Hip Pain in Athletes and Active Adults: Common Causes and When Physical Therapy Can Help

Hip pain is one of those conditions that tends to get dismissed or pushed through longer than it should be. Athletes attribute it to soreness from training. Active adults assume it is just part of getting older. Runners keep logging miles hoping it will work itself out. And in many cases the hip is quietly limiting performance, altering movement patterns, and setting the stage for a more significant problem down the road before anyone decides to do something about it.

At Cross the Line Physical Therapy and Performance in Winter Park, FL, hip pain is one of the most common presentations we see across both athlete and active adult populations. The good news is that most hip conditions, when accurately identified and properly addressed, respond very well to Physical Therapy. The key is getting an accurate picture of what is actually going on rather than guessing or waiting.

Why Hip Pain Is So Easy to Ignore and So Important Not To

The hip is a deep joint surrounded by powerful muscle groups, which means it takes a significant amount of dysfunction before pain becomes severe enough to demand attention. Many people experience months of vague discomfort, stiffness, or a gradual reduction in what they can do before they finally seek care.

The problem with waiting is that the hip plays a central role in nearly every lower body movement. Running, squatting, cutting, kicking, and even walking all depend heavily on hip strength, mobility, and control. When the hip is not functioning optimally, the body compensates by shifting load to the lower back, the knee, and the ankle. Over time these compensations create their own problems, turning what started as a hip issue into a more complex, multi-region problem that is harder and slower to resolve.

Getting an accurate evaluation early, when symptoms first appear, is almost always the most efficient path to resolution.

The Most Common Hip Conditions We See

Hip pain is not a diagnosis. It is a symptom that can come from several different sources, each with its own specific characteristics and treatment approach. Here are the conditions we see most frequently at Cross the Line Physical Therapy and Performance.

Femoroacetabular Impingement and Hip Labral Tears

Femoroacetabular impingement, commonly called FAI, occurs when there is abnormal contact between the ball and socket of the hip joint due to bony irregularities. Over time this abnormal contact can stress and eventually tear the labrum, the ring of tissue that lines the hip socket and contributes to joint stability and shock absorption.

FAI and labral tears are particularly common in athletes who perform significant amounts of hip flexion under load, including soccer players, baseball players, cyclists, and weightlifters. They are also increasingly recognized in active adults who maintain demanding training schedules well into their 40s and 50s. The most common symptom is a deep aching pain in the groin or front of the hip, sometimes with a clicking or catching sensation, that worsens with prolonged sitting, getting in and out of a car, or hip-loaded activities like squatting and lunging.

Not all FAI and labral tears require surgery. Many respond very well to a Physical Therapy program focused on improving hip strength, optimizing movement mechanics, and reducing the forces that cause impingement and irritation during activity. For those who do require surgical intervention, rehabilitation plays a critical role in the recovery process. Our Post-Surgical Physical Therapy FAQ covers our approach to post-operative hip rehabilitation in detail.

Hip Flexor Problems

Hip flexor strains and tendinopathy are among the most common hip conditions in athletes and active adults alike. The hip flexors, primarily the iliopsoas and rectus femoris, are responsible for lifting the leg and driving the knee forward during running, kicking, and explosive movements. They are under significant demand in soccer players, runners, cyclists, and anyone who performs repetitive hip flexion movements, and they can become strained, irritated, or chronically overloaded when training volume spikes or when the surrounding muscles are not sharing the load effectively.

Hip flexor problems typically present as pain or tightness at the front of the hip or groin that worsens with lifting the knee, running, or sustained hip flexion positions like sitting. In runners specifically, hip flexor issues often accompany a reduction in stride length and a sense of restriction or tightness at the front of the hip that does not fully resolve with stretching.

Hip Osteoarthritis

Hip osteoarthritis involves gradual wear of the cartilage within the hip joint and is one of the most common causes of hip pain in active adults. It typically presents as stiffness, particularly in the morning or after prolonged sitting, along with a gradual reduction in hip range of motion and pain that may worsen with activity or after a demanding workout.

One of the most persistent misconceptions about hip osteoarthritis is that activity makes it worse and that reducing activity is the appropriate response. The research tells a different story. Targeted strengthening and movement-based Physical Therapy consistently improves pain and function in people with hip osteoarthritis, often significantly, without accelerating the underlying joint changes. Staying active with appropriate management is almost always a better strategy than reducing activity and waiting.

Hip osteoarthritis does not automatically mean hip replacement is in your future. For many active adults, a well-designed Physical Therapy program provides enough improvement in pain and function that surgery is delayed for years or avoided altogether.

Gluteal Tendinopathy

Gluteal tendinopathy involves irritation and breakdown of the tendons attaching the gluteal muscles to the outside of the hip. It is one of the most commonly misdiagnosed hip conditions, frequently labeled as hip bursitis, and it is particularly prevalent in runners and active adults who perform repetitive single leg loading.

It typically presents as pain on the outside of the hip that may radiate down the outer thigh, and is often aggravated by climbing stairs, walking on inclines, crossing the legs, or lying on the affected side at night. Unlike bursitis, which involves inflammation of the fluid-filled sac near the joint, gluteal tendinopathy is primarily a tendon loading problem and requires a progressive strengthening approach rather than rest and anti-inflammatory treatment alone.

Athletic Pubalgia

Athletic pubalgia, sometimes called a sports hernia or core muscle injury, involves pain in the lower abdomen and groin from weakness or disruption of the soft tissue structures around the pubic region. It is most common in athletes who perform explosive cutting, twisting, and kicking movements, making it particularly prevalent in soccer players, hockey players, and football players.

It can be a difficult condition to diagnose accurately since it overlaps with other groin and hip conditions, and it often responds well to a targeted Physical Therapy program focused on progressive core and hip strengthening when identified correctly.

What Athletes and Active Adults Get Wrong About Hip Pain

The most common mistake across both populations is treating hip pain as a flexibility problem rather than a strength and control problem. The instinct when the hip feels tight or restricted is to stretch it more. While mobility work has a role in hip rehabilitation, the research consistently shows that hip strength, particularly in the glutes and external rotators, is the more important factor in both treating and preventing most hip conditions.

Foam rolling, stretching, and mobility drills feel productive and provide temporary relief, which is why people keep doing them. But if the underlying strength deficits are not addressed, the tightness and pain keep coming back because the root cause has not changed.

The second mistake is assuming that imaging results tell the whole story. Many athletes and active adults are told they have FAI, a labral tear, or hip osteoarthritis on an MRI and immediately assume the worst. These findings are common, often present in people with no pain at all, and do not by themselves determine whether surgery is necessary or whether full recovery is possible with Physical Therapy. A thorough physical evaluation gives a far more accurate picture of what is actually driving symptoms than imaging alone.

How We Approach Hip Pain at Cross the Line Physical Therapy and Performance

Our approach to hip pain starts with a thorough evaluative process that gives us objective information about everything that could be contributing to the problem. This means looking beyond the hip itself to assess the lumbar spine, the pelvis, the knee, and the way the entire lower extremity functions as a unit during the movements that matter most to you.

We measure what we can measure. Strength, range of motion, movement quality, and functional performance are all assessed and documented so that treatment decisions are based on data rather than assumptions, and so that progress can be tracked objectively throughout the rehabilitation process.

From there, treatment is built around what the evaluation actually reveals. Two people with the same hip diagnosis can have completely different underlying drivers, and a program that addresses the specific factors at play in your case will be far more effective than a generic hip protocol.

And as is the case with everything we do at Cross the Line Physical Therapy and Performance, our goal is not to immediately tell you to stop running, stop training, or stop doing the things you love. In most cases, staying active in some form is both possible and beneficial throughout the rehabilitation process. Our job is to find the level of activity you can tolerate, keep you moving, and simultaneously address the underlying issues that are driving your pain.

When Hip Pain Does Require More Than Physical Therapy

It would be dishonest to suggest that every hip condition can be fully resolved with Physical Therapy alone. Some situations genuinely require surgical intervention, including significant labral tears with instability, FAI with meaningful structural impingement that does not respond to conservative care, and advanced hip osteoarthritis where joint replacement is the most appropriate path forward.

The most important thing is getting an accurate evaluation early so that you know exactly what you are dealing with and what the realistic options are. Physical Therapy is almost always the appropriate first step, both because many hip conditions respond fully to conservative management and because entering surgery with better strength and mobility consistently improves surgical outcomes and accelerates post-operative recovery.

If during your evaluation we believe your situation requires imaging, an orthopedic consultation, or surgical management, we will tell you directly and help point you in the right direction.

Hip Pain Does Not Have to Be Something You Just Live With

Whether you are a runner dealing with persistent hip tightness that is affecting your stride, a soccer or baseball player managing groin pain through your season, or an active adult whose hip stiffness and discomfort has been quietly limiting what you can do, a thorough evaluation at Cross the Line Physical Therapy and Performance can give you the clarity and direction you need.

We will identify exactly what is driving your hip pain, explain it in terms that make sense, and build a plan around getting you back to doing what you love at the level you want to be doing it.

Call, text, or fill out our contact form to schedule your evaluation in Winter Park, FL.