Written by Dr. Jonny Blue, DPT ยท Founder, Land and Sea Physical Therapy
Hip pain is one of the most misread conditions we see in the clinic. Patients arrive having been told they have bursitis when they have a labral tear, or told they have a labral tear when they have impingement, or told it’s their back when it’s actually their hip and vice versa.
The reason misdiagnosis is so common is that the hip is complex, the structures are deep, and pain from the hip refers frequently to places that have nothing obvious to do with the joint itself.
The Most Common Sources of Hip Pain
The hip joint itself, including the labrum, cartilage, and femoral head produces pain that’s typically felt deep in the groin or front of the hip. It’s often described as a catching, clicking, or aching sensation worse with hip flexion, prolonged sitting, or getting in and out of a car.
The structures around the hip, including the greater trochanteric bursa, the glute tendons, and the IT band produce pain on the outside of the hip or buttock. This is frequently worse with stairs, lying on that side at night, and sustained walking.
The lumbar spine refers pain into the hip and buttock regularly. L3 and L4 nerve roots in particular refer into the anterior thigh in a pattern that closely mimics hip joint pathology.
Why Imaging Doesn’t Always Tell the Whole Story
MRI findings of labral tears, cartilage changes, and hip impingement morphology are common in people with no pain whatsoever. Research consistently shows that structural findings on imaging correlate poorly with symptoms. This means a labral tear on an MRI is not automatically the cause of your pain. Sound hard to believe? I know. But the research supports it and see it all the time in the clinic.
But this is very important and it matters enormously for treatment decisions. Treating what the MRI shows rather than a clinical presentation leads to unnecessary procedures *including surgery* for pathology that may be entirely incidental.
What has always stood out to me is that most people’s pain happens during movement. Going up and down stairs, leaning forward to tie your shoes, sitting down or getting up from a low chair, at the bottom of a lunge, etc. But what do they tell you when go in to take an MRI?
“DO NOT MOVE.”
If the pain comes with movement… and the MRI is taken when you are not moving and your hip is in not in the position where the pain starts, how can we be SURE that “small tear” that is shown on the MRI is truly causing the pain we feel with movement?
We can’t.
Pain with the movements I described above are almost always the result of muscular imbalances and compensations around the joint. We can confirm this during the course of a 1 hour session. Here’s how it goes: we’ll have a patient do a lunge, squat, etc. They tell us the pain is a 5/10 once they get to a certain depth in their squat. We will start treating the imbalances that we found and have them re-test their squat and ask their pain level. If they tell us the pain is a 0/10 now (which is extremely common, btw) then we have confirmation of what was causing the pain. The “tear” that the MRI showed is still there, yet their squat is now pain free.
What a Proper Assessment Looks Like
The only way we can provide such targeted, and effective, treatment is to first identify what is truly at the root cause of a person’s issue. A skilled clinical assessment of hip pain involves more than reviewing imaging. It includes movement testing to identify which directions and loads provoke symptoms, palpation of specific structures to localize the source, hip strength testing, lumbar spine screening to rule out referred pain, and functional movement assessment under real-world demands.
At Land and Sea PT in Oceanside, we spend the first session building a complete clinical picture before we start treatment. The diagnosis drives everything, which is why getting it right matters so much.
If you’ve been dealing with hip pain in North County San Diego and haven’t gotten a clear answer about what’s actually causing it, we’d be happy to take a look. Learn more about our approach to hip injury physical therapy or request an appointment to get started.
Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.