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Hip pain is incredibly common but often misunderstood. Whether you’re an athlete, a weekend warrior, or someone who spends long hours at a desk, the position and strength of your hip joint play a crucial role in how your body moves and feels. In this post, we’ll break down the most common reason why hip pain happens, and what you can do to fix it for good.
But before we dive into exercises and treatment strategies for hip pain, it’s important to understand how the hip joint works.
Anatomy of the Hip: Ball and Socket, but Built Different
The hip is a ball-and-socket joint, just like the shoulder. However, unlike the shoulder, which prioritizes mobility, we walk on our legs, not our hands. This means the hips have evolved to prioritize stability.
Think of the shoulder like a golf ball sitting on a tee: it’s highly mobile but inherently unstable, relying heavily on muscles to stay in place. The hip socket, on the other hand, is more like an ice cream scooper, large and encompassing. The socket of the hip (the acetabulum) surrounds the ball (the femoral head) much more fully than the shoulder, providing a deep, secure fit, which provides a lot of the hips stability, so it doesn’t rely as heavily on surrounding muscles for joint integrity (like the shoulder does).
The Hip Capsule: Your Joint’s Safety Pouch
Like all joints, the hip is wrapped in a fibrous capsule, which acts like a tough pouch to keep the joint stable. This capsule is made of strong ligaments and connective tissue that surround the joint entirely.
One of the most common patterns leading to hip pain is tightness and restriction in the posterior capsule, the back part of this joint envelope. When this happens, the femoral head tends to migrate forward (anteriorly), leading to:
- Hyper-flexibility in the front of the capsule
- Painful pinching in the front of the hip
- Eventual injuries like:
- Iliopsoas tendinitis/tendinosis
- Iliopsoas bursitis
- Snapping hip syndrome
- Chronic groin strains
- Hip impingement
- Labral tears
- Sports hernias
The exact location and type of pain you feel depends on your lifestyle and repetitive movements, but the root cause is often the same: posterior capsule restriction combined with muscle imbalance.
The Hidden Culprits: Your Daily Habits
Many of these hip dysfunctions are directly related to how we sit, sleep, and stand – habits we repeat every day, often for years. Let’s break it down:
1. Sitting
Sitting, especially slouched or cross-legged, limits hip movement and disengages the posterior capsule.
Take the “long sitting” (legs out straight, crossed at the ankles, back slouched). This position is extremely common and very comfortable for many, but it does nothing to engage or stretch the posterior capsule.
Over time, if you’re never getting into deep hip flexion, the joint loses its ability to move through that range. As the saying goes: “If you don’t use it, you lose it.”
Another common posture is sitting with your ankle resting on the opposite knee in a figure-4 position. This externally rotates the hip for extended periods and overstretches the ligaments and muscles that should be stabilizing the joint.
2. Sleeping
Two sleeping positions we commonly see contributing to hip problems are:
- On your stomach with one leg hiked up: This recreates the same externally rotated position as the figure-4 sit, only now for hours on end.
- Side-lying with the top knee resting forward on the bed (aka the “mountain climber” position): This twists the pelvis and hip asymmetrically. Over time, a process called “creep” sets in, where stiff ligaments slowly stretch and lose their integrity. You may wake up with a sore hip, achy back, or both.
3. Standing
The most energy-efficient (and most damaging) way to stand is the swayback posture: your hips shift forward past your shoulders and ankles, and you “hang out” on your ligaments instead of using muscle. Add to that a habit of putting most of your weight on one leg, and you’re putting a lot of pressure on the anterior hip capsule, encouraging the femoral head to shift forward, exactly what we don’t want.
None of these positions are inherently bad in small doses. But when done repeatedly – day after day, year after year – they can create the kind of instability, dysfunction, and pain we see in so many patients.
The “Popular” Stretch To Be Cautious Of
Believe it or not, the infamous pigeon stretch is another major contributor. It pushes the hip into deep external rotation (which causes anterior femoral head translation) and stretches the glutes excessively, muscles that are crucial for stability. Muscles don’t function well when they’re constantly held in a lengthened, weakened state. So, while the pigeon stretch may feel good momentarily, it can contribute to long-term imbalance.
The Most Common Imbalances Leading to Hip Pain
1. Posterior Hip Capsule Tightness
We’ve already covered how this restriction can cause anterior hip pain and joint instability. It sets the stage for compensation, muscle overuse, and eventually, injury.
2. Glute Weakness and Dynamic Valgus
Weak glutes, especially the posterior glute med and glute max, can allow the leg to collapse inward during movement, a pattern called dynamic valgus. Over time, this leads to:
- Outside hip pain
- Bursitis (e.g., trochanteric bursitis)
- Piriformis syndrome
- Lateral and posterior hip pain
When the glutes are weak, other muscles like the TFL, medial hamstrings, and hip flexors take over. The result is poor joint control, subsequent poor movement patterns, irritation of the stabilizing structures, and pain.
So… What’s the Fix?
1. Stretch the Posterior Hip Capsule
This is the foundation. We utilize manual therapy to get this thing much looser. Then we follow it up with a specific posterior capsule stretch that targets the right part of the joint without putting the hip into problematic external rotation. You’ll find this stretch on our Instagram, YouTube, and website—it’s practically our mascot. Here’s the link!But stretching isn’t enough on its own. Once you restore mobility to the capsule, you have to build strength and stability around that range.
2. Manual Therapy for Overworked and Underworked Muscles
We often start by releasing the psoas, a deep hip flexor that gets chronically tight from long periods of sitting and/or poor sleep position patterns. This manual therapy release can be uncomfortable at first but makes a huge difference.
Other common soft tissue targets include:
- QL (Quadratus lumborum)
- TFL (Tenser Fascia Lata)
- Anterior glute med
- Medial hamstrings
Manual release helps reset these patterns so your body is ready to recruit the right muscles.
3. Rebuild Glute and Core Control
Glute training is critical—but it must be done right. That means:
- You feel the work in your glutes during and after the exercise
- You don’t feel it more in your quads or hamstrings
- You target both glute max (hip extension) and glute med (stabilization)
Too often, patients think they’re training their glutes, but their body is compensating. So when you’re doing the glute strengthening to address this weakness in this pattern, you have to make sure that you are not only feeling it in the glutes while you’re doing the exercises, but especially the next day. Ask yourself – where am I sore? You need to be sore in the glutes. Not the hamstrings. Not the quads. The glutes. Otherwise, if you’re more sore elsewhere, your body is just compensating. You’re not gonna get the result as quick as you as you want it to.
4. Understand the Hamstring’s Role
Here’s a cool piece of anatomy: the hamstrings don’t attach to the femur. They attach from the sit bone (ischial tuberosity) to the lower leg bones (tibia and fibula). This means that when they contract, they can actually pull the femur forward in the socket—worsening the anterior translation we want to avoid.
So while hamstrings are important for many reasons, they often become over-dominant compared to the glutes in hip extension, especially in runners. Instead, we want the glutes to do the majority of the work, they attach directly to the femur and help keep it centered, aka creating a very healthy joint.
5. Strengthen the Psoas….. Correctly
The psoas is another key player here. While not always the case, it’s often long, weak, and dysfunctional, which makes it a major contributor to the pattern we’ve been discussing. That’s why strengthening the iliopsoas, especially the psoas portion, is so important for building resilience in the hip.
But here’s the catch: the psoas can only be effectively strengthened above 90 degrees of hip flexion. While the iliopsoas as a group is active below 90°, it’s the psoas specifically, the deepest and most influential hip flexor in this pattern, that really kicks in once you go beyond 90°. That’s where it can work in the most targeted and isolated way.
So if you want to train the psoas effectively, you have to strengthen it above 90° of hip flexion.
This deep core strength helps stabilize the hip from the front, while the glutes stabilize it from behind, creating a balanced, powerful hip complex.
Here’s a YouTube link of our favorite psoas strengthening exercises!
Long-Term Results Come from Daily Habits
The biggest cause of chronic hip pain isn’t a specific injury—it’s repetition. The way you sit, stand, sleep, and move every day either reinforces dysfunction or helps correct it. Patient education is at the core of our approach, because we know long-term results only happen when you understand the why behind your pain.
Whether you’re dealing with hip impingement, groin pain, snapping hip, or vague hip stiffness that won’t go away, we can help identify the root cause and guide you back to high level performance.
Final Thoughts
Whether your hip pain is due to joint capsule tightness or muscle weakness (or both), the treatment principles remain consistent:
- Restore mobility where it’s restricted
- Strengthen what’s weak
- Address dominant patterns
- Change your daily postures and habits
- Educate yourself on the why—not just the what
This is exactly what we do during our sessions. We combine manual therapy, movement retraining, and patient education to treat not just the symptoms, but the root causes.
So if you’re dealing with nagging hip pain, whether you’re a runner, a power athlete, or just someone who sits all day—this is your roadmap.
Got questions? Reach out. We’re here to help.
-Dr. Andrew