Hip Pain: Causes, Symptoms and How Physiotherapy Can Help

Hip pain can transform simple activities – walking to the pasar malam, climbing stairs in your apartment, or playing with your grandchildren – into daily challenges. As a major weight-bearing joint that connects your trunk to your legs, the hip is essential for nearly every movement you make.

In Malaysia, hip pain is increasingly common among both the ageing population and younger adults with sedentary desk jobs. Understanding the cause of your hip pain is the first step toward effective treatment.

Hip Joint Anatomy and Function

The hip is a ball-and-socket joint where the head of the femur (thighbone) fits into the acetabulum (a cup-shaped socket in the pelvis). This design allows a wide range of motion while bearing substantial loads – up to 3-5 times your body weight during walking and even more during running or stair climbing.

The joint is surrounded by a strong capsule, reinforced by powerful ligaments, and supported by large muscle groups including the gluteals, hip flexors, and adductors. Damage to any of these structures can produce hip pain.

Common Sources of Hip Pain

Hip pain can originate from the joint itself, the surrounding muscles and tendons, or even be referred from the lower back:

• Osteoarthritis – The most common cause of hip pain in Malaysians over 50. Arthritis involves gradual wearing of the cartilage lining the joint, leading to pain, stiffness, and reduced mobility
• Greater trochanteric pain syndrome – Previously called trochanteric bursitis, this condition causes pain on the outer hip and is extremely common, particularly in women over 40. It involves the gluteal tendons rather than the bursa
• Hip flexor tendinopathy – Pain at the front of the hip, common in runners and those who sit for prolonged periods, causing the hip flexor muscles to become short and overloaded
• Femoroacetabular impingement (FAI) – A bony mismatch between the ball and socket that causes pinching during certain movements, particularly deep flexion and rotation
• Referred pain from the lumbar spine – Lower back problems can cause pain that is felt in the hip, groin, or buttock, making accurate diagnosis essential
• Labral tears – Damage to the ring of cartilage (labrum) that lines the hip socket, causing clicking, catching, and deep groin pain

Identifying Your Hip Pain Pattern

The location and behaviour of your hip pain provides important clues about its cause:

• Groin pain that worsens with weight-bearing and activity – often points to joint pathology such as osteoarthritis or FAI
• Pain on the outer hip that is worse when lying on that side at night – suggests greater trochanteric pain syndrome
• Front-of-hip pain that worsens after prolonged sitting or when climbing stairs – may indicate hip flexor tendinopathy
• Deep buttock pain – could be piriformis syndrome, sacroiliac joint dysfunction, or referred pain from the lumbar spine
• Catching, clicking, or locking sensations – may suggest a labral tear
• Morning stiffness lasting more than 30 minutes – a classic feature of inflammatory arthritis

If you recognise these symptoms, it is important to seek professional assessment rather than trying to self-diagnose. Many conditions share similar symptoms, and an accurate diagnosis is crucial for effective treatment.

Struggling with Hip Pain? A physiotherapist can assess your condition and create a personalised recovery plan. Chat with a physiotherapist near you

Physiotherapy for Hip Pain

Physiotherapy is the recommended first-line treatment for most causes of hip pain, with strong evidence supporting its effectiveness – including for hip osteoarthritis, where it can delay or prevent the need for joint replacement.

Thorough Assessment

Your physiotherapist will conduct a thorough assessment examining your hip joint mobility, muscle strength, movement patterns, and gait. Importantly, they will also screen your lower back and sacroiliac joint, as pain from these areas is frequently misattributed to the hip.

Targeted Strengthening Programme

Strengthening the muscles around the hip is the key part of treatment for almost all hip conditions:

• Gluteal strengthening – The gluteus medius and maximus are critical for hip stability and function. Exercises progress from side-lying hip abduction through to standing and single-leg exercises
• Hip flexor and adductor work – Balanced strengthening of all muscle groups around the hip joint
• Core stability – The deep core muscles work in coordination with the hip muscles to control pelvic position during movement
• Functional exercises – Squats, lunges, step-ups, and single-leg activities that mirror the demands of daily life

Manual Therapy

Hands-on techniques including hip joint mobilisation, soft tissue release of tight muscles (particularly the hip flexors and piriformis), and stretching help restore mobility and reduce pain.

Hip Pain and Malaysian Lifestyle Considerations

• Prolonged sitting in traffic and at desks is a major contributor to hip flexor tightness and weakness – stand and walk regularly throughout your day
• Sitting cross-legged on the floor, common in Malaysian culture, can aggravate certain hip conditions – discuss modifications with your physiotherapist
• Maintain a healthy weight – every kilogram of body weight translates to several kilograms of force through the hip joint
• Swimming and cycling are excellent low-impact exercises for maintaining hip fitness, and Malaysia's climate makes pool access convenient year-round
• Walking on flat surfaces is generally beneficial for hip health – aim for 30 minutes most days as tolerated

When to Consider Joint Replacement

For advanced hip osteoarthritis that significantly impacts your quality of life despite thorough physiotherapy, hip replacement surgery may be appropriate. Malaysia has excellent orthopaedic centres that perform this procedure. Post-surgical physiotherapy is essential for best recovery, typically spanning 3-6 months, focusing on rebuilding strength, restoring mobility, and returning to full function.

Start Moving Toward Pain-Free Hips

Hip pain does not have to limit your independence and quality of life. With the right diagnosis and a targeted physiotherapy programme, most hip conditions improve significantly.

A qualified physiotherapist can assess your specific situation and create a treatment plan designed for your needs. Find a physiotherapist near you and take the first step toward getting back to the activities you love.