Hip pain treatment starts with where it hurts. Deep groin pain is usually the hip joint. Pain on the outer hip is usually the gluteal tendons. Pain in the buttock is often the lower back, the sacroiliac joint or the piriformis muscle. A hip pain specialist tells these apart with an exam and image-guided diagnostic injections, then treats the source. At the Padda Institute in St. Louis you need no referral, and most hip pain is treated without surgery.
“Hip pain” is three or four different problems that share a word. People point to their belt line, their back pocket, the side of their thigh or their groin and call all of it the hip. Only one of those is the hip joint. Get that wrong and you can spend a year treating the wrong structure, or end up on an operating table for a scan finding that never hurt.
That last risk is real. Researchers scanned the hips of 45 volunteers who had never had hip pain, with an average age of 38. Three radiologists read the scans without knowing who had symptoms. They found a labral tear in 69 percent of these pain-free hips. A labral tear on your report is a common finding. Whether it is your problem is a separate question.
True hip joint pain sits in front, behind the crease of the groin, and often slides down the front of the thigh toward the knee. You cannot point to it with one finger, so people cup their hand around the side of the hip in a C shape. It shows up putting on socks, getting out of a car, or crossing your legs. Arthritis, a labral tear that actually hurts, and bone problems all live here. Our hip joint pain in the groin page goes deeper.
Pain over the bony point on the side of the hip, tender to the touch, worse lying on that side, climbing stairs or standing on one leg. This was called trochanteric bursitis for decades. Most of it is actually the gluteus medius and minimus tendons wearing where they attach, with the bursa irritated on top. The name matters, because a tendon and a bursa are treated differently. See lateral hip pain labeled trochanteric bursitis.
Pain in the back pocket area, sometimes running down the back of the thigh, is more often the lower back, the sacroiliac joint, or a nerve trapped deep in the buttock. Piriformis syndrome and the cluneal nerves belong to this group. Our page on hip arthritis or sciatica walks through how they are told apart.
Yes to both. The obturator and femoral nerves carry sensation from the hip joint and also from the inner thigh and the knee. A worn hip can announce itself as a knee that aches while the knee itself is healthy. Children with a hip problem often complain only of the knee, and adults do it too.
The link to the back runs both ways. A stiff hip that will not extend forces the lower spine to arch more with each step. The back then hurts from doing the hip’s job. A pinched nerve in the back, in turn, can send pain into the groin and thigh. When the picture is mixed, a small dose of numbing medicine placed into the hip joint under imaging answers the question. If the pain disappears for a few hours, the joint is the source. If it does not, the hip is off the list. See the image-guided hip joint injection.
Lying on the painful side presses the gluteal tendons against the bone. Lying on the other side lets the top leg drop across the body, which stretches the same tendons over the same bony point. Either way, the tendon is squeezed for hours. A firm pillow between the knees keeps the top leg level and takes most of the pressure off.
A hip joint that aches at rest, deep in the groin, while you lie still and are not pressing on it is a different signal. Night pain from inside the joint points to active inflammation, and occasionally to a bone problem that needs imaging.
More than most hip workups admit. A meta-analysis of 31 studies found that tendon problems were more than three times as common in people with diabetes. People with both conditions had had diabetes about five years longer than those with diabetes alone. Sugar binds to tendon collagen and stiffens it, the same chemistry that stiffens a diabetic shoulder. High insulin keeps tissue inflamed and slows the cell repair a loaded tendon depends on. Those are two biological drivers.
The third is how we live. Most of our patients sit for eight to ten hours a day: at a desk, in a car, on a couch. The gluteal muscles that hold the pelvis level go quiet when you sit, and a weak gluteus medius hands its load to the tendon. Sitting is not a character flaw. It is the job most people have.
I have drawn my own blood and run my own labs to watch what food and heat do to my body, so I do not ask patients for a measurement I would not take myself. For a hip that keeps failing, that means an A1c, a fasting insulin and a triglyceride-to-HDL ratio sit next to the X-ray.
For the outer hip, load the tendon and treat the tissue. A progressive strength program for the hip stabilizers is the base of every plan. In a double-blind trial of 80 patients with gluteal tendon pain lasting more than 15 months, a single ultrasound-guided PRP injection into the tendon beat a steroid shot at 12 weeks and at 24 weeks. The PRP group was still improving at two years. The steroid benefit peaked at six weeks. Our orthobiologic hip bursitis treatment page covers the tendon in detail, along with tendon injections and shockwave therapy.
For the joint, guidance first. The hip sits deep under a thick tendon, with the main nerve and artery of the leg close by. Injections here are placed under ultrasound or X-ray every time. A steroid injection calms an inflamed joint lining and buys weeks to months. For longer relief, our orthobiologic hip arthritis treatment page explains how PRP, bone marrow concentrate and fat work inside the joint.
Why hip PRP results vary. Two things decide it. The first is the platelet dose that actually reaches the joint: a weak preparation, or an injection that misses the capsule, delivers almost nothing. The second is the rehab that follows. The glutes, the hip stabilizers and your walking pattern have to take back the load. Studies that skipped either one report weak results, and we control both.
For the buttock, find the nerve or joint first. Sacroiliac and piriformis pain each have their own diagnostic injection, and each one answers a yes-or-no question before any longer treatment.
All of these are done with local anesthetic. You stay awake, there is no sedation, and most patients drive themselves home and resume normal activity within two to four hours.
When the joint is finished. A hip that has collapsed, a bone-on-bone X-ray with pain at rest, or a hip that no longer lets you walk a block is a hip that replacement surgery fixes well. We say so plainly when we see it.
Younger hips are a different decision. Someone who gets a new hip at 50 has many more years in which it can wear out and need a second operation. That is a strong reason to try treatment that preserves the joint first. Arthroscopy for a labral tear makes sense when the tear is the proven source. It makes much less sense when the tear was simply found on a scan, given how often pain-free hips have one.
More on the hip from Dr. Padda on YouTube:
If you fell and cannot bear weight, go to the emergency room. For pain that has built up over months, start with whoever will find the source before offering an operation. That is what we do, and we tell you when a surgeon is the right next step.
No. Call or book online without one. If your insurance plan needs a referral before it pays, our referral guide covers which plans do.
The skin is numbed first, and most patients describe pressure more than pain. A sore day or two afterward is common. A flare before improvement does not mean the injection failed.
No. Bursitis and tendon pain live on the outside of the hip, over the bone you can feel. Arthritis lives inside the joint, felt in the groin. You can have both, which is one reason a diagnostic injection is useful.
Ones that load the gluteal tendons without squeezing them. Standing hip-abduction holds, bridges and step-ups at a height you control work well. Avoid crossing your legs, standing hip-cocked on one leg and deep side stretches across the body, which compress the tendon.
Bring hip and lower back imaging, the dates and results of every injection you have had, and any recent lab work. If an MRI report mentions a labral tear, bring it and ask us whether it is causing your pain. Call us or request an appointment. See all conditions we treat.
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