- 1008 Victoria Road West Ryde NSW 2114 Australia
- Thursday: 1:00pm – 6:00pm
By Dr Don Kim · Chiropractor & Acupuncturist · TOP Chiropractic Acupuncture, West Ryde
The hip is the body’s junction. It connects the spine and pelvis above to the knee, ankle and foot below. Everything that happens at either end of that chain directly influences how the hip loads, how the muscles and tendons work, and how vulnerable the joint becomes over time.
This is why hip pain is one of the most commonly misdiagnosed regions we see at TOP Chiropractic Acupuncture. A patient with pain in the outer hip may have a gluteal tendinopathy driven by a lumbar spine restriction above. A patient with pain in the front of the hip may have a hip flexor overload driven by years of desk posture rather than a hip joint problem. A patient told they have a ‘hip impingement’ may have an ankle mobility restriction below that forces the hip into a compromised position during every squat and step.
Treating the hip in isolation — without assessing the full chain — is the primary reason hip pain recurs after treatment ends. The joint settles temporarily. But the forces creating the problem remain unchanged.
At TOP Chiropractic Acupuncture in West Ryde, every hip presentation is assessed as part of the full kinetic chain — from the lumbar spine and pelvis above to the ankle and foot below. Treatment is structured to address the entire picture.
Hip pain presents in several distinct ways depending on the structure involved, the mechanism of overload, and the patient’s activity profile and occupation.
CONDITION | WHO IT AFFECTS | WHAT’S HAPPENING |
Femoroacetabular impingement (FAI) | Gym athletes, desk workers, young adults under 40 | The ball (femoral head) and socket (acetabulum) make contact abnormally during hip flexion — particularly in deep squatting, sitting and lunging. Causes a pinching sensation in the front of the hip or groin. Two types: cam impingement (excess bone on the femoral head) and pincer impingement (excess coverage of the acetabulum). Often co-exists with labral pathology. |
Hip labral tear | Gym athletes, dancers, contact sport players | The labrum is the cartilage ring that deepens the hip socket and seals the joint. Tears produce clicking, locking or sharp pain — typically in the groin or front of the hip — and a feeling of instability. Often develops alongside FAI. Can be managed conservatively when identified early. |
Greater trochanteric pain syndrome (GTPS) | Women over 40, runners, cyclists, those who sit cross-legged | Pain over the outer hip at the greater trochanter — the bony prominence on the outside of the femur. Caused by gluteal tendinopathy (glute medius and minimus tendons) and compression of the tendons against the greater trochanter. Aggravated by hip crossing, lying on the affected side, prolonged walking and standing. |
Hip flexor tendinopathy | Desk workers, cyclists, runners, gym athletes | Overload of the iliopsoas tendon at its attachment on the lesser trochanter or femoral head. Produces anterior hip or groin pain, particularly with resisted hip flexion and prolonged sitting. The iliopsoas is chronically shortened in anyone who sits for extended periods — making this one of the most common hip complaints in office workers. |
Piriformis syndrome | Runners, cyclists, office workers | The piriformis muscle, which externally rotates the hip, can compress the sciatic nerve where it passes through or beneath the muscle. Produces buttock pain that radiates down the leg, similar to lumbar disc sciatica. Differentiated by provocative hip rotation testing rather than lumbar loading tests. |
Hip osteoarthritis | Adults over 50, previous hip injury or overuse | Degenerative changes in the hip joint cartilage producing morning stiffness, groin aching with activity, and progressive loss of internal rotation. Often attributed entirely to the X-ray findings — but the load through the joint, the muscular support around it, and the mechanics of the spine above significantly influence how much pain the structural changes produce. |
Sacroiliac joint dysfunction | Pregnant and post-partum women, manual workers, athletes | The sacroiliac joint sits at the back of the pelvis where the sacrum meets the ilium. Dysfunction produces one-sided low back and buttock pain often mistaken for hip pain. Aggravated by single-leg loading, rolling in bed and prolonged standing. Often associated with pelvic asymmetry and altered load transfer through the hip. |
Referred hip pain | Any patient with lumbar disc or nerve pathology | Lumbar disc pathology at L1–L3 commonly refers pain into the anterior hip and groin. L4 and L5 involvement refers into the outer hip and thigh. Patients in this category have extensive hip treatment with no improvement — because the hip is not the source. Lumbar movement reproduces the hip symptoms. |
⚠️ Not all hip pain originates at the hip. Lumbar disc pathology, sacroiliac dysfunction and lumbar nerve root referral can produce identical symptoms with very different treatment requirements. A thorough assessment that includes the lumbar spine, pelvis and neural chain is essential before any hip treatment is applied. |
The hip is simultaneously the most stable and most mobile joint in the body. It carries enormous load with every step, squat and stair. When the structures above and below it are not doing their job, the hip compensates — and that compensation is what eventually produces pain.
When the lumbar spine and pelvis drive it ↓ Lumbar restriction changes how load is transferred through the pelvis to the hip. A pelvis that is rotated or asymmetric — often from SIJ dysfunction, lumbar disc pathology or long-standing posture — loads one hip significantly more than the other with every step. Over months and years, the overloaded hip develops impingement, tendinopathy or degenerative change. | When the hip is the problem itself → FAI, labral tears, gluteal tendinopathy and hip OA are intrinsic hip pathologies. But even these are rarely caused by the hip in isolation. The position the hip is loaded in — which is determined by ankle mobility below and spinal alignment above — determines which structures bear the greatest stress. A cam impingement that is asymptomatic at low load becomes symptomatic when a stiff ankle forces the hip into deeper impingement during a squat. | When the ankle and foot drive it ↑ Restricted ankle dorsiflexion — commonly from an old sprain, chronic tightness or structural limitation — forces the lower limb into a compensatory pattern during gait and loading. The hip must externally rotate and abduct to compensate for what the ankle cannot do. This creates abnormal shear across the hip joint and compressive load on the gluteal tendons at the greater trochanter. |
What makes our approach different is that we assess the entire chain — not just the painful hip. A patient with GTPS may have a lumbar restriction changing pelvic alignment and compressing the gluteal tendons from above. A patient with hip impingement may have a stiff ankle driving the compensatory squat pattern from below. Identifying and addressing these contributing factors is what prevents the problem from returning after treatment ends. |
In practice, the most common chains we identify driving hip pain include:
The desk worker pattern | Years of sustained sitting shorten the iliopsoas and anterior hip capsule while allowing the gluteal muscles to become progressively inhibited. The hip flexors pull the pelvis into anterior tilt, which loads the posterior hip and compresses the anterior structures. When this patient stands up, their hip extension is limited — and every step, lunge and stair is taken with a hip that cannot fully extend. The result is anterior hip impingement and hip flexor tendinopathy from a posture that has been sustained for years. |
The runner pattern | Weak gluteus medius allows the pelvis to drop on the swing side with each stride — a positive Trendelenburg sign. This increases hip adduction and internal rotation on the stance side, compressing the IT band against the greater trochanter and overloading the gluteal tendons. The runner feels outer hip pain that increases with mileage. Treating the hip without addressing the gluteal weakness and pelvic control produces temporary relief that fails on return to running. |
The gym athlete pattern | Restricted ankle dorsiflexion prevents full squat depth in a mechanically sound position. To hit depth, the athlete shifts their knees inward (valgus collapse) or rounds their lower back (lumbar flexion under load). Both compensations dramatically increase the stress through the hip joint — anterior impingement from the valgus, posterior hip shear from the lumbar flexion. The impingement is real, but the driver is the ankle, not the hip. |
The middle-aged woman pattern | The combination of hormonal changes affecting tendon resilience, years of loading asymmetry, and lifestyle factors — sitting cross-legged, resting with hip in adduction, sleeping on the affected side — compress the gluteal tendons repeatedly against the greater trochanter. GTPS is the most common presentation of outer hip pain in women over 40 and responds well to a specific load management and progressive strengthening protocol — but requires avoidance of the compressive positions that perpetuate it. |
Every hip presentation begins with a thorough assessment — evaluating the lumbar spine, sacroiliac joints, hip joint mechanics, muscle activation patterns, ankle mobility and neural involvement. Treatment is structured around what the assessment finds.
What makes our approach different is that we do not just treat where the pain is — we assess the entire biomechanical chain. Treatment is structured to address the contributors above and below the hip at the same time as treating the hip itself.
Acupuncture Targets the gluteal, hip flexor and piriformis muscles for pain modulation and trigger point release. Particularly effective for GTPS, hip flexor tendinopathy and piriformis syndrome where the depth and location of the structures make manual release difficult. Reduces the neural sensitisation that amplifies hip pain over time. | Chiropractic mobilisation Restores lumbar and sacroiliac joint mobility that directly influences how load is transferred to the hip. Addresses the pelvic asymmetry that is present in the majority of chronic hip presentations. Where ankle restriction is identified as a contributing factor, targeted ankle mobilisation is included in this stage. |
Soft tissue and joint mobilisation Direct release of the hip capsule, iliopsoas, TFL, piriformis and gluteal muscles that accumulate tension around a dysfunctional hip. Hip joint mobilisation restores the internal rotation and extension range that sustained posture and activity have progressively restricted. Combined with lumbar and pelvic work to maintain the improvement. | Shockwave therapy for tendinopathy Where gluteal tendinopathy, hip flexor tendinopathy or GTPS has been present for more than 3 months and has not responded to conservative care, shockwave delivers focused acoustic waves that restart the stalled healing process in the degenerated tendon tissue. Combined with manual therapy and the loading programme. Never used in isolation. |
Isometric loading The first stage for gluteal and hip flexor tendinopathy. Sustained contractions at a sub-threshold load reduce tendon pain and begin stimulating structural adaptation without exceeding capacity. Particularly important for GTPS — isometric glute med holds remove the compressive tendon loading while maintaining the training stimulus. | Eccentric and progressive loading Slow, controlled lengthening of the hip muscles under resistance. The primary driver of tendon structural remodelling for gluteal tendinopathy and GTPS. Progressed systematically from isometric to isotonic to functional loading — advancing only when the previous stage is tolerated without next-day flare. | Functional and sport-specific loading Exercises that replicate the demands the hip needs to tolerate — hip extension strength for a runner, single-leg stability for a gym athlete, load transfer efficiency for a tradesperson. Includes gait retraining, squat pattern correction and sport-specific movement where indicated. The programme is selected based on your occupation and activity profile. |
The most common advice given for GTPS and gluteal tendinopathy is rest and avoidance of painful movements. This advice is correct for the short term — removing compressive positions and high-load activities reduces acute pain. But extended rest without progressive loading does not resolve the underlying tendon pathology.
Tendons adapt to load. When a tendon is unloaded for weeks or months, its structural capacity decreases — the collagen fibres become less organised and the tendon tolerates progressively less load before becoming symptomatic again. The patient rests until the pain settles, returns to activity, and the symptoms return because the tendon’s capacity has not improved and in some cases has worsened.
At TOP Chiropractic Acupuncture, loading begins early — at an intensity the tendon can tolerate. We identify the threshold below which loading produces adaptation rather than irritation, start there, and progress systematically. The speed of progression depends on the stage and chronicity of the tendinopathy. What does not change is the principle: the tendon gets stronger by being loaded, not by being rested.
Hip osteoarthritis is one of the most commonly over-diagnosed and under-managed conditions we see. Patients receive an X-ray, are told their joint is ‘bone on bone’ or has ‘significant wear and tear’, and are advised that the only long-term option is hip replacement. This framing is not accurate — and it is not helpful.
The research is clear: appropriate exercise is the single most effective intervention for hip osteoarthritis, producing outcomes superior to medication for long-term pain and function. The structural changes on imaging do not determine the level of pain or disability — the load management, the muscular support around the joint, and the mechanics of the spine and pelvis above strongly influence how much the degeneration affects daily life.
We regularly see patients with significant hip OA on imaging who achieve meaningful improvements in pain and function through joint mobilisation, targeted glute and hip flexor strengthening, and activity modification — without surgical intervention. If you have been told that exercise is not an option or that surgery is inevitable, a thorough biomechanical assessment may reveal modifiable factors that significantly change your experience of the condition.
A subset of patients presenting with hip pain — particularly those with a background in gymnastics, dance, yoga or martial arts — have naturally hypermobile hips. Their range of movement is well beyond average, which is an advantage for many activities but creates a different clinical picture when pain develops.
For hypermobile hips, further stretching and mobilisation is counterproductive. The hip already has excessive range — the problem is that the muscular control system cannot maintain stability through that range under load. Treatment for hypermobile hip presentations prioritises stability exercises over mobility work, neuromuscular control training, and graduated loading to build the muscular support the ligaments cannot provide. If you have been told you are hypermobile or if your hip feels like it ‘clunks’ or gives way during movement, mention this during your assessment. It changes the treatment approach significantly.
Most hip conditions respond well to conservative treatment. Where a hip is not improving within the expected timeframe, or where the clinical picture suggests structural pathology, we recommend further investigation.
At TOP Chiropractic Acupuncture, we set clear criteria at the start of your treatment plan for when imaging or referral would be recommended. Diagnostic ultrasound is the first-line investigation for gluteal tendinopathy and GTPS. MRI is recommended where labral pathology or FAI is suspected. X-ray provides the baseline assessment for hip OA.
Where lumbar referral is the suspected primary driver — which is the case in a significant proportion of patients presenting with apparent hip pain — appropriate lumbar imaging and, where indicated, referral to a pain specialist or spinal surgeon is discussed. In many cases, conservative treatment and specialist co-management work effectively together: an injection to settle an acutely inflamed hip joint can create a window where rehabilitation becomes significantly more effective.
At the end of your treatment plan, we perform a full re-examination — retesting everything from your first visit and comparing the results side by side. This gives you a clear, objective picture of how much you have improved.
There is no guesswork and no vague ‘how do you feel’ — we measure your hip range of motion, your single-leg strength and stability, your tendon provocation tests, your lumbar and pelvic mechanics, and your functional capacity against your original baseline. Those results determine whether you are ready for maintenance, need continued treatment, or should be referred for further investigation. The numbers make the decision.
Chiropractic Lumbar and SIJ mobility. Pelvic alignment. Ankle mobility. Hip joint mobilisation. Addresses the chain above and below the hip that drives joint and tendon overload. | Acupuncture Pain modulation at the gluteal, hip flexor and piriformis muscles. Neural desensitisation. Promotes blood flow to degenerated tendon tissue. Effective for GTPS, hip flexor tendinopathy and piriformis syndrome. | Shockwave For chronic gluteal tendinopathy and GTPS unresponsive to conservative care. Restarts the stalled healing response in degenerated tendon tissue. Applied after acute reactivity has settled. Combined with progressive loading. | Rehabilitation Progressive loading to rebuild tendon and muscular capacity. Gait and movement pattern retraining. Sport and occupation-specific exercises. The phase that makes recovery permanent rather than temporary. |
⚠️ If you have experienced a significant fall, direct impact to the hip, or a sudden inability to weight-bear, seek medical assessment before beginning conservative treatment. These symptoms may indicate a hip fracture, particularly in older patients with osteoporosis, and require imaging and specialist evaluation before manual therapy is applied. |
Book an assessment at TOP Chiropractic Acupuncture if you are experiencing:
Hip or groin pain with walking, squatting, stairs or prolonged sitting that is not improving with rest Pain on the outside of the hip — particularly when lying on that side or walking longer distances A clicking, clunking or locking sensation in the hip with movement Morning stiffness in the hip that takes more than 10 minutes to ease Hip or buttock pain that radiates down the leg — particularly combined with back stiffness Hip pain that flares after exercise and takes days to settle Hip symptoms that have not responded to rest, anti-inflammatory medication or previous treatment Hip pain combined with lower back or pelvic symptoms — these may be directly connected |
Dr Don Kim is a dual-qualified chiropractor and acupuncturist at TOP Chiropractic Acupuncture in West Ryde. He holds a Masters of Chiropractic, Bachelor of Chinese Medicine and Bachelor of Acupuncture, and has been treating hip, pelvic and lower limb conditions since establishing the clinic in 2016. His patient caseload includes runners with gluteal tendinopathy and GTPS, gym athletes with hip impingement, desk workers with hip flexor dysfunction, and post-partum women with sacroiliac and pelvic pain — conditions where the full kinetic chain approach consistently produces outcomes that local hip treatment alone does not.
