Hip Pain Isn't One-Size-Fits-All — And Neither Is the Fix
How to tell if your hip pain is arthritis, a labral tear, or a tendinopathy — and why personalized PT gets better results than generic stretching
Jon Grygalonis, PT, DPT, Cert. DN, C-PS, TPI certified
6/30/20263 min read
Hip pain is one of those complaints that gets treated like it has one cause and one solution. Stretch it. Rest it. Maybe foam roll it for a few weeks and hope it goes away.
The problem is, hip pain rarely has just one cause — and treating it like it does is usually why it keeps coming back.
That's the approach we take differently here at River Elite Performance.
Hip Pain Is a Symptom, Not a Diagnosis
Here's the core principle: the location of your pain tells you where it hurts — not why it hurts.
Two people can both describe "pain in the front of my hip" and be dealing with completely different problems underneath. One might have early-stage osteoarthritis. Another might have a labral tear. A third might have a tendinopathy that's been quietly building for months. Same general area, three very different treatment plans.
Treating all hip pain the same way is like treating every car that won't start with a new battery. Sometimes that's the fix. Often, it isn't even close.
What's Actually Driving the Pain
A few of the most common culprits we see at REP:
Hip osteoarthritis (OA) shows up as a gradual narrowing of the joint space, often with stiffness that's worse in the morning or after sitting for a while. It tends to respond well to a combination of mobility work, targeted strengthening, and load management — the joint isn't necessarily the enemy, but how it's being loaded often needs to change.
Labral tears involve the cartilage ring that helps stabilize the hip socket. These often present as a sharp, catching, or pinching sensation — particularly with rotation or deep hip flexion. Not every labral tear needs surgery. Many respond well to a rehab approach focused on improving hip control and addressing the movement patterns that may have contributed to the tear in the first place.
Tendinopathies — most commonly involving the gluteal tendons on the outside of the hip — develop when a tendon is repeatedly loaded beyond its current capacity. This is less about a single injury and more about a slow mismatch between demand and tolerance. The fix usually isn't rest. It's a progressive loading program that rebuilds the tendon's capacity over time.
Three different problems. Three different starting points. Three different plans.
Why a Generic Program Falls Short
If you've ever been handed a printout of hip stretches with no real explanation of why, you've experienced the limits of a generic approach.
The truth is, most hip pain is a downstream result of something else — a hip that's not rotating well, a glute that's not firing when it should, a movement pattern that's been quietly overloading one structure for months. Stretching the area that hurts often treats the symptom while leaving the actual driver untouched.
This is where a thorough evaluation matters. Before we build a plan, we need to understand what's actually limited, what's compensating, and what's been asked to do too much for too long.
How We Approach It at REP
When a patient comes to us with hip pain, we start by figuring out what's actually going on — not just where it hurts, but why.
That typically includes:
A movement assessment to identify mobility restrictions, asymmetries, or compensations contributing to the pain
Manual therapy techniques — joint mobilization, soft tissue work, and instrument-assisted treatment — to address restrictions that exercise alone often can't reach
A progressive, individualized exercise program built around your specific findings, not a generic protocol
Ongoing reassessment to make sure the plan is actually addressing the problem as it evolves
For some patients, manual therapy plays a bigger early role in calming things down and restoring motion. For others, the priority is building strength and loading capacity from day one. The plan changes based on what we find — not the other way around.
The Bottom Line
Hip pain is common, but it's rarely simple. Whether it's arthritis, a labral issue, or a tendinopathy that's been building for a while, the path forward starts with understanding what's actually happening — not just treating the area that hurts.
If hip pain has been holding you back, let's figure out what's actually going on and build a plan around it.
RIVER ELITE PERFORMANCE
1145 Gaskins Rd.
Richmond, VA 23238
Expert physical therapy for orthopedic and sport conditions in Richmond.
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