Hip pain.
Groin, buttock, or the bony point on the side — three different problems that all get called hip pain. Where you point decides what we treat.
Three problems, one word.
When a patient says hip pain, they could mean any of three quite different things, and the distinction changes the entire plan. Pain deep in the groin and the front of the hip, often with a catch on rotation, points to the hip joint itself. Pain over the bony prominence on the outside, worse lying on that side, points to the gluteal tendons. Pain across the buttock and into the back of the thigh often is not the hip at all — it is the lumbar spine or the sacroiliac joint referring.
This matters because the treatments diverge. A hip joint that has lost internal rotation needs the joint addressed. A gluteal tendon that has been compressed against bone for months needs load management and a tendon protocol, and the exercises that help a stiff joint can actively aggravate it. Referred lumbar pain will not respond to hip work at all.
The hip is also the joint that most often makes other things hurt. It carries the load of the whole upper body into the leg, and when it stiffens the consequences travel — low back pain from lumbar compensation above, and knee pain from rotational compensation below.
At our Jacksonville and Orange Park offices, the evaluation separates these patterns first, then treats what is actually driving it — rather than treating the word.
Does this sound familiar?
Sort the pattern first, then treat it.
Gluteal tendinopathy is not bursitis
Outer hip pain has been labelled trochanteric bursitis for decades, and the label has driven a lot of treatment aimed at an inflamed bursa. Current understanding places the primary problem in the gluteal tendons where they attach to the bony prominence, with any bursal involvement secondary.
The distinction is not academic, because it changes the advice. If the problem is tendon compression against bone, then the positions that compress it are the ones to modify — sitting cross-legged, standing with the weight hung onto one hip, sleeping directly on the side without a pillow between the knees, and stretches that pull the leg across the body. Those last ones are frequently what people have been told to do, and they are often making it worse.
The treatment that works is load management to stop the compression, plus progressive strengthening of the gluteal muscles, with shockwave to stimulate a tendon that has stopped responding.
When the hip is really the back
Buttock pain is one of the most commonly misattributed symptoms in musculoskeletal practice. The lumbar spine, the sacroiliac joint, and the hip joint all refer into overlapping territory, and patients understandably call all of it the hip.
A few patterns help. True hip joint pain concentrates in the groin and is provoked by rotation. Sacroiliac pain tends to sit just below the belt line on one side, often pointed to with a single finger. Lumbar referral tends to be a broader band that can travel down the back of the thigh and changes with spinal position rather than hip position.
The examination sorts this out by loading each structure independently and seeing what reproduces the pain you actually came in with.
What a stiff hip costs the rest of you
The hip is designed to rotate substantially in both directions. When it loses that — through arthritic change, impingement, or simply years of sitting — the demand does not go away. The lumbar spine takes on rotation it is not built for, and the knee absorbs torsion it cannot control.
This is why hip restriction shows up so often in patients who came in for something else entirely. A person with recurrent low back pain and a hip that will not rotate is frequently treating the back repeatedly while the actual driver sits below it.
It also explains why restoring hip motion can settle complaints at both ends of the chain, sometimes faster than treating those complaints directly.
Hip arthritis and what conservative care can still do
Degenerative change in the hip is common with age and, as in the knee, the severity on imaging corresponds imperfectly with symptoms. Strength, remaining range of motion, and how well the surrounding structures share load all shape how an arthritic hip actually functions.
Conservative care for an arthritic hip aims at maintaining available motion, building the muscular support around the joint, and reducing the mechanical stress it absorbs from above and below. That can meaningfully improve function and comfort.
Where the joint is genuinely worn out and function is severely limited despite that work, hip replacement is a well-established operation with reliably good outcomes. We will tell you when we think you have reached that point rather than continue treating around it.
Common questions about hip pain
Find out which hip problem you actually have.
Groin, outer hip, and buttock pain are three different conditions with three different plans. The evaluation sorts them out. Jacksonville and Orange Park.
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