Simple and Effective

Getting to the "What" and "Why" of Hip Pain

By Douglas Nelson
[Table Lessons]

“I brought some things for you to read,” my client said.     
"Whoa, you certainly did," I thought to myself. Mr. L. had a stack of paper about a half-inch thick, organized chronologically.
“I thought you might want to see these physician reports, physical therapy notes, and let’s see, what else …,” his voice trailed off.
“Before I do that, could you tell me what brings you here?” I asked.
“My right hip hurts. Nothing has helped and several people recommended I see you,” he said.
 “Can you tell me in your own words what you feel and what other people have done?”
 “One of these reports describes the injection,” Mr. L. said, looking for the right note.
“Injection?” I asked.
“Yes, a steroid injection in the hip about six months ago. It didn’t help, so we decided the pain wasn’t coming from my hip. An X-ray of my spine showed a narrowing of the disc space, so we thought the hip pain was coming from my back. An MRI showed a possible disc issue, which was extremely discouraging.”
“The vast majority of people with no back pain also show disc abnormalities on an MRI,” I countered. “Perhaps you are one of those people, where it shows up on the MRI but it isn’t clinically relevant.”
Mr. L. struggled to process this information, trying to reconcile the MRI image with the idea that it might not matter. The image clearly had a powerful effect on his perception of the problem.
“Maybe that’s true,” Mr. L. admitted. “After the MRI, I had a back injection and there was no improvement in my hip. We tried a second injection in a different place and still my hip was unchanged. I then saw an orthopedist, but he did not think that back surgery was in order. He recommended physical therapy for my back, which I did for three months without results. I guess that is why I am here.”
“It seems to me that everyone thinks your hip pain is from your back,” I said. “Perhaps your hip pain is actually coming from your hip.”
“But the X-rays looked fine and the injection in my hip didn’t help,” Mr. L. said.
“True, but that doesn’t rule out problems with the muscles around the hip. You have had great people treat your back, but if that was the source, your hip would be better. Let’s take a different tack and see what happens.”
Showing me his pain, Mr. L. pointed to the lateral aspect of his hip. He explained that occasionally the pain runs down his leg, even below his knee. Now I understood why people thought it might be coming from his back.
“Does this look familiar?” I said, showing Mr. L. a referral chart of the gluteus minimus.
“It sure does,” he said.
Having Mr. L. lie on his left side, I took his right leg into adduction. The moment I lowered his leg toward the table, his pelvis also moved caudally, showing restricted range of motion of the gluteus medius and minimus. As I pressed firmly on the tissue, Mr. L.’s eyes widened.
“Wow, is that tender!” he exclaimed. “Is it supposed to hurt like that?”
“Nope. Notice what happens if I move about 2 centimeters posterior,” I said.
“That doesn’t hurt at all,” he replied. “Why is that?”
“While there are multiple muscles in your hip, the problem is likely to be coming from one or two of them, and only selected areas of those muscles. It’s hyperprecise.” Moving anteriorly and closer to the trochanter, I found an exquisitely sensitive spot. Mr. L.’s facial expression changed immediately.
“That shoots right down my leg,” he said. “What the heck? Why is that?”
“There are two issues here—what and why. The what part is clear: if I press exactly on that spot, you feel it down the leg. The why part is not clear; how this referral happens is not well understood. On the other hand, we used aspirin for decades without understanding how it worked. Not understanding a mechanism doesn’t prevent you from using it effectively. I have treated scores of people with this symptom and they no longer have pain radiating down the leg. Results are what matter.”
Subtle repositioning of Mr. L.’s leg allowed me to examine his gluteus medius and minimus in multiple-length tension relationships. Changing the angle of entry and the direction of my pressure, I examined the abductor complex in minute detail. After 20 minutes, I retested Mr. L.’s adduction capability and it had improved significantly. Standing up, Mr. L. noticed an immediate difference in his mobility and perceived strength.
“I’m surprised that something so simple was so effective. Next time I hurt, I am doing this first,” Mr. L. said.
Thus, a new advocate for the power of massage therapy left my office.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and a trustee for the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at