Hip Pain Physiotherapy in Bolton

"Hip pain" covers several genuinely different problems, and the location is the first clue.

• Groin and front of hip — most often the hip joint itself. Hip osteoarthritis, or in younger and more active people, femoroacetabular impingement or a labral problem.
• Outside of the hip, over the bony point — usually not the joint. This is most commonly gluteal tendinopathy, historically mislabelled "trochanteric bursitis". It is tender to lie on, sore on stairs and on standing from a chair, and it responds to progressive loading rather than to rest.
• Buttock, sometimes travelling down the leg — frequently referred from the lower back rather than arising in the hip at all. Which is why a hip assessment that never examines your back is an incomplete one.

Getting this right changes the treatment entirely, and it is the single most common thing that has been missed by the time someone arrives having already tried something that did not work.

NICE guideline NG226, Osteoarthritis in over 16s, is unambiguous that therapeutic exercise should be offered to everyone with osteoarthritis, for both symptoms and function. Not as something to try while waiting for a joint replacement — as the core treatment.

Two things in that guideline are worth knowing because they contradict what patients are commonly told. First, NG226 advises that a diagnosis of osteoarthritis can usually be made clinically, without imaging, in people over 45 with activity-related joint pain and no morning stiffness lasting beyond 30 minutes. Second, it makes the point that the severity of changes on an X-ray correlates poorly with how much pain and disability someone actually has.

That second point is the one that changes how people feel about their prospects. "Bone on bone" is a phrase that does a great deal of harm — it sounds terminal, it makes people stop moving, and the stopping makes the symptoms worse. Plenty of people with marked X-ray changes function well, and plenty with mild changes struggle.

NG226 is also explicit that exercise may cause some discomfort at first and that this does not mean harm is being done — a caution worth having in writing when the first fortnight feels counter-intuitive.

Pain on the outside of the hip, tender to lie on at night, worse on stairs and on standing from low chairs. It is one of the most common hip presentations, particularly in women over 40, and it is frequently managed in exactly the wrong direction.

The old label — bursitis — implied inflammation of a fluid sac, and the treatment that followed was rest and injection. Current understanding is that the primary problem is usually the tendon, and that the aggravating factor is often compression of that tendon against the bone: sitting cross-legged, standing hanging on one hip, sleeping with the top leg dropped across the body.

Which means treatment is not rest. It is removing the compressive positions, then progressively loading the gluteal tendons. It is slower than people want — measured in months rather than weeks — but it addresses the cause rather than the symptom.

• History. Where exactly it hurts, what brings it on, what it stops you doing, what you have already tried.
• Examination. Hip movement and its limits, strength through the glutes and around the joint, plus the lumbar spine and knee — because both refer to the hip and both get missed.
• An honest diagnosis. Including telling you if what you have is degenerative change that will not reverse, and what can still be improved despite that.
• A loading programme. Specific, progressive, and reviewed each session. This is the part that works, and it needs weeks of consistency before it is fair to judge it.

Appointments run at Unit 28, Flexspace Bolton with free on-site parking — worth mentioning for hip pain, since walking from a distant town-centre car park is the last thing you want. Home visits are available if getting out is the difficult part.

Sometimes it is, and pretending otherwise would not serve you. Hip replacement is one of the more reliably successful operations in orthopaedics, and where arthritis is advanced and quality of life is significantly affected despite genuine conservative treatment, it is the right call.

What physiotherapy offers around it: a proper attempt at conservative management first, so the decision is informed rather than premature; strength and movement work beforehand, which is associated with better recovery; and structured rehabilitation afterwards. If you are heading toward surgery or recovering from it, the joint replacement rehabilitation page covers that in detail.