Hip Pain Treatment Without Surgery | Dr. Verg Chiropractic

A patient guide from Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR

Hip pain is remarkably common. An estimated one in four adults will develop symptomatic hip osteoarthritis at some point in their lives, and many more experience hip pain from causes that have nothing to do with arthritis at all (Chamberlain, American Family Physician, 2021). Whether it flares up on a walk, wakes you up at night, or builds up after a day at a desk, the right treatment starts with understanding what’s actually going on. If you’ve been searching for a hip pain chiropractor in Clackamas, OR or Vancouver, WA, here’s a quick, evidence-based guide to the most common causes, and what non-surgical care can do about them.

Key Takeaways

Hip pain often comes from the pelvis, the low back, or the soft tissues around the hip, not only from the hip joint itself.
Pelvic instability is the pattern Dr. Verg sees most often: one SI joint is stuck, the other moves too much, and the extra load lands on the hip.
Even when an X-ray shows hip arthritis, the arthritis is rarely the whole story.
Non-surgical care combines gentle adjustments, manual therapy, decompression, and targeted exercise, and serious complications from manual therapy are very rare.
Conservative care is the starting point. If a labral tear is suspected, we order an MRI with contrast and refer for a surgical consult when needed.

What’s Behind Your Hip Pain?

Hip pain generally falls into one of these categories, often overlapping:

Joint or lower back-related pain: osteoarthritis, sacroiliac (SI) joint dysfunction, or pain referred from the lumbar spine.
Sciatica: nerve irritation in the low back that radiates into the hip and leg.
Hip flexor tightness: from prolonged sitting, shortening the muscles at the front of the hip.
Greater trochanteric pain syndrome (bursitis): irritation on the outside of the hip, aggravated by walking or lying on that side.
Pelvic instability: the pelvic joints move too much, increasing inflammation and pain in the hip joints.

From Dr. Verg’s practice: The pattern I see most often in my office is pelvic instability. I tell patients the pelvis is the foundation the spine sits on. When one SI joint is stuck and the other moves too much, the loose side becomes inflamed, and the extra load lands on the hip, the low back, and the discs. Even when an X-ray shows hip arthritis, the arthritis is rarely the whole story. As I explained to one patient whose hip had suddenly flared: “Arthritis didn’t get worse in two weeks, but we have muscle spasms, ligaments are pulled tight, inflammation in these ligaments… And with this we can help.”

To learn more about this common and often missed cause, read our guide to pelvic instability as a cause of low back, pelvic, and hip pain.

Hip Pain When Walking or Sleeping on Your Side

Hip pain when walking or sleeping on your side is the hallmark of greater trochanteric pain syndrome, a condition affecting the outside of the hip that’s about two to five times more common in women. It’s estimated to affect roughly 15% of women and 8% of men, typically between ages 40 and 60, and is aggravated by repetitive hip motion, extra body weight, and, notably, direct pressure from lying on the affected side at night (StatPearls, 2024). The good news: conservative care succeeds in more than 90% of cases, without needing surgery or injections.

From Dr. Verg’s practice: Not every hip that hurts at night is bursitis, so I examine the hip joint and the pelvis too. When a patient tells me they need a pillow between their knees to sleep, I check for hip joint arthritis as well.

Case example: A woman with long-standing left hip pain came to us limping and unable to sleep past 2 a.m. Sitting on a couch or in a car “pinched” her hip. On exam, hip rotation was limited and painful, the thigh thrust test was positive, and one side of the pubic bone had shifted forward. We used gentle hip adjustments, a pubic bone correction with drop table technique, flexion-distraction decompression of the hip, core strengthening, and deep tissue work on the hip flexor. At her re-exam she rated herself about 60% better: “I can walk now. I don’t limp anymore,” and “Last night, I slept like eight hours straight. It was like heaven.” For chronic hip pain like hers, I count that as a very good recovery so far. Because her findings can also come from a hidden labral tear, I ordered an MRI with contrast to check.

Hip Flexor Pain From Sitting All Day

Hip flexor pain from sitting all day has real biomechanical evidence behind it. A cross-sectional study of 98 adults found that people who sat more than 7 hours a day and were minimally active had roughly 6 degrees less passive hip extension than those who moved more and sat less than 4 hours a day (Boukabache et al., Musculoskeletal Science and Practice, 2021). In plain terms: prolonged sitting shortens and stiffens the hip flexors (especially the iliopsoas), which pulls on the front of the pelvis and can produce anterior hip and low back pain even without any injury.

From Dr. Verg’s practice: I see this constantly in desk workers and drivers. As I told a young office worker with SI joint inflammation: “Prolonged sitting is very stressful on the body… it’s probably something that’s been slowly developing because of the sitting desk. And now it’s started to really give a signal in the body that, hey, this is too much for me.” One caution: aggressively stretching a tight hip flexor can backfire. “Whenever we overstretch a muscle or it’s not ready for it, then it spasms.” When a stretch makes a patient worse, I switch to hands-on soft tissue work and joint correction first.

Case example: A woman with a mostly seated office job developed pain on the outside of her right hip after a car accident. It flared when she sat too long. We treated her with hip and pelvic adjustments, home exercises, and a low pelvic brace that she wore at night and while sitting at work. After about three months of care her overall improvement went from 60% to 75%. She could squat and rise again, which she couldn’t do at the previous exam, and she was back to brisk walking three times a week. In her words: “My hip is still bothering me, but it’s not as bad as it was.” The beauty of these improvements is that they last even when care is complete. She had further improvement over time with home exercises.

Sciatica and Hip Pain Relief

Sciatica and hip pain relief are closely linked, since true sciatica originates in the low back and radiates through the hip and leg. In a randomized, double-blind trial of 102 patients with acute back pain and sciatica from disc protrusion, those receiving real spinal manipulation had significantly better outcomes than those receiving sham manipulation: 55% became pain-free from radiating leg pain, compared to 20% in the sham group, with no adverse events reported (Santilli et al., The Spine Journal, 2006).

From Dr. Verg’s practice: Many patients who come in for “hip pain” actually have pain that starts in the hip and shoots down the leg. That points me to the low back and pelvis, and I treat the nerve gently.

Case example: A man who used to jog 2 to 4 miles a day came in with left hip pain shooting down to his foot, a cold, numb big toe, and night pain. Sitting more than 30 minutes made it worse. His straight leg raise was positive at just 30 degrees, and his ankle and big-toe strength were reduced (3/5). We used drop-table adjustments of the low back and pelvis, spinal decompression and traction therapy, McKenzie exercises, and a pelvic brace. His leg raise improved from 30 to 45 degrees in the first visit. About two months later, his radiating leg pain was 95% resolved and he no longer woke at night. By his next re-exam he had no active pain, his low back motion was normal, every orthopedic test for the disc, SI joint, and nerve was negative, and he was jogging again.

Hip Misalignment: What It Actually Means

Patients often ask about hip misalignment treatment, so it’s worth being precise about what this term does and doesn’t mean. “One hip higher than the other” is rarely a bone literally out of place. It’s more often a functional imbalance involving the sacroiliac joint, pelvic muscles, or an asymmetry in how the pelvis moves. Research has even shown that simple visual leg-length checks can be misleading and, if misinterpreted, can lead a practitioner to adjust in the wrong direction entirely (Cooperstein, Journal of Chiropractic Medicine, 2010).

That’s exactly why an accurate exam matters more than a quick visual check. At Dr. Verg Chiropractic, we assess pelvic and SI joint motion with orthopedic testing (not guesswork) before treating a suspected imbalance, correcting the specific joint restriction or muscular asymmetry we actually find, rather than treating “misalignment” as a one-size-fits-all diagnosis.

From Dr. Verg’s practice: Patients often tell me one leg feels longer than the other. Here is how I explain it: when there are muscle spasms or the pelvis is rotated, the leg itself is not shorter. A rotated pelvis makes one side sit higher, and spasms pull on the leg so it seems shorter. When I find a pelvis that moves too much (pelvic instability), I often add a thin pelvic brace worn low around the hips, mainly at night and while sitting. Worn that way, it helps the ligaments tighten up and gives the pelvis, and the hips, more stability. Unlike a wide lumbar brace, a low pelvic brace doesn’t weaken the back muscles.

Chiropractic Care for Hip and Lower Back Pain: Non-Surgical Options

Chiropractic care for hip and lower back pain typically combines a few tools: chiropractic adjustments to the hip, SI joint, and spine; manual therapy and soft tissue work for tight hip flexors or glutes; and targeted stretching and strengthening exercises. For hip osteoarthritis specifically, a systematic review found “silver level evidence that manual therapy is more effective than exercise for those with hip OA in the short and long-term” (French et al., Manual Therapy, 2011). For low back pain feeding into hip symptoms, clinical guidelines are even more consistent: roughly 90% of current guideline recommendations favor spinal manipulative therapy (Trager et al., Journal of Clinical Medicine, 2024).

Non-surgical hip pain treatment is also a genuinely low-risk starting point: a systematic review of 39 studies on manual therapy found serious complications occur in only about 0.003% of treatments, roughly 3 in 10,000 (Carnes et al., Manual Therapy, 2010). Most patients begin noticing meaningful change within the first two to three weeks of consistent, individualized care.

From Dr. Verg’s practice: For the hip itself I use gentle drop-table adjustments of the hip and pubic bone, traction, and hip mobilization into the motions that are stuck. I judge progress by function, not just pain: how long you can walk, how long you can sit, and whether you can squat and rise. Full recovery is not only no pain; it’s when we can load the hip well and still feel nothing.

A variety of adjustments for hip pain

No two hips are the same, so we don’t rely on a single technique. Depending on what the exam shows, we may use gentle drop-table adjustments of the hip, pelvis, and pubic bone; a supine hip flexion adjustment that reaches deeper into the joint capsule; long-axis traction and hip mobilization to open up a stiff joint; flexion-distraction and spinal decompression for the low back; and traditional side-posture adjustments when they’re appropriate. When the pelvis is unstable or a patient is in acute pain, we choose non-twisting, low-force options instead.

To learn more about the full range of techniques we use, browse our Research Corner for our article on the variety of spinal adjustments offered at our clinic.

More case examples

An older patient with hip arthritis needed support to stand upright and couldn’t sit comfortably; earlier care elsewhere hadn’t helped. Hip flexion was severely limited, and traction of the hip relieved the pain on the table. After the first treatment the pain had eased noticeably, and by the next week walking was easier with less pain.
A patient with over a year of pain from the back of the hip to the knee, with arthritis on X-ray, had stopped walking because of it. After a course of hip and pubic adjustments and decompression, the patient reported that the hip work “helped a whole lot,” with relief lasting almost two weeks between visits.
An older patient treated for several problem areas, including a stiff, painful hip, finished care with every hip and SI test normal and was doing squats and lunges with light weights.

When I refer out

Conservative care is my starting point, not my only answer. If walking keeps bringing hip pain back, I suspect a labral tear and order an MRI with contrast, which shows parts of the labrum a regular MRI can miss. When a confirmed tear doesn’t respond to care, I refer for a surgical consult. When conservative care has done all it can, hip surgery works, and works especially well for pain coming from hip labral tears.

Hip Pain After a Car Accident

From Dr. Verg’s practice: Hip and pelvic injuries are easy to miss after a car accident, because the neck and back hurt more at first. One patient came to us after an accident with hip pain that flared with too much sitting or too much movement. We used hip adjustments, decompression, and a pelvic brace while sitting. By the final exam the patient was about 85% recovered, walking several miles at a time on uneven ground, and squatting and lifting light weights again. My advice for the next step applies to everyone: gradual is the key, because overuse injury is a real thing.

If your hip pain started after a collision, see our page on chiropractic care after a car accident. We work directly with auto insurance claims.

Frequently Asked Questions About Hip Pain

Why does my hip hurt when I sleep on my side?

Pain when lying on one side is the hallmark of greater trochanteric pain syndrome, which affects the outside of the hip and is aggravated by direct pressure at night. Not every hip that hurts at night is bursitis, though, so we also examine the hip joint and pelvis. Conservative care succeeds in more than 90% of cases of trochanteric pain syndrome.

Can a chiropractor help with hip pain?

Yes. Chiropractic care for hip and lower back pain combines adjustments to the hip, SI joint, and spine, manual therapy for tight hip flexors or glutes, and targeted stretching and strengthening. Most patients begin noticing meaningful change within the first two to three weeks of consistent, individualized care.

Is one of my legs really shorter than the other?

Usually not. When the pelvis is rotated, one side sits higher, and muscle spasms pull on the leg so it seems shorter. Simple visual leg-length checks can also be misleading, which is why we use orthopedic testing of pelvic and SI joint motion.

Can hip pain really be sciatica?

Often, yes. True sciatica starts in the low back and radiates through the hip and leg. If your “hip pain” shoots down the leg, that points to the low back and pelvis, and we treat the nerve gently.

When do I need an MRI or surgery for hip pain?

If walking keeps bringing the pain back, I suspect a labral tear and order an MRI with contrast. A confirmed tear that doesn’t respond to care is referred for a surgical consult. Conservative care is the starting point, and surgery is an option when it has done all it can.

Schedule a Hip Evaluation in Vancouver, WA or Clackamas, OR

Whether your hip pain shows up on a walk, at night, or after a long day sitting, Dr. Anatoliy Vergulyanets and the team at Dr. Verg Chiropractic offer thorough evaluations and individualized, evidence-based care at both of our locations:

Vancouver, WA — 109 SE 101st Ave — (360) 203-6000
Portland / Clackamas, OR — 10001 SE Sunnyside Rd #120 — (503) 386-9819

We offer a free consultation for new patients, work directly with auto insurance claims for accident-related injuries, and our team communicates with patients in English, Ukrainian, and Russian. Call the location nearest you to find out what’s really behind your hip pain.

References

Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician. 2021;103(2):81-89.
Greater Trochanteric Pain Syndrome (Greater Trochanteric Bursitis). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
Boukabache A, Preece SJ, Brookes N. Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study. Musculoskeletal Science and Practice. 2021;51:102282.
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The Spine Journal. 2006;6(2):131-137.
Cooperstein R. Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions. Journal of Chiropractic Medicine. 2010;9(3):146-153.
French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Manual Therapy. 2011;16(2):109-117.
Trager RJ, Bejarano G, et al. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. Journal of Clinical Medicine. 2024;13(19):5668.
Carnes D, Mars TS, Mullinger B, Froud R, Underwood M. Adverse events and manual therapy: a systematic review. Manual Therapy. 2010;15(4):355-363.

Hip Pain: Common Causes and Non-Surgical Chiropractic Relief