Hip Pain Physical Therapy in Louisville, KY
Clinical Approach Designed by Dr. Brandon Evans, PT, DPT | Kentucky Is a Direct-Access State | No Physician Referral Required
Relief From Hip Pain, Stiffness, and Reduced Mobility, Without Medication, Injections, or Surgery
Rest, ice, and modifying activity help some hip pain resolve on its own. If yours hasn't, and you've already tried the obvious things without lasting relief, the issue usually isn't a lack of effort. It's that the underlying cause was never identified and treated.
We hear a common story in the clinic: hip pain starts, an X-ray shows arthritis, and the conversation jumps straight to a hip replacement, often without a real trial of guided rehabilitation first. That order can be backwards for most people.
Physical therapy is the evidence-based first step for most hip pain, before medication, injections, or surgery are needed. At ProActive Physical Therapy and Wellness, we find the actual cause of your hip pain and build a plan around it, so the relief lasts.
Talk to us first — complimentary, no pressure, no obligation.
Prefer to text or email instead? Same number: (502) 512-2165.
What Causes Hip Pain?
Most hip pain comes from one of a few sources: osteoarthritis of the hip joint, greater trochanteric pain syndrome (commonly called hip bursitis), a labral tear, femoroacetabular impingement (a bony mismatch between the ball and socket of the hip), piriformis syndrome, or a strained hip flexor or tendon from overuse. Where the pain is felt is a useful clue: groin pain is usually coming from the joint itself, while pain on the outer hip is usually a tendon or bursa issue.
Hip pain and low back pain frequently overlap, since sacroiliac (SI) joint dysfunction and hip conditions can produce similar pain patterns in the buttock and groin. Our Back Pain Physical Therapy page covers that overlap in more depth. Hip pain can also radiate down the leg when a muscle like the piriformis irritates the sciatic nerve, a pattern that mimics but isn't the same as spinal sciatica; our Sciatica Physical Therapy page covers that distinction.
When You Should See a Doctor Before Starting Physical Therapy
Most hip pain is safe to evaluate with physical therapy first. But a small number of cases need medical attention before that. See a doctor promptly if your hip pain follows a fall or significant trauma, comes with an inability to bear weight, fever, unexplained weight loss, groin pain with signs of infection, or pain that doesn't ease at rest or at night. If any of that applies to you, please see your physician first, then come talk to us.
Physical Therapy, Injections, and Hip Replacement Surgery: What's the Difference?
All three have a role, and the right choice depends on what's actually causing your hip pain. An injection can calm inflammation and buy a window of reduced pain. Hip replacement surgery addresses joint damage when repair is truly needed. Physical therapy does something neither of those does on its own: it restores the strength, mobility, and movement pattern that let the hip get into trouble in the first place, and current research supports it as the first step for the large majority of hip pain, including many cases of hip osteoarthritis.
Physical therapy at ProActive includes:
- A hands-on evaluation to identify the actual source of your pain
- Manual therapy to reduce pain and restore range of motion
- Dry needling, when appropriate, for muscle tension and trigger points
- Shockwave therapy (ESWT), when chronic tendinopathy or a soft-tissue component is part of your hip pain
- A personalized, progressive strengthening plan that corrects the underlying cause
- Guidance on activity and movement modification to prevent the pain from returning
This isn't:
- A quick injection with no plan for what happens after
- Generic exercises pulled from a video, unrelated to your specific cause
- Passive treatment you receive without any change on your part
- A substitute for emergency or physician care when red flags are present
Is My Hip Pain Actually Osteoarthritis?
"Arthritis" is one of the most common things patients hear after an X-ray, and it often gets treated as an automatic countdown to a hip replacement. That's not what current evidence supports. Joint changes on an X-ray are common with age and don't always match how much pain someone actually feels; two people with the same X-ray can have very different levels of pain and function.
Current clinical practice guidelines recommend patient education combined with exercise and manual therapy as first-line treatment for hip osteoarthritis. A long-term randomized trial found that patients who received exercise therapy and education were significantly less likely to need a total hip replacement six years later than those who received education alone. Surgery still has an important role for advanced joint damage, but it isn't the automatic next step older thinking suggested.
Sources: Cibulka MT, Bloom NJ, Enseki KR, et al. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. J Orthop Sports Phys Ther. 2017;47(6):A1–A37. Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis. 2015;74(1):164–169.
Hip Pain From Bursitis (Greater Trochanteric Pain Syndrome)
If your pain sits on the outer point of your hip, gets worse lying on that side at night, and flares with climbing stairs or standing from a chair, you may be dealing with greater trochanteric pain syndrome, often called hip bursitis. Despite the name, it's usually a tendon-loading problem more than true bursa inflammation, which is why the treatment approach differs from arthritis.
A randomized clinical trial comparing education plus exercise to a cortisone injection found that education and exercise produced better functional outcomes and lower rates of pain at eight weeks. That doesn't mean injections have no place, but it does mean guided exercise deserves to be the first option tried, not the last.
Source: Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.
Built on Evidence-Based Care, Not Guesswork
Our approach to hip pain follows current clinical practice guidelines published in the Journal of Orthopaedic and Sports Physical Therapy, which recommend patient education combined with exercise and manual therapy as first-line treatment for hip osteoarthritis, with surgery reserved for advanced cases. A long-term randomized trial found that guided exercise therapy meaningfully postponed the need for total hip replacement compared with education alone. We start with a thorough one-on-one evaluation to find your actual cause, then build a plan around it. Care is delivered by our licensed physical therapists and progressed as your body responds, not from a generic protocol.
Sources: Cibulka MT, et al. 2017 (above). Svege I, et al. 2015 (above).
What to Expect
- A thorough evaluation. We assess your hip, low back, and movement pattern to identify the actual source of your pain, not just where it hurts.
- A plan built around you. Manual therapy, dry needling when appropriate, and an exercise plan targeted at your specific cause, not a generic handout.
- Progressive, one-on-one care. Your plan is adjusted session to session as your hip responds, with the goal of lasting relief, not just short-term symptom relief.
Who This Program Is For
- Adults 45 and older dealing with ongoing or recurring hip pain
- Anyone told hip arthritis means an automatic hip replacement who wants to try guided rehabilitation first
- People whose hip pain limits walking, standing, climbing stairs, or sleeping
- Anyone recovering from a hip replacement who wants a structured return to strength
Common Conditions We Treat
Hip Osteoarthritis
Symptoms: Groin or deep hip ache, stiffness after sitting, and pain that worsens with walking or standing over time.
Treatment: Patient education, manual therapy, and a progressive strengthening program shown to postpone the need for surgery. See the full breakdown above.
Greater Trochanteric Pain Syndrome (Hip Bursitis)
Symptoms: Sharp or aching pain on the outer point of the hip, often worse lying on that side, climbing stairs, or standing from sitting.
Treatment: A tendon-loading exercise program and activity modification, shown to outperform cortisone injection in clinical trials. See the full breakdown above.
Hip Labral Tear
Symptoms: Deep groin pain, catching, clicking, or a sense of instability, often with certain twisting or pivoting movements.
Treatment: Movement retraining and progressive strengthening to reduce load on the labrum, with surgery reserved for cases that don't respond to a real trial of rehabilitation.
Femoroacetabular Impingement (Hip Impingement)
Symptoms: Groin pain with deep hip flexion, such as sitting low, squatting, or putting on shoes and socks.
Treatment: Hip and core strengthening paired with movement pattern correction to reduce the bony impingement during daily activity.
Piriformis Syndrome
Symptoms: Deep buttock pain, sometimes radiating down the back of the thigh, often worse with prolonged sitting.
Treatment: Manual therapy and hip mobility work targeted at the piriformis muscle. See our Sciatica Physical Therapy page for how this differs from spinal sciatica.
Hip Flexor Strain or Tendinopathy
Symptoms: Ache or sharp pain at the front of the hip, worse with lifting the knee, climbing stairs, or a quick start into walking.
Treatment: Graded loading of the hip flexor tendon, manual therapy, and a return-to-activity progression.
IT Band Syndrome
Symptoms: Aching or burning pain along the outer hip and thigh, sometimes extending toward the outer knee, common with walking or stair use.
Treatment: Hip and glute strengthening to correct the loading pattern driving the irritation, paired with manual therapy.
Post-Hip-Replacement Recovery
Symptoms: Reduced strength, stiffness, and limited walking tolerance following total or partial hip replacement surgery.
Treatment: A structured, progressive rehabilitation plan to restore strength, range of motion, and confidence with walking and daily activity.
Why ProActive
- Every plan is built around your specific evaluation findings, never one-size-fits-all
- Kentucky is a direct-access state, so you can start without waiting on a referral
- Delivered by our licensed physical therapy team, with a clinical approach designed by Dr. Brandon Evans, PT, DPT, grounded in evaluation, not generic exercise sheets
Visit Our Louisville Clinic
Serving Lyndon, St. Matthews, Hurstbourne, and the greater Louisville, KY area.
Frequently Asked Questions
What causes hip pain in adults over 45?
Most hip pain in this age group comes from osteoarthritis, greater trochanteric pain syndrome (hip bursitis), a labral tear, hip impingement, or a strained hip flexor or tendon. A physical therapy evaluation identifies which of these is driving your specific pain.
Can physical therapy help hip osteoarthritis without a hip replacement?
For many people, yes. Current clinical practice guidelines recommend education, manual therapy, and exercise as first-line treatment for hip osteoarthritis. A long-term trial found that exercise therapy significantly postponed the need for total hip replacement compared with education alone. Surgery still has a role for advanced joint damage.
Is my hip pain a labral tear or arthritis?
Both can cause groin pain, but a labral tear more often involves catching, clicking, or a sense of instability with twisting movements, while arthritis tends to feel like a deeper, more constant stiffness and ache. A hands-on evaluation is the most reliable way to tell the difference.
What is the difference between hip bursitis and arthritis?
Hip bursitis, more accurately called greater trochanteric pain syndrome, causes pain on the outer point of the hip, especially lying on that side or climbing stairs. Arthritis tends to cause deeper groin pain and stiffness. They're treated differently, which is why identifying the actual source matters.
Do I need an X-ray or MRI before starting physical therapy for hip pain?
Not usually. Imaging findings like joint changes don't always match how much pain someone feels, so imaging alone doesn't tell the full story. A hands-on evaluation is often the more useful first step, and we'll let you know if imaging is genuinely needed for your specific case.
Do I need a doctor's referral to start physical therapy?
No. Kentucky is a direct-access state, which means you can start physical therapy for hip pain at ProActive Physical Therapy and Wellness without a physician's referral. Medicare and some insurance plans have their own separate requirements, so call or text us and we'll walk you through what applies to your specific situation.
How long does physical therapy for hip pain take?
It depends on the cause and how long you've had symptoms. Many people notice meaningful improvement within a few weeks of consistent care, though a complete plan is built around your evaluation, not a fixed timeline.
What if I've already tried rest, ice, and stretching and nothing has worked?
That's common, and it usually means the underlying cause hasn't been identified yet, not that nothing will help. A thorough evaluation is the next right step before considering medication, injections, or surgery.
How do I get started?
Call or text us at (502) 512-2165, or email info@proactiveptlou.com. We'll talk through your history and figure out together whether physical therapy is the right next step for you.
Talk to us first — complimentary, no pressure, no obligation.
Prefer to text or email instead? Same number: (502) 512-2165.
Hip pain and low back pain often occur together. If your pain also involves your low back or radiates down your leg, visit our Back Pain Physical Therapy or Sciatica Physical Therapy page.
Sources
Cibulka MT, Bloom NJ, Enseki KR, Macdonald CW, Woehrle J, McDonough CM. Hip Pain and Mobility Deficits-Hip Osteoarthritis: Revision 2017. Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(6):A1–A37.
Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis. 2015;74(1):164–169.
Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662.
