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HIP PAIN Diagnosis & Treatment · Las Vegas, NV
Hip pain doesn’t always mean a hip replacement
If you’ve been told a replacement is coming eventually, and the plan until then is a cortisone shot every few months, it’s worth knowing what’s actually being treated. “Hip” covers the joint behind your groin, the tendons along the side, and the tissue under your back pocket, and those are different problems with different answers.
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You’re not imagining it
Most people who reach us with hip pain have been handed a different explanation by every clinician they’ve seen. It’s the nerves, it’s the spine, it’s coming from the foot; three, four, five doctors and about as many answers. That isn’t bad luck, and it isn’t you being a difficult case. It’s what happens when one word covers several different problems.
Why “my hip” is not specific enough
“Hip” refers to several anatomical regions that are close in proximity, connected, yet represent distinct structures, and a treatment aimed at the wrong one won’t work, no matter how well it may work elsewhere. That’s the whole reason having a correct diagnosis matters, and why so many people arrive here having carried the wrong label for months or years.
The location of your discomfort is the first piece of diagnostic information we confirm. Here’s a helpful guide for knowing where to point:
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The groin, where your front pocket is. This is the hip joint; the ball and socket where the head of the femur meets the pelvis. Groin pain that flares when you get out of a chair or go up and down stairs often turns out to be this joint.
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The outside of the hip, over the bony point you can feel through the skin. This is where the gluteal tendons attach (the gluteus minimus and the gluteus medius), and it’s the location most often given the wrong name. It gets its own section below.
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The buttock. More things converge here than anywhere else on the list. Your hamstrings start at the ischial tuberosity (also known as the sit bones, or the part of you that meets the chair), and run down to the back of the knee. Hamstring tendinopathy lands here, as do piriformis syndrome, sciatic nerve entrapment, and lumbar radiculopathy. They’re all different in cause and treatment, but they can feel identical.
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The sacroiliac joint, at the base of the spine. The SI joint is a half hip, half spine joint, and can often be overlooked as a source of pain, especially since it is not routinely examined in X-rays or MRIs.
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The lower back. Nerve damage in the lumbar spine can present as hip pain, with nothing wrong in the hip at all.
It runs in the other direction, too. Arthritis in the knee, foot, or ankle can show up as pain that isn’t felt in the knee or the foot at all, but in the hip. This is called referred pain, and it's part of what makes the diagnostic reasoning process so challenging.
Lateral hip pain: the bursitis label is usually wrong
Pain along the outside of the hip is the one most often misnamed, and the correction changes the treatment completely.
It’s usually gluteal tendinopathy, which is degeneration of the gluteus minimus and gluteus medius tendons. It’s a genuinely painful condition, under-recognized as a cause of lateral hip pain, and it behaves much like tennis elbow: a tendon wearing down rather than flaring up.
It’s frequently misdiagnosed as trochanteric bursitis. Bursitis is an inflammatory process where a sac of fluid appears over the swollen area. The treatment is a cortisone shot into the side of the hip to reduce inflammation. But the real diagnosis is the opposite: there’s no swollen sac, and the process isn’t inflammatory at all; it’s degenerative. Using an anti-inflammatory against a degenerative problem worsens the tendinopathy and leads to poor long-term outcomes. That’s why a proper diagnosis is critical.
How we figure out what’s actually wrong
A word this imprecise has to be resolved before anything else happens. That’s why a consultation at OASIS includes:
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A real medical interview — what hurts, when it started, and specifically what it’s stopping you from doing.
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A full physical examination — of the painful area, and of everything above and below it.
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Musculoskeletal ultrasound, live and under motion — to watch the hip while it’s working, not while it’s lying still.
The examination includes observing how patients walk, because the way someone moves separates a hip problem from a spine, knee, or foot and ankle problem, and sometimes tells him it’s several of those at once.
The most useful question in the interview is also the simplest: point to where you feel it. From there it’s a matter of narrowing: is the pain in the groin, and does it bother you changing from sitting to standing, or on stairs? Groin pain with those movements tends to point toward the true hip joint. The examination then has to cover more than the sore part, and we’ll sometimes scan somewhere else entirely, such as the knee or the sacroiliac joint, to be sure we have the whole picture.
The ultrasound is where the hip gives itself up. A lot of hip disorders are dynamic, meaning they only appear when the hip moves: femoroacetabular impingement, labral tears, snapping hip syndrome. An MRI asks you to lie perfectly still, and to see the labrum, it sometimes requires an injection of contrast into the joint first, which is painful. With ultrasound, we can see certain labral tears simply by taking the hip through a range of movement. Many of the provocative maneuvers we’d perform in the physical exam can be done at the same time as the imaging, so we’re watching the structure while we reproduce your symptoms.
That’s what makes a finding mean something. A picture of a damaged structure only counts if it explains the pain you came in with, and matching those two is what the visit is for.
How regenerative medicine compares to cortisone, physical therapy, arthroscopy, and replacement
Which treatment is right for you comes from the diagnosis. With that settled, here’s how the options stand.
Regenerative medicine vs. physical therapy and loading. Therapy has a real place here, and for the tendon problems it isn’t optional. Where it falls short is on its own: a hamstring injury given therapy alone tends to reach a ceiling, which is how so many people end up being told nothing more can be done. Where it does its best work is alongside an injection, because loading a tendon in a controlled way is how it learns to recover its strength.
Regenerative medicine vs. cortisone. For gluteal tendinopathy, a corticosteroid is aimed at an inflammatory problem that isn’t there, and it accelerates the degeneration it’s meant to treat. That’s the reason a shot into the side of the hip so often buys a few weeks and then leaves things worse.
Inside an arthritic joint, the argument is different, but it's still a trade. Cortisone gives you today in exchange for tomorrow: short-term pain relief, paid for with faster long-term degeneration of your cartilage. Dr. Kiok hasn't banished it, because sometimes a quick boost is exactly what's needed to get through a wedding or a holiday. But he's recalibrated how often it gets used.
Regenerative medicine vs. hip arthroscopy. This is the operation used to repair a labral tear. It’s a technically demanding surgery, the recovery is long (often many months on crutches), and the patients Dr. Kiok has seen afterward haven’t generally been happy with the result. Labral tears used to be the borderline case he sent to a surgeon. Having seen what PRP does for them, he no longer routinely does.
Regenerative medicine vs. hip replacement. If your hip needs replacing, that's what Dr. Kiok will recommend, not an injection. Hip replacement is one of the best-tolerated joint replacements in orthopedics. Patients report higher satisfaction after a hip than after a knee, 89% against 81%, and they're likelier to say they'd go through it again.¹ Surgical complications are also considerably less common: compared with a hip, the adjusted odds ran about 2.7 times higher for a knee and 4.5 times higher for a shoulder in the first 90 days.²
There’s one more referral we make without hesitating: A full-thickness tear of a hamstring or gluteal tendon, caught early enough, is worth a conversation with a surgeon about repairing it, and we’ll send you for that conversation.
What non-surgical hip treatment actually involves
Say the examination points somewhere we can help. Here’s what the rest of it looks like:
For most of what comes through the door, whether that’s a hamstring injury, gluteal tendinopathy, a labral tear, or early hip arthritis, PRP is the first option on the list, with physical therapy alongside it more often than not. PRP restarts the healing process, and therapy loads the tissue in a controlled way so that it rebuilds its strength properly.
Not everything in the buttock is a hamstring, and the answer changes with the diagnosis. If the ultrasound shows the sciatic nerve is entrapped, that's hydrodissection, where fluid is used to free the nerve from the tissue binding it. If the sacroiliac joint is the source, that's PRP. If it turns out to be coming from the lumbar spine, we'll say so, and we'll tell you honestly whether it's something we treat or something better handled elsewhere.
It's one injection, not a series. We use a high-dose, highly concentrated PRP preparation, and current evidence suggests a stronger biological effect from concentrating the dose that way rather than diluting it into a series of injections.
Recovery depends on whether the injection went inside the joint or into a tendon outside it, and the two are quite different:
Inside the hip joint, it’s straightforward. There’s a pain flare for a couple of days, you start feeling the effects over days to weeks, and the final result is readable around the three-month mark. There are no activity restrictions in the meantime.
Into a tendon like the hamstring or the gluteal tendons, it asks more of you. People are considerably more sore afterward than they’d be after an injection into the joint, and there are real limits on what you can do. You’ll need to avoid weightlifting, strength training, and impact of any kind, so no running, jumping, or explosive movement, for a minimum of four to six weeks. We also insist on pairing the injection with a structured rehab program, and that part isn’t negotiable. Tendons need to be loaded to heal well. Inject a tendon and leave it alone, and what you may grow back is a mass of disorganized connective tissue rather than a smooth, uniform tendon. The timeline from there is the same one we’d give you for a tendon at the shoulder or the elbow: a flare for a couple of days, pain relief over days to weeks, and mechanical strength and function returning over a couple of months.
Then we check the work. Everyone gets a repeat examination, and after a PRP injection you stay in Dr. Kiok's care for about three months, with another scan when it's needed.
Where this is unlikely to help: a hip that’s already bone-on-bone, or that has lost its range of motion. Those hips are past the point where PRP restores anything structural. PRP can still provide pain relief in a severely arthritic hip, and for some people that’s the goal, but it won’t give back range of motion that’s already gone, and we’ll tell you that before you spend anything.
The other side of that line is worth stating just as plainly. Arthritis caught early, in someone’s 40s or 50s, treated with PRP every couple of years, is a different proposition entirely. For those hips, we may be able to prevent a replacement altogether.
Learn more about PRP and hydrodissection.
Our consultation isn't your typical doctor's appointment
One hour with Dr. Kiok. $500, credited toward your treatment plan if you decide to move forward. You leave with:
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A specific diagnosis, not a label.
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A treatment plan, not a referral or “let’s follow up in six weeks.”
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A clear answer on whether you’re a candidate for regenerative medicine.
Do you take insurance?
No, we’re a cash-pay clinic. We don’t take insurance because we don’t believe a coverage desk should shape your care. Treatment plans are made in person, with you and Dr. Kiok, on a timeline that fits your goals. No delays, no denials.
Learn more about why regenerative medicine isn't covered by insurance.
Outcomes vary by patient, condition, and stage of disease. Whether regenerative medicine is right for your hip is determined during the consultation, based on the diagnosis and your individual goals.
1. Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K. Comparing patient outcomes after THA and TKA: is there a difference? Clinical Orthopaedics and Related Research. 2010;468(2):542-546.
2. Horn ME, George SZ, Giczewska A, Alhanti B, Tanner IL, Bolognesi MP. Comparison of adverse events, prescription medication, and costs after hip, knee, and shoulder total joint arthroplasty. Arthroplasty. 2025;7(1):24.
Ready for an actual answer?
If you’ve been given a different explanation by every clinician you’ve seen, or you’ve been told a replacement is coming eventually, and you want to know if there’s another way forward, book a consultation.
If you’re not sure whether you’d be a candidate, that’s exactly what the consultation is set up to figure out.