Hip pain can come from any of your thighs, buttock or lower back muscles also your hip, sacroiliac and lower back joints. To establish where precisely the hip pain is can be very helpful in identifying what structure is causing the pain.

Hip pain is one of the most common aches and injury that we treat. We treat hip injuries in young dancers to 80-year-old patients with arthritis.

Pain may arise from structures that are within the hip joint or from structures surrounding your hip. The precise location of your hip pain can provide valuable clues about the underlying cause. The area of pain can identify structures with problems. The hip is a complex region to determine where the pain is coming from due to the proximity to the lower back.  It can make it difficult to distinguish if the pain is indeed coming from your hip or lower back.

Any pain or problem in the hip joint will have a ripple effect on the knee, ankle and foot. So get it sorted before you cause even more problems. Hip pain causes include the muscles, tendons or joints of the hip. So let’s look at the different types of structures in your hip.

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Hip pain, Hip injury, Hip pain treatment, Hip injuries, Hip leg pain

Muscle pain

The primary muscle group in the back of the hip are the Gluteal muscles. There are a large number of muscles around the hip, each one doing its part to keep our hip joint stable. The gluteal group consists primarily of three muscles (Gluteus Maximus, Gluteus Medius, Gluteus Minimus muscle). Underlying the three layers is an inner layer of muscles that mainly turn the hip outwards.

Firstly, in the front of the hip, we find the Quadriceps muscles. Secondly, at the back, the Hamstring muscles start just below the fold of our buttocks. Thirdly, on the inside is a group of four muscles forming the adductor group. And lastly, on the outside, the tensor fasciae latae and a thick band of connective tissue called the ITB (Iliotibial band).

The muscles around the hip are injured if stretched too far. Muscle strains are also known as ‘muscle tears/pulls’ or ‘torn/pulled muscles’ because of the way these injuries occur. The muscle tissue will tear if forcibly stretched resulting in an injury.

Inside the Hip joint

The inside of the hip joint has a ring of fibrocartilage called the labrum. The labrum makes the socket deeper and helps to stabilise the joint. Labrum tears can happen from increased pressure or strain to the structure. Labrum injuries also known as Labral tears are sometimes surgically repaired. However, in most cases, it is first picked up by a Physiotherapist and is treatable.


Large bursas (fluid-filled sacs) surround areas of the hip to allow the muscles and tendons to glide more easily over bony bumps. Hip Bursitis is a condition when this protective fluid-filled sac, becomes inflamed and irritated.  Direct pressure over the bony point where the bursa is on the side of the hip will cause pain. These patients usually complain of being unable to sleep on their side because it is too painful.


A hip joint can refer pain downwards, or upwards towards the lower back. The hip is a ball-and-socket joint. The femur forms the ball, and the hip acetabulum forms the socket.  The joint surfaces is lined with articular cartilage that allows the bones to move frictionlessly within the joint.

Also, the socket area has a fibrous labrum to increase compatibility. Just like any other joint cartilage, these areas can wear away or tear and become the source of pain.

Hip joint pain mainly presents close to the groin area as the hip sits about 2.5cm in and down from the crest of your hip bone. In contrast, a labrum injury presents with C-sign. This sign describes pain as on your hip by putting your hand over your hip with your thumb pointing backwards (Your thumb and index finger creates a “C” around your hip).

On the other hand groin pain when moving your hip is a warning sign of a problem inside the joint itself.  Joint pain is challenging to pinpoint; therefore a skilled physiotherapist is necessary.

Hip joint issues arise from damage or injury to the hip ball-and-socket connection. Osteoarthritis (OA) is normal wear and tear of the joint and is a problem only if severe. Diseases can also attack and destroy the hip joint surfaces. The disease are commonly arthritis-type conditions like Rheumatoid Arthritis (RA), Juvenile arthritis and gout.

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Tendon pain

Tendons are cables that anchor the bone to muscle to the bone. Every muscle has a tendon on either side of the muscle, the one at the top called the proximal tendon and one at the bottom, called the distal tendon. Either or both tendons can become irritated resulting in an inflamed tendon. The gluteal tendon is one of the most commonly damaged tendons in the hip.

The hamstring tendon that attaches onto our sitting bone can become irritated and give you a hamstring tendinitis. The Rectus femoris muscle attaches onto the front of the hip and can cause you to feel pain there.

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Radiating pain

Structures outside the hip joint can refer pain to the joint. Meaning that while the hip hurts, the problem may potentially originate elsewhere. Inflammation or compression of the sciatic nerve, as it arises from the spinal cord in the back, can cause hip pain.  Compression or inflammation in the L1 to L5 nerve roots can refer to the hip.

Other types of nerve inflammation may manifest as hip pain, including pain in the lateral femoral cutaneous nerve of the thigh. Pain from an inguinal or femoral hernia may also cause pain that is felt deep inside the hip and groin.


The hip joint is kept stable by a group of robust ligaments that must be able to allow movements into specific directions but prevent the femur head from popping out of its socket. Thick bands of tissue surround your hip joint, forming a capsule. Inside the capsule, constant negative pressure allows light suctioning to pull the joints together. The ligaments and capsule weave into each other and keeps the hip joints stable.

Ever seen a Ballet dancer do the splits? They take years to lengthen and condition their hips to allow such an increased range of movement. If you would jump into a split you may rip some of your hip ligaments and start experiencing clicking deep inside your hip. This ‘click’ is an abnormal translation of the ball & socket joint due to the hip ligaments not being able to stabilise your hip joint. Be very careful.

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Nerve pain

Nerve supply to the hip comes from two big branches. The firsts is the femoral nerve in the front of the hip. The second is the sciatic nerve at the back. Irritation, compression or impingement of these nerves can cause a dull ache with sharp sting running down your leg.

Sciatica is the common condition that can cause thigh pain at the back of the leg and down to your toes. Pain radiating from your lower back down your leg is a problem.

Hip Injuries

Hip pain is a common complaint that we treat daily. We have helped many patients successfully relieve their pain. Unfortunately, we frequently see patients suffering for months before they decide to get help. Usually, hip pain develops gradually, but it can occur as a result of sports injuries, work injuries or merely walking.

If you are suffering from hip pain, get it checked out. Do not delay in consulting your physiotherapist if you experience hip pain. Instead, do something about it and get it diagnosed as it is easier to treat early.

An accurate diagnosis is vital to manage your pain and treat it appropriately. Treating without a diagnosis is not ethical, as what works for one problem rarely works for another. There are so many home remedies that can cause complications; we strongly advise you to see an expert that work with these types of problems every day. Delayed treatment or misdiagnosis results in longer healing times, sometimes months extra.

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Hip pain, Hip injury, Hip pain treatment, Hip injuries, Hip leg pain

Causes of Hip pain

It’s a problematic assessment, and only a few medical practitioners can pinpoint the primary source of your pain. The result is that they instead only attempt to relieve the symptoms of your hip pain, but rarely get to the root cause. Poor management makes your hip more vulnerable to injury and wears down the joint. Hip pain must not be taken lightly; there is a reason why hip replacement surgery is such a well-known surgery.

Your hip contains some of the most important muscles in your body, not to mention you use them every day. We rely on your hip muscles to stand up, walk and run. The structures in the hip are vulnerable to overuse injury, i.e. repetitive movements like walking, climbing stairs and running.

Hip pain may be caused by:

  • Overuse – Tendon inflammation, labrum injuries and arthritis
  • Trauma – Contusions, fractures and labrum injuries as well as muscle or ligament strains.
  • Repetitive – A high repetition of muscle contractions like increasing your running distance too fast. Tendons become inflamed causing tendinitis or bursitis (hip bursitis).
  • Overload – The muscle is suddenly and forcefully contracted, as in overloaded leg press, squats or lunges.
  • Overstretch – Muscles are vulnerable in a stretched position. When the hip structures forcibly extended beyond its normal boundaries, it will tear.
  • Weakness – Muscle fatigue can play a role or general muscle weakness.
  • Poor technique – During improper training loading can stress specific structures more.
  • Poor Management – Neglecting an injury that has not entirely healed.
  • Excessive stretching – of the muscle against a force, for example during weight lifting like a dead-lift, when the load is applied on both sides of the tendon, while it needs to contract and lengthen at the same time.
  • Instability – The femur buckles under load, and its not able to stay centred in the hip socket.
  • Autoimmune – Rheumatoid arthritis
  • Referral from other joints – Hip or the Lower back
  • Referral from nerves – Irritation, compression of the femoral or sciatic nerves.
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What needs to be tested to determine the source of the hip pain

  • The movements from your ankle, knee and hip (how they interact with each other)
  • Lumbar and Sacral vertebrae
  • Pelvis (forwards and backwards tilt)
  • Muscles surrounding the hip joint
  • Core muscle control and pelvic floor muscles
  • All the thigh muscles that attach onto the Femur (Quadriceps, Hamstrings, Adductors)
  • The Sciatic and Femoral nerves
  • The articular surface of the Ball and socket joint of your hips
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Hip pain, Hip injury, Hip pain treatment, Hip injuries, Hip leg pain

Hip Pain Treatment

  • Acupuncture & Dry Needling
  • Heat packs (Thermal therapy)
  • Kinesiology Tape
  • Rigid Strapping or taping
  • Neurodynamics (Nerve tissue mobilisations)
  • Dynamic Strapping
  • Strengthening exercises
  • Guided loading protocol
  • Stretches (Static, dynamic and ballistic)
  • Moon boot
  • Brace
  • Compression Bandage or Sleeve
  • Supportive strapping and taping
  • Biomechanical Analysis
  • Gait Analysis
  • TENS
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Hip pain, Hip injury, Hip pain treatment, Hip injuries, Hip leg pain

The Older Hip

If you are in the older population group, you will be more vulnerable to age-related hip issues such as hip arthritis, trochanteric bursitis and GTPS (Greater Trochanteric Pain Syndrome). Functional limitations could include walking, sit to stand, single leg balance, stairs or even sleeping in severe cases.

Hip pain goes hand in hand with reduced balance. A thorough balance assessment may be required to predict a falls risk. Falls prevention exercises may be prescribed by your physiotherapist to address any individual problems. They may even advise you to use a walking aid such as a walking stick, crutches or a walking frame.

The Sporting Hip

Younger sports-related hip issues may come on after prolonged running, jumping or landing activities. Specific sporting hip conditions should be discussed and thoroughly assessed by your hip physiotherapist. Biomechanical issues and subtle hip weakness  may only show on a slow-motion video.

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Groin pain is one of the most common symptoms associated with hip joint pathologies such as hip osteoarthritis and hip labral injury. There are also many other causes of groin pain that need to be excluded by a health professional.  More info: Groin Pain.

Only after a thorough hip assessment will your hip pain be effectively rehabilitated to relieve your current hip pain and joint dysfunction, plus prevent the return of any future hip pain.

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Other Causes of Hip pain

Have you asked yourself these questions?

“How to put an end to Hip Pain & Stiffness – without taking painkillers, without risking surgery & without having to wait to see the GP!

If you’ve got hip pain, stiffness or an ache – it’s very tempting to think that it’s nothing, that it will go away on its own. Or, you pass it off as having just “slept awkwardly”, or that it’s just a “spasm” or a bit of stiffness that “everyone” your age suffers from…

There’s no obvious reason why it happened – but it doesn’t seem to be shifting! If that’s happening to you, you’re not alone – and we hear this type of thing all the time. Hip Pain and Sciatica is THE most common problem that we see in our physio practice in Pretoria.
And when it comes to living with hip pain, everybody we see wants to know

“Why is this happening to Me?” or,
“Why am I still suffering from Hip Pain after putting up with it for six months (Maybe even more)?”

Most people think that when they get Hip Pain, it’s just going to go away on it’s own.
That they’ll wake up one morning and like “magic”, it’ll be as if the hip pain never happened…
But then 6 months later you’re still living with hip pain – often even worse than it was when it came on.

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Does That Sound Like You?

Another scenario we see all the time in our Physio Practice is when people go to the Doctors, and the Doctor tells them to rest and “try these painkillers” and “see how it goes”.

But this is rarely ever the best advice and often 6 weeks later, they end up going back to the Doctor again because it hasn’t got any better. Worse, they’re often given yet another prescription of even stronger pills, and advised MORE rest. This is madness and explains why so many people are suffering with chronic hip pain.

Has this happened to You?

Why else does hip pain last longer than it should? Well, it’s easy to get confused because you’ve been told different things, by different people. There’s lots of people out there who are happy to dispense advice – but not all of it is credible.

Maybe you think your hip pain was caused by doing something – like lifting or sleeping awkwardly – but it was caused by years and years of poor posture that caused the muscles in your hips to become weak and walking in that awkward position was just the EFFECT of that.

If you don’t know what you’re doing – hip pain can be very confusing. Many people just end up accepting it as ‘part of life’, thinking as if it’s normal and ‘just the way it is’.

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Hip pain, Hip injury, Hip pain treatment, Hip injuries, Hip leg pain

Why is your hip pain lasting longer than expected?

  • You believed the pain would go away over time (on its own) but it didn’t

  • You went to the Doctor who told you to rest and take painkillers. The painkillers helped to relieve the immediate pain but didn’t help your injured hip. As soon as the painkillers wore off, the hip pain returned

  • A family member (or friend) told you that “Everybody experiences hip pain as they grow older,” and that you should just accepted it

  • In the past you went to other Healthcare Professionals (or a Physiotherapist) but nothing they said or did seemed to help

  • YouTube exercises and home remedies didn’t help relieve the pain, or in some cases made the hip pain ten times worse

  • You thought it would be a good idea to rest because your hip was so sore. However, afterwards your hip felt even more stiff and tight than before

  • You went for massages, hoping they would relieve the pain. The massages felt pleasant and relaxing, but didn’t do anything to fix your hip pain in the long term

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Experiencing these situations or applying similar advice and not getting results is a good thing. Why? Because these experiences help you know what doesn’t work for you. It means that you are closer to finding out what does work for you!

We invite you to book an appointment with a Physiotherapist (at our Pretoria practice). During an appointment we assess your symptoms, diagnose the cause, educate you about what is happening in your body and then start treatment. See our FAQ for more in depth information about what to expect from a physiotherapy session.

Alternatively, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make an informed decision about what to do next concerning your hip pain.

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Choose a Cilliers & Swart Physiotherapist to aid you in getting rid of your hip pain

What can we do for you?

  • We quickly put an end to pain and stiffness – often within a couple of sessions

  • We help you find out what is going on in your body and help you understand the root cause of your hip pain

  • Pain can rob you of sleep or rest. We make it easier for you to return to your normal sleeping patterns and positions so that your energy and potential for recovery increases

  • Cilliers & Swart Physiotherapists closely manage and treat your problem. We also provide you with related exercises to speed up your recovery

  • Using painkillers in the long-term can be harmful to your health. We help you lower or completely stop your need for painkillers to manage pain

  • Our physiotherapists safeguard you against dangerous and costly surgeries and painful injections

  • We reduce visits to specialists or doctors who only order you to take more pills

  • Hip pain can limit the activities you enjoy with your family and friends. Our experts help you get back to spending quality time on the activities you (and your loved ones) like

  • We can get you to sit comfortably and walk longer than 15 minutes, in both cases without feeling that your hip is weak, in pain or about to collapse

In short, we help you get back to living life free from chronic hip pain. For information about costs and availability, click the button below:

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4 steps to get rid of hip pain quickly.

  • Decide to get help.
    Many people put off going for treatment, that by the time they receive treatment the injury has worsened over time or caused other problems. Don’t think that hip pain will ‘just go away with time’. It might sound brave to ‘put up with pain’ over an extended period of time, but the lack of treatment could end up costing you more in terms of time (for recovery) and resources (money) the longer you wait.

  • Do the RIGHT exercises.
    One of the best things to help ease your hip pain is the appropriate series of progressed exercises (as advised by your Physiotherapist or Health Professional). The right kind of activities can reduce your pain and increase your range of movement. Above all, exercises ensure that problems don’t come back. However, the wrong kind of exercises have the potential to increase the pain in your hip even more.

  • Avoid sitting still for long periods.
    Ever tried to get up from the sofa after resting for a while, but you struggle because your hip feels painful and tight? That’s because one of the worst things you can do is to ‘rest’ in a sitting position for too long. Too much rest and sitting in awkward positions makes your body stiff and tight. As a safety measure we recommend specific strengthening exercises for better posture. We can help you get active by combining these exercises with our Physiotherapists’ hands-on treatment.

  • Get hands-on Physiotherapy treatment.
    Physiotherapy is proven to improve the lives of people suffering from hip pain. Hip pain could be affecting your physical performance in a professional or private capacity. It could even threaten your independence or get in the way of spending quality time with family and friends. Physiotherapy can enable you to live the life you desire as quickly as possible.

If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-freeCall me back” phone call.

Note: This free call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.

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