Conditions · Hip
Hip pain,
rarely on its own.
Hips are the joint people most often mislocate. "Hip pain" turns out to mean the groin, the outside of the thigh, the buttock or the lower back, depending on who is describing it. Those point at genuinely different problems.
In my experience hips also seldom arrive alone. They come with a lower back that has been stiff for years, or a knee on the same side that started complaining a few months later. That is why I examine all three, even when only one of them hurts.
01 · The differential
Three different problems, one word.
Most of the work in a hip assessment is separating these, because they need different handling and they can feel similar to the person experiencing them.
The hip joint itself
Usually felt in the groin rather than the outside, often worse on weight-bearing or turning in bed, and typically with a specific loss of rotation on examination. Osteoarthritis of the hip belongs here — I work alongside the core treatments and exercise for that rather than instead of them.
The muscles and tissue beside it
Pain on the outer hip that is tender to lie on, worse on stairs or standing on one leg. It usually reflects how load is being shared between the hip and the pelvis rather than a problem inside the joint, which is why treating the joint alone often disappoints.
Referred from the lower back
A hip that hurts but examines cleanly, with the lower back stiff on the same side, is a common pattern. The pain is real and felt at the hip. The driver is upstream of it.
02 · The chain
Back, hip, knee — usually a set.
The lower back, the hip and the knee sit on one chain, and they share the work. When the lower back loses movement on one side, the hip on that side tends to compensate; when the hip stops rotating properly, the knee below it takes more of the load and the timing of the muscles around it changes.
So when a hip has been treated locally and keeps coming back, I will usually want to examine a lower back nobody has mentioned. I would rather find the problem one level up than treat the same hip repeatedly.
It runs downward too. If your knee started hurting some months after the hip did, that order is information, not a coincidence.
03 · The appointment
How a hip gets examined.
Forty-five minutes for a first appointment. I start by asking where exactly you feel it, what provokes it, whether anything else on that side has been grumbling, what you have stopped doing. Then the examination: hip range of movement in every direction and what limits it, testing to separate joint from surrounding tissue, how the muscles around the hip and pelvis are firing, and an examination of the lower back and the knee on the same side.
As a Certified Chiropractic Extremity Practitioner, the extremity assessment is postgraduate training rather than something bolted onto a spinal exam. That matters most for exactly this kind of case, where the answer is not where the pain is.
04 · The limits
When a hip needs someone else.
Some hips need imaging or a surgical opinion before anyone treats them, and I would rather say so at the first visit than work around the uncertainty.
Go to A&E
Hip pain after a significant fall or impact, an inability to bear weight, or an obviously deformed or shortened leg. Hip pain with fever needs urgent medical assessment.
When imaging or a specialist should come first
Severely restricted movement with night pain, symptoms that are progressing steadily, or a history that raises questions the examination cannot settle. Advanced hip osteoarthritis may need an orthopaedic opinion — I refer, and where appropriate work alongside it.
Patients who came in with this
Richard was recommended to me by a friend when I had ongoing hip and knee pain that was not resolving. Within the first session Richard identified the problem and has been working on this since with great results. Richard is highly professional and knowledgeable and an expert in his field. I highly recommend him
…I am 27 and suffered with hip issues that stopped me sleeping at night. I was also unable to sit at my desk for prolonged periods without stretching.
…I've been seeing Richard for various back/neck/hip issues for the past year. On top of that, he is very personable. I would absolutely recommend him!
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.