Getting to the Bottom of Hip Pain: What Happens During a Physio Hip Assessment?
If you’ve been dealing with a stubborn ache in your hip, deciding to see a physiotherapist is the best first step. But if you’ve never had a formal assessment, you might be wondering what actually happens behind those clinic doors.
A thorough hip assessment isn’t just about poking where it hurts; it’s a structured, clinical process designed to find the exact root cause of your problem. Here is a breakdown of exactly how we analyse your hip, what we are looking for, and why we do it.
The Subjective Assessment (The Investigation Phase)
Before we even touch your hip, we start with a detailed conversation. This is where you tell me the story of your injury, but it’s also where the clinical detective work begins. I will ask you specific questions about the type of pain you are experiencing; whether it is a sharp catch, a dull ache, or a burning sensation. The character of the pain gives us major clues about the mechanism behind your injury, such as whether it’s involving a joint, a tendon, or a nerve.
We will also discuss your aggravating factors. Does it hurt when you sit for a long period, or does it flare up when you try a new workout routine? Your answers here guide the entire physical assessment, telling me exactly what structures I need to test and what conditions I am already starting to suspect.
Ruling Out the Lower Back
Here is a fun body fact: your nervous system loves to play tricks on you. Quite often, what feels like a hip problem is actually referred pain coming straight from your lower back.
Because of this, a crucial part of our assessment is clearing the lumbar spine. We need to rule out the back immediately so we can confidently focus our attention on the hip itself. Rest assured, we do this to ensure we are treating the actual source of your pain, not just chasing a ghost symptom.
Observation and Functional Movement Screening
Next, we move on to the physical observation to see how you handle real-world mechanics. I will ask you to perform a few everyday movements like a double-leg squat, a single-leg squat, and some balancing exercises.
No, I am not judging you here!
Instead, I am looking for specific clinical deficits. For example, during a single-leg balance or squat, I am checking for a Trendelenburg sign, which is a fancy medical term for when your pelvis drops on one side because your hip stabiliser muscles are slacking off. Seeing how you perform these functional movements shows us exactly where your weak links are and helps guide the rest of the physical assessment.
The Neurological Exam
Before we zero in on the hip joint itself, we have to check your body’s wiring. We need to determine whether your pain is coming from an irritated nerve, or if it is strictly a muscle or joint issue.
To do this, we perform a quick neurological exam. We will tap your knees and ankles to test your reflexes, and we will check your dermatomes (a medical term for testing how well the skin along different parts of your leg feels sensation). This helps us confidently rule out the nerves, ensuring we aren’t blaming your hip joint for a nerve’s mistake.
Range of Motion (ROM) Testing
Once we know the nerves are clear and we’ve seen how you move as a whole, we narrow it down to the joint itself by testing your Range of Motion in two distinct ways:
Active Range of Motion: I will ask you to move your leg into different positions (like bringing your knee to your chest or turning your foot outward) using your own muscle power. This shows us what your muscles and joints can achieve together.
Passive Range of Motion: This is where you relax completely and I move your leg for you. By taking your muscles out of the equation, I can feel the true flexibility of the joint capsule and ligaments, noting exactly where and when the movement gets restricted.
Special Tests and Diagnosis
Finally, we move on to targeted physical examinations known as special tests. These are structured movements and specific pressures applied to the hip, such as compressing or stretching the joint to see if we can safely reproduce your specific pain.
These tests are highly diagnostic. They help us narrow down the possibilities, figure out exactly which tissue is irritated, and arrive at a likely clinical diagnosis.
If your case is straightforward, we can usually pinpoint the issue right here. If things are a bit more complex, this is also the stage where we determine if we need additional imaging, like an X-ray or an MRI. Once we have our definitive diagnosis, it completely guides our rehabilitation plan, allowing us to build a customised strategy to get you moving comfortably again.
At the end of the day, a hip assessment isn’t just a random guessing game, it’s a systematic checkup to make sure we treat the actual cause of your discomfort, not just the symptoms. Once we have our answers, the guesswork stops, and the real work begins. We will map out a personalised rehabilitation plan tailored entirely to your body, safely paving the way to get you moving comfortably, efficiently, and completely pain-free again.
