Hip pain shows up in the groin when you climb the steps of the old town, on the outside of the hip when you lie on it in bed, or in the buttock after a long day on the Promenade des Anglais. It stiffens the first steps in the morning and takes the pleasure out of walking, padel and cycling. Most hip pain comes from the joint itself, the tendons on the outside of the hip, the groin muscles or the lower back, and manual therapy combined with the right movement helps most people. As an osteopath, I work out which structure is responsible and treat the hip, pelvis and lower back as one system.
I am Aloïs Ruetsch, an English-speaking osteopath and manual therapist in central Nice, with 15 years of practice and more than 10,000 consultations. If you see a chiropractor or a manual therapist back home, a French osteopath is the closest equivalent.
This article covers the common causes of hip and groin pain, what osteopathy can and cannot do, including for osteoarthritis, and when a doctor should see you first.
The essentials
- Groin pain with morning stiffness and loss of rotation points to the hip joint, often osteoarthritis; pain on the outside of the hip, worse lying on it, usually comes from the gluteal tendons; groin strain follows sport.
- For hip osteoarthritis, exercise is the core treatment and manual therapy is a useful add-on; for tendon pain and strains, osteopathy eases pain and restores movement while gradual loading does the healing.
- Most hip problems need two to four sessions; arthritis is managed over the long term with spaced sessions and a walking and strength routine.
- Keep walking on the flat, avoid sitting cross-legged or lying on the painful side, use a pillow between the knees at night and build activity gradually.
- Inability to bear weight after a fall, hip pain with fever, hip or knee pain in a child or teenager, a groin lump, or night pain with weight loss need a doctor first. In France, dial 15 or 112 for emergencies.
What causes hip and groin pain?
The hip is a deep ball-and-socket joint, and pain from the joint itself is usually felt in the groin and sometimes the front of the thigh or the knee. In people over fifty the commonest cause is osteoarthritis, with morning stiffness, difficulty putting on socks and a loss of rotation. In younger, sporty people a deep pinching groin pain when squatting or crossing the legs can come from the shape of the joint, known as impingement, or from the cartilage rim, the labrum.
Pain on the outside of the hip, worse lying on that side, climbing stairs and standing on one leg, is most often gluteal tendinopathy, an overloaded tendon once called bursitis, common in women in their fifties and sixties and in runners who have increased their mileage on the hills above Nice. Groin strains of the adductor muscles follow padel, tennis, football and sudden sprints on the beach, and tight hip flexors from cycling and long hours sitting cause an ache at the front of the hip. The lower back and the sacroiliac joint refer pain into the buttock and hip, which is why I always examine the spine too. A groin lump, a fracture or infection are rarer and need a doctor, as described below.
What does an osteopath actually do for hip pain?
I start by sorting out where the pain comes from, because the joint, a tendon, a muscle and the back each need a different plan. I watch you walk, squat and stand on one leg, test the movement and rotation of the hip, feel the tendons and muscles around it, examine the lower back and pelvis, and screen for the warning signs that need a doctor.
Treatment combines soft-tissue work on the buttock, hip flexor and groin muscles, gentle articulation and mobilisation of the hip joint, including traction to decompress it, mobilisation of the pelvis and lower back, and muscle energy techniques to restore rotation and length. Where a joint of the lower back or pelvis is locked and it is appropriate, I use a short-lever manipulation with your consent. For tendon pain on the outside of the hip, I settle the irritated tissue and then help you load it gradually rather than resting it completely. Every session ends with a plan: how to walk, sit, sleep and train, and for arthritis a simple routine to keep the hip strong and moving.
Does osteopathy work for hip pain and hip arthritis?
For hip osteoarthritis, the guidelines are clear that exercise, weight management and information are the core treatments, and they suggest manual therapy as an add-on alongside exercise, which is exactly how I use it. Osteopathy does not change the arthritis itself, but it can reduce pain and stiffness, improve the rotation you need for socks and stairs, and keep the back and pelvis from compensating. For gluteal tendinopathy, education and a gradual loading programme have the best evidence, and manual therapy helps with pain and with the surrounding stiffness while that work is done.
For groin strains and hip flexor tightness, hands-on treatment speeds the return of comfortable movement while the muscle heals with time and progressive activity. I am honest that for advanced arthritis, when the pain wakes you most nights and walking distance has shrunk to a few hundred metres, a surgical opinion is sensible, and a hip replacement is one of the most successful operations in medicine. Osteopaths in France do not make medical diagnoses, and osteopathy complements the care of your doctor; it does not replace it.
How many sessions will I need?
A groin strain, a hip that stiffened after a long flight or a flare of a known arthritic hip usually needs two to four sessions of manual therapy over four to six weeks, with the gaps lengthening as you improve. Visitors to Nice often come once or twice and continue the plan at home.
Gluteal tendinopathy follows a slower clock, with a loading programme over two or three months and sessions every few weeks to help the pain and the surrounding stiffness. Hip osteoarthritis is a long-term relationship: once the flare has settled, many patients come every one to three months to keep the hip and back moving, alongside daily walking and strength work. If a hip is not responding as expected, I say so and suggest an X-ray or a medical review rather than more sessions.
What can I do myself in the meantime?
Keep walking, on the flat Promenade rather than the hills during a flare, and keep the hip moving through its range each day. Swimming and cycling on an easy gear are kind to an arthritic hip. Avoid sitting cross-legged, deep low chairs and long periods in one position; stand up and move every half hour at the laptop.
For pain on the outside of the hip, stop lying on that side, put a pillow between the knees at night, avoid standing with the weight hitched onto one hip and avoid stretching the painful side hard, which irritates the tendon further. Heat helps a stiff arthritic hip; ice after activity calms an angry tendon. A pharmacist in Nice can advise on over-the-counter pain relief. Keeping a healthy weight makes a measurable difference to an arthritic hip, and strength in the buttock muscles protects every hip, young or old.
When should you see a doctor instead?
Call for emergency help if you cannot put weight on the leg after a fall, the leg looks shortened or turned out, or you have had a hip replacement and the hip suddenly feels out of place after a movement, because these may be a fracture or a dislocation. In France, dial 15 (SAMU) or 112.
See a doctor the same day for hip pain with fever, a hot swollen joint or feeling unwell, which can be an infected joint; for a painful lump in the groin that will not go back, which may be a trapped hernia; and for any hip, thigh or knee pain with a limp in a child or teenager, which needs a paediatric assessment. See a doctor promptly for night pain unrelated to movement, unexplained weight loss, a history of cancer, long-term steroid use, pain that started with a long run and keeps worsening, which can be a stress fracture, or numbness and weakness in the leg. In all of these I refer rather than treat.
Osteopath, chiropractor or physio: who should I see in Nice?
For hip and groin pain without warning signs, an osteopath is a sensible first stop in Nice, and no referral is needed. Osteopaths and chiropractors are very similar hands-on professions; in France the osteopath is the everyday equivalent, with a five-year state-recognised degree, and chiropractors are far fewer. A physiotherapist (kinésithérapeute) works on prescription and is the right person for a supervised strengthening programme, particularly for arthritis and gluteal tendinopathy, and I often work alongside one.
Your médecin généraliste can see you without a referral, arrange an X-ray or ultrasound, prescribe physiotherapy and refer you to a rheumatologist or orthopaedic surgeon when needed. Pharmacies advise on pain relief, SOS Médecins visits hotels and homes, and 15 or 112 are for emergencies. Osteopathy complements this care; it does not replace it.
How do I see an English-speaking osteopath in Nice?
Message me on WhatsApp at +33 7 71 27 24 25 or book online via Doctolib. My clinic, Pôle Ostéo, is at 22 rue Gounod in the Musicians’ quarter of central Nice, with a lift. A session lasts about 45 minutes and costs €90 at the clinic. I am open seven days a week, often with same-day availability, and I consult in English, Spanish and French.
I also visit hotels, villas, apartments and yachts at berth in Nice and along the nearby Côte d’Azur coast for €120, with no surcharge for evenings, weekends or same-day calls, which suits patients who find stairs and taxis hard. I take card or cash and give you a receipt for your insurance, in English on request. No referral is needed in France to see an osteopath or manual therapist.
In practice
Illustrative example, details changed. A retired Englishwoman living in Nice came in with three months of pain on the outside of the right hip, worst when lying on it at night and climbing the stairs to her apartment, which had started after she took up long daily walks along the coastal path. The hip joint itself moved well, the gluteal tendon was tender and the pain was reproduced by standing on one leg, with no warning signs. Three sessions of soft-tissue work, hip and pelvic mobilisation and lower back treatment, combined with a pillow between the knees, a halt to stretching the painful side and a gradual strengthening routine for the buttock muscles, brought the night pain down over six weeks, and she kept her walks, shorter and on the flat at first.
Frequently asked questions
Is an osteopath the same as a chiropractor?
Can osteopathy help hip osteoarthritis?
Is my hip pain coming from my back?
Do I need an X-ray before treatment?
Should I stop walking and sport?
Book an English-speaking osteopath in Nice
Clinic at 22 rue Gounod (€90) or a visit to your hotel, villa, yacht or home in Nice (€120, no surcharge). Seven days a week, often same day. Write in English, Spanish or French.