Partner with Us | Call: (03) 4050 7755
You roll onto your side at 2am and the outside of your hip lights up. You shift to the other side, which is fine for twenty minutes, and then that hip starts too. By morning you've slept badly, the first few steps out of bed are stiff, and climbing into the car feels like a negotiation. Sound familiar?
Hip pain is one of those problems people put up with for far longer than they should. It comes on slowly, it fluctuates, and it's easy to blame on sleeping badly, getting older, or "just a bit of bursitis". Some of those guesses are partly right. Plenty are wrong in ways that matter, because the treatment for pain on the outside of the hip is quite different from the treatment for pain in the groin, and both are different again from pain that really comes from the lower back.
This guide is for people in Truganina, Tarneit and the surrounding west who have a sore hip and want to understand what's probably going on, what physiotherapy actually involves, how long it honestly takes, and when a hip needs to be checked by a doctor first. It's general information, not a diagnosis. Hips are one of the joints where a proper hands-on assessment changes the answer.
"Hip pain" is a lazy label. Ask ten people to point at their sore hip and you'll get several different spots, and each spot points to a different set of likely causes. The location is the single most useful piece of information you can give a physio.
The outside of the hip, over the bony bump you can feel at the side (the greater trochanter), is the most common site of hip pain in adults, particularly women over about 40. It tends to hurt when you lie on that side, climb stairs, stand on one leg, or sit with your legs crossed. This is usually gluteal tendinopathy, sometimes called greater trochanteric pain syndrome.
The groin or the front of the hip is the classic site for pain that comes from the hip joint itself. Osteoarthritis, a hip impingement problem or a labral irritation tend to show up here, sometimes spreading to the front of the thigh or down towards the knee. People often describe it as a deep ache and tend to reach for the groin crease when they point to it.
The buttock and back of the hip can come from the gluteal muscles, the deep hip rotators, the sacroiliac joint or the lower back. This is also where sciatica-type pain overlaps. If your pain travels below the knee with tingling or numbness, our article on sciatica in Truganina and Tarneit covers how that differs.
The inner thigh is more often a muscle strain (the adductors), especially in people who play football or run.
A useful rule of thumb is that pain you can cover with one finger on the outside of the hip is usually tendon or soft tissue, and pain you need a whole hand to describe in the groin is more likely to involve the joint. It's a rule of thumb only, and it gets broken constantly, but it gives you somewhere to start.
For years, pain on the outside of the hip was automatically called trochanteric bursitis, and plenty of people were told they had an inflamed bursa and handed a cortisone injection. Imaging and surgical studies over the last couple of decades have shown that in most people with this pain, the main problem is actually in the tendons of the gluteus medius and gluteus minimus, the muscles that sit on the side of your pelvis and stop it dropping every time you take a step. The bursa can be irritated too, but it's often a bystander.
That matters because a tendon problem behaves differently from an inflamed bursa. Tendons don't like being squashed and they don't like sudden spikes in load. They also respond well to carefully graded strengthening, which is why the treatment looks different from what many people expect.
When you lie on your side, the weight of your body presses the sore tendon against the bone beneath it. When you cross your legs, or stand with your weight hanging on one hip, or sit in a low couch with your knees dropped across the midline, the top leg pulls the tendon across the bony point and compresses it. Tendons that are already irritated don't tolerate that squeezing, which is why night pain and pain after sitting are so characteristic.
Typical features of gluteal tendinopathy include:
It often creeps in after a change: a new walking routine, a few weeks of extra standing, a weekend of gardening, menopause, or a period of weight gain or weight loss. Hormonal changes around menopause are one reason this condition shows up so often in women in their 40s, 50s and 60s, although the exact relationship isn't fully understood, so be a little wary of anyone who claims it's the whole story.
Plenty of well-meant habits feed this problem. Stretching the outer hip, using a foam roller on the side of the hip, and massaging the sore spot hard all compress the tendon further, and they can leave it more irritable. If you've been stretching it for months and it's no better, that's useful information rather than a personal failing. Stretching the glutes is not what the tendon needs.
Habits that tend to help are boring but effective: avoiding crossed legs, putting a pillow between the knees when sleeping on your side, not standing with your weight shifted onto one hip, and keeping your walking at a level that doesn't leave you paying for it the next day. Then the real work, which is progressive strengthening, usually guided by a physio so that the load on the tendon increases at a sensible pace.
An Australian trial run out of Melbourne and Brisbane compared a program of education plus exercise with a corticosteroid injection and with a wait-and-see approach in people with long-standing outer hip pain. The pattern reported was that the injection tended to help faster in the short term, while the education and exercise program held up better over the following year. That fits with what most clinicians see: an injection can calm things down for a while, but it doesn't fix why the tendon was overloaded in the first place. If you're considering an injection, it's a reasonable conversation to have with your GP, and many people use it alongside a rehab program rather than instead of one.
Osteoarthritis of the hip is common, and it's often misunderstood. It isn't simply the joint "wearing out like a tyre". The cartilage, the bone underneath it, the joint lining and the muscles around the hip all change together, and how much it hurts doesn't always match what an X-ray shows. Some people have fairly dramatic changes on imaging and manage well. Others have modest changes and are quite limited.
The usual story is a deep ache in the groin, sometimes spreading to the thigh or the knee, that is stiff first thing in the morning, eases after you get moving, and then returns after a long day. Putting on socks and shoes gets harder. Getting in and out of the car gets harder. Rotating the leg, for example turning on a planted foot, can catch.
Hip pain that refers to the knee is worth knowing about. Occasionally someone spends months treating a sore knee when the real source is the hip. If your knee hurts but looks and feels normal, and you also have stiffness at the hip, mention both. Our post on knee pain in Truganina and Tarneit covers the knee side of this overlap.
Current guidelines for hip and knee osteoarthritis lean heavily on the same three things: education, exercise and, where relevant, weight management. Surgery has its place, and a hip replacement can be life-changing for the right person, but for most people with mild to moderate arthritis the first step is a good exercise program, not an operation.
Exercise doesn't "wear the joint out". The research is fairly consistent that appropriate strengthening and aerobic activity reduces pain and improves function in people with hip and knee arthritis. Strong muscles take load off the joint, and the joint itself tends to be happier with regular movement than with rest. There is also some recent Australian research into whether targeted work on specific gluteal muscles may help more than general strengthening, because the gluteal muscles around an arthritic hip can change in quality. That work is still being tested, so treat it as promising rather than settled.
One more finding that tends to surprise people: check-in sessions with a physio help people stick with their exercise. The most common reason exercise doesn't work is simply that it stops after a few weeks. A physio who adjusts the program and keeps you honest is part of what makes it work.
It would be tidy if every sore hip was one of the two conditions above. In practice, there are a few other common ones worth knowing about.
Some people are born with a hip shape where the ball of the thigh bone and the socket don't glide perfectly. When the hip is bent deeply, as in squatting, sitting low, driving or sporting movements, the bone shapes can pinch against each other and the soft cartilage rim (the labrum) can become irritated. This tends to present as a pinching or catching pain at the front or in the groin, mostly in younger and more active adults. Rehab can help a lot of people, and a smaller group are referred on to an orthopaedic surgeon. Having the bone shape on an X-ray does not automatically mean it's the cause of your pain, because plenty of people with no symptoms have the same shapes.
Sudden pain in the front of the hip or inner thigh while sprinting, kicking or changing direction is usually a muscle strain. These tend to recover well with graded loading. Footballers and runners in the local clubs get them regularly. If this is you, the framework in our sports physiotherapy guide applies, particularly the section on returning to sport safely.
The lower back and the sacroiliac joint can send pain to the buttock and the side of the hip. Clues that the back is involved include pain that changes with bending or sitting, pain that is mostly in the buttock, and symptoms that change when you test the spine rather than the hip. A good physio will examine both areas, because treating a hip that is not the source gets nowhere. Our lower back pain guide covers that side.
Pregnancy and the postnatal period change how the pelvis and hips handle load, and hip and pelvic girdle pain is common. This is a specific area of treatment with its own approach, so it's covered separately in our women's health physiotherapy article.
Rare but important. Deep, worsening groin or hip pain, particularly with a recent jump in running volume, low bone density, or after a fall, needs medical review and often imaging. We'll come back to this in the red flags section, because it's one of the situations where waiting to see if it settles is the wrong plan.
If you've never seen a physio about your hip, it helps to know what the first appointment looks like, because it's mostly a conversation and a series of simple movements.
The questions. Expect to be asked where the pain is, when it started, what makes it better or worse, what your nights are like, how your walking has changed and what you've already tried. Your work, your sport, your sleeping position and any previous injuries all matter. So does your general health, including past fractures, cancer history, steroid use and anything else relevant to bone and joint health.
The watching. The physio will often watch you stand, walk, step up on to a box and balance on one leg. That last one is more informative than it sounds. Standing on one leg is a fairly honest test of the gluteal muscles, and many people with outer hip pain find it reproduces their symptoms or shows the pelvis dropping on the opposite side.
The hands-on testing. The hip is moved through its range, including rotation and bending, to see whether it's stiff, whether it pinches, and whether it reproduces the pain you describe. The tender spot is checked, and the lower back and the sacroiliac joint are screened. Strength is tested around the hip and the thigh.
The explanation. You should leave knowing what is probably going on, what the plan is, what to avoid in the meantime, and how long it typically takes. If the physio thinks you need imaging or a medical opinion first, they'll say so. Scans are not always necessary, and they're not a prerequisite for starting treatment in most cases. Many people with a clear clinical picture don't need one.
At Wellcare Physio, assessments take place at our clinics in Truganina and Tarneit, and you can read more about how we work on our physiotherapy treatment page.
Treatment varies with the diagnosis, but several themes run through almost every hip rehab program.
It isn't glamorous, but understanding what's going on is often the first thing that reduces fear and pain. Knowing that a sore tendon is a load problem, not a sign of damage that will keep getting worse, helps people keep moving. Knowing that arthritis is not a sentence to the couch changes behaviour. A good session should leave you with a clear picture, not a vague sense that your hip is "worn" or "inflamed".
For tendon problems especially, the aim is to find a level of activity that the tendon tolerates and build from there. That might mean shorter walks to start with, breaking up long periods of standing, avoiding the crossed-leg position, and being careful with stairs for a few weeks. It isn't about stopping everything. Complete rest often makes a tendon weaker and more sensitive.
This is the core of treatment for most hips. For gluteal tendinopathy, rehab usually begins with gentle isometric holds, where the muscle works without the hip moving through its sore range. As the tendon settles, it progresses to bridges, side-lying leg work, step-ups, split squats and eventually single-leg exercises and walking and running drills. For arthritis, the strengthening is broader, covering the glutes, the quadriceps, the hamstrings and the calf, along with balance and everyday tasks like standing from a chair.
The principle is boring and reliable: the load goes up slowly, the pain is monitored, and the program changes depending on how the hip responds. A mild ache during exercises that settles within a day is usually acceptable. Sharp pain, or pain that is clearly worse the next morning, tells the physio to back off.
Hands-on techniques can be useful for easing stiffness, reducing muscle guarding and giving you a window in which movement feels easier. They're an add-on, not the treatment. For some people with tight, painful muscles around the hip and buttock, dry needling is one option clinicians use to settle muscle tension so that exercise is more comfortable. It's best seen as a way to get you moving, not a cure on its own, and it isn't suitable for everyone.
Heat, electrotherapy and similar tools can ease pain in the short term for some people. The evidence for them being the thing that changes the outcome is limited, which is why the honest answer from a good clinic is that they can be useful for comfort but should not replace exercise.
Once the acute pain has settled, supervised group movement can help maintain gains. Clinical Pilates suits a lot of people with hip and pelvic conditions because it builds control and strength around the hips and trunk with the exercise adapted to your body. It's not a requirement, but it's a practical bridge from one-on-one rehab to staying strong long-term.
People always ask how long it will take, and the honest answer is that it depends on what's wrong and how long it has been going on.
These are broad ranges rather than promises, and anyone who promises a specific number of sessions before assessing your hip is guessing. Progress also isn't a straight line. Most people have good weeks and flat weeks, and a flare doesn't mean the plan has failed.
While you're waiting for an appointment, or between sessions, a few sensible things apply to most hip pain.
Simple pain relief from a pharmacist can help in the short term, but check what is suitable for you with a pharmacist or your GP, particularly if you have other health conditions or take other medication.
Most hip pain is musculoskeletal and safe to manage with exercise. Some situations need a medical review first, and a good physio will refer you on without fuss.
If you are unsure, it is always reasonable to ask. A short phone call or a GP visit costs far less than a missed fracture.
Not usually, at least not at the start. A thorough clinical assessment can often identify gluteal tendinopathy, muscle strains and many cases of hip arthritis without imaging. Scans are more useful when there is a history of significant trauma, when the picture does not fit, when symptoms are not responding to a reasonable trial of rehab, or when surgery is being considered.
There's another reason to be careful with scans: they find things. Plenty of people with no hip pain at all have labral tears, cartilage changes or thickened tendons on imaging. A scan result needs to be read alongside what your hip actually does and where it actually hurts, otherwise it can send you down the wrong path or leave you more worried than the findings justify.
Some people do reach the point where a hip replacement or arthroscopy is the right call, because pain and function have gone beyond what exercise can manage. If that's you, rehab still matters at both ends. Getting stronger before an operation tends to make recovery smoother, and a well-structured program afterwards gets you back to walking, stairs and life. Our article on pre and post-operative physiotherapy walks through what that looks like week by week.
Usually no. Walking is one of the best low-impact activities for most hip conditions, including arthritis and tendon problems. What matters is the dose. If your walking jumps suddenly from a little to a lot, a sensitive tendon can flare. Build up gradually, and use pain the next day as your guide rather than pain during the walk alone.
With outer hip pain, it's usually pressure and position. Lying on the sore side compresses the tendon, and lying on the good side lets the top leg drop across and stretch and load it. A pillow between the knees often helps. With arthritis, stiffness and aching after a day of activity can show up in the evening. Pain at night that is constant, severe and unrelated to position is a reason to see a doctor.
Both can occur, but current thinking is that tendinopathy is the main driver in most people with outer hip pain, and the bursa is often secondary. The practical difference is that tendon problems respond well to progressive loading, and aggressive stretching or rubbing can make them worse.
Rarely. Most hips do better with modified activity than with complete rest. The aim is to avoid the specific things that aggravate the problem while keeping the rest of you moving. Your physio can help you work out which is which.
Some people choose a corticosteroid injection, particularly for severe pain that is getting in the way of rehab. It's a decision to make with your GP. The research suggests it can help in the short term but that exercise-based treatment tends to do better over the following year, so for many people the sensible approach is to treat the load problem, not just the pain.
Sometimes. The hip muscles and the pelvic floor work closely together, and women with ongoing pelvic or hip pain, especially after childbirth, may benefit from an assessment that looks at both. If that sounds like you, ask about it at your appointment.
You can book physiotherapy without a referral. If you have a GP management plan or Medicare chronic disease referral, it may help with costs, and our fees page sets out what applies. If you're unsure, ask when you book.
Hip pain, falls and reduced mobility often go together, and getting to a clinic can itself be the barrier. Our mobile service brings physiotherapy to the home for eligible participants across greater Melbourne, which is covered on our NDIS physiotherapy page. For a hip problem, a home visit can be particularly practical, because the physio can look at how you actually get out of your own chair, bed and shower, not just how you move in a clinic room.
Hip pain has a handful of common causes, and the location of the pain is the best clue to which one you're dealing with. Pain on the outside, worse lying on your side, is usually a tendon problem that responds to progressive loading and to avoiding compression. Pain in the groin, with morning stiffness, is more often the joint itself, and the strongest evidence points to education and exercise. Pain after a fall, severe night pain, fever or any bladder or bowel changes need medical attention first.
Most hips improve with a clear diagnosis and a program that builds strength at a sensible pace. It takes weeks to months rather than days, and the people who do best are those who stay with the plan after the first flush of improvement. If you've had a sore hip for a while and you're not sure which category you're in, an assessment will tell you, and it's a lot easier to sort out now than after another six months of guessing.
You can book an appointment at our Truganina clinic or our Tarneit clinic through the booking page.
This article is general information and isn't a substitute for an individual assessment. If you have severe pain, an injury from a fall or any of the warning signs above, see a doctor or go to your nearest emergency department.
