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Managing Hip Pain with Physio and Pilates

Mary arrived at physio with a painful, right hip joint. She had noticed pain increasing over time as she had increased her walking distances after Covid lockdown hit. Pain was radiating down her leg and keeping her awake at night at times. The hip had been clicking a lot during some movements for quite a while. Her low back was also painful at times.

At her initial assessment her physio noted that:

  • Mary’s sub conscious de fault standing posture was what physios and Pilates instructors call ‘sway back’ posture, meaning she hangs her pelvis forward with the ribcage hanging back, and the knee joints hyperextended. This pushes the top of the thigh bone (head of femur) forward. This can put excessive pressure on the front hip muscles and joint structures.
  • Mary was unable to stand on one leg without ‘Sitting into the hip’. The dynamic control of her stabilising abdominal, hip and pelvic muscles had been affected by pain.
  • Hip Impingement test was positive: This involved flexing Mary’s hip up to 90 degrees and slightly inwards. This causes a pinching pain in the groin area, showing a consequence of a forward hip posture.
  • The area around Mary’s lower spine and pelvic was tight and painful, with many muscles activating in a protective compensatory mode  around the hip.


The Physios at Activate Physio. Pilates aimed to calm the inflamed hip tissues and solve the underlying postural and muscle activation issues. Our treatment involves some hands on treatment to release tight muscles and joints. We give advise on specific measures to do at home, work and sport to calm pain. We have a strong focus on specific evidence based exercise rehab. We follow guidelines from the Australian Ballet’s wonderful hip exercise rehab programme, that has been developed over the years by the brilliant work of Sue Mayes and her team at the Aussie ballet physio, and also on Dr Alison Grimaldi’s hip rehab protocols. We use Pilates equipment to give support and resistance in a supportive, ‘ low impact’ way.

Pilates based exercise rehab commences when acute pain has settled. Pilates focuses on ‘core’ muscle control with release of excessive back and hip muscle tension patterns. Exercises start with a lot of support initially then progress to  different ‘closed chain’ positions, meaning many traditional Pilates exercises are not taught without modification. The leg is supported and the heel is in contact with a ball or reformer footbar at first.

Mary learned how to prevent flare ups and walk further again, although building hip muscle strength and control took some time.  Mary found that not only did her hip pain settle but she found a new exercise method with great community of people to work with in a small group, where everyone exercised at their own pace and level.

You can learn more about Activate Physio.Pilates physiotherapy & injury rehabilitation or dance & sport rehabilitation services by following the links. Or get in contact with our team if you have more questions.

Susie Bond

Susie Bond is the founder of Activate Dance Physio. Susie Bond is the practice director of Activate Physiotherapy, Evolution Pilates and MG Pilates.   She has been a physiotherapist for 30 years, a Pilates instructor since 1996 and a dancer since she was 5 years old.

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