Hip

Hip pain is one of the more commonly misattributed complaints in orthopedics. Pain in the groin usually reflects the joint itself. Pain on the outside of the hip is more often gluteal tendon or bursal in origin. Pain at the back of the hip may come from the hamstring origin, the pelvis or the lumbar spine.

The evaluation works through those possibilities in order — history, gait, range of motion, provocative testing of the joint and the surrounding tendons, and an assessment of the spine when the pattern suggests it. Radiographs are obtained for nearly everyone; MRI is added when a labral tear, tendon tear or stress injury is suspected and would change management.

Most hip conditions are treated first without surgery. Femoroacetabular impingement, gluteal tendinopathy and early arthritis all respond to a well-designed rehabilitation program that restores hip and core strength and changes how the hip is loaded during sport and daily activity.

Injections are used selectively — both to relieve symptoms and, in some cases, diagnostically, since a response to an intra-articular injection helps confirm that the joint itself is the pain generator.

When structural injury persists despite appropriate rehabilitation, surgery is discussed. Labral injury with impingement, full-thickness gluteal tendon tears and proximal hamstring tendon tears are the conditions most likely to benefit from operative treatment.

Hamstring and gluteal tendon repair restore the attachment of tendons that rehabilitation alone cannot reattach, and they are procedures often overlooked in patients told their pain is simply bursitis or a chronic strain. Each is planned around the tear pattern, tissue quality and the patient's functional goals.

Tendon repairs around the hip involve a protected period, often with crutches and defined restrictions, followed by progressive loading. Arthroscopic procedures follow a staged protocol focused on restoring motion before strength.

Protocols are written out and shared with the treating therapist, and return to running or sport is based on strength and control testing rather than time alone.