Hip pain is one of the most diagnostically complex and most clinically underserved conditions in musculoskeletal practice. The hip sits at the mechanical junction of the lumbar spine and the lower extremity — making it simultaneously a source of pain for structures above and below it, and a site where pain originating elsewhere is frequently referred. The result is a population of patients whose hip pain has been attributed to the wrong source, treated at the wrong level, or dismissed as untreatable because the structural cause was never accurately identified. At Flowers Chiropractic, Dr. Taylor M. Watkins, D.C. provides chiropractic care for hip pain in Flowers Plantation, Clayton, NC that begins with thorough assessment of the hip and its contributing structures — because treating hip pain effectively requires knowing exactly where it is coming from. Call (919) 553-6711 or Schedule Appointment today.
Understanding Hip Pain — Why Diagnosis Comes First
The hip joint itself — the ball-and-socket articulation of the femoral head in the acetabulum — is a deep, well-protected joint capable of significant load-bearing and a wide range of motion. True intra-articular hip pain from osteoarthritis, labral tears, or femoroacetabular impingement presents in a characteristic pattern: groin pain, pain deep in the anterior hip, and the C-sign — the patient cupping their hand over the lateral hip to indicate where their pain is located. This is the pain of intra-articular hip pathology, and it requires a different assessment and treatment approach than the far more common extra-articular hip pain produced by the tendons, bursae, and musculature surrounding the hip.
Extra-articular hip pain — pain outside the joint capsule itself — is significantly more prevalent than true joint pathology and encompasses a wide range of conditions: gluteal tendinopathy, greater trochanteric pain syndrome, hip flexor strain and tendinopathy, iliotibial band syndrome, piriformis syndrome, sacroiliac joint dysfunction, and the referred pain of lumbar nerve root compression. Each produces pain in or around the hip region but originates from a different structure, responds to different treatment, and requires different clinical assessment to identify.
Additionally, lumbar spine pathology — disc herniation, facet syndrome, and spinal stenosis at the lower lumbar levels — commonly refers pain into the hip, buttock, and thigh in patterns that closely mimic hip pathology. A patient whose hip pain is actually referred from an L3–L4 disc herniation will not improve with hip-directed treatment, regardless of how well it is applied. Accurate differential diagnosis is the prerequisite to effective treatment.
Conditions Treated at Flowers Chiropractic
Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome (GTPS) — previously and inaccurately termed trochanteric bursitis — is the most common cause of lateral hip pain in adults, affecting an estimated 10 to 25 percent of the population at some point in their lives and most prevalent in women between 40 and 60 years of age. The condition is now understood to involve primarily tendinopathy of the gluteus medius and gluteus minimus tendons at their insertions on the greater trochanter, rather than bursitis of the trochanteric bursa — a distinction with significant treatment implications.
Gluteal tendinopathy — like all tendinopathies — is a degenerative condition in the chronic phase, not primarily an inflammatory one. The tendon has undergone pathological change at the cellular level from chronic compressive and tensile overload, and it responds to treatments that drive tissue remodeling rather than those that suppress inflammation. This is why cortisone injection into the trochanteric bursa — the standard treatment for many years — produces short-term pain relief in approximately 50 percent of GTPS patients but inferior long-term outcomes compared to load management and targeted soft tissue therapy.
Shockwave therapy targeting the gluteal tendon insertions at the greater trochanter is one of the most evidence-supported interventions for GTPS — multiple clinical trials demonstrate significant improvement in pain and function in patients who have not responded to other conservative management. Combined with dry needling of the gluteus medius and minimus muscle bellies — which reduces the myofascial tension that increases compressive load on the tendon insertions — and chiropractic assessment of the lumbar spine and sacroiliac joint that influence hip abductor loading, the outcomes are consistently better than isolated local treatment.
Hip Flexor Strain and Iliopsoas Tendinopathy
The hip flexors — primarily the iliopsoas (iliacus and psoas major) and the rectus femoris — are among the most chronically overloaded muscle groups in modern sedentary adults. Prolonged sitting shortens the hip flexors and the anterior hip capsule, creating a state of chronic tension and reduced extensibility that predisposes to strain under the sudden loads of sprinting, kicking, or rapid direction change. Iliopsoas strain produces pain in the anterior hip and groin — sometimes extending into the anterior thigh — that is aggravated by hip flexion against resistance and passive hip extension that stretches the shortened muscle.
Chronic iliopsoas overload produces tendinopathy at the lesser trochanteric insertion of the iliopsoas tendon — a pain source that is frequently overlooked because of the deep, inaccessible location of the tendon. Dry needling of the iliopsoas muscle belly — accessed through a specific needling approach that reaches the deep hip flexor — is one of the most effective interventions for chronic iliopsoas myofascial pain and tendinopathy, combined with myofascial release of the anterior hip capsule and hip flexor fascia, and chiropractic adjustment of the lumbar spine and sacroiliac joint to normalize the mechanical environment in which the iliopsoas functions.
Piriformis Syndrome
The piriformis — a deep external hip rotator originating on the anterior sacrum and inserting on the greater trochanter — lies in immediate proximity to the sciatic nerve as it exits the pelvis through the greater sciatic foramen. Piriformis syndrome involves spasm or tightness of the piriformis muscle that compresses or irritates the sciatic nerve, producing buttock pain and sciatic-pattern leg pain that can be clinically indistinguishable from disc-driven sciatica in the absence of positive lumbar neurological findings.
Piriformis syndrome is significantly more common in women than men — the wider female pelvis creates a greater angle of the piriformis relative to the femur, increasing both the mechanical demands on the muscle and the likelihood of sciatic nerve proximity or passage through the muscle. It is aggravated by prolonged sitting, hip internal rotation, and direct pressure over the piriformis — and is consistently worsened by the same sustained sitting postures that shorten the hip flexors and compress the posterior hip soft tissue.
Dry needling of the piriformis is among the most effective treatments available for piriformis syndrome — reaching the deep external rotator through a specific needling approach that produces the local twitch response and trigger point release that manual therapy alone cannot achieve in this deep, poorly accessible muscle. Myofascial release of the gluteal and deep external rotator group complements needling for the fascial component of piriformis restriction. Chiropractic adjustment of the sacroiliac joint addresses the joint component of posterior hip pain that almost always coexists with piriformis syndrome. Learn more: Sciatica
Sacroiliac Joint Dysfunction
The sacroiliac joints — the paired articulations connecting the sacrum to the iliac bones of the pelvis — are a frequently misdiagnosed source of buttock and posterior hip pain that closely mimics hip joint pathology and lumbar disc pain. SI joint dysfunction produces pain at the posterior iliac crest and buttock that may refer into the posterior thigh, is typically unilateral, and is aggravated by prolonged standing, transitional movements (sitting to standing), and activities that load the pelvis asymmetrically.
SI joint pain is particularly prevalent in pregnant and postpartum women — the ligamentous laxity produced by relaxin during pregnancy makes the SI joint susceptible to dysfunction under the increased postural load of pregnancy and the mechanical demands of delivery. It is also common in patients with leg length discrepancy, athletes with asymmetrical loading patterns, and anyone who has sustained a fall or direct impact to the pelvis. Dr. Watkins is Webster Technique certified — a chiropractic protocol specifically designed to assess and adjust sacral and pelvic mechanics — and incorporates comprehensive SI joint evaluation into all hip and pelvic pain assessments. Learn more: Prenatal Chiropractic & Webster Technique
Iliotibial Band Syndrome
The iliotibial band — a thick strip of connective tissue running from the iliac crest along the lateral thigh to the lateral knee — is a primary source of lateral hip and knee pain in runners, cyclists, and athletes performing repetitive lower extremity movement. At the hip, IT band dysfunction produces pain at the lateral iliac crest and greater trochanter — often confused with GTPS. At the knee, it produces the lateral knee pain of IT band friction syndrome that is among the most common running injuries. The IT band itself does not contract — it is a passive structure — but its tension is determined by the muscles that attach to it, primarily the tensor fasciae latae (TFL) and the gluteus maximus. Addressing IT band tension requires addressing these contributing muscles rather than treating the band itself in isolation.
Myofascial release of the TFL, gluteus maximus, and the IT band itself reduces the fascial tension that drives lateral hip and knee pain. Dry needling of TFL trigger points — which refer pain along the lateral thigh in a pattern closely resembling IT band pain — deactivates the muscular contribution to IT band tension. Chiropractic adjustment of the lumbar spine and hip addresses the joint mechanics that influence gluteal and TFL loading. Learn more: Knee Pain
Hip Osteoarthritis
Hip osteoarthritis — the progressive loss of articular cartilage in the hip joint — produces deep groin pain, reduced hip range of motion (particularly internal rotation), and the gradual loss of function that significantly limits walking, stair climbing, and daily activity in older adults. While chiropractic care cannot reverse articular cartilage loss or alter the structural course of osteoarthritis, it is one of the most effective conservative interventions for managing the pain and functional limitation that osteoarthritis produces — maintaining the maximum available joint mobility, reducing the periarticular muscle tension and myofascial restriction that amplify arthritic pain, and preserving quality of life for as long as possible before surgical joint replacement is required.
For hip osteoarthritis patients, the treatment emphasis is on low-force joint mobilization, myofascial release of the hip flexors, gluteals, and adductors, trigger point therapy for the periarticular muscles that develop trigger points in response to chronic joint pain, and ultrasound therapy for its anti-inflammatory and circulation-enhancing effects in the periarticular tissue. Patients with severe hip osteoarthritis requiring total hip replacement are supported through conservative management until surgery is appropriate and, where indicated, through the postoperative recovery period.
Femoroacetabular Impingement
Femoroacetabular impingement (FAI) occurs when abnormal contact between the femoral head and the acetabular rim produces pain with certain hip movements — typically flexion combined with internal rotation — and progressively damages the acetabular labrum and articular cartilage. It is most common in young, active adults and in athletes performing high hip flexion activities. FAI produces anterior hip and groin pain that is aggravated by sustained sitting, hip flexion, and the end-range movements of athletic activity.
Conservative chiropractic management of FAI focuses on optimizing the neuromuscular control and soft tissue mobility around the hip — reducing the excessive anterior and posterior hip capsule tightness that increases impingement contact forces, addressing the myofascial restrictions in the hip flexors and external rotators that alter femoral head positioning within the acetabulum, and managing the periarticular pain through targeted soft tissue therapy. Significant labral tears and structural bony impingement require orthopedic co-management; Dr. Watkins coordinates with orthopedic surgeons when imaging and clinical findings indicate that conservative care has clear limitations.
The Hip as the Hub of the Lower Extremity Kinetic Chain
The hip is the mechanical hub of the lower extremity — the joint through which forces from the foot and ankle are transmitted to the pelvis and lumbar spine, and through which spinal mechanics influence lower extremity loading. Dysfunction at the hip does not remain isolated at the hip. Reduced hip extension range of motion — one of the most consistent consequences of hip pathology and prolonged sitting — forces compensatory lumbar extension with each step, increasing facet joint loading and accelerating lumbar degeneration. Reduced hip abductor strength — the consequence of gluteal tendinopathy and inhibited gluteus medius function — allows pelvic drop during single-leg stance, driving medial knee stress and contralateral lumbar side-bending with every step.
At Flowers Chiropractic, hip pain assessment evaluates the full kinetic chain — the lumbar spine and sacroiliac joint above, and the knee and ankle below — because treating the hip in isolation without understanding its mechanical context within the movement system produces incomplete and frequently unsatisfactory results. Learn more: Back Pain · Sciatica · Knee Pain · Ankle Pain
How Chiropractic Care Treats Hip Pain
Hip pain management at Flowers Chiropractic begins with a thorough clinical assessment — history of onset and aggravating activities, palpation of the hip and periarticular soft tissue, hip range of motion testing, provocative testing for intra-articular and extra-articular hip pathology, assessment of sacroiliac joint mechanics, and lumbar spine evaluation for referred pain contribution. Where intra-articular pathology including labral tear or significant osteoarthritis is suspected, imaging is obtained or arranged accordingly.
Treatment is built from the clinical findings. Gluteal tendinopathy receives shockwave therapy as the primary tissue-remodeling intervention. Piriformis syndrome and hip flexor pathology receive dry needling and myofascial release. IT band syndrome receives myofascial release of the TFL and gluteals alongside lumbar and hip joint adjustment. Sacroiliac joint dysfunction receives specific chiropractic SI joint adjustment. Electric muscle stimulation provides pain relief and muscle activation support across presentations. All treatment is integrated with chiropractic adjustment of the lumbar spine and sacroiliac joint — because the joint and soft tissue are always addressed as a system, never in isolation.
Serving Flowers Plantation, Clayton, Smithfield, and Surrounding Communities
Flowers Chiropractic is located at 14 Flowers Crossroads Way, Suite 106, Clayton, NC 27527, in the heart of the Flowers Plantation community. Dr. Watkins treats hip pain patients from Flowers Plantation, Clayton, Smithfield, Selma, Wilson’s Mills, Archer Lodge, Knightdale, Wendell, and across Johnston and Wake County.
If hip pain has been limiting your activity, altering your gait, or resisting treatments that should have worked, chiropractic care at Flowers Chiropractic provides the comprehensive assessment and integrated soft tissue treatment that hip conditions require. Call (919) 553-6711 or Schedule Appointment online. Office hours: Monday, Tuesday, and Thursday 7:00 AM – 6:00 PM; Wednesday 9:00 AM – 12:00 PM; Friday 7:00 AM – Noon.
Frequently Asked Questions About Hip Pain
How do I know if my hip pain is from the joint or the surrounding muscles and tendons?
True intra-articular hip pain — from osteoarthritis, labral tear, or femoroacetabular impingement — typically presents as groin pain or deep anterior hip pain that is reproduced by hip flexion combined with internal rotation. Extra-articular pain from gluteal tendinopathy, IT band syndrome, or piriformis syndrome tends to be more lateral or posterior, reproduced by direct palpation over the affected structure and aggravated by the specific loading of the involved tissue. Clinical assessment including provocative testing of both intra- and extra-articular structures — combined with imaging where indicated — determines the primary source. Dr. Watkins performs this differentiation as a standard component of every hip pain assessment.
Can chiropractic help hip bursitis?
What is commonly diagnosed as hip bursitis — trochanteric bursitis — is now understood to primarily involve gluteal tendinopathy at the greater trochanter rather than true bursitis in the majority of cases. When the bursa is involved, it is usually secondarily inflamed by the adjacent tendinopathy rather than the primary pain generator. Chiropractic care addresses the gluteal tendinopathy directly — through shockwave therapy, dry needling, and myofascial release — producing better and more lasting outcomes than the cortisone injection that has historically been the standard treatment for trochanteric bursitis.
Can a back problem cause hip pain?
Yes — and this is more common than most patients realize. Lumbar disc herniation at L3–L4 refers pain into the anterior hip and thigh in an L3 dermatomal distribution. Facet syndrome at L4–L5 refers pain into the buttock and posterolateral hip. Sacroiliac joint dysfunction produces buttock and posterior hip pain that closely mimics hip joint pathology. Any patient with hip pain who also has low back symptoms, or whose hip pain has not responded to hip-directed treatment, warrants lumbar and sacroiliac evaluation. Learn more: Back Pain · Sciatica
Is hip pain common during pregnancy?
Yes — hip and pelvic pain is among the most prevalent musculoskeletal complaints of pregnancy, affecting a significant proportion of pregnant women in the second and third trimesters. The combination of sacroiliac joint laxity from relaxin, the anterior pelvic tilt of pregnancy, and the progressive increase in postural load produces pain at the posterior iliac crest, buttock, and lateral hip that can be significantly limiting. Chiropractic care during pregnancy — including the Webster Technique for sacral and pelvic assessment and adjustment — is safe throughout all trimesters and one of the most effective interventions for pregnancy-related hip and pelvic pain. Learn more: Prenatal Chiropractic & Webster Technique
How many sessions will I need for hip pain?
That depends on the condition, its severity, and how long it has been present. Acute hip flexor strains and mild SI joint dysfunction often respond significantly within four to six visits. Chronic conditions including gluteal tendinopathy and established piriformis syndrome typically require eight to twelve visits for meaningful improvement, with shockwave therapy sessions spaced within that broader treatment course. Dr. Watkins will give you a realistic prognosis at your first visit based on examination findings rather than a generic estimate.
Can hip pain cause knee pain?
Yes — through the lower extremity kinetic chain. Reduced hip abductor strength — a consistent consequence of gluteal tendinopathy — allows pelvic drop during single-leg stance, driving medial knee valgus stress with every step. IT band tightness from TFL overactivation drives lateral knee pain. Hip internal rotation limitations alter patellofemoral mechanics. At Flowers Chiropractic, knee pain assessment includes hip evaluation as a standard component when lower extremity kinetic chain involvement is suspected. Learn more: Knee Pain