Hip Pain Treatment in Burlington
Hip pain is rarely one condition. The label covers everything from a gluteal tendon that cannot tolerate side-lying to a deep joint-related pinch in the groin. This page is a guide I use with patients to map where the pain is, what usually drives it, and how I go about treating it.
Assessing and treating hip pain at the Burlington clinic. Convenient for Waterdown, Oakville, Hamilton, Flamborough, and Carlisle residents.
Important: when to seek medical care before physiotherapy
Sudden inability to bear weight after a fall or trauma
Go to emergency to rule out hip or pelvic fracture, especially if over 65 or on bone-affecting medication.
Hip pain with fever, chills, or feeling systemically unwell
See a physician or urgent care to rule out joint infection.
Severe, constant pain that is not relieved by any position, particularly at night
Book a physician review to investigate for stress fracture or other bone pathology.
Progressive numbness, weakness, or changes in bowel or bladder control
Seek emergency care to rule out cauda equina syndrome.
Unexplained weight loss or a history of cancer with new hip pain
See your family physician for medical workup before starting physiotherapy.
Hip pain in a child or adolescent that limits walking
See a physician to rule out conditions such as slipped capital femoral epiphysis or Perthes disease.
First, figure out which hip problem you actually have
“My hip hurts” can mean half a dozen different things. One person points to the bony spot on the side and tells me they cannot sleep on that side anymore. Another points into the groin and describes a pinch every time they sink into a deep squat. A third points into the deep buttock and asks whether this is sciatica. All common, all real, and all treated very differently. So the first job on your first visit is simply sorting out which of these pictures is actually yours.
The honest version: most hip pain in adults is mechanical and manageable. NICE and OARSI guidelines, the JOSPT hip osteoarthritis CPG revised in 2025, and the 2018 LEAP trial in the BMJ all point the same way. Education, graded strengthening, and sensible load management produce the strongest long-term outcomes. Hands-on work sits alongside that, not in place of it. What changes between people is the tissue, the history, and how load needs to be dosed.
The rest of this page walks through the common sources of hip pain grouped by where they sit, the red flags that sit outside physiotherapy scope, how I approach the first assessment in clinic, and the questions patients ask me most. If you already know which condition fits your picture, the related conditions block at the bottom links straight to the deeper pages.
Where does it hurt?
A quick guide to the most common sources of hip pain by location. Use it to find the deeper page that most closely matches your pattern. If your picture overlaps a few of these, that is normal and worth an assessment.
Side of the hip (lateral)
Pain over the bony point on the outside of the hip
Tender over the greater trochanter, worse lying on that side at night, and cranky when standing on one leg. This is the most common presentation in people over 40, especially post-menopausal women and runners who recently increased volume.
Front of the hip and groin
Deep anterior pain, sometimes a pinch with flexion
Often described as a pinch or ache deep in the front of the hip or groin. Worse with deep squats, sitting low, getting out of a car, or cutting and pivoting in sport. Stiffness first thing in the morning or after sitting is common with joint-related causes.
- Hip osteoarthritis
Joint stiffness and groin pain that worsens with activity and improves with gentle movement.
- Femoroacetabular impingement (FAI)
A mechanical pinch at end-range hip flexion, common in younger athletes.
- Hip labral tears
Clicking, catching, or a sharp groin pain with rotation or deep flexion.
- Adductor (groin) strains
Inner-thigh pain after a sudden change of direction or kick, common in hockey and soccer.
Back of the hip and deep buttock
Deep posterior ache, sit bone tenderness, or nerve-like pain
Pain sitting on hard surfaces, aching in the deep buttock, or a sciatic-type symptom that travels down the back of the leg. The source can sit in the joint, in deep gluteal muscles, or in the lumbar spine referring pain into the buttock, so careful assessment matters here.
- Proximal hamstring tendinopathy
Sit-bone pain that flares with sitting, driving, and hill running.
- Piriformis syndrome
Deep buttock pain, sometimes with radiating leg symptoms from sciatic nerve irritation.
- Deep gluteal syndrome
Broader sciatic nerve entrapment in the deep gluteal space, can mimic lumbar radiculopathy.
- Sacroiliac (SI) joint dysfunction
Pain over the SI joint or upper buttock, provoked by single-leg loading.
Hamstrings, and pain that travels down the leg
Referred and nerve-related symptoms
Sometimes what people call hip pain is actually referred from the low back. A burning or electric quality, numbness, or pain that runs past the knee points toward a nerve source rather than the hip joint itself. A careful history and physical exam help sort this out.
- Hamstring strains
Sudden pull or ache in the back of the thigh, usually after a sprint or acceleration.
- Sciatica
Nerve root irritation from the lumbar spine producing buttock and leg pain.
- Low back pain with referral
Lumbar joints and discs can refer pain into the hip and buttock without true leg nerve symptoms.
How I approach hip pain in clinic
The first appointment runs on questions before it runs on equipment. Where does it actually hurt, how did it start, what makes it worse, what makes it better. The small details do real work here. How you cross your legs on the couch. Whether you can sleep on that side. Whether a recent running block pushed weekly volume up faster than the tissue could adapt. Whether sitting, standing, or walking is the main trigger. By the end of the history I usually have two or three working hypotheses, and the physical exam is about confirming or ruling them out.
I look at how you move before I test what hurts. Watching you walk, squat, and step tells me more than any single provocation test. From there I check hip range, strength through the key muscle groups, and the targeted tests that separate lateral tendon pain from joint pain from posterior nerve-related pain. I palpate the greater trochanter, the groin, the hamstring origin, and the SI joint with intent, because tenderness pattern is genuinely useful information when it is read in context with everything else.
The plan that comes out of that is individual, but it tends to have the same shape. Settle the irritable tissue with a short list of things to stop doing and a few things to add in. Build capacity with progressive strengthening exercises dosed to your current tolerance, usually across hip abductors, deep rotators, glutes, and the trunk. Joint mobilization, soft tissue therapy, dry needling, or cupping sit alongside that work where they speed things along. I write the plan down with you and track a handful of markers so we can both see whether it is actually working. If it is not, I change direction sooner rather than later.
Hip pain questions I hear most
How do I know if my hip pain is arthritis?
Hip osteoarthritis usually sits in the groin or deep front of the hip, feels stiff for the first twenty to thirty minutes after rest, and gets cranky with longer walks or stairs. Rotation is often the first range to drop off, which is why people notice it when putting on socks or getting out of a car. I build a working diagnosis from the history and exam, and order imaging only when it is going to change the plan.
Can physiotherapy help hip pain without surgery?
For most hip pain, yes. NICE and OARSI guidelines put exercise, education, and load management as first-line care for hip osteoarthritis, and the LEAP trial (BMJ 2018) showed education plus exercise beat a corticosteroid injection for lateral hip pain at one year. Surgery is still the right call for some labral tears and advanced arthritis, but a structured rehab block almost always comes first.
When should I worry about hip pain?
Most hip pain is mechanical. Get medical review before physiotherapy if you have had a fall with sudden inability to weight-bear, fever with joint pain, progressive neurological changes, unexplained weight loss, or pain that is severe and unrelieved by any position.
What causes hip pain at night?
Lying on that side compresses the gluteal tendons against the bony point on the outside of the hip. That is the classic night-pain picture, and it is a hallmark of gluteal tendinopathy. Hip osteoarthritis can also ache at night when the joint loses its capacity to dampen load. The fix is rarely more rest. Sleep position, sitting and standing habits, and a progressive loading program are what usually settle it over a few weeks.
Is it safe to keep exercising with hip pain?
Usually yes, with adjustments. Full rest tends to make most hip conditions more reactive, not less. I modify load rather than remove it: adjust volume, drop the specific provoking positions, and swap in pain-tolerant options like cycling, pool work, or lower-load strength training while the irritable tissue rebuilds capacity. I set clear guardrails at the first visit so the dosing is obvious.
Do I need imaging before starting physiotherapy?
For most people, no. Labral fraying, mild cartilage wear, and tendon signal changes show up in pain-free adults all the time, so scans often muddy the picture rather than clarify it. I order imaging when it is going to change management: suspected fracture, progressive neurological symptoms, or a case not progressing the way a thorough exam predicted.
How long does hip pain take to recover with physiotherapy?
The tissue drives the timeline. Muscle strains often settle in four to eight weeks. Gluteal tendinopathy and other tendon-related hip pain typically needs three to six months of progressive loading to rebuild capacity. Hip osteoarthritis is longer-term management, but most people notice meaningful improvement in pain and function inside eight to twelve weeks of structured exercise and hands-on work.
Do you treat hip pain after a hip replacement?
Yes. Post-surgical hip rehab runs in stages: protect the joint early, restore range and gait, then build strength and confidence under load. I follow your surgeon's protocol where one exists and adapt based on how your tissues respond. Most people progress through guided exercise work across the first three to four months after surgery.
Evidence this page is built on
The recommendations above draw on national clinical guidelines and published trials. Research evolves, but these are the anchor sources I rely on when I plan hip pain care.
Education and exercise outperform corticosteroid injection for lateral hip pain
In a randomised trial of 204 adults with gluteal tendinopathy, education plus a progressive exercise program produced greater improvements in pain and global rating of change than a single corticosteroid injection at both eight weeks and one year.
OARSI guidelines for non-surgical management of hip osteoarthritis
International guideline recommending land-based exercise, education, and self-management as core treatments for hip osteoarthritis, with weight management and structured strengthening as strongly supported adjuncts.
NICE guideline on osteoarthritis assessment and management
UK national guidance identifying therapeutic exercise as a first-line intervention for people with osteoarthritis, alongside information and support, with surgery considered when conservative care has not produced adequate response.
Hip pain and mobility deficits: hip osteoarthritis clinical practice guideline (Revision 2025)
Updated APTA Academy of Orthopaedic Physical Therapy guideline recommending progressive strengthening, manual therapy, patient education, and gait and functional training for hip osteoarthritis, with dry needling newly supported for short-term relief in pain, range, strength, and function.
Improving function in people with hip-related pain: a systematic review and meta-analysis of physiotherapist-led interventions
Systematic review synthesising physiotherapist-led exercise, manual therapy, and education for hip-related pain. Found improvements in function, pain, and strength, with hip arthroscopy showing only small short-term benefit over physiotherapy and no significant difference at 24 months.
Related hip and pelvis conditions
Deeper pages for each of the specific conditions that sit under hip pain.
Lateral Hip Pain & Gluteal Tendinopathy
GTPS, gluteal tendinopathy, and lateral hip pain formerly called trochanteric bursitis
Hip Osteoarthritis
Joint degeneration, cartilage breakdown, activity-related pain
Femoroacetabular Impingement (FAI)
Hip impingement causing groin pain with deep hip flexion
Hip Labral Tears
Cartilage ring tears causing clicking, catching, groin pain
Hip Bursitis
Bursal inflammation causing localized hip pain
Proximal Hamstring Tendinopathy
Sitting bone pain, hamstring origin tendon issues
Piriformis Syndrome
Deep gluteal syndrome causing sciatic-type pain
Deep Gluteal Syndrome
Sciatic nerve entrapment in deep gluteal space
Sacroiliac (SI) Joint Dysfunction
SI joint pain and instability
Groin Strains
Adductor strains common in hockey and soccer
Hamstring Strains
Hamstring tears and chronic tightness
Sciatica
Nerve root compressions and radiculopathy
Treatments that commonly sit inside a hip plan
None of these are stand-alone fixes. They are pieces that fit inside a plan built around your specific diagnosis and goals.
Exercise Therapy
Personalized exercise programs designed to restore strength, flexibility, and function.
Joint Mobilization
Graded techniques to restore joint movement and reduce stiffness.
Dry Needling
Precise needle therapy targeting trigger points for effective pain relief and improved muscle function.
Cupping Therapy
Technique using controlled suction to address muscle tension and localized pain.
Soft Tissue & Myofascial Therapy
Targeted hands-on techniques to address muscle tension, pain, and movement restrictions.
Sports Rehabilitation & Return to Sport
Evidence-based recovery programs for athletes to safely return to sport after injury.
Access, hours, and how to book
I see patients for hip pain at Endorphins Health & Wellness Centre in Burlington. The clinic serves people coming in from Burlington, Waterdown, Oakville, Hamilton, Flamborough, and Carlisle, with free parking on site and a ground-floor entrance.
4631 Palladium Way, Unit 6
Burlington, ON L7M 0W9
Direct insurance billing available. No physician referral needed.
- Monday1:30 PM - 7:30 PM
- Tuesday1:30 PM - 7:30 PM
- Wednesday2:00 PM - 7:30 PM
- Thursday1:30 PM - 7:30 PM
- Friday2:00 PM - 7:30 PM