What causes hip pain?
Hip pain is not always what it seems. The hip joint itself, a deep ball-and-socket joint designed for stability and load-bearing, can certainly be the source. But in clinical practice, a significant proportion of patients presenting with “hip pain” actually have a problem originating elsewhere. The lumbar spine, sacroiliac joint, and surrounding soft tissues all refer pain into the hip region, and getting the source right is essential before starting treatment.
True hip joint pathology tends to produce pain deep in the groin, often worsening with weight-bearing, walking, or internal rotation. A patient presenting with lateral hip pain that’s worse when lying on the affected side, climbing stairs, or crossing legs is far more likely dealing with greater trochanteric pain syndrome, commonly known as trochanteric bursitis. And dull, aching pain across the buttock that worsens with prolonged sitting may well originate from the lower lumbar spine or sacroiliac joint rather than the hip itself.
How does referred pain complicate hip diagnosis?
Referred pain is one of the most common reasons hip problems get misdiagnosed or mistreated. The lumbar nerve roots L2, L3, and L4 supply sensation to the front of the thigh and groin, meaning a disc bulge or facet joint problem in the lower back can produce pain that feels identical to a hip joint issue.
Paul Morrison, MChiro DC and GCC-registered chiropractor at Costa Health, sees this pattern frequently. A typical case involves a patient who has been told they have hip arthritis based on an X-ray, yet their clinical presentation doesn’t match. They have full range of motion in the hip, no groin pain on loading, but significant restriction and tenderness in the lumbar spine. Treating the back resolves the “hip pain” entirely.
The opposite also occurs. Genuine hip osteoarthritis can refer pain to the knee, leading patients to seek treatment for a knee problem that’s actually driven by progressive hip degeneration. According to a 2019 study published in BMC Musculoskeletal Disorders, up to 27% of patients with hip osteoarthritis report knee pain as their primary complaint. A thorough clinical examination that tests both regions prevents these diagnostic blind spots.
Why do golfers get hip pain?
Golf places asymmetric rotational demands on the hips. The lead hip (left hip for right-handed players) requires significant internal rotation during the downswing and follow-through. The trail hip needs adequate external rotation during the backswing. When either is restricted, the body compensates, and pain follows.
Many golfers on the Costa del Sol play three or four times per week. That volume of repetitive, one-directional rotation creates predictable patterns: tight hip flexors, restricted internal rotation on the lead side, and overactive piriformis on the trail side. Over time, this leads to labral irritation, femoroacetabular impingement symptoms, or gluteal tendinopathy.
Costa Health’s approach to golfer hip pain starts with a movement assessment rather than jumping straight to treatment. Chiropractic adjustment can restore joint play to restricted hip and lumbar segments. Osteopathy uses articulation and muscle energy techniques to improve capsular mobility. Sports massage addresses the muscular imbalances, particularly through the hip flexors, adductors, and deep external rotators. Targeted rehabilitation then maintains the gains and prevents recurrence through the season.
What is trochanteric bursitis, and how is it treated?
Greater trochanteric pain syndrome, often called trochanteric bursitis, causes pain on the outer hip at the bony prominence where the gluteal tendons attach. It affects roughly 1.8 per 1,000 patients per year in primary care (Lievense et al., 2005) and is more common in women, runners, and people who sleep on their side.
The term “bursitis” is actually a bit misleading. Research over the past decade has shown that most cases involve gluteal tendinopathy, degeneration of the gluteus medius and minimus tendons, rather than isolated bursal inflammation. This distinction matters because the treatment approach differs. Anti-inflammatory strategies (ice, medication) might settle a flare, but they won’t address the underlying tendon weakness.
Effective treatment combines manual therapy to address compensatory patterns in the lumbar spine and pelvis, progressive tendon loading exercises (isometric holds progressing to slow heavy resistance), and activity modification. Stretching the ITB aggressively, a common piece of advice, can actually compress the tendons further and worsen symptoms. Costa Health avoids this approach and focuses instead on graduated strengthening.
For patients who don’t respond to conservative care within eight to twelve weeks, referral for imaging and possible corticosteroid injection may be appropriate. But the injection alone, without addressing the tendon loading deficit, typically provides only temporary relief.
How does Costa Health assess and treat hip pain?
Every hip pain consultation begins with identifying the true source. This means examining the hip joint itself through range of motion and provocation tests, but also assessing the lumbar spine, sacroiliac joint, and relevant soft tissue structures. A diagnosis based solely on imaging findings without clinical correlation leads to poor outcomes.
Chiropractic treatment for hip pain focuses on restoring normal joint mechanics through the hip, pelvis, and lumbar spine. When the sacroiliac joint is contributing, specific adjustment techniques can reduce pain quickly. Paul Morrison uses a combination of manipulation, dry needling, and soft tissue work tailored to each patient’s presentation.
Osteopathy offers techniques particularly suited to hip conditions requiring gentle, sustained mobilisation. Muscle energy techniques and articulation work well for patients with capsular restriction or those who prefer a less forceful approach.
Sports massage plays a specific role in hip pain management, particularly when muscular tension in the hip flexors, adductors, or gluteal muscles is driving or maintaining the problem. For runners, golfers, and padel players on the Costa del Sol, regular maintenance work through these areas can prevent hip problems from developing in the first place.
When should hip pain prompt further investigation?
Most hip pain responds well to conservative treatment. But certain presentations warrant further investigation. Night pain that wakes you from sleep and doesn’t settle with position changes, pain that progressively worsens over weeks despite rest, or unexplained weight loss alongside hip symptoms should be assessed promptly.
In younger patients (under 40), persistent groin pain with clicking or catching during hip movement may indicate a labral tear, which benefits from MRI arthrography for diagnosis. In older patients, a sudden inability to bear weight after a fall requires urgent imaging to rule out fracture.
Hip pain rarely exists in isolation. The lumbar spine, pelvis, knee, and ankle all influence how the hip functions. Costa Health’s approach accounts for this, treating the region rather than a single structure, and building a plan that addresses both the immediate pain and the underlying movement patterns that caused it.