How to diagnose and
treat hip pain

How do clinicians diagnose hip pain?

When you see a clinician for hip pain, the first step is a detailed conversation and examination, not just a quick look at a scan. They will ask: ^{1 4 5 10}

• Where you feel the pain (groin, outer hip, buttock, thigh, or knee)
• What brings it on (walking, stairs, putting on shoes, running, lying on one side)
• How it started (gradual vs sudden, trauma vs no clear injury)
• Whether there is night pain, rest pain, limp, or difficulty weight bearing
• Your activity levels, sports, recent training changes, and work demands
• Other health factors such as weight, metabolic health, inflammatory disease, or infection risks⁵ ⁶ ¹⁰ ¹³

They will also screen for red flags such as fever, feeling unwell, history of cancer, major trauma, or severe pain with inability to walk, which can signal fracture, septic arthritis, or significant bone stress injury.⁵ ¹⁰ ¹¹ ¹²

The physical exam usually includes:¹ ⁴ ⁵ ⁷ ⁸

• Watching how you walk and stand
• Measuring hip range of motion, especially bending (flexion) and inward rotation
• Provocation movement tests such as FADIR (flexion, adduction, internal rotation) and FABER (Flexion, abduction, External Rotation) to stress the hip joint and surrounding tissues
• Palpation over the greater trochanter (outer hip) to check for gluteal tendinopathy which is also known as Greater Trochanteric Pain Syndrome (GTPS)
• Strength testing of hip abductors, extensors, and flexors
• Basic checks of the lumbar spine and sacroiliac joints, because they can refer pain to the hip region

In younger, active adults with suspected femoroacetabular impingement (FAI) or labral problems, clinicians often look for a “C sign” (hand cupping around the hip), clicking or catching, and reduced flexion and rotation.⁴ ¹⁴ For outer hip pain, they look for trochanteric trochanteric (outter bony proeminence) tenderness, pain when lying on the side, and pain with resisted abduction.⁷ ⁸ ¹⁵

Not everyone with hip pain needs advanced imaging straight away. Many people with typical osteoarthritis or GTPS can be diagnosed based on their story, examination, and simple X rays.¹ ⁵ ⁷ ⁸ Imaging is more likely to be recommended when:¹ ⁴ ¹⁰ ¹¹ ¹²

• Symptoms are severe, atypical, or worsening
• There is night or rest pain over the femoral neck (groin) area
• A femoral neck stress injury is suspected
• Labral or cartilage pathology is suspected in FAI syndrome
• Infection, inflammatory arthritis, or tumour is a concern
• Symptoms do not improve after a period of good quality conservative care
• Surgery is being considered

Typical imaging pathways include:

• X rays (radiographs): Usually the first line for persistent hip pain. They show joint wear signs, broken bones and bone shape variations.¹ ⁵ ⁶
• MRI: Used to detect stress injuries in the femoral neck, labral and cartilage damage, early avascular necrosis (death of bone tissue due to a lack of blood supply), or occult fractures when X rays are normal. MRI is the most sensitive test for bone stress injury.¹ ¹⁰ ¹¹ ¹²
• Ultrasound: Useful for assessing gluteal tendons and bursae (fluid-filled sac that acts like cushion between the tendon and bone), guiding injections, and, in some cases, looking for effusion or soft tissue problems.¹ ⁷ ⁸

If septic arthritis (joint infection) is suspected, guidelines emphasise urgent joint aspiration for lab analysis, along with early intravenous antibiotics.¹⁰ Unstable fractures need urgent orthopaedic review because of the risk of non union and loss of blood supply to the femoral head.¹¹ ¹²

Throughout this process, your clinician’s goal is to match your symptoms, exam findings, and any imaging into a coherent diagnosis that guides safe and effective treatment.¹ ⁴ ⁵

Clinical insight

Modern hip care emphasises that FAI is a clinical syndrome, not just a scan finding. Many people have bone shape variations on imaging without any pain.^4,14 FAI syndrome is only diagnosed when symptoms, clinical tests, and imaging all line up.⁴ This helps avoid unnecessary surgery based solely on bone shape.

What are the treatment options for hip pain?

Treatment depends on the main diagnosis and your goals, but most plans start with education, activity changes, and exercise based rehabilitation. Surgery and injections are usually reserved for specific indications after a good trial of conservative care.² ³ ⁵ ⁶ ⁷

Education and load management

Across causes, clinicians often begin by adjusting how much load your hip is taking and how that load is spread through the week.⁵ ⁶ ⁹ ¹³ This may include:

• Temporarily reducing long walks, deep squats, or high impact activities such as running or jumping
• Swapping some sessions for low impact options like cycling, pool work, or the elliptical
• Breaking up long periods of sitting or standing in one position
• Avoiding positions that strongly compress sore tendons, such as lying on the painful side or “hanging” on one hip⁷ ⁸ ¹⁵
• Planning graded return rather than jumping straight back to previous levels

Education also covers realistic expectations, flare management, and how to use a pain scale to guide progression (for example, keeping pain during and after exercise in the mild range and allowing 24 hours to settle).⁵ ⁷ ⁸ ¹³ ¹⁵

Exercise based rehabilitation for hip pain

Hip osteoarthritis (bone and cartilage wear)

Guidelines strongly recommend land based exercise for everyone with hip osteoarthritis, regardless of age or weight. Helpful components include:

• Strengthening: Focus on hip abductors, extensors, and quadriceps with exercises like bridges, sit to stands, squats within tolerance, and step ups.
• Neuromuscular training: Balance, coordination, and functional tasks that challenge the hip in real life patterns.
• Aerobic exercise: Such as walking, cycling, or water based exercise, adapted to pain and fitness levels.

These programs can reduce pain and improve function with moderate effect sizes and are central to care, not an optional add on. ⁵ ⁶ ¹³

FAI syndrome and labral related pain

First line care is typically physiotherapist led and includes:

• Education about irritants and safe ranges
• Activity modification to reduce repeated impingement positions (deep flexion with rotation, prolonged end range squats)
• Targeted strengthening of hip and trunk muscles
• Movement retraining to adapt cutting, pivoting, and squatting mechanics

Randomised trials show that both physiotherapy improved outcomes for FAI syndrome. In carefully selected patients, surgery can yield greater improvement in patient reported scores at 12 months, but not everyone needs or benefits from it. ^{2 3 4}

GTPS / gluteal tendinopathy

Gluteal tendinopathy is outer hip pain due to irritation of the tendons, inflammation of the cushion sac or bone. A major trial (the LEAP lateral hip pain study) found that education plus specific hip abductor strengthening produced better global improvement at 52 weeks than a single corticosteroid injection or a wait and see approach ^{7 8}. Programs typically:

• Reduce compressive positions (side lying on the painful hip, crossing legs, hanging on the hip)
• Start with isometric or low load abductor work in mid range
• Progress to heavier loading with side lying or standing hip abduction, lateral steps, and single leg tasks
• Integrate trunk and lateral chain strengthening and gait retraining where needed ^{7 8 15}

Femoral neck stress injury

Management depends on the injury side and severity. Rehabilitation then follows a phased plan to restore hip strength, balance, and impact tolerance. ^{11 12}

• Compression side, lower grade injuries may be managed with load reduction and protected weight bearing plus progressive strengthening once pain and imaging allow.
• Tension side or displaced fractures usually need surgical fixation and stricter protection to reduce the risk of non union and avascular necrosis (lack of blood supply).

Medications

Short courses of simple analgesics or non steroidal anti inflammatory drugs (NSAIDs) can help manage flares and support participation in rehab when used appropriately. [5][6] Medication use is usually part of a broader plan, not the main treatment. Guidelines highlight that ⁵ ⁶ ¹³ :

• Paracetamol on its own has limited benefit for osteoarthritis.
• Chronic opioid therapy is discouraged because of limited benefit and higher risk.

Injections

Injections can offer short term relief for some people and situations, but they do not cure the underlying problem.

• Hip osteoarthritis: Ultrasound guided intra articular corticosteroid injections can provide short term pain reduction and may help people engage in exercise, but benefits typically last weeks to a few months. Hyaluronic acid Hyaluronic acid (substance found in the fluids in the eyes and joints that act like a lubricant) is generally not recommended in UK guidance and many commissioning policies, but it can act like a cushion and alleviate pain temporarily.⁵ ⁶ ⁹ ¹⁶
• GTPS / gluteal tendinopathy: Corticosteroid injections can reduce pain in the short term but, in the LEAP trial, people who received education and exercise had better long term global results than those who had an injection alone. Shockwave therapy shows mixed evidence and is best considered an adjunct to a solid loading program rather than a stand alone fix. A platelet-rich plasma injection is a therapeutic treatment derived from your blood that can reduce tendon inflammation.⁷ ⁸ ¹⁶

Surgery

Surgery is reserved for specific, well defined situations after shared decision making and a good conservative trial.

• FAI syndrome and labral pathology: Arthroscopic surgery can reshape bone deformities and repair or debride labral cartilage. Trials show larger average improvements in patient reported outcomes at 12 months compared with best conservative care in selected patients, although both groups improve.² ³ ⁴ Decisions about surgery consider age, sport and work goals, imaging findings, and response to physiotherapy.
• End stage hip osteoarthritis: A total hip replacement is considered when pain and stiffness significantly limit life and work despite comprehensive non operative care, and imaging confirms advanced joint changes.⁵ ⁶ ¹³
• Femoral neck stress fracture: Unstable fractures usually require surgical fixation to protect the femoral head.¹¹ ¹²
• Septic arthritis: Requires urgent joint aspiration, intravenous antibiotics, and often operative washout to protect the joint and reduce systemic risk.¹⁰

Recovery timelines for hip pain vary

• GTPS and soft tissue issue hip injuries: often meaningful improvement within 8–12 weeks, with further gains over the year.⁷ ⁸
• Osteoarthritis: symptoms fluctuate over years, but many people achieve lasting improvements and can delay or avoid surgery with ongoing exercise and weight management.⁵ ⁶ ¹³
• FAI syndrome: some people do well with physiotherapy alone; others choose surgery after a focused conservative block.² ³ ⁴
• Femoral neck stress injuries: often require months of structured management and careful return to impact, especially for higher grade or tension side lesions.¹¹ ¹²

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find pain relief for groin pain?

While you’re waiting for an appointment or alongside a supervised program, some simple steps can often help:

• Adjust your activity, don’t stop everything. Swap some high impact or deep flexion tasks (running, deep squats, long hill walks) for lower impact options like cycling, swimming, or flat surface walking, guided by symptoms.⁵ ⁶ ¹³
• Use a pain scale to guide what’s okay. A common rule is to keep pain during and after activity in the mild range (for example, ≤3 out of 10) and make sure any increase settles within 24 hours. If pain is sharp, worsening, or present at night or at rest, reduce the load and seek assessment.⁵ ⁷ ⁸ ¹³
• Support your hip muscles. Depending on your pain level, gentle bridges, sit to stands, or side stepping with a band may be appropriate starting points, then progress under guidance.⁵ ⁷ ⁸ ¹³ ¹⁵
• Look after sleep, weight, and general health. Better sleep and metabolic health metabolic health (diabetes, high blood pressure, cholesterol) can improve pain processing and joint health over time.⁵ ⁶ ¹³
• Use short term pain relief if appropriate. Simple pain medicines or NSAIDs, when safe for you, can make it easier to keep moving and engage in rehab.⁵ ⁶

If pain lasts more than a few weeks, keeps coming back, or stops you from doing things that matter to you, a tailored plan from a clinician is important.