The Hip Physio

The Hip Physio 🎓 Simplifying the Hip | Course Tutor
📅 Specialist Hip Pain Clinic
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23/04/2026

🧠 Common signs and symptoms of hip dysplasia 🧠

🔵Hip dysplasia is characterized by reduced acetabular coverage of the femoral head leading to an increased mechanical load on the hip joint and the acting hip muscles. The acetabular labrum plays a major role in load transfer and joint stability of the hip . Excessive stress on the labrum in the dysplastic hip joint results in labral injuries in 49–83% of dysplastic hips. However, the muscles acting close to the hip joint also play a vital role in load transfer and in maintaining the femoral head in place of the acetabular socket, (Jacobsen et al., 2018)

🟢Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip.

🟢An increase in mechanical stress on the cartilage matrix with failure of the acetabular labrum represents the major pathomechanism of degeneration.

🟢Because the prevalence of associated femoral deformities is high (>50%), the structural anatomy of the dysplastic hip must be assessed in multiple planes using radiographs and, if needed, advanced imaging modalities. (Gala et al, 2016)

23/04/2026

Thursday 4th June 6.30pm, Seven Dials Club, Covent Garden.

Half-price tickets (£10) for all attendees of the previous event.

22/04/2026

Clamshells are fine. But if you’re looking to load up the lateral hip in a more functional position, I tend to favour weight bearing variations.

Glute med has two main jobs. Hip abduction and pelvic stabilisation in stance. The clamshell trains the first in a non-weight bearing position. This standing variation trains both at the same time.

You’re loading it through range, in a position it actually has to work in.

🔹 If this level is too challenging to start, here’s how to regress it:
🔹 Use a wall or chair in front of you for balance support
🔹 Place your back foot down lightly behind you (isometric version) rather than lifting fully
🔹 Start without the ball altogether — just focus on the movement pattern first

Build from there once you’ve got control.

One thing worth flagging. If you have gluteal tendinopathy, be cautious with clamshells. They’re often given early on because people assume they’re a gentle option, but they can flare the tendon quickly. I wouldn’t use them in an irritable tendon. Get the tendon settled first before introducing them.

Not saying clamshells are useless in general. But context matters a lot here.

21/04/2026

1.
Flexing the hip close to 90° reorients the muscle’s line of force from nearly parallel to nearly perpendicular to the longitudinal axis of rotation at the hip

2.
Anterior glute med fibres slightly internally rotate in neutral, but increase 8x in leverage by 90° of flexion

3.
The clam exercise appeared least favourable in terms of recruiting GMed muscle activity due to relatively short anti-gravity lever arm to overcome.

⁣ ⁣ ⁣ glutealtendinopathy lateralhippain gluteexercises hipsurgery exeter hipflexor hipflexorpain hipflexorrelief hipflexorstretch hipflexorstretches greatertrochantericpainsyndrome glutealstrengthening glutealexercises hippain hiprehab groinrehab physiostudent exetercity physiotherapystudent gtps physio physiotherapy physicaltherapy ⁣ sportsphysio Thanks to

21/04/2026

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21/04/2026

Hamstring strain injury (HSI) is one of the most common injuries in sports involving high-intensity sprinting, acceleration, and decelerations. Injury rates of the hamstring muscles ranges from 6% to 29% of all injuries in track and field, soccer, Australian football, rugby, basketball, or cricket.

hamstringinjury hamstringexercises hamstringworkout hamstringstretch hamstringrehab

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Hip dysplasia means the acetabulum doesn’t fully cover the femoral head. That changes how load is distributed across the...
21/04/2026

Hip dysplasia means the acetabulum doesn’t fully cover the femoral head. That changes how load is distributed across the joint and puts the labrum under far more demand than it was designed for.

Over time, that labrum hypertrophies, degenerates, and tears. But here’s the problem: that tear gets treated as the primary issue, not as a response to underlying instability.
The structural cause goes undetected.

Why? Because standard MRI doesn’t routinely assess acetabular coverage. The lateral centre edge angle often isn’t reported.

Symptoms like deep groin ache, a feeling of giving way, or discomfort with prolonged walking aren’t the “classic” presentation people expect. So dysplasia gets missed. And patients get treated for impingement, hip flexor tightness, or general muscle pain instead.

Borderline cases are even harder. Some people sit in a grey zone where nothing looks clearly abnormal on imaging, yet the clinical picture tells a very different story.

If the numbers don’t quite meet the threshold for dysplasia but the symptoms fit, that context matters.
🔹 Dysplasia reduces femoral head coverage
🔹 The labrum compensates and overloads
🔹 Standard imaging often misses the acetabular measurements that matter
🔹 Symptoms are frequently subtle and overlap with other diagnoses
🔹 Borderline cases can still be clinically significant

Getting the right imaging, with the right views and measurements, changes everything.

Does your diagnosis feel like it’s not adding up?

Drop a comment below.

Which exercises actually load the iliopsoas the most?Juan et al. (2024) measured peak normalised EMG activity of the ili...
21/04/2026

Which exercises actually load the iliopsoas the most?

Juan et al. (2024) measured peak normalised EMG activity of the iliopsoas across a range of exercises. Here’s what came out on top 👇

🔹 Bilateral leg lift — ~86% MVC (highest of all tested)
🔹 Hip flexion bent knee — ~80% MVC
🔹 Unilateral leg lift — ~68% MVC
🔹 SLR isometric @60° +20ER +30ABD — ~65% MVC
🔹 Hip flexion straight leg — ~60% MVC

The bilateral leg lift came out highest. The combined demand of spinal stabilisation and bilateral hip flexion likely drives that higher activation compared to unilateral work.
Adding external rotation and abduction to SLR isometrics also increased activation. Position influences which fibres are recruited and how hard they have to work.

Now some important context before you take this and run with it.

🔹 This study measured peak EMG, not total muscle work across a full rep. High peak activation doesn’t automatically mean it’s the best exercise for your patient or your goal.

🔹 EMG measures electrical activity, not force production directly. It’s a proxy, and it has variability between individuals and between sessions.

🔹 The sample was healthy participants. How this translates to someone post-op, with FAI, or with iliopsoas tendinopathy is a different question entirely.

🔹 These were mostly isometric or simple open-chain tasks. How the iliopsoas behaves during functional loading like running or stair climbing is more complex.

Use this to inform your exercise selection. Don’t use it as a rigid prescription.

20/04/2026

Something that doesn’t get talked about enough. Calcified AIIS avulsions and subspine impingement.

Most people have heard of FAI. Cam, pincer. But there’s another type that gets missed regularly, especially in athletes, and it lives outside the joint entirely.

The AIIS is where your re**us femoris attaches. In adolescent athletes the growth plate is still open, so a powerful kick, a sprint, a sudden lunge, and that muscle can pull a fragment of bone clean away from the pelvis. An avulsion fracture.
Most of the time these heal fine. Rest, activity modification, physio. Job done.

Except sometimes they don’t heal cleanly. The fragment migrates down, calcifies, and forms a bony mass right below the AIIS. And now every time you flex your hip, that chunk of bone is crashing into the front of your femoral neck. That’s subspine impingement.

Here’s where it gets missed. You can have this with a perfectly normal hip joint. No cam. No pincer. Just an extra-articular block sitting in the way. So if someone’s had FAI surgery and still has pain on deep hip flexion, this is one of the first things I’m thinking about.

👉 Who gets it: young footballers, gymnasts, sprinters. Teens to early 20s.
👉 Symptoms: anterior groin pain on flexion and internal rotation, sometimes a grinding or blocking sensation, loss of flexion range.
👉 Diagnosis: X-ray can show it, CT gives you the 3D picture you actually need. Plain films miss this more than they should.
👉 Treatment: conservative first, always. When that fails, arthroscopic AIIS decompression has solid evidence behind it.

Not all hip impingement lives inside the joint. If you’re working with a young athlete who had a groin injury a year or two ago, never fully recovered, and now struggles with hip flexion, go back and look at the AIIS.

20/04/2026

Did you spot it?

Sorry I posted this ages ago and forgot to follow up!

“It’s your I get it. Anterior hip pain, patient can’t lift their leg properly, hip flexors feel tight. It seems obvious....
20/04/2026

“It’s your

I get it. Anterior hip pain, patient can’t lift their leg properly, hip flexors feel tight. It seems obvious.

But the iliopsoas gets blamed for a lot of anterior hip pain that it is simply not responsible for.
The labrum, the capsule, intra-articular pathology in general, these are far more common sources of anterior hip pain in active people than an isolated hip flexor problem. And when you miss that, you delay the diagnosis, you delay the right management, and the patient keeps coming back wondering why hip flexor stretches aren’t helping.

Snapping? Doesn’t always mean pain. Weakness? Doesn’t mean the flexor is the source. Pain in flexion, adduction and internal rotation? That’s loading the anterior capsulolabral complex, not the iliopsoas tendon.

And don’t forget the referral picture. L1-L2, femoral nerve, ilioinguinal entrapment. These can all look like hip flexor pain on clinical presentation alone.

Assess properly. Rule out the joint first. Thorough subjective history, FADIR, joint quadrant testing and the rest. Not just palpating the front of the hip and calling it a day.

Hip flexor pain as a standalone diagnosis should be a diagnosis of exclusion.

References:
Enseki et al., 2014, Anterior hip pain in the active patient
Groh & Herrera, 2009, A comprehensive review of hip labral tears
Griffin et al., 2016, The Warwick Agreement on FAI syndrome
Wahl et al., 2004, Coxa saltans interna in athletes
Freke et al., 2016, A systematic review of physical impairments associated with hip related pain
Reiman et al., 2015, Diagnostic accuracy of clinical tests for FAI
Brukner & Khan, 2017, Clinical Sports Medicine

20/04/2026

Here are some of my thoughts on managing hip OA....

Hip arthritis doesn’t have to mean the end of doing the things you love.

And honestly, a lot of the advice people get when they’re diagnosed is either too vague, too scary, or just flat out wrong.
So here are my top tips as a hip specialist for managing hip arthritis and actually getting on with your life.

👉 Movement is medicine. Not rest. Not “taking it easy forever.” Graded, consistent movement is one of the most powerful things you can do.

👉 Strength matters more than most people think. A strong hip is a more resilient hip, full stop.

👉 Pain doesn’t always mean damage. A flare doesn’t mean things are getting worse structurally. Understanding that changes everything.

👉 Don’t wait until it’s unbearable to act. The earlier you get on top of this the better your outcomes.

And if you’re living with hip OA, drop a comment below and let me know how you’ve been managing it. I read every single one and I’d love to hear from you.

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