Hip Pain: Everything about its origin, causes and new treatment methods

Image of a hip x-ray

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You Can Become Pain-Free and Mobile Without an Artificial Joint

Lying on your side or climbing stairs has become a torture? Especially after rest or in the morning you are plagued by stabbing hip pain or groin pain? You are not even thinking about sports and you are happy if only a few hours a day pass without pain? Then you feel like many other people who suffer from hip pain.

Perhaps you have already received one or two diagnoses after several examinations: Hip impingement, meralgia paraesthetica, joint degeneration, hip joint inflammation (coxitis) due to arthritis, hip dysplasia or hip joint arthrosis or coxarthrosis. Are you considering an artificial hip joint because of this pain? We want you to be able to manage without one. Because even an artificial hip joint can get arthrosis and cause pain.

How can that be? This article will tell you. In addition, we explain how hip pain occurs, what you can do against your pain and why an artificial hip joint should only be the very last option.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's most trusted pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

Read more

Roland Liebscher-Bracht is Germany's most trusted pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

1. Origin and Cause: How Does Pain in the Hip Occur?

Hip pain, like all pain, is an annoying thing and can lead to movement restrictions of varying degrees. If they persist over a long period of time and are not treated, they can lead to serious problems, consequential damage and diseases in the hip region: to bones, cartilage and joints.

1.1 Hip Joint: Structure and Function

Your hip joint is the link between your pelvis and your legs. As a ball-and-socket joint, it allows movement in every direction — whether it is stretching, twisting or bending.

Overall, a healthy hip joint thus fulfils two special tasks: On the one hand, it helps you to achieve great mobility, and on the other hand, it provides firm cohesion between the structures involved.

However, bones, cartilage and joints are under permanent strain as a result.

In detail, the hip joint (acetabulum) is made up of several parts:

  • the acetabulum, which borders on the pelvis. It is surrounded by a layer of cartilage and synovial fluid and encompasses almost half of the head of the femur
  • the head of the femur (caput femoris), which merges into the femur
  • ligaments, which are located both inside and outside the joint capsule and provide stability
  • different muscles, allowing full freedom of movement in every direction.The individual movements, which are divided into anteversion (lifting the thigh), retroversion (stretching the thigh backwards) and abduction (lateral spreading of the leg), each involve their own muscle groups

The head of the femur and the acetabulum are both covered with a layer of cartilage, which normally ensures a fluid movement and prevents excessive wear and tear of the joints. Violent impacts between the individual areas can be cushioned in this way and protect the individual regions from the occurrence of arthrosis and other diseases.

1.2 Shortened Muscles and Overstretched Fascia: Often the Real Cause of Your Pain

We at Liebscher & Bracht believe that your everyday life is responsible for many states of pain. One-sided movements and lack of exercise are the main causes of many issues. Frequent sitting and ingrained movement patterns also play a key role in hip pain.

Although hip pain, especially start-up pain on one side of the hip joint after resting or in the morning, is usually directly associated with Arthrosis (hip joint arthrosis), wear and tear and signs of wear and tear are not the actual causes of pain.

Also possible are:

  • injuries such as real cartilage damage,
  • injuries in the hip area after accidents (e.g. bone fractures),
  • hip rhinitis and infections such as hip joint inflammations (coxitis; sometimes with fever, in children often as harmless hip rhinitis with swelling of the joint mucosa),
  • osteoporosis,
  • impingement,
  • bursitis trochanterica (inflammation of the bursae),
  • meralgia paraesthetica (compression of a skin nerve running along the outside of the thigh),
  • arthritis, rheumatism, gout and other metabolic diseases,
  • hip luxation (dislocation or dislocation of the hip joint after an accident or as a congenital form),
  • hip dysplasia (hereditary malformation of the acetabulum),
  • hip head loosening (epiphysiolysis capitis femoris; epiphysiolysis capitis femoris is a hip disease in adolescence, in which the femoral head moves in the growth plate on the neck of the femur),
  • labrum lesion = tear of the lip of the hip joint (labrum), which forms the front, upper and rear edge of the bony socket in the hip joint,
  • and necrosis of the femoral head/Morbus Perthes (death of the living bone tissue due to a circulatory disorder; in children the clinical picture is Perthes disease).

However, we can reassure you: The real cause of your pain is usually not serious injuries, bone fractures or metabolic disorders, but rather the soft tissues, more precisely your muscle and fascial tissue. Even if you spend a lot of time sitting down, your muscles “shorten” and the fasciae become unyielding.

Long hours of sitting cause tension in the front parts of the body. If we then straighten up, our back body, especially our buttocks, must withstand this force and counter-tension.

In this rapidly increasing field of tension, the head of the joint in the hip joint is pulled further and further into the acetabulum. This results in a constantly increasing pressure, which rubs the joint surfaces against each other during movement. 

If this unfavourable situation remains for a longer period of time, changes in the joint cartilage due to excessive wear and tear and finally arthrosis of the joint can be the result.

a woman sitting on a chair and holding her aching hip

© Andrey Popov | shutterstock.com

1.3 Which Body Parts Are Involved in Hip Pain?

When sitting, it is mainly your hip flexor that is shortened. This muscle develops from a small projection on the inside of your thigh. It extends across the groin to the ilium or lumbar spine

Hip and Back

This clearly shows the close connection between hip and back. Both areas are closely connected, both muscularly and fascially. Because the fasciae surround all bones, joints and muscles and give our whole body its shape, pain can pass from one part of the body to another when the connective tissue is overstretched and tangled. Hip and back pain often occur together for this reason. 1)

Hip and Thigh

Often the complaints on the hip are also accompanied by hurting thighs. These pains are felt on a specific bone, the greater trochanter, known as the trochanter major in the technical jargon. This bone is located on the outside of your thigh. Muscles that are attached to the great trochanter and converge there cause you pain in this region. The tensile force built up in the muscles has a strong effect on the bones and is responsible for the pressure sensitivity of the trochanter.

Hip, Sciatic Nerve and Gluteal Muscle

Typical for hip complaints are also buttock pains that wander into the legs. These pains are very often caused by problems of the sciatic nerve. The sciatica is the longest and thickest nerve of our body. It runs underneath a pear-shaped buttock muscle (musculus piriformis) into the leg and is often squeezed by tense muscles and fasciae. The result of this piriformis syndrome is, besides hip pain, especially the typical sciatic pain as a symptom of the constricted sciatic nerve.

Hip and Groin

In addition, many patients with hip ailments suffer from pain and swelling in the groin, which causes all kinds of movement restrictions for those affected. According to our experience, the trigger for such groin pain is very often in strained muscles and fascia.

1.4 Other Causes: Inflammations, Nerve Irritations and Circulatory Disorders

Hip pain can manifest itself in many ways and affect different areas of the hip. The surrounding limbs can also hurt. Sometimes the pain is even more pronounced in other areas than on the hip itself. But who are we to tell you this? You have probably already experienced some pain in the area of your hip.

For us, one thing is certain: in all these cases it is mainly strained muscles and fasciae that are responsible for the pain. In the next chapter we will explain how this happens.

Before that though, we will look at some of the causes and diseases that can also be responsible for hip pain, groin pain and other accompanying symptoms.

Anatomy of the hip with bursitis

© MedicalArtInc | shutterstock.com

Bursitis (Inflammation of the Bursa)

Bursa sacs are small tissue buffers designed to withstand pressure and stress in joints. They are located wherever there is a lot of friction — between bones and tendons. At the hip there is a large tendon plate which exerts permanent pressure on the bursa when it is tense, for example in the case of muscular imbalance. In the long term, this can become inflamed and your orthopaedic surgeon will eventually diagnose bursitis trochanterica.

Improper posture, for example by sitting with the legs crossed, chronic overstraining and falls can lead to this painful inflammation. If you are aware of your one-sided strain, an inflammation of the bursa can be easily prevented or cured with balancing exercises for muscles and fascia.

Nerve irritation as a cause of hip pain

Nerve Irritations

Your hip pain may be caused by nerve irritation. The dull pain that you feel can actually get on your nerves and last for a long time. Nerve cords run along your lumbar spine, running through your pelvis and buttocks to your legs and feet. Starting from the spine, they are extremely sensitive to pressure, especially in the spinal cord and at the nerve root itself.

The biggest culprit among the nerves is the sciatic nerve mentioned above. Its nerve root also originates from the spinal column. If this root or a branch of the sciatic branches is constricted by strained muscles, dull, sometimes stabbing pain can develop in the hip and thigh, but especially in the buttocks at the level of the piriformis.

Football players fight for the ball

Overstrain During Sports Activities

Many athletes have to struggle with hip pain. Particularly in hip-stressing sports such as soccer, the neck of the femur can strike the hip socket when the leg is moved backwards or forward. Here, too, recurring one-sided movements of the trunk-pelvis-leg region cause imbalances and tensions in muscular-fascial structures.

The complaints are caused by overstrained muscles on the one hand and neglected muscles on the other. Soccer players are often affected by hip pain that radiates into the groin area. During abrupt starting and halting manoeuvres, those affected feel traction pain in the adductors, the inner thighs. But also in runners, a malposition can cause overloading of muscles and fasciae, which cause pain in the hip and groin.

Other Causes


Hip impingement refers to a joint blockage caused by a collision between the neck of the femur and the acetabulum. This can sometimes be caused by a bony malformation at the edge of the femoral head. However, the acetabulum can also have a deformity of shape, resulting in permanent contact between the femoral head and the acetabulum. The result is a significant restriction of movement and inflammation of the joint. If this condition persists for a longer period of time, the hip impingement causes pain, increased wear in the hip region and in the further course of hip arthrosis.

Hip Necrosis

In the case of hip necrosis (necrosis of the femoral head), the bone tissue of the hip continues to deteriorate. Due to reduced blood flow to the artery that runs across the neck of the femur, the hip bone is insufficiently supplied with oxygen. The bone cells die and the bone tissue becomes brittle.

The Best Exercises and Tips Against Hip Pain

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of hip pain. 
The Liebscher & Bracht Hip Pain Guide.
All gain. No pain.

2. Healthy Joint vs. Artificial Joint

Human beings have around 200 joints that keep them flexible and agile. 2) This may surprise you, because often we only talk about those that cause us problems. Among the culprits are mainly knees, shoulders, elbows, wrists, hips and ankles, of which we have one on each side of the body. 

A joint is a connecting piece between two or more bones or cartilage structures. It ensures that we can move flexibly and according to the situation. Joints generally consist of a joint head and a socket. These two parts are each covered with cartilage and fit exactly together. Between them is a cavity filled with synovial fluid. It is a kind of protective coating and prevents direct contact between the two surfaces.

In an ideal case, this prevents excessive wear and tear during movement. If this ideal case is not given due to overstraining or malpositioning and a severe arthrosis develops, artificial joints are used to prevent further abrasion and to enable pain-free movements again.

Did you know that in 2015 most artificial hip and knee joints have been inserted in Germany after Switzerland, Austria and Belgium? On average, the use of artificial hip joints increased by as much as 30 percent within 15 years (2000–2015). Every year, doctors in Germany perform 230,000 hip operations. It is noteworthy that every tenth of these operations is an “exchange operation” in which an existing prosthesis is replaced. As you can see, even with an artificial hip joint, long-term freedom from pain is by no means guaranteed. 3)

2.1 Why Are So Many Hip Prostheses Used?

One of the main reasons for the use of artificial hip joints is certainly the suffering of the patients in case of persistent severe pain. You can certainly understand that this severely restricts and torments the patients in their everyday life — especially if the painkillers administered have no effect in the long run and even the prescribed physiotherapy only provides short-term relief. Frustration and hopelessness are spreading. We understand this well, because who wants to suffer from pain every day, have to have new examinations and diagnoses and go for regular x-rays?

Nevertheless, you should be aware that replacing a joint is always a major operation and can never replace your own joint.

Artificial hip joint on a skeleton

Please do not misunderstand: We do not condemn surgery or the use of prosthetics. We only want to offer you an alternative that will protect you from possible consequential damage and further replacement operations.

Our treatment starts at the points that you can influence yourself through your movements. In the following section we will explain how this works and further down you will find exercises that you can try out immediately. It is worth a try, do you not think so?

2.2 Programming of Movement Sequences

The control of muscle programs and movement sequences takes place in the brain.

We should first of all be aware that we have a direct influence on our movement sequences. Every joint is surrounded by muscles, tendons and fasciae (soft tissues), with the muscles in particular playing an important role.

They are the only driving forces that we can activate for our movement sequences. Brain and muscle activity enter into an important connection here. Recurrent movement sequences and the associated muscle tensions are stored in our brain. These stored patterns can be quickly recalled during everyday movements and executed smoothly. Thus we no longer have to think about every single movement, but fall back on an automated process.

🚩 It is therefore only the interaction of brain and muscles that brings movement to our joints.k.

The main task of the joints is to take up different angles and, together with the muscles, enable movements in different directions: through our elbow joint, for example, we can stretch and bend our arm. With our knee joint we can bend and stretch our lower leg. It helps us when walking, sitting or jumping and enables us to take every step in everyday life.

The hip joint connects the thigh (the femur) with the pelvis. It is important for all movements of the legs and enables a wide variety of movements

Good News: Reprogramming Is Possible at Any Time

As you already know, our brain stores different movement programs that you can access again and again. On the one hand, this bears the danger that ingrained movement patterns can cause damage, as they are usually performed unilaterally and unconsciously in everyday life — hip joint arthrosis with changes in the joint cartilage, bursitis, hip luxation and impingement are just a few of them. On the other hand, you can re-program these stored procedures independently and consciously.

2.3 Why Do Our Joints Wear Out?

The ingrained movement patterns are the trigger for pain, inflammation in the joint, wear and tear and cartilage damage. One-sided movements are automatically controlled by our brain. The range of movement of our joints is limited each time. Due to the one-sided execution of movements, the cartilage structures are only partially loaded and thus to varying degrees.

Muscles and fasciae around your hip, but also in the groin, thighs and calf, shorten and span over time. Thus, more and more tension builds up around the joint and restricts your range of movement. The fasciae in these joint areas are matted and pull the joint unevenly on all sides.

This badly distributed pressure ensures that the nutrients can no longer be properly absorbed or removed in the joint. The cartilage in our joints uses a sponge principle to supply nutrients. By pressing the surfaces of a healthy joint evenly together, the cartilage can optimally absorb nutrients and at the same time dispose of waste products.

An unevenly distributed pressure ensures that the cartilage is only pressed together at certain points. This causes unnaturally strong cartilage abrasion and the joint surfaces become smaller and smaller over time. Pain develops in the joint. If this process is not stopped, arthrosis can develop.

2.4 The “New” Joint — Just a Beautiful Dream?

With age, both doctors and patients become less inhibited about using artificial joints. If those affected are too restricted in their everyday movements and suffer from pain, an artificial joint seems to be the last resort.

For 95 percent of those patients who undergo hip surgery, the reason for wanting a “new” joint is the severe pain.

A “new” joint should help in the long term. At least that is the hope. Little is known that an artificial joint does not necessarily prevent further pain. Wear and tear can also occur in an artificial joint.

🚩 Muscle and fascial tensions are rarely recognised as the cause of arthrosi. Further, the pain or signs of wear and tear are usually only treated symptomatically, for example by using artificial joints. Although this initially restores the healthy joint functions, it does not eliminate the cause of your arthrosis: the damaged structures, such as the cartilage, the worn bones, the cartilage abrasion and the inflammation of the inner skin of the capsule are gone. The only thing left are the matted fasciae and strained muscles. But these are exactly what cause your pain. After all, the programming of the movement patterns has not changed and the program continues to run as before. 4) Your surgery was for nothing!

The dream of a pain-free life will therefore not come true by a simple “joint change”. The surgical procedure involves risks and side effects. Keep in mind that an original can never be replaced by material foreign to the body. 5)

In the long term, the pain and arthrosis can only be eliminated if the tensions around your hip, which have become too great, are relieved. This is where we want to help you. We have made it our great task to enable everyone to live a pain-free life — without medication or surgery.

No need to worry: if you already have an artificial joint, you can still become pain-free. You now have the necessary knowledge and all the exercises for your journey into a pain-free life are explained in this article.

The Best Exercises and Tips Against Hip Pain

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of hip pain. 
The Liebscher & Bracht Hip Pain Guide.
All gain. No pain.

3. Exercises & Therapy According to Liebscher & Bracht

The pain therapy according to Liebscher & Bracht provides you with cost and risk-free treatment methods for your own therapy. With our exercises, which are explained and demonstrated by our pain specialist Roland Liebscher-Bracht on our YouTube channel in over 500 videos, you can easily help yourself. There are also videos in join-in length, with which you can get started immediately at home or in the office.

Our Therapy Approach

With our therapy we start where conventional medicine neglects the cause of your pain — almost independently of diagnosed “disease patterns” such as hip arthrosis, bursitis in the hip area, hip joint inflammation (coxitis), rheumatism, arthritis, gout or osteoporosis. Prescribed painkillers merely suppress your pain. In contrast, we understand our therapy not only as a treatment of symptomatic pain states, but primarily as a removal of the true cause. This is especially true in the case of arthrosis.

Roland Liebscher-Bracht shows anatomy at the skeleton

3.1 Osteopressure for Acute Pain Conditions

Osteopressure forms the basis of our pain therapy. Our more than 30 years of experience in the application of osteopressure shows a very high and fast effectiveness to relieve pain of any kind. Our manual therapeutic technique is based on the so-called interstitial receptors. They are located in your periosteum and measure states of tension in your muscles and fasciae. They send this information to your brain. If they register tension, this information is passed on to your brain and you feel pain.

We call these aches signal pains because they have an important function: they signal you to avoid movements that will lead to damage to your musculoskeletal system in the long term. So it is important to understand that pain per se is not a bad thing. On the contrary: we can use pain to get to know our body and to make our lives permanently pain-free.

Our pain specialists therefore use interstitial receptors for your hip pain as well. During treatment, they press special points on your bone to relieve tension. With the help of our light osteopressure you can also do this yourself. 

The programs in your brain that are responsible for the tension in muscles and fasciae are reset this way. Your body reacts immediately: the built up tensions subside and your hip pain decreases noticeably. The best thing about it: your brain is always ready for reprogramming.

3.2 Exercises for Hip Pain: Become Active Yourself!

As you have learned in this article, hip pain is mainly caused by inflexible muscles and fascia, which in turn are caused by lack of exercise. If you are just starting to read the article at this chapter and want to know how your hip pain develops, it is best to read this article from the beginning. But if you want to find out right now what you can do about your hip pain, try the following exercises.

Why Are These Exercises So Important?

If your hip pain has decreased significantly thanks to osteopressure, it is important that you prevent renewed tension. Even if you have given up osteopressing, you can easily manage to delete old pain programmes in the brain and establish new pain-free programmes yourself. We show you how you can help yourself!

With our exercises against hip pain you can offer your brain new patterns of movement that ensure optimal function and mobility of muscles and joints.

Another Highly Effective Exercise Against Hip Pain with Our Foam Ball

With this foam rolling massage you can make your muscles and fascia (the connective tissue that surrounds your muscles) flexible and supple again. In this way, you can directly counteract the cause of your hip pain.

Exercise 1 for hip pain

1.  Exercise with the Medi Foam Ball

  • Sit on a mat or the floor for this exercise.
  • Take a medi foam ball and place yourself with one side of your buttocks on the ball. Support yourself with your arms on the floor behind you.
  • Now slowly roll the ball over the surface of your buttock muscles and always stay on the points where you notice them to be particularly sensitive.
  • Small spiral-shaped movements ensure the flow of fresh cell fluid at these points. Accumulated harmful substances and acidity in the tissue can be effectively removed, so that the tension in your entire hip area can be reduced.
Exercise 2 for hip pain

2. Exercise with the Mini Foam Ball

  • Also for this exercise, get on a mat or the floor.
  • Take a mini foam ball and place it on an inner thigh. Press the ball into your tissue with both hands and find an area that is particularly sensitive.
  • Then find points that are in the outer third of your thigh and pay special attention if you feel pain there.
  • Again, by massaging in a spiral, you can always find points where you feel the tension more or less strongly. The deeper you can push with the ball, the better the effect.
Exercise 3 for hip pain

3. Exercise: Lunge at the Chair

  • For this exercise take a chair and place it with the seat facing your body.
  • Now kneel on the floor as if you want to do a lunge. If it is too uncomfortable for your knee on the floor, grab a pillow and put it underneath.
  • The thigh of the leg with which you are kneeling on the floor should form a straight line with your upper body. The other leg should be slightly further forward with your foot than at right angles.
  • Caution: for this exercise you should pay particular attention to keeping your lower back straight.
  • Now push the groin of the leg that is kneeling on the floor forward. Be careful not to take the rest of your body forward with you.
  • Now you should feel a distinct pulling in the thigh under the affected hip.
  • Stay in this position for two to two and a half minutes.
Exercise 4 for hip pain

4. Exercise: Counter-Exercise for the Buttocks

  • For this exercise you need a chair again. Sit forward on the edge of your chair and cross your legs.
  • Make sure that the upper leg is at right angles above the other. The foot should rest on the knee of your other leg.
  • For the exercise go into the hollow back and lean forward with your pelvis. You can also turn to the side of the upper leg to intensify the stretch.

📌 Checklist for the Liebscher & Bracht Exercises

To ensure nothing goes wrong with our exercises, we have summarised the most important information in a checklist. So you have all tips at a glance and can practice with a good feeling.

Always use your personal pain scale of one to ten as a guide. You will achieve the best results if you work on a scale of eight or nine for each stretch. Nine means you feel an intense pain, but you can still breathe calmly during the stretch and do not have to counter-tense.

Practice six days a week and do the exercise at least once a day. If you would like to support the relaxing repair processes in your muscles and fasciae even better, you can also repeat the exercise in a 12-hour rhythm: once in the morning, once in the evening..

For each exercise step you should invest two to two and a half minutes and stretch intensively for at least 90 seconds.

✅ Avoid taking painkillers as far as possible. Our exercises use your pain as a starting point and daily comparison value. You should therefore not artificially suppress it, but use it as a guide for the correct execution of the exercise and stretching intensity. Painkillers would only falsify your progress and give you an unrealistic picture of your pain condition.

Be patient — even if quick results are not uncommon. It may take some time for your brain to store new movement programs, for your metabolism to normalise and for the tension and counter-tension forces to decrease.

If the pain increases due to the exercises, there is no reason to panic. An initial worsening can be a normal reaction of your body. If your overall body statics change as a result of regular exercise, the musculoskeletal system will have to adapt to this gradually. If, however, you feel permanently worse instead of better after the exercises, your body signals that you may be overdoing it. Then simply take a break for a day or two. Alternatively, reduce the intensity a little bit during your next training sessions in order to increase it again in small steps. This way, you gently guide your body to the eight or nine on the pain scale that is right for you.

4. Conclusion

Especially if you have already noticed wear and tear on your hip joint, it is important to act quickly. However, in this case you are not necessarily dependent on an artificial hip joint. Contrary to the conventional opinion that your joint can no longer recover from the wear and tear, we offer you a possibility to relieve acute pain. At the same time, you can tackle the cause in the long term and keep the tension in the muscles and fasciae as low as possible. With us you can walk the path to a pain-free life together. You are no longer helplessly at the mercy of your pain.

The Best Exercises and Tips Against Hip Pain

We've got your back! Download our FREE PDF guide featuring our 6 most effective exercises for getting rid of hip pain. 
The Liebscher & Bracht Hip Pain Guide.
All gain. No pain.

Sources & Studies [+]