I want to tell you about a pattern I see regularly in my practice. Someone comes in with hip pain. They’ve usually had it for a while- months, sometimes years. They’ve tried stretching it, strengthening it, maybe had an injection or two. Things improve for a bit and then drift right back to where they started. By the time they get to me they’re frustrated, a little defeated, and convinced something is structurally wrong that nobody has been able to find.
And then I assess their lower back. Or their pelvic floor. Or their anterior core. And suddenly we’re having a very different conversation.
The hip doesn’t work in isolation
Here’s something that doesn’t get said enough: the hip is one of the most affected joints in the body. It sits at the intersection of your lower back, your pelvis, and your leg — which means everything above it and everything below it has an opinion about how it functions.
When something goes wrong at the hip, the most important question isn’t just “what’s happening here?” It’s “what is the hip responding to?” Because in my experience, the hip is often the messenger. And we keep treating the messenger with poor results.
Where hip pain actually comes from
Let me walk you through the usual suspects.
The lumbar spine is probably the most common one I see. The nerves that exit your lower back travel directly through the hip area and down the leg. When they’re irritated from something in the back, the pain lands in the hip, the buttock, the outer thigh. It feels exactly like a hip problem. But it isn’t. I’ve had patients who’d been told for over a year their hip was the issue, and within two sessions of treating their spine they were a completely different person.
The sacroiliac joint is another one that flies under the radar constantly. The SI joint connects your spine to your pelvis, and when it’s not moving well it produces deep, achy, sometimes sharp pain that most people describe as hip pain. It rarely shows up clearly on imaging, which means it gets missed a lot.
The surrounding musculature can also be an issue. When the psoas, the TFL, or the glute complex are really tight or weak (or both) and are not doing their job, the hip joint ends up taking a load it wasn’t designed to handle. Things wear unevenly. Pain shows up. And it keeps showing up until the muscle problem gets addressed.
And then there’s the pelvic floor which I know sounds like a stretch when we’re talking about hip pain, but bear with me. The pelvic floor muscles attach directly to the pelvis and have real connections to the hip rotators. Pelvic floor tension can refer pain into the hip, groin, and inner thigh in ways that are genuinely easy to miss if you’re not specifically looking for it. I assess it in alot of hip patients I see.
Why this matters for your treatment
If you’ve had hip pain treated in isolation and haven’t gotten lasting results, this is probably why. Treating the symptom without identifying the source is the most common reason hip pain keeps coming back. And the most common reason people end up in my office after seeing two or three other providers.
A real assessment looks at the whole picture- the spine, the pelvis, the SI joint, the surrounding musculature, and the movement patterns driving the whole thing. It’s not complicated. It just requires someone willing to zoom out instead of going straight to the painful spot.
What treatment actually looks like
Once we know what we’re actually treating, things tend to move pretty quickly. Hands-on manual therapy for the restricted joints and tight tissue. Targeted exercise for the strength and coordination deficits that have been quietly contributing to the problem. Movement retraining to change the patterns that started this whole thing.
The goal is never just to get the pain down. It’s to understand why it was there in the first place and make sure it doesn’t have a reason to come back.
If your hip pain keeps returning no matter what you try, I’d genuinely love to take a fresh look. Sometimes that’s all it takes.
Rachel Atufunwa PT, DPT