outside, which is different from deep groin pain, which is different from the posterior hip. Location and activity context narrow down the cause significantly.
Common Causes Based on Location and Activity
Front of the hip or groin, especially with squatting or hip flexion: Hip flexor strain or tendinopathy, femoroacetabular impingement (FAI), or hip labral irritation are the most common culprits. FAI occurs when there’s a structural abnormality in how the ball and socket fit together, creating a pinching sensation at the end of hip flexion range.
Outside of the hip, especially with running: Greater trochanteric pain syndrome (often called hip bursitis, though the bursa is rarely the primary issue) and IT band-related compression are typical. This is the most common presentation in runners and is driven by hip abductor weakness and pelvic control during the stance phase of running.
Deep hip pain without a clear location, sometimes with clicking: Hip labral tears create a deep, hard-to-localize ache that’s often worse with prolonged sitting, hip rotation, or end-range hip flexion. The labrum is a ring of cartilage that lines the socket and provides stability. Tears are more common than most people realize and respond well to conservative care in many cases.
Hip pain after extended sitting: Hip flexor tightness and compression of the anterior capsule are common in people who sit for long periods. The hip flexor complex shortens, the anterior structures get compressed, and pain develops with activity after prolonged static loading.
Why the Low Back Gets Blamed
The lumbar spine and sacroiliac joint frequently refer pain into the hip and buttock region in patterns that can mimic true hip pathology. This is why assessment matters. Treating a lumbar problem as a hip problem, or vice versa, won’t get results. A clinical assessment distinguishes between the two quickly.
What Treatment Looks Like at DSM
We assess hip mobility through all planes of movement, hip strength across the glutes and external rotators, pelvic control under load, and lumbar and sacroiliac function. We want to understand what structure is involved and what is driving it.
Treatment depends on the finding. It typically includes manual therapy to address joint restriction and capsular tightness, dry needling for hip flexor and glute trigger points, targeted strengthening for glute weakness and hip stability deficits, and activity modification to protect the hip during recovery. We keep people moving throughout.
