Move Past Hip Pain.
Get Back to Performing
in Walnut Creek.

Presentations We See Often, and What Was Actually Going On

Many people in Walnut Creek and the surrounding communities come to us after a course of physical therapy, several chiropractic sessions, or a few brief medical visits, and the hip still hurts. They often worry that conservative care has failed and that surgery is next.

1. “I Thought a Hip Replacement Was My Only Option”

A 55-year-old East Bay professional with a year of deep aching in the front of the hip and groin. Walking, stairs, and getting out of the car all hurt.

• The problem: X-rays showed moderate arthritis, so a hip replacement started to feel inevitable.
• What was missed: A short round of physical therapy and a few chiropractic visits helped the back. Nothing addressed how the hip was being loaded, or the strength available to support it.
• What changed: Specific hip and core strengthening, attention to joint mechanics, and targeted activity changes in place of a general exercise sheet.

2. “Running Hurt My Hip, and I Thought I Would Need Surgery”

A 42-year-old who runs the local trails, with sharp pain on the outside of the hip that hurt when lying on that side and flared with every run.

• The problem: The X-rays were normal, so the pain was treated as nonspecific. Anti-inflammatories and a generic handout followed.
• What was missed: The pattern pointed toward irritated tendons on the outside of the hip rather than a worn-out joint. Continuing to run through it kept those tendons loaded.
• What changed: Load management built around the actual running schedule, plus progressive hip abductor strengthening and education about the positions that compress the tendon.

3. “My Hip Pain Was Actually Coming From My Back”

A 35-year-old who sits at a desk most of the day, with a deep ache in the back of the hip and buttock, sometimes running down the leg.

• The problem: Every treatment was aimed at the hip, because that was where it hurt.
• What was missed: A more careful examination pointed to the low back, and to sitting and movement habits, rather than a failing hip joint.
• What changed: Care directed at the low back, specific strengthening, and changes to how he sits and moves.

What these presentations have in common is not that the hip could not improve. It is that:

• The working diagnosis was incomplete. Hip joint, tendon, and referred pain from the back were never clearly separated.
• The previous care was too brief, or not specific enough to the problem and the person’s activity level.
• Load management, targeted strengthening, and lifestyle factors were never really explored.
• The current plan may benefit from a more coordinated progression from evaluation and treatment into rehabilitation and return to performance.

Built for the Demands You Need to Meet

Hip rehabilitation should be judged by more than whether everyday pain has started to settle. The real question is whether the hip is becoming ready for the demands you need to place on it again.

At Performance Sport Care, that may mean progressing from pain-limited movement into supervised strength work, single-leg control, lifting, running, or other activity-specific loading as the condition allows. The destination depends on the person. For one patient, success may mean walking and climbing stairs comfortably. For another, it may mean returning to heavy training or sport.

That progression is one of the reasons our professional-athletics-inspired model matters: treatment, rehabilitation, and return to performance are considered as connected parts of the same process rather than separate episodes of care.

That is the standard of care Dr. Cancel has spent more than 40 years refining at Performance Sport Care. He is mindful of the same evidence that informs guideline-level practice, and a sample of it is cited at the bottom of this page rather than gestured at vaguely. Published evidence sets the foundation. Experience and clinical judgment determine how it is applied to the person in front of us. What gets layered on top of the evidence is what makes the difference: clinical judgment honed across decades, and a level of attention to each patient that respects their time, money, and goals.

Hip Conditions We Evaluate and Treat

We evaluate and treat the full spectrum of hip-region pain. Each condition requires its own approach. Getting the diagnosis right is what separates a successful course of care from months of wasted time, wasted money, and false starts.

• Femoroacetabular impingement (FAI) and labral injury. FAI syndrome requires symptoms, clinical signs, and imaging findings together. Shape alone on an image is not a diagnosis, because cam and pincer morphology are common in active people who have no pain at all. It is often confused clinically with iliopsoas or rectus femoris tendon pain. The hallmark of a careful workup is testing pain reproduction with resisted hip flexion, straight-leg raise and other maneuvers, meticulous examination of the regional structures, snapping reproduction, range-of-motion limits, and lumbar screening, not just relying on “deep groin pain plus clicking” as the stand-alone signal.
• Hip osteoarthritis. Exercise, education, physical activity, and appropriate load management are central to conservative care, with weight management where body mass is adding joint load. On average the benefit of exercise is real but modest, and it appears to depend on continuing to train rather than completing a fixed course of treatment. Manual therapy and chiropractic care can provide useful short-term relief for selected patients, but they do not replace progressive exercise. In younger and more active patients, hip arthritis is frequently secondary to an underlying structural issue rather than simple wear and tear.
• Greater trochanteric pain syndrome (“hip bursitis”). Many persistent cases reflect gluteal tendinopathy, sometimes with accompanying bursal irritation, rather than isolated bursitis. The best-supported approach is education plus load management and progressive abductor strengthening, with specific attention to reducing compressive positions such as prolonged hip adduction, side-lying on the painful side, and poorly dosed stretching into adduction. External snapping at the outside of the hip, where the iliotibial band catches over the trochanter, belongs to this same region and is assessed at the same visit.
• Atraumatic hip instability. Most appropriate for conservative care when instability is mild, related to generalized hypermobility or poor neuromuscular control, and not due to major bony deficiency or severe dysplasia. The focus is gluteal, deep hip rotator, trunk, and pelvic control training.
• Hamstring, groin and adductor, hip flexor, iliopsoas, and rectus femoris tendon injuries. There is a strong rationale for graduated reloading: isometrics, heavy slow resistance, eccentric strength exercise and sport-specific activities. Adductor-related groin pain has the strongest supporting trial evidence of this group. The evidence base for iliopsoas and hip flexor rehabilitation specifically is thinner, and programming there leans more on clinical reasoning and mechanism than on large trials. Front-of-hip pain blamed on a hip flexor strain is frequently rectus femoris tendon pain instead, which is reproduced by both resisted hip flexion and resisted knee extension. Inguinal-related groin pain sits in the same region and is separated out on examination. Aggressive stretching can aggravate proximal tendinopathies. We always use stretching selectively and carefully.
• Hip pain referred from the low back. Lumbar spine, sacroiliac region, and peripheral nerve irritation can all produce hip-region pain. In these cases, hip-only treatment will not help. A proper workup screens both regions every time. Posterior hip and buttock pain can also come from structures that are neither the hip joint nor the spine, including the deep gluteal space, the hamstring origin at the sit bone, and the back of the hip joint itself. We cover those non-spinal sources of sciatica-type pain in a separate article.
• Stress reactions and stress fractures. Red-flag patterns, relevant in runners, dancers, military trainees, and athletes with bone-density or energy concerns, that demand careful screening and timely imaging or referral, not blind continued conservative trials.

How We Tell These Problems Apart and Decide the Right Next Step

The goal is to determine whether a conservative plan at Performance Sport Care makes sense now. Dr. Cancel reviews your history, examination findings, imaging when relevant, and the activities you need to return to. When the findings support conservative care, the plan is built around those needs. When imaging, surgical consultation, or another specialist is the better next step, he will tell you directly.

That judgment rests on a careful history covering your sport, activities, job, past injuries, medical history, and lifestyle factors, followed by a structured examination protocol. Pain location narrows the field before anything else. From there we combine findings rather than leaning on any single test, because no single hip examination test is accurate enough to stand alone. Range-of-motion loss, a small set of provocative tests, and a lumbar and sacroiliac screen are interpreted together.

All imaging findings that you provide are reviewed. If not already done, imaging is ordered when it will clarify an important clinical question or change management. For suspected impingement or arthritis, that usually means a weight-bearing pelvis radiograph with a lateral view of the femoral neck rather than an MRI. Advanced imaging is reserved for red flags, atypical presentations, or symptoms that persist after an adequate trial of conservative care. This restraint is deliberate, because cam morphology, labral irregularity, and mild cartilage change are common findings in people with no hip pain at all. We do refer patients for orthopedic or surgical consultation when that is what the findings indicate. The goal is to give you information that provides the right options and answers for you.

A Professional-Athletics-Inspired Model of Care

The model is inspired by high-level professional athletics, where diagnosis, treatment, rehabilitation, and return to performance are connected parts of one process. At Performance Sport Care, that philosophy is adapted to the patient in front of us rather than copied from a team setting.

Our treatment integrates manual therapy and chiropractic care with progressive, supervised exercise and education on the specific loading patterns driving your condition. Tendinopathies, for example, may require graduated reloading, graded resistance, or eccentric exercise at intensities calibrated to progressively rebuild tendon capacity. Osteoarthritis may require supervised exercise plus weight management plus chiropractic care and manual therapy as a true adjunct. Atraumatic instability may require a spectrum of supervised activations that target the deep rotator, gluteal, trunk, and pelvic muscles.

Nutritional guidance is part of the care plan when it is clinically relevant, and for many of the conditions we treat, it is. In practice that means adequate energy intake to support tissue repair, adequate protein, whole-food nutrition, body composition considerations where excess joint load or muscle loss is a factor, and screening for low energy availability in athletes with recurrent tendon or bone-stress problems. Where the findings point to a hormonal contributor, disordered eating, or clinical low energy availability, we refer rather than manage it ourselves. This is foundation work, not afterthought.

Our facility is purpose-built for supervised strength rehabilitation. That is one of the central strengths of our approach: hands-on care can be paired with supervised progressive loading in the same facility when the patient needs it. The protocols we run are the same kind that work for athletes who need to be back at their sport on a calendar. The same principles are adapted for our non-athlete patients who have regular jobs or are home makers, students or parents with children to chase. Our professional sports model of care works very well for a broad spectrum of people.

When Conservative Care Is the Right Choice, and When You Need Something Else

Conservative-first care is the right choice when symptoms are tolerable, when there is no rapidly worsening neurologic or structural problem, when arthritis is early to moderate rather than end-stage, when pain is provoked by modifiable loading patterns, and when you have not yet completed a properly supervised rehabilitation program of adequate length, generally at least 8 to 12 weeks and longer for some hip conditions, with someone who knows what they are doing.

When conservative care is unlikely to succeed we will tell you so without hesitation so that other appropriate options are not unduly delayed. We make prompt referrals to appropriate medical specialists including orthopedic surgeons, pain management specialists, neurologists, and rheumatologists, among others. With more than 40 years of experience, we are well acquainted with the medical resources in our community and will expertly guide you to what your case requires. Knowing the difference is part of why our patients trust us.

What One Motivated Patient Can Accomplish Here

A great recovery is not a miracle. It is a seasoned clinician, a properly designed plan, the right equipment and supervision, and a motivated patient willing to show up and do the work. When those four elements line up, what well-executed conservative care can accomplish is often well beyond what patients have been previously led to expect, including patients who had already been sent for a surgical consultation and turned out to be good candidates for a conservative trial first.

Many of our hip patients come to us after months, sometimes years, of care that wasn’t working. The goal we work toward with them is a return to running, lifting, playing, and working without pain. We don’t promise outcomes. We promise the caliber of care it takes to make outcomes possible when they are possible. For a motivated patient with a properly diagnosed, conservatively manageable hip problem, working in a supervised rehabilitation facility with a sports chiropractor who has been doing this for more than 40 years, the realistic upside can be a great deal more than what most patients have been told.