Straight From the Hip : Honest Conversations on Hip and Groin Pain

Half of all physiotherapists are missing it. Are you?In Episode 9 of Straight from the Hip, Benoy and Callum tackle one of the most under-diagnosed conditions in active adults — hip osteoarthritis. Not in your 70-year-old patient shufflingtowards a hip replacement. In your 35-year-old male athlete. Your 42-year-old female runner. The patients who are quietly losing capacity, reducing their activity, and drifting towards inactivity — while being told it's tight hip flexors or weak glutes. This episode dismantles the myths, challenges the guidelines, and gives you the clinical tools to catch hip OA earlier — because earlier recognition means better outcomes, full stop. What you'll take away:•      Why the NICE guideline age cut-off of 45 is a guideline— not gospel•      The key subjective and objective features of early hipOA in active adults•      How to separate symptomatic OA from radiological OA(and why imaging may not change a thing)•      How hip OA, GTPS, and tendinopathy coexist — and what'sactually driving the presentation•      The labelling debate: when a diagnosis empowers, andwhen it terrifies•      Three clinical scenarios that actually warrant imaging Stop waiting for the limp and the walking stick. The patients you're missing look nothing like that.

Conservative care fails FAI syndrome patients every day — but is it really the treatment that's failing, or the process surrounding it?In this episode, Benoy and Callum break down the five most common reasons why patients with femoroacetabular impingement syndrome don't respond to non-operative management. This isn't about blaming patients. It's about clinicians holding up a mirror and asking the harder questions.What we cover:🔵 Misdiagnosis— The most common reason rehab doesn't work is that it was never targeting the right condition. Early OA, hip dysplasia, and proximal ITB syndrome are frequently mislabelled as FAI syndrome. The Warwick Agreement triad — symptoms,clinical signs, and imaging — must all be present before you can confidently diagnose.🔵 Failure tomodify activity — Deep end-range loading in the gym, premature adductor rehab, and provocative sport-specific movements keep the joint constantly irritated. Relative load management isn't optional — it's foundational.🔵 Severity of morphological deformity — A large cam lesion with restricted ROM creates a mechanical conflict that no amount of glute work will resolve. Recognising the ceiling of conservative care early leads to better conversations and better outcomes.🔵 Inadequate or generic rehabilitation — If the programme was a generic lower limb circuit without baseline deficit assessment or meaningful progression, the patient hasn't had a genuine trial of conservative care. Full stop.🔵 Psychological and cognitive factors — Fear-avoidance, catastrophising, low self-efficacy, and co-existing mental health conditions are still under-screened in hip patients. The bottom line: Before you refer on or label a patient as a conservative care failure, ask yourself whether you — and the system around them — gave them the best possible shot.𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists,strength coaches, and any health care professional managing active patients with hip and groin complaints.

Your patient has FAIS. So now what? Do you keep rehabbing, refer for an injection, or send them down the surgical pathway?And how do you know you've actually done enough before escalating?In this episode, we cut through the noiseand break down the full management spectrum — from conservative care, through the three main injection options, to hip arthroscopy. Whether you're a physio, osteopath, sports therapist, or S&C coach, this is the decision-making framework every clinician managing hip and groin pain needs in their backpocket.What you'll learn:·      Why the bone shape doesn't change withconservative care — but the way the hip functions around it absolutely can·      The three phases of conservative rehab: calmingit down, building it up, and returning to sport — with realistic timelines yourpatients can actually trust·      Why strength beats stretching in FAIS, and howaggressive mobility work can make impingement worse·      The three main injection options —corticosteroid, PRP, and hyaluronic acid — compared side-by-side on onset,duration, cost, and who they're actually suited for·      The four clinical filters specialists use todecide which injection fits which patient·      How to turn an injection's pain-free window intoreal rehab gains — and the one mistake that wastes every injection·      The "sweet spot" hip arthroscopycandidate, and the four red flags that predict surgical failure (Tönnis grade,age, dysplasia, and chronic pain sensitisation)·      Why hip dysplasia is the most common reason fora failed arthroscopy — and how to spot the suspicion on imaging·      The psychological side of surgical recoverynobody prepares patients for: the Week 3 Blues and the Three-Month Slump·      Post-op milestones from crutches to pivotingsport — plus three non-negotiable tips for surgical successConservative, injections, and surgery aren't competing pathways — they're layered, sequential, and patient-specific. Surgery is 50% of the result; rehab is the other 50%. And no injection, no matter howwell-placed, works without the physio work that follows it.Tune in, take notes, and share it with the clinician who's still defaulting to "just give it time" for every FAIpatient on their caseload.𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists,strength coaches, and any health care professional managing active patients with hip and groin complaints.

Your patient has FAI Syndrome. They're in pain, frustrated, and wondering if they'll ever squat, sit comfortably, or train hard again. The answer? They almost certainly can — but only if we stop blaming morphology and start managing load.In this episode, we break down exactly how to modify everyday activity and gym exposure, so your patients keep moving, keep training, and actually start recovering. From the sitting habits silently driving flare-ups, to the squat, deadlift, and spin class tweaks that take the heat out of the anterior hip — this is the practical playbook you can take straight into clinic on Monday morning.What you'll learn:• Why FAIS is a cumulative compression problem, not a single-event injury• How to modify sitting, walking, stairs, car transfers, and sleep to calm an irritable hip• Gym adjustments for squats, deadlifts, lunges, leg press, and core work — without pulling strength training away from your patient• How CAM vs pincer morphology should shape your walking and loading advice• Saddle height, handlebar position, and cadence tweaks for cyclists and spin class regulars• The five clinician mistakes that keep FAIS patients stuck — including chasing perfect posture and over-restricting flexionRange isn't the enemy-unprepared range under load is. We modify to restore tolerance, not to protect forever.Tune in, take notes, and share it with a colleague who's still telling their FAI patients to avoid the squat rack.

A 22-year-old male footballer with a CAM lesion and a 28-year-old female runner with a pincer pattern — same diagnosis, completely different clinical pictures. So why are so many clinicians still assessing and rehabbing them the same way?In this episode, we unpack how sex and morphology shape everything from presentation to rehab strategy in FAIS. We cover why males typically present with reduced ROM and sharp anterior groin pain, while females often have full — or even excessive — range yet still can't tolerate load at end-range. We explore the key strength and movement strategy differences, why "chasing flexibility" can be a trap in pincer-dominant patients, and how surgical considerations differ between morphology types. If you've ever wondered why some FAIS patients plateau despite doing "all the right things," this episode might change how you approach your next hip assessment. Same diagnosis doesn't mean same patient — treat the person, notthe scan. 

Are you ordering the right scans for your hip patients — or just ticking a box? In this episode of Straight from the Hip, Benoy and Callum dives deep into the world of diagnostic imaging for the young hip. From the X-ray views most clinicians forget torequest, to why MRI should be your first call for a limping young athlete — this episode is a practical session, in choosing the right investigation at the right time. You'll learn why hip complaints demand a completely different imaging mindset compared to spinal presentations, and why less than 5% of back patients need investigation while hip patients often need it far sooner.  Benoy breaks down the specific roles of X-ray, MRI, ultrasound, and CT, explains the key radiological parameters you should know cold (alpha angle, lateral centre edge angle), and makes a compelling case for diagnostic injection as your ultimate problem-solver when imaging and clinical findings don't match up.Perhaps most importantly, this episode tackles the growing narrative that imaging is overused — arguing that scans don't cause harm, but poor reasoning and poor communication absolutely do.Whether you're in primary care deciding when to investigate, or a specialist building a multimodal assessment strategy, this episode gives you six clear principles you can take straight back into clinic on Monday morning.𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists, strength coaches, and any health care professional managing active patientswith hip and groin complaints.

Misdiagnosed Hip Impingement? These 6 Conditions Could Be the Real Culprit (JUST RELEASED)𝐘𝐨𝐮𝐫 𝐅𝐀𝐃𝐈𝐑 𝐭𝐞𝐬𝐭 𝐢𝐬 𝐩𝐨𝐬𝐢𝐭𝐢𝐯𝐞. 𝐘𝐨𝐮𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐢𝐬 𝐲𝐨𝐮𝐧𝐠 𝐚𝐧𝐝 𝐚𝐜𝐭𝐢𝐯𝐞. 𝐈𝐭 𝐦𝐮𝐬𝐭 𝐛𝐞 𝐅𝐀𝐈… 𝐫𝐢𝐠𝐡𝐭? 𝐍𝐨𝐭 𝐬𝐨 𝐟𝐚𝐬𝐭.IIn this episode of Straight from the Hip, Benoy and Callum break down six conditions that can masquerade as hip impingement — and why getting it wrong could mean missed red flags, delayed treatment, or unnecessary interventions.From femoral neck bone stress injuries that demand urgent action, to hip dysplasia hiding behind hypermobility, to the often-overlooked ischio-femoral impingement — we walk you through the key clinical features, risk factors, and distinguishing signs that separate FAI from its mimickers.In this episode, we cover:🔹 Why FAI clinical tests lack specificity — and what that means for your diagnosis🔹 Three common mimickers: bone stress injuries, hip dysplasia, and early hip OA🔹 Three less common but crucial differentials: proximal ITB syndrome, ischiofemoral impingement, and avascular necrosis🔹 The red flags you can't afford to miss🔹 How history, risk factors, and imaging correlation can sharpen your clinical reasoning.Whether you're an early-career physio or a seasoned clinician, this episode will challenge how you approach hip pain and give you the tools to look beyond the impingement label.Don't let a positive test become a diagnostic dead end.𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists, strength coaches, and any health care professional managing active patients with hip and groin complaints.

Your FADIR test is positive. Your patient is young and active. It must be FAI… right?Not so fast.In this episode of Straight from the Hip, Benoy and Callum break down six conditions that can masquerade as hip impingement — and why getting it wrong could mean missed redflags, delayed treatment, or unnecessary interventions.From femoral neck bone stress injuries that demand urgent action, to hip dysplasia hiding behind hypermobility, to the often-overlooked ischio-femoral impingement — we walk youthrough the key clinical features, risk factors, and distinguishing signs that separate FAI from its mimickers.In thisepisode, we cover:🔹 Why FAI clinical tests lack specificity — and what that means for yourdiagnosis 🔹 Three common mimickers: bone stress injuries, hip dysplasia, and early hip OA 🔹 Three less common but crucial differentials: including a red flag🔹 The red flags you can't afford to miss 🔹 How history, risk factors, and imaging correlation can sharpen your clinical reasoningWhether you're an early-career physio or a seasoned clinician, this episode will challenge how you approach hip pain and give you the tools to look beyond the impingementlabel.Don't let a positive test become a diagnostic dead end.𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists,strength coaches, and any health care professional managing active patientswith hip and groin complaints.Self-rated joint hypermobility: the five-part questionnaire https://pmc.ncbi.nlm.nih.gov/articles/PMC7079417/

You've taken a thorough subjective history and FAIS is sitting high on your differential list—but how do you confirm it objectively? In this episode, we break down the essential clinical examination findings that separate FAI syndrome from other hip pathologies.Discover the five critical objective markers you should be looking for: from restricted hip range of motion to the most sensitive clinical tests. We'll show you what to watch for in functional movement patterns—why your male patients prefer wider squat stances, toe out, and compensate through spinal flexion.But here's where most clinicians get it wrong: That "weakness" you're finding in strength testing? It'slikely pain inhibition, not true structural weakness. FAIS doesn't cause primary muscle weakness, but pain, fear, and central sensitisation absolutely inhibit function.Most importantly, we challenge you to step back. Don't just examine the hip in isolation—assess the entire kinetic chain.As we say: "If you're looking solely at the planet, step back and look at the universe." Because behind every hip impingement is a human being with unique movement patterns, beliefs, and compensatory strategies.Key Topics:·      The FADDIR and FABER tests: sensitivity vs specificity·      Why prone IR testing gives you more accurate ROM measurements·      Functional testing that reveals real-world limitations·      Understanding pain inhibition vs true weakness·      The whole-system approach to FAIS assessmentWhether you're an experienced MSK clinician or refining your hip assessment skills, this episode gives you the practical clinical framework to confidently evaluate FAIS.For further insights and clinical tips, FollowBenoy Mathew @function2fitnessCallum East @hiprehablab

Think you know how to spot FAI syndrome in your clinic? Think again.In this episode, we break down the seven key subjective indicators that should immediately raise your clinical suspicion for FAIS—before you've even laid hands on your patient.You'll learn how to recognise the classic demographic profile (hint: it's not just elite athletes), which sporting backgrounds scream "CAM morphology risk," and why that patient complaining their hip flexors feel "constantly tight" might be telling you something far more significant.We dive into the pathognomonic C-sign, decode the difference between primary anterior hip pain and secondary referral patterns, and explore why FAIS patients describe suchspecific aggravating factors—from getting out of the car to that familiar pinch at the bottom of a squat.What You'll Take Away: ✅ The exact age range and activity profile most at risk✅ Which sports and training patterns during adolescence predispose to FAIS✅ How to differentiate FAIS pain from other hip and groin pathologies based on history alone✅ The functional limitations your patients describe that point directly to impingement✅ Why gradual onset with load-related flares is the pattern you're looking forWhether you're assessing a 22-year-old footballer with groin pain or a 35-year-old gym-goer who "just can't squat anymore," this episode gives you the clinical framework to start building your FAIS hypothesis from the moment they walkthrough your door.Perfect for: Physiotherapists, osteopaths, sports therapists, strength coaches, and anyone managing active patients with hip and groin complaints.