Hip Pain

What Causes Hip Pain?

Hips are deep, ball-and-socket joints — probably the most stable joint in your body, but that complexity means pain can be confusing because it presents in different locations depending on what’s actually wrong.

Lateral hip pain (outside of the hip) is usually tendon-related. Groin pain often points to impingement, adductor issues, or labral problems. A deep, persistent ache might be arthritis or referred from the lower back.

Common in runners ramping up mileage, gym-goers squatting heavy or doing too much volume, and desk workers who’ve spent years sitting in hip flexion then suddenly decide to take up running. The hip doesn’t appreciate sudden changes in load or prolonged static positions.

Common Hip Problems I Treat

Here’s what typically brings people through the door across Liverpool, Chester, Queensferry, and the wider Merseyside and Cheshire areas.

Greater Trochanteric Pain Syndrome (Lateral Hip Pain / Glute Tendinopathy)

The classic. Pain on the outside of your hip, worse when lying on that side at night, walking up stairs, or standing on one leg.

Often misdiagnosed as “hip bursitis” or “trochanteric bursitis” — but research shows it’s usually a tendon problem, not inflammation of the bursa. The gluteal tendons (specifically glute medius and minimus) attach at the side of the hip and can become overloaded and painful.

Common in runners — particularly those who’ve increased mileage too quickly — and in middle-aged women, though I see plenty of blokes with it too. Also common in gym-goers who’ve ramped up single-leg work or heavy squatting without the tendon capacity to handle it.

Responds well to progressive loading of the glutes, but it’s slow. We’re talking 3-6 months of structured rehab. Tendons don’t heal quickly. Anyone promising to fix your glute tendinopathy in three weeks with massage or acupuncture is talking rubbish.

Hip Flexor Strain / Tightness

Pain at the front of your hip, where your thigh meets your torso. Can be acute (sudden strain from sprinting or kicking) or chronic (tightness and discomfort from prolonged sitting).

Acute strains are common in footballers, rugby players, and sprinters — sudden acceleration or high kicks overload the hip flexor muscles (psoas and iliacus). You’ll know when you’ve done it.

Chronic hip flexor tightness is rampant among desk workers across Chester and Queensferry who sit for 8-10 hours a day then try to run or train without addressing the fact their hips have been locked in flexion all week. The hip flexors get stiff, weak in lengthened positions, and painful when you try to extend the hip properly during running or squatting.

Treatment for acute strains: progressive loading over 2-6 weeks depending on severity. Chronic tightness: a combination of strengthening in lengthened ranges, mobility work, and sorting out your sitting ergonomics.

Labral Tears

The labrum is a ring of cartilage around the hip socket that deepens the joint and provides stability. It can tear from a traumatic injury (awkward landing, high-impact collision) or degenerate over time in athletes who repetitively load the hip at end-range — squatters, footballers, dancers.

Symptoms: Deep groin pain, often with a catching or clicking sensation. Pain is typically worse with deep hip flexion (bottom of a squat) or twisting movements.

Here’s the thing: labral tears are common on MRI scans in people with zero symptoms. Having a tear doesn’t automatically mean you need surgery. Many labral tears can be managed conservatively with physio focusing on hip strength, mobility, and load management.

If conservative management doesn’t work after 3-6 months of proper rehab, then we consider surgical options. But surgery isn’t a guaranteed fix either — outcomes vary. I’ll tell you straight if I think you need a surgical opinion, but let’s try physio first.

Hip Impingement (Femoroacetabular Impingement / FAI)

Structural pinching from hip bone shape that causes groin pain, particularly in deep squats or repetitive hip flexion movements. Effective treatment involves modifying aggravating positions, strengthening the hip in pain-free ranges, and gradually building tolerance through structured rehab.

Read more about Hip Impingement →

Groin Pain (Adductor-Related)

Pain on the inside of the thigh or groin common in footballers and athletes with kicking or rapid direction change movements, usually involving adductor tendon overload. Acute strains respond to 4-8 weeks of progressive loading, while chronic cases may require 8-12 weeks with comprehensive strength and movement assessment.

Read more about Groin Injuries →

What You Can Expect in Your Assessment

I’ll take a detailed history of how the pain started, where exactly you feel it, what makes it worse, what you’ve tried already, and what your goals are — whether that’s getting back to running, squatting pain-free, or just being able to sleep on your side without waking up.

Then I’ll assess your hip — range of movement, strength testing, special clinical tests to differentiate between tendon, labrum, impingement, or muscle issues.

Often I’ll watch you squat, lunge, or perform sport-specific movements to see how your hip moves and where the pain is coming from.

By the end of the session, you’ll have:

Do I Need a Scan?

Maybe. Many hip problems can be diagnosed clinically without imaging.

Greater trochanteric pain syndrome, hip flexor strains, and groin pain can usually be identified through clinical examination and movement testing. We can start treatment straight away.

You might need imaging if:

• There’s been significant trauma and I suspect a labral tear or fracture
• Symptoms aren’t responding to rehab as expected and we need to rule out structural issues like FAI or arthritis
• You’re being considered for surgery and the surgeon needs imaging to plan the procedure

Here’s the catch with hip imaging: MRI and X-ray findings don’t always correlate with symptoms. You can have FAI morphology, labral tears, or mild arthritis on a scan and have zero pain. Conversely, you can have significant pain with minimal findings on imaging.

If imaging is needed, I’ll guide you on the best route — NHS referral via your GP (free but slower), or private MRI or ultrasound if you want results quickly.

Why Rest Alone Doesn’t Work

People rest their hip, pain settles a bit, they go back to running or squatting, and it flares up within days. Sound familiar?

Rest reduces pain by removing the aggravating load, but it doesn’t fix the underlying problem — usually weakness, poor load tolerance in the hip muscles, or movement patterns that keep overloading the same structures.

When you return to activity at the same level you were at before, you’re asking a deconditioned hip to handle loads it couldn’t manage when it was stronger. No surprise it breaks down again.

What Does Hip Rehab Involve?

Depends on the specific diagnosis, but here’s what most hip rehab programmes include:

Glute strengthening: Non-negotiable for almost every hip problem. Weak glutes contribute to lateral hip pain, groin issues, impingement, and pretty much every other hip problem. We’re building strength in single-leg stance, hip extension, hip abduction, and external rotation. This isn’t a few clamshells and calling it a day — proper progressive loading over weeks and months.

Hip mobility: Restoring full range of movement, particularly if you’ve been avoiding certain positions due to pain. This might include stretching tight hip flexors for desk workers, or improving hip internal rotation for squatters dealing with impingement.

Load management: Modifying training volume, intensity, or exercise selection to keep symptoms manageable while you build capacity. That might mean reducing running mileage temporarily, adjusting squat depth, or swapping high-impact for low-impact cardio for a period.

Running or squat modifications: If running or squatting is aggravating your hip, we’ll modify technique, cadence, stance width, or depth to find a pain-free position. Then we gradually work back to your normal pattern as strength and tolerance improve.

Progressive return to sport: Once you’ve built strength and symptoms are settling, we gradually reintroduce the activities you want to get back to. Structured progression, not guesswork — specific benchmarks and criteria to hit before ramping up intensity or volume.

How Long Does Recovery Take?

Realistic timescales for common hip problems:

Glute tendinopathy (lateral hip pain): 3-6 months of progressive loading. It’s slow. Tendons adapt gradually and there are no shortcuts. You’ll likely see some improvement by 6-8 weeks but full resolution takes longer.

Hip flexor strain (acute): 2-6 weeks depending on severity. Grade 1 strains might settle in a fortnight with progressive loading. More significant tears need 4-6 weeks before returning to full sprinting or kicking.

Hip flexor tightness (chronic): 6-12 weeks to properly address strength and mobility deficits. Chronic issues take longer because we’re undoing months or years of adaptive shortening and weakness.

Groin strain (adductor-related): 4-8 weeks for acute strains. Chronic groin pain can take 8-12 weeks or longer if there are significant strength deficits or training load issues to address.

FAI / labral management (conservative): 8-12 weeks of structured rehab to see if symptoms respond. If conservative management works, you might avoid surgery. If not, we consider surgical options.

Post hip arthroscopy (labral repair or FAI surgery): 3-6 months to return to full sport. Rehab is progressive and shouldn’t be rushed. Hospital physio typically discharges around 8-12 weeks, but the real work of getting back to sport continues beyond that.

These are broad ranges. Your specific timeline depends on injury severity, how long you’ve had it, and how well you stick to the rehab programme.

When to Book an Assessment

Location and Booking

I run a clinic in Chester, with appointments available Monday, Wednesday, Thursday, and Friday.

Whether you’re a runner with lateral hip pain, a gym-goer from Chester dealing with hip impingement from squatting, or a desk worker across Cheshire with chronic hip flexor tightness, I can help.

Book online to see available slots, or get in touch if you’ve got questions before booking.

No hard sell. No obligation. Just honest physio focused on getting you back to doing what you want to do, pain-free.