What is the difference between hip bursitis and gluteal tendinopathy?

Greater trochanteric pain syndrome (GTPS) was previously called trochanteric bursitis, but research has established that pain in the vast majority of cases arises from gluteal tendinopathy — degenerative change in the gluteus medius and minimus tendons — rather than from the bursa. This distinction matters significantly for treatment: stretching the hip into adduction, which was commonly prescribed for bursitis, actually compresses and worsens the gluteal tendons. Progressive gluteal loading and shockwave therapy produce excellent outcomes for GTPS.

What are the symptoms of a hip labral tear?

A hip labral tear produces deep anterior groin pain — often described with a C-sign, cupping the hand around the front and side of the hip. A catching, clicking or locking sensation with hip flexion and rotation is characteristic. Pain worsens with prolonged sitting in low seats, getting in and out of cars, pivoting and kicking. The FADIR test (hip flexion, adduction, internal rotation) reproduces the groin pain on clinical examination. MRI arthrogram is the definitive diagnostic investigation.

HIP PAIN

Q: How can I tell if my sciatic pain is from my back or my hip?

Lumbar disc sciatica produces back pain alongside leg symptoms, and lumbar loading tests reproduce the leg pain. Sciatic nerve irritation from the hip (deep gluteal syndrome or piriformis syndrome) produces buttock and leg pain without significant lumbar involvement — lumbar tests don't provoke the leg pain, but prolonged sitting, hip internal rotation and deep buttock palpation do. Our osteopaths assess both regions thoroughly to identify the correct source and apply the right treatment.

Q: Do I need a referral to see an osteopath for hip pain?

No referral is needed. Book directly online or call (03) 9551 7110. Same-week appointments usually available. Covered by most private health insurance extras — HICAPS on-site. WorkCover and TAC patients welcome. Imaging is coordinated through your GP when required.

Hip pain can affect people of all ages, from active individuals dealing with a sports injury to those experiencing the gradual onset of arthritis or bursitis. Whether your pain is felt deep in the joint, around the outside of the hip, or radiating into the groin or thigh, our osteopaths and remedial massage therapists at Dingley Health Hub will take the time to understand what's going on and create a treatment plan tailored to you. Through hands-on care and targeted rehabilitation, we'll work to restore your mobility, reduce discomfort, and get you moving with confidence again.

Osteopathy

Massage

Shockwave

Common Hip Conditions

Hip osteoarthritis

Hip osteoarthritis is one of the leading causes of disability in adults over 50 and involves the progressive loss of articular cartilage within the hip joint, along with subchondral bone remodelling and the formation of osteophytes (bone spurs) that restrict movement and cause pain. It is more common in people with a history of hip injury, previous labral tears, femoroacetabular impingement (FAI), hip dysplasia, and those who have performed heavy manual work over many years. Genetics also plays a significant role. While hip OA cannot be reversed, pain, stiffness and functional capacity can be substantially improved with evidence-based exercise therapy and hands-on osteopathic care.

Symptoms include:
Deep groin pain, anterior thigh aching or buttock pain that worsens with prolonged walking, climbing stairs and rising from a seated position. Morning stiffness lasting less than 30 minutes that eases once the joint is warmed up. Progressive reduction in hip internal rotation and flexion range of movement — often noticed when putting on shoes and socks, getting in and out of a car, or crossing the legs. An antalgic gait (limping) that develops as the condition progresses, and a positive FABER test on clinical assessment by your osteopath.

How we treat it:
Evidence strongly supports exercise therapy and manual therapy as the primary treatments for hip osteoarthritis — significantly superior to passive treatments and rest alone. Hip joint mobilisation and articulation techniques reduce stiffness, improve joint nutrition and provide meaningful pain relief. Targeted strengthening of the gluteals, hip abductors and deep hip external rotators offloads the arthritic joint surfaces and reduces pain during daily activities. Aquatic exercise is particularly beneficial, as the buoyancy of water allows progressive loading with minimal compressive force on the hip joint — ideal for patients whose symptoms are too severe for comfortable land-based exercise. We provide pre-operative optimisation for patients who are planning total hip replacement, building the strength and mobility that improves surgical outcomes. We also deliver comprehensive post-surgical rehabilitation to restore gait mechanics, hip strength and full functional independence.

Hip labral tear

The acetabular labrum is a ring of fibrocartilage attached to the rim of the acetabulum that deepens the hip socket, improves joint stability and distributes load evenly across the articular cartilage surface. Labral tears are commonly associated with femoroacetabular impingement (FAI), where abnormal bony morphology causes the femoral head or acetabular rim to pinch the labrum with certain hip positions. Tears can also result from acute trauma (a fall or twisting injury), repetitive hip loading in athletes (particularly ballet dancers, gymnasts, hockey players and distance runners), and structural hip dysplasia where the shallow socket places the labrum under excessive stress. Hip labral tears are one of the most common causes of anterior groin pain in active adults aged 20–40 and are frequently missed for months or years due to the nonspecific nature of the initial symptoms.

Symptoms include:
Deep anterior groin pain, often described as a dull ache in the groin or a sharp catching pain with certain hip movements. A catching, clicking, locking or clunking sensation felt at end range of hip flexion and rotation. Pain with prolonged sitting — particularly in low seats or car trips — hip flexion past 90 degrees, and rotational activities such as pivoting and kicking. A positive FADIR test (flexion, adduction, internal rotation) on clinical examination, which reproduces the groin pain by mechanically impinging the tear.

How we treat it:
A conservative management trial of 3–6 months is the appropriate first approach for most hip labral tears, and many patients achieve excellent functional outcomes without surgery. Hip and core strengthening improves the dynamic muscular stability that the labrum normally contributes statically, reducing the mechanical stress on the torn tissue. Activity modification avoids the specific hip positions and loading patterns that impinge and irritate the tear — particularly deep hip flexion with internal rotation. Manual therapy addresses the hip capsule stiffness and surrounding muscle tightness that commonly develop alongside a labral tear. We coordinate MRI arthrography (an MRI with contrast injection into the hip joint) with the GP or orthopaedic surgeon when definitive diagnosis is required. For patients who do not achieve adequate improvement with conservative care, we provide comprehensive rehabilitation following hip arthroscopy and labral repair or reconstruction.

Femoroacetabular impingement (FAI)

Femoroacetabular impingement (FAI) occurs when abnormal bony morphology of the femoral head, acetabular rim or both causes mechanical abutment (impingement) between the femur and acetabulum during hip movement — particularly at the end ranges of hip flexion and rotation. Cam-type FAI (an aspherical "bump" on the femoral head-neck junction) is most prevalent in young athletic males and develops partly from high-impact loading during adolescent skeletal growth. Pincer-type FAI (over-coverage or retroversion of the acetabulum) is more common in active females. Mixed cam-pincer FAI is very common. Over time, the repeated mechanical impingement damages the articular cartilage and tears the acetabular labrum — making FAI a recognised leading cause of early-onset hip osteoarthritis in young adults if left unaddressed.

Symptoms include:
Deep anterior groin pain or a general aching in the hip and groin that is provoked by deep hip flexion activities — prolonged sitting, squatting, cycling, kicking a ball and getting in and out of low cars or chairs. Stiffness after prolonged sitting, especially noticeable on rising. A positive FADIR impingement test (hip flexion, adduction and internal rotation) that reproduces groin pain on clinical examination. Reduced hip internal rotation in 90 degrees of flexion compared to the opposite side — a consistent clinical finding in cam FAI.

How we treat it:
Conservative management is the appropriate first-line approach for FAI and focuses on two parallel goals: modifying the hip positions and activities that provoke impingement, and building the neuromuscular control needed to reduce mechanical contact stress within the hip joint during movement. Hip abductor and deep external rotator strengthening reduces the anterior superior translation of the femoral head that occurs in hip flexion, decreasing the degree of impingement. Thoracolumbar mobility work and lumbar-hip dissociation exercises improve movement patterning. Posterior hip capsule mobilisation is an important manual therapy component for cam FAI, as posterior capsule tightness is a consistent finding that increases anterior impingement forces. Surgical femoroacetabular osteoplasty — reshaping the bony morphology arthroscopically — is reserved for cases that fail an adequate trial of conservative care or where significant labral and cartilage damage is confirmed on imaging.

Hip Bursitis

Greater trochanteric pain syndrome (GTPS) is the current clinically preferred term for lateral hip pain at the greater trochanter, previously referred to simply as trochanteric bursitis. Contemporary research has clarified that the pain in the vast majority of cases arises primarily from gluteal tendinopathy — pathological change in the gluteus medius and gluteus minimus tendons at their insertion on the greater trochanter — with the trochanteric bursa being secondarily inflamed only in a minority of cases. This distinction matters significantly for treatment, as the compression-avoidance approach used for tendinopathy differs substantially from older stretching-based treatments. GTPS is the most common hip pain presentation in middle-aged women aged 40–60, and is also very prevalent in distance runners of all genders.

Symptoms include:

Localised tenderness directly over the greater trochanter on the outer aspect of the hip — identifiable as the bony prominence felt when lying on your side. Lateral hip pain that is typically worse when lying on the affected side in bed (a very common and sleep-disrupting symptom), when crossing the legs, after prolonged sitting, when climbing stairs and hills, and when walking on uneven ground. Pain that may radiate down the outer thigh towards the knee. A compressive load test — lying on the affected side — typically reproduces the pain strongly and is a reliable diagnostic finding.

How we treat it:

Load management is the fundamental first principle of GTPS treatment. The gluteal tendons in GTPS are in a sensitised, reactive state and respond very poorly to aggressive stretching or compression — both of which are counterproductive in the early treatment phase. Activities that place the hip in adduction — crossing the legs, sitting with legs together, standing with weight shifted onto one hip, lying on the affected side — compress the gluteal tendons over the greater trochanter and must be avoided or modified initially. Progressive gluteal and hip abductor strengthening — beginning with isometric exercises (side-lying hip abduction holds) and advancing through isotonic and then functional single-leg loading — is the cornerstone of treatment and drives the tendon remodelling needed for sustained improvement. Shockwave therapy is highly effective for GTPS and is supported by level 1 randomised controlled trial evidence, stimulating tendon repair in the degenerative tissue. We consistently achieve excellent outcomes for GTPS with 8–12 weeks of targeted management combining load management, progressive loading and shockwave therapy.

Gluteal tendinopathy

Gluteal tendinopathy involves pathological structural change in the gluteus medius and/or gluteus minimus tendons at their insertion on the greater trochanter of the femur. It is fundamentally a tendon overload problem — the tendons are exposed to a combination of tensile loading and compressive forces that exceeds their capacity to adapt and repair, leading to progressive tendon degeneration. It is highly prevalent in peri- and post-menopausal women, where the reduction in oestrogen — which plays an important role in tendon collagen synthesis and repair — significantly increases tendon vulnerability. It is also common in distance runners who overtrain, particularly those who increase mileage rapidly, and in sedentary individuals who suddenly become more active.

Symptoms include:
A persistent aching, throbbing or burning pain on the outer hip that is typically worse first thing in the morning (before the tendon warms up), after prolonged sitting — particularly with the legs crossed or in a low chair — climbing or descending stairs, single-leg activities such as getting dressed or stepping up a kerb, and with increased exercise volumes. The pain can radiate down the outer thigh. Symptoms are typically aggravated by positions that compress or stretch the gluteal tendons across the greater trochanter.

How we treat it:
The LEAP (Load, Education, Activity Prescription) framework provides the evidence-based structure for our gluteal tendinopathy management. Education about tendon load management and the specific positions that compress and irritate the gluteal tendons — and how to modify them in daily life — is the essential first step that underpins all other treatment. An isometric-to-isotonic-to-functional loading program, carefully progressed over 8–12 weeks based on the patient's symptom response, stimulates the tendon remodelling process and progressively builds load capacity. Shockwave therapy is incorporated for chronic or recalcitrant cases where the tendon has lost its capacity for spontaneous remodelling. Hip abductor and external rotator strengthening — progressed from side-lying exercises to standing and single-leg functional tasks — forms the core of the rehabilitation exercise program. For runners, a detailed training load analysis identifies the volume and intensity errors that triggered the tendinopathy and guides a safe return to running.

Piriformis syndrome

Piriformis syndrome occurs when the piriformis muscle — a small but powerful external rotator of the hip lying deep within the buttock — becomes hypertonic, hypertrophied or inflamed and compresses or irritates the adjacent sciatic nerve, producing buttock pain and sciatica-like symptoms that closely mimic lumbar disc radiculopathy. Accurate differentiation from true lumbar disc sciatica is essential because the treatment approaches are entirely different. In a proportion of the population, an anatomical variation exists where the sciatic nerve passes through the body of the piriformis muscle rather than beneath it, increasing susceptibility to nerve compression even with relatively minor piriformis dysfunction.

Symptoms include:
Deep, aching buttock pain on the affected side, often with sciatic-type referral pain down the posterior thigh — and in some cases extending to the calf or foot. Pain that is characteristically worsened by prolonged sitting (particularly on hard surfaces), climbing stairs, squatting and hip internal rotation. Tenderness on deep palpation directly over the piriformis muscle in the buttock. A positive FAIR test (hip flexion, adduction and internal rotation in a side-lying position) that reproduces the buttock and leg pain. Importantly, lumbar loading tests — forward bending, extension, lumbar rotation — typically do not provoke pain in piriformis syndrome, which helps differentiate it from lumbar disc sciatica.

How we treat it:
Deep soft tissue therapy applied directly to the piriformis and surrounding deep hip external rotators — including obturator internus, gemelli and quadratus femoris — is highly effective at releasing the persistent muscular hypertonicity compressing the sciatic nerve. Dry needling of active trigger points within the piriformis produces a local twitch response that releases deep muscle tension in a way that is difficult to achieve with manual therapy alone. Neural mobilisation (sciatic nerve flossing) addresses the sensitisation and perineural adhesion of the sciatic nerve downstream from the compression point. Hip external rotator and abductor strengthening corrects the underlying muscle imbalances — typically weak gluteals with compensatory piriformis overactivity — that drove the original muscle overload. A thorough lumbopelvic assessment and treatment addresses any contributing lumbar or sacroiliac dysfunction. Most patients achieve significant and lasting improvement within 4–8 treatment sessions.

Hamstring tendinopathy

Proximal hamstring tendinopathy (PHT) involves degenerative change in the conjoint hamstring tendon at its attachment on the ischial tuberosity — the bony sitting bone at the base of the pelvis. It is widely regarded as one of the most challenging tendinopathies to rehabilitate, because the proximal hamstring tendon is placed under its greatest tensile load precisely in the hip-flexed, knee-extended position that is virtually impossible to avoid in daily life — sitting, walking upstairs, forward bending and hill running all load the tendon in this provocative position. PHT is most common in middle-aged and masters distance runners, cyclists and triathletes, and typically develops in association with a significant increase in running volume or intensity.

Symptoms include:
A deep, aching or burning pain at the lower buttock at the sitting bone that is characteristically worse with prolonged sitting on hard surfaces — making commuting, desk work and attending events with hard seating particularly uncomfortable. Pain that builds progressively with running, particularly uphill running and at faster paces, often starting after a warm-up period rather than from the outset. Tenderness on direct palpation of the ischial tuberosity. Morning stiffness in the lower buttock that eases after a few minutes of walking. Pain with activities that stretch the hamstring with the hip in flexion — such as toe touches, yoga forward bends and hamstring stretching.

How we treat it:
PHT requires a very carefully progressed loading program that avoids provocative hip flexion loading in the early stages — a key difference from other hamstring conditions. We begin with isometric hamstring contractions performed with the hip in a neutral (non-flexed) position, which provides pain relief through cortical inhibition while maintaining the tendon stimulus needed for adaptation. Loading is progressively advanced to isotonic exercises (heavy slow resistance hamstring curls, Romanian deadlifts with limited hip flexion), then to more functional hip-hinge movements, and finally to running-specific loading over a total program of 12–16 weeks. Shockwave therapy is used for chronic or insertional PHT where degenerative tendon change has reduced the tissue's capacity for self-repair. Simple but important sitting modifications — using a cushion or sitting on the edge of a chair to offload the ischial tuberosity — provide meaningful symptom relief during daily activities while rehabilitation progresses. The training load errors that triggered the tendinopathy — typically an abrupt increase in running volume, hills or intensity — are identified and addressed to prevent recurrence.

Sciatic nerve irritation from the hip

The sciatic nerve can be compressed or irritated not only by lumbar disc herniation but also by structures within the deep buttock and hip region — a condition increasingly recognised and termed deep gluteal syndrome. The potential compressing structures include the piriformis muscle (piriformis syndrome), the proximal hamstring tendons at the ischial tunnel, the obturator internus, the gemelli muscles and fibrous bands within the posterior hip. Deep gluteal syndrome produces sciatica-type symptoms — buttock pain with radiation down the leg — without any pathology in the lumbar spine, and can be very difficult to distinguish from lumbar disc sciatica without careful clinical examination. It is a significant cause of misdiagnosed or treatment-resistant sciatica.

Symptoms include:
Buttock and posterior leg pain that may extend to the calf or foot, mimicking lumbar disc sciatica. Pain that is provoked by prolonged sitting, walking and hip internal rotation, but — crucially — is not reproduced by lumbar flexion, extension or rotation loading tests that would be expected to provoke lumbar disc pain. Tenderness on deep palpation of the sciatic nerve pathway in the buttock. No lumbar pain or lumbar-level provocation findings on clinical assessment. The absence of lumbar pathology on MRI in a patient with persistent sciatic symptoms is an important clue pointing towards deep gluteal syndrome.

How we treat it:
Thorough clinical examination to differentiate lumbar from extra-spinal (deep gluteal) sciatic irritation is the critical first step — treatment is only effective when applied to the correct diagnosis. Neural mobilisation — sciatic nerve flossing and slider techniques — is central to the treatment approach, reducing the perineural adhesion and nerve mechanosensitivity that develop when the nerve is chronically compressed or irritated. Deep soft tissue therapy and dry needling of the compressing muscles directly at the buttock relieve the source of the nerve compression. Hip strengthening — particularly gluteal and deep external rotator strength — corrects the muscle imbalances that place excessive strain on the sciatic nerve pathway. MRI of the hip and pelvis (rather than the lumbar spine) is coordinated for imaging when the clinical diagnosis is uncertain, and we work with hip arthroscopists when endoscopic sciatic nerve decompression is being considered for refractory cases.

Post-surgical hip rehabilitation

Hip surgery covers a wide spectrum of procedures — from total hip replacement (THR) and hip resurfacing for end-stage osteoarthritis, to hip arthroscopy for FAI and labral repair in younger active patients, and periacetabular osteotomy (PAO) for structural hip dysplasia. Each procedure has a specific rehabilitation pathway that must respect the surgical tissue constraints and healing timelines while progressing efficiently towards full functional recovery. The surgical approach used for total hip replacement (posterior vs anterior vs lateral) dictates specific movement precautions that must be strictly observed, particularly in the first 6–12 weeks.

Post-surgical recovery phases (total hip replacement):
Weeks 0–6: Protected weight-bearing, early range of motion exercises, managing post-surgical pain and swelling.
Weeks 6–12: Progressive weight-bearing, gluteal and hip strengthening, normalising gait mechanics.
Months 3–6: Functional rehabilitation, stair negotiation, return to driving and light activity.
Months 6–12+: Return to recreational activity and sport (procedure and patient dependent).

How we treat it:
We provide surgeon-aligned rehabilitation from the acute post-operative phase through to full return to the patient's desired activity level. In the early phases, manual therapy addresses joint stiffness and prevents the capsular tightening that can otherwise develop rapidly after hip surgery. Scar tissue management — for patients with surgical incisions — prevents adhesion formation that can limit movement. Progressive gluteal, hip abductor and quadriceps strengthening systematically rebuilds the muscular support and control of the replaced or reconstructed joint. Gait retraining is a particularly important component, as patients typically develop altered movement patterns over months or years of pre-operative pain that do not automatically correct after surgery — targeted gait rehabilitation normalises heel-toe pattern, stride length and hip extension. We maintain close and regular communication with the operating surgeon throughout the rehabilitation process, particularly regarding movement precautions and progression timelines.

Hip stress fracture

Hip stress fractures — most commonly of the femoral neck — are serious overuse injuries that occur when repetitive cyclical bone loading exceeds the bone's capacity for repair and remodelling, leading to the development of a fatigue crack within the cortical bone. They are most common in female distance runners, particularly those affected by the female athlete triad (low energy availability, menstrual irregularity and low bone mineral density), military recruits undergoing sudden dramatic increases in marching load, and masters athletes returning to high training volumes after periods of inactivity. Femoral neck stress fractures are classified as tension-side (superior neck) or compression-side (inferior neck) — tension-side fractures are at risk of complete fracture and avascular necrosis and constitute an orthopaedic emergency requiring urgent specialist review.

Symptoms include:
An insidious onset of groin or anterior hip pain that develops gradually over weeks, worsens progressively with impact activity, and in later stages becomes present even at rest or at night. Pain that is provoked by single-leg weight-bearing and the single-leg hop test. A positive fulcrum test (pressing down on the thigh with the knee extended and the hip flexed over the edge of the bed) in femoral shaft and neck stress fractures. Importantly, plain X-ray is frequently negative in early stress fractures — MRI is the definitive investigation of choice and should be arranged urgently when a stress fracture is clinically suspected.

How we treat it:
Any suspected femoral neck stress fracture is treated as an orthopaedic emergency at Dingley Health Hub — we immediately arrange urgent MRI imaging and same-day GP or orthopaedic referral, as a delay in diagnosis and management significantly increases the risk of complete fracture. Once the fracture has been medically managed (non-weight-bearing for compression-side fractures; surgical fixation for tension-side fractures), rehabilitation focuses on a carefully protected and monitored return to impact loading, guided by bone healing response rather than a fixed timeline. Bone health optimisation is a critical component — calcium and vitamin D intake, energy availability (working with a sports dietitian to address any relative energy deficiency) and hormonal factors are all reviewed and addressed. The training load errors and biomechanical factors — stride mechanics, hip strength deficits, running surface — that contributed to the stress fracture are identified and corrected before full return to running.

Hip adductor strain (groin strain)

Adductor strains are among the most common acute injuries in field sports that involve explosive direction changes, kicking, sprinting and sudden deceleration — including AFL, soccer, rugby league and union, hockey and basketball. The adductor longus is by far the most frequently strained muscle due to its relatively small cross-sectional area and the high tensile forces it is exposed to during kicking and direction change. Adductor strains are graded I (mild — muscle fibre stretching with no significant tearing), II (moderate — partial muscle or tendon tearing with some functional impairment) and III (severe — complete muscle or tendon rupture). Grade III injuries and suspected bony avulsions require imaging confirmation and specialist review.

Symptoms include:
Sudden onset of sharp medial thigh and groin pain at the moment of injury — typically during a kicking, sprinting, lunging or rapid change-of-direction effort. Localised tenderness on palpation along the adductor muscle belly or at the adductor origin on the pubic bone. Pain and weakness on resisted hip adduction testing. In Grade II–III injuries, visible bruising tracking down the inner thigh, significant weakness and difficulty weight-bearing may be present. Chronic or recurrent groin strains that have become established over many months require careful assessment to differentiate adductor tendinopathy from osteitis pubis and sports hernia.

How we treat it:
Acute adductor strain management follows the POLICE principles — Protection, Optimal Loading, Ice, Compression and Elevation — in the first 48–72 hours. Early introduction of gentle pain-free range of motion exercises prevents the excessive scar tissue adhesion that forms with complete immobilisation. Progressive adductor loading, advancing from isometric holds through to isotonic, eccentric and then sport-specific loading, guides a safe and systematic return to play. The Copenhagen adductor strengthening program — a challenging adductor eccentric exercise performed with a partner — is incorporated both for rehabilitation and as a long-term prevention strategy, as it has strong evidence for reducing adductor strain recurrence in field sport athletes. Return to sport timelines range from 2–3 weeks for Grade I strains to 6–12 weeks for Grade II–III strains, guided by functional testing criteria rather than time alone.

Hip flexor strain

Hip flexor strains most commonly involve the iliopsoas (the primary hip flexor) or the rectus femoris (the only quadriceps muscle that also crosses the hip), occurring during activities that require explosive hip flexion against resistance — kicking a ball at speed, sprinting, hurdling or sudden acceleration from a standing start. Rectus femoris has a particularly elevated strain rate in kicking sports due to its biarticular nature — it is maximally stretched at the hip while simultaneously contracting powerfully at the knee during the kicking action, creating extreme eccentric demand. Proximal rectus femoris avulsion at the anterior inferior iliac spine (AIIS) — where the tendon tears away from its bony attachment — is seen specifically in adolescents and young adults whose growth plates have not yet fully matured, and requires imaging confirmation to determine the degree of bony displacement.

Symptoms include:
Sudden onset of sharp anterior hip or deep groin pain at the precise moment of injury — typically a maximal kicking or sprinting effort. Immediate pain and weakness with active hip flexion (lifting the knee). In rectus femoris strains, pain is also reproduced by resisted knee extension with the hip in extension — the position that maximally stresses the muscle. Tenderness on palpation along the musculotendinous junction or at the bony origin. Difficulty walking with a normal stride length, climbing stairs or performing high knee running in the days following the injury.

How we treat it:
In the acute phase, early soft tissue therapy — beginning within 48–72 hours of injury — reduces haematoma organisation and prevents the excessive scar tissue adhesion that significantly prolongs recovery when the muscle is left to heal without treatment. A carefully structured rehabilitation program progresses from pain-free isometric hip flexion holds, through isotonic strengthening (hip flexion against resistance with progressively increasing load), to dynamic and then sport-specific loading at match pace and intensity. We address the predisposing factors that elevated injury risk: hip flexor flexibility deficits, core and lumbopelvic control limitations, inadequate warm-up practices and training load spikes that reduced muscle resilience. Ultrasound or MRI imaging is coordinated through the GP for Grade II–III strains to confirm the extent of tearing and guide the rehabilitation timeline. Suspected AIIS avulsion injuries in adolescents require urgent imaging to assess bony displacement and determine whether surgical fixation is required.

Frequently asked Questions

Can osteopathy help with hip pain?

Answer:

Yes. Osteopathy is highly effective for a wide range of hip conditions. Our osteopaths assess the full hip and lower limb complex — including the joint mechanics, muscle balance, movement patterns, loading habits and the contribution of the lumbar spine and sacroiliac joints — to identify exactly what is causing your hip pain. Treatment includes hip joint mobilisation and articulation to restore movement, soft tissue therapy and dry needling to release overloaded muscles, progressive strengthening of the gluteals and hip stabilisers, shockwave therapy for tendinopathy, and rehabilitation programs tailored to your specific condition, age and activity goals. We treat everything from hip osteoarthritis and gluteal tendinopathy to sports injuries, labral tears and post-surgical rehabilitation.

What is greater trochanteric pain syndrome and how is it different from hip bursitis?

Answer:

Greater trochanteric pain syndrome (GTPS) is the clinically accurate term for lateral hip pain at the greater trochanter — the bony prominence on the outer hip. It was previously called trochanteric bursitis, but contemporary research has established that the pain in the vast majority of cases arises from gluteal tendinopathy — degenerative change in the gluteus medius and minimus tendons — rather than from the bursa itself. This distinction matters significantly for treatment: the compression-avoidance and progressive tendon loading approach used for gluteal tendinopathy produces far better outcomes than the older stretching-based approaches designed for bursitis. Stretching the hip into adduction — crossing the legs, pulling the knee across the body — actually compresses the gluteal tendons and makes tendinopathy worse. Shockwave therapy combined with progressive gluteal loading produces excellent outcomes for GTPS in 8–12 weeks.

What does a hip labral tear feel like?

Answer:

A hip labral tear typically produces a deep aching pain in the anterior groin, sometimes described as a "C-sign" — the patient cupping their hand around the front and side of the hip to indicate where the pain is. A characteristic catching, clicking, clunking or locking sensation with hip flexion and rotation is common, as is pain that worsens with prolonged sitting in low seats, getting in and out of cars, pivoting and kicking. The positive FADIR test — hip flexion, adduction and internal rotation — reliably reproduces the groin pain on clinical examination and is the key diagnostic manoeuvre. Labral tears are frequently missed for months or years because the initial symptoms can be vague and non-specific. MRI arthrogram (with contrast injection into the hip joint) is the gold-standard imaging investigation for definitive diagnosis.

How can I tell if my sciatic pain is coming from my back or my hip?

Answer:

This is one of the most important clinical differentiations we make at Dingley Health Hub. Sciatica from a lumbar disc herniation typically produces lower back pain alongside the leg symptoms, and lumbar loading tests — forward bending, extension, lumbar rotation — reproduce or worsen the leg pain. Sciatic nerve irritation from the deep hip (deep gluteal syndrome or piriformis syndrome) produces buttock and leg pain without significant lumbar involvement, and lumbar loading tests do not provoke the leg pain. The pain is instead provoked by prolonged sitting, hip internal rotation and deep buttock palpation. Many patients who have been told their sciatica is coming from their back — especially when their MRI shows little or no disc pathology — are actually experiencing deep gluteal syndrome. Our osteopaths assess both regions thoroughly and apply the correct treatment to the correct source.

How long does hip pain take to get better?

Answer:

Recovery timelines vary considerably depending on the specific condition. Acute hip adductor and hip flexor strains (groin strains) typically resolve in 2–6 weeks depending on severity. Gluteal tendinopathy and greater trochanteric pain syndrome generally require 8–12 weeks of targeted management. Piriformis syndrome typically improves significantly within 4–8 sessions. Hip labral tears managed conservatively require 3–6 months before full assessment of conservative treatment success. Hip osteoarthritis is a long-term management condition — symptoms can be substantially reduced in 6–10 weeks but ongoing exercise and periodic treatment are important for sustained results. Post-surgical hip rehabilitation following total hip replacement typically takes 6–12 months to achieve full function. Starting appropriate treatment early is the single most important factor in any hip condition — delays allow compensatory movement patterns to become established, which significantly complicate and prolong recovery.

What exercises should I avoid if I have gluteal tendinopathy or hip bursitis?

Answer:

Yes — The key positions to avoid with gluteal tendinopathy are those that compress or overstretch the gluteal tendons across the greater trochanter — the bony outer hip. These include crossing your legs when sitting, sitting with your knees together, standing with your weight shifted onto one hip (hip sway), pulling your knee across your body for a hip stretch, and adductor or IT band stretching. Lying on the affected hip also compresses the tendons and should be avoided for sleep. These positions are so problematic that patients who consistently avoid them — even before starting their strengthening program — often notice a significant reduction in pain within the first week. The exercises you should be doing are progressive gluteal loading exercises starting with side-lying isometric hip abduction holds and building towards single-leg standing exercises over 8–12 weeks.

Can I still exercise with hip osteoarthritis?

Answer:

Yes — and you should. Exercise is the most evidence-supported treatment for hip osteoarthritis and produces better outcomes than rest, medication or passive therapies alone. Regular low-to-moderate impact exercise reduces pain, improves hip function, maintains cartilage health and slows functional decline. The key is choosing the right exercises and the right amount. Swimming, cycling, water aerobics and walking on flat surfaces are generally well tolerated and highly beneficial for hip OA. High-impact activities like running and jumping may need to be modified depending on symptom severity. Targeted strengthening of the gluteals, hip abductors and quadriceps is particularly important as these muscles are the primary shock absorbers for the hip joint. Our osteopaths design individualised exercise programs for hip OA patients that are matched to your current capacity and progressively advance as your strength and tolerance improve.

What should I do if I think I have a hip stress fracture?

Answer:

Stop all impact activity immediately and seek same-day assessment. Hip stress fractures — particularly femoral neck stress fractures — are serious injuries that can progress to complete fracture if loading continues. At Dingley Health Hub we treat suspected hip stress fractures as an orthopaedic emergency. We immediately arrange urgent MRI — plain X-ray is frequently negative in early stress fractures — and same-day GP or orthopaedic referral. Tension-side femoral neck fractures (superior neck) are at risk of avascular necrosis and complete fracture displacement, and may require surgical fixation as an emergency. Warning signs that should prompt immediate attention include groin pain that has been gradually worsening over weeks, is now present at rest or at night, and is reproduced by single-leg standing or hopping.

What is the most common cause of hip pain?

Answer:

The most common causes of hip pain vary significantly by age and activity level. In adults over 50, hip osteoarthritis and greater trochanteric pain syndrome (gluteal tendinopathy) are the most prevalent presentations. In active middle-aged women aged 40–60, gluteal tendinopathy at the greater trochanter is extremely common and is frequently misdiagnosed as trochanteric bursitis. In younger active adults and athletes, femoroacetabular impingement (FAI) and labral tears are leading causes of deep groin pain. Piriformis syndrome and sciatic nerve irritation from the deep buttock are common causes of hip and buttock pain that is frequently mistaken for lumbar disc sciatica. Our osteopaths use specific clinical tests to differentiate between these conditions accurately before treatment begins.

Do I need a referral to see an osteopath for hip pain?

Answer:

No referral is needed. You can book directly online at dingleyhealthhub.au1.cliniko.com/bookings or by calling (03) 9551 7110. Same-week appointments are usually available. Osteopathy and remedial massage for hip pain are covered by most Australian private health insurance funds with appropriate extras cover — we have HICAPS on-site for on-the-spot claiming. WorkCover and TAC patients are welcome and managed with full documentation. If imaging such as X-ray, ultrasound or MRI is required to confirm a diagnosis, we will advise you and coordinate this through your GP.

HIP PAIN

Common Hip Conditions

Hip osteoarthritis

Hip labral tear

Femoroacetabular impingement (FAI)

Hip Bursitis

Gluteal tendinopathy

Piriformis syndrome

Hamstring tendinopathy

Sciatic nerve irritation from the hip

Post-surgical hip rehabilitation

Hip stress fracture

Hip adductor strain (groin strain)

Hip flexor strain

Frequently asked Questions

Can osteopathy help with hip pain?

What is greater trochanteric pain syndrome and how is it different from hip bursitis?

What does a hip labral tear feel like?

How can I tell if my sciatic pain is coming from my back or my hip?

How long does hip pain take to get better?

What exercises should I avoid if I have gluteal tendinopathy or hip bursitis?

Can I still exercise with hip osteoarthritis?

What should I do if I think I have a hip stress fracture?

What is the most common cause of hip pain?

Do I need a referral to see an osteopath for hip pain?

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