Manual Therapy for Hip Dysplasia: A Non-Surgical Approach to Hip Pain

Manual Therapy for Hip Dysplasia: A Non-Surgical Approach to Hip Pain

I see many clients with hip dysplasia, most commonly the developmental type (DDH) that went undiagnosed during childhood. They often come in not because of the hip, but due to pain in the groin, lower back, or knees. Some even experience pelvic floor tension, varicose veins, or issues in the abdominal and pelvic organs—due to changes in posture, gait, or fascial tension.


What Is Hip Dysplasia?

Hip dysplasia refers to a condition where the femoral head does not fit properly into the acetabulum (the hip socket). This can result in a shallow, misaligned, or unstable joint.

There are two primary forms:

Developmental Hip Dysplasia (DDH): Present at birth or developing in infancy/childhood. Often treated while infant/baby. But can also go undiagnosed, and might never be a problem later in life, but for some, depending on the severity of the dysphasia, might have issues in their adult life.

Acquired (Adult-Onset) Hip Dysplasia: Occurs due to repeated minor trauma, joint instability, or chronic soft tissue issues. It can also result from untreated or mild DDH that worsens with age or activity.

How to Spot Hip Dysplasia

There are several signs that may suggest undiagnosed hip dysplasia:

  • Glutes of different height when viewed from behind
  • Leg length discrepancy – one leg appears longer or shorter
  • Altered gait – limping, Trendelenburg gait, or asymmetrical movement
  • Feeling of weakness or instability in the hip
  • Increased internal rotation and greater overall hip range of motion (ROM) compared to those without dysplasia

These clues, combined with pain in the groin, back, or knee, often indicate the need for a deeper assessment.

What It Means for Movement and Function

When the joint is unstable, the body naturally compensates:

  • Weak or inhibited gluteal muscles, leading to poor hip stability
  • Tight psoas and hip flexors, often misdiagnosed as the primary issue
  • Trendelenburg gait – the pelvis drops on the opposite side during walking
  • Overactive adductors and TFL, compensating for poor glute activation
  • Swayback posture or anterior pelvic tilt
  • Hip clicking, catching or snapping
  • Excessive range of motion in the hip joint
  • Pelvic and spinal imbalances, often causing pain and dysfunction elsewhere
  • Clients may be misdiagnosed with IT band syndrome, hip impingement, SI joint dysfunction, or just "tight hips."
  • Muslce tension in lower back
  • Femoral triangle impaired leading to higher risk of artery, vein and nerve issue in leg and foot.
  • Tear on the joint capsule and cartilage - Leading to labrum tear or synovial joint inflammation.

Risk Groups

Those at higher risk include:

  • Females
  • Firstborns
  • Breech births
  • Family history of DDH
  • Athletes in sports requiring extreme hip mobility (e.g. dancers, gymnasts)
  • Individuals with general joint hypermobility

Levels of Dysplasia

Hip dysplasia exists on a spectrum from mild to severe:
Mild dysplasia (borderline coverage)
Moderate dysplasia
Severe dysplasia (minimal coverage)
Dislocated hip joint

Hip Dysplasia - Prevent Further Damage

When the femoral head is not properly supported, it can cause:

  • Labral tears from friction
  • Cartilage degeneration and early arthritis
  • Knee or lower back pain from altered biomechanics
  • Varicose veins or pelvic congestion, possibly due to femoral vein compression or poor vascular return in the groin area

Surgical Option: PAO (Periacetabular Osteotomy)

Surgery may be recommended in moderate to severe cases, especially when pain or dysfunction is significant. PAO involves cutting the pelvic bone in multiple places and repositioning the acetabulum to better support the femoral head.

However, it's important to understand:

  • PAO does not reverse arthritis
  • It does not guarantee pain elimination
  • Its main purpose is to restore joint mechanics and slow down degeneration

Surgical intervention should be weighed carefully, especially if functional improvements can be achieved through conservative care.

Consider Femoral Torsion (Anteversion or Retroversion)

In some cases, the femoral bone itself is rotated excessively (anteversion) or insufficiently (retroversion), adding to instability or abnormal gait. This may coexist with dysplasia and must be considered during treatment.

Treating Hip Dysplasia with Manual Therapy

In manual therapy and osteopathy, we recognise that the body isn’t perfectly symmetrical. Many of us have unique bone shapes and functional imbalances that do not always require surgical correction. Instead, we can:

  • Train muscles to stabilise and protect the joint
  • Release fascial restrictions that overload the hip
  • Optimise neuromuscular function to distribute load efficiently

With the right approach, people with hip dysplasia often regain function and reduce pain without surgery.

What We Look at in Clinic

When someone comes in with suspected or diagnosed hip dysplasia, we assess:

  • Gluteal function and muscular tension patterns
  • Pelvic alignment and sacral motility
  • Adductor tension and hip joint congruency
  • Lower back segments, especially L2-L4 (femoral nerve) and L4-S2 (gluteal and sciatic nerves)

We aim to improve mobility and motility (internal dynamics of fascia and organs), not just flexibility.

A Word on Training

Training must be gradual and intentional:
Avoid high-impact loading early on
Build hip stability before flexibility
Prevent inflammation in the hip joint through appropriate volume and technique

Hip dysplasia is more common than many think. It may go undetected for years but can cause widespread dysfunction. Whether or not surgery is appropriate, manual therapy and intelligent training play a crucial role in improving quality of life, reducing pain, and preserving joint health.