Nonarthritic Hip Joint Pain

Clinicians should consider the presence of osseous abnormalities, local or global ligamentous laxity, connective tissue disorders, and nature of the patient’s activity and participation as risk factors for hip joint pathology. (F)

Clinicians should use the clinical findings of anterior groin or lateral hip pain or generalized hip joint pain that is reproduced with the hip flexion, adduction, internal rotation (FADIR) test or the hip flexion, abduction, external rotation (FABER) test, along with consistent imaging findings, to classify a patient with hip pain into the International Statistical Classification of Diseases and Related Health Problems (ICD) categories of M25.5 Pain in joint, M24.7 Protrusio acetabula, M24.0 Loose body in joint, and M24.2 Disorder of ligament, and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based categories of hip pain (b28016 Pain in joints) and mobility impairments (b7100 Mobility of a single joint; b7150 Stability of a single joint). (C)

Clinicians should consider diagnostic categories other than nonarthritic joint pain when the patient’s history, reported activity limitations, or impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline or when the patient’s symptoms are not diminishing with interventions aimed at normalization of the impairments of body function. (F)

Clinicians should use a validated outcome measure, such as the Hip Outcome Score (HOS), the Copenhagen Hip and Groin Outcome Score (HAGOS), or the International Hip Outcome Tool (iHOT33), before and after interventions intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions in individuals with nonarthritic hip joint pain. (A)

When evaluating patients with suspected or confirmed hip pathology over an episode of care, clinicians should assess impairments of body function, including objective and reproducible measures of hip pain, mobility, muscle power, and movement coordination. (B)

Clinicians may utilize patient education and counseling for modifying aggravating factors and managing pain associated with the nonarthritic hip joint. (F)

In the absence of contraindications, joint mobilization procedures may be indicated when capsular restrictions are suspected to impair hip mobility, and soft tissue mobilization procedures may be indicated when muscles and their related fascia are suspected to impair hip mobility. (F)

Clinicians may utilize therapeutic exercises and activities to address joint mobility, muscle flexibility, muscle strength, muscle power deficits, deconditioning, and metabolic disorders identified during the physical examination of patients with nonarthritic hip joint pain. (F)

Clinicians may utilize neuromuscular re-education procedures to diminish movement coordination impairments identified in patients with nonarthritic hip joint pain. (F)