Pain may be referred to the hip region from either poor mobility of the lumbosacral region or referred nerve pain. Some trigger points in the spinal muscles may also cause referred pain to the hip or buttock. Things are not always as they seem, so it is important to assess the back while examining hip pain in order to determine the root cause. Treatment may include manual therapy, mobilizations, soft tissue mobilization, stretching, strengthening, neuromuscular reeducation and core training.

Symptoms may include, but are not limited to:

• Pain that travels down the leg, potentially down the the foot
• Pain that increases or decreases with bending of the low back
• Weakness specific to one side
• Decreased balance
• Foot drop or Toes catching while walking
• Difficulty performing stairs
• Pain increases when sitting

Osteoarthritis occurs as the joint degenerates. It may be brought on earlier in adults who have suffered trauma to the hip such as fractures or labral tears causing the joint to experience increased levels of wear and tear. It is important to learn how to manage activity levels to avoid causing further damage while also staying active enough to slow the degeneration and maintain a healthy life with maximum function.

Symptoms may include, but are not limited to:

• Stiffness, especially in the morning or after prolonged sitting

• Pain in the groin or front of thigh

• Stiffness may decrease with activity depending on severity

• Decreased range of motion of the hip

• Weakness of the hip

• Grinding or clicking sensation in the hip with movement

Hip Labrum tears are often the result of a rotational injury and will typically be a deep pain. Pain will be at end ranges of motion and the individual may experience a clicking or catching sensation. Typically, will be found in an individual such as a dancer who is performing their sport at or near end ranges of motion. Physical therapy may be part of conservative management of the pain, but these injuries often result in the person needing surgery. Physical therapy will help the individual progress through a phased rehab program in order to return to their sport or activity at their previous high level.

Symptoms may include, but are not limited to:

• Painful clicking or popping of hip, especially with rotational movements

• Feeling of hip being unstable

• Decreased balance

• Locking sensation of hip or limited Range of motion

Tendonitis is common in the hip, mainly with the Glute Medius. Often difficult to differentiate from hip bursitis which is the inflammation of the fluid filled bursa sac of the hip. With bursitis the pain is often present even with passive motion at the hip. Tendonitis of the hip can be treated by strengthening the muscles of the hip, properly loading the muscles to promote tendon healing, stretching, manual therapy and soft tissue mobilization. Neuromuscular reeducation may also be included in the rehab program in order to promote proper hip, knee and ankle mechanics.

There are two types of snapping hip syndrome, internal and external. Internal snapping hip is often a pathology of the labrum and is typically managed arthroscopically with surgery. External snapping hip is the result of either the iliopsoas tendon or IT band. It can be brought on with external rotation and abduction or with hip flexion. It is characterized as a snapping, clicking or clunking sensation and can be an audible sound as well. Physical therapy can help improve joint positioning through manual therapy, mobilizations, stretching, strengthening and neuromuscular reeducation in order to improve muscle function and joint mechanics.