Hip & Thigh

What It Is

Hip capsulitis (also called adhesive capsulitis of the hip) occurs when the capsule around the hip joint becomes inflamed and then thickened and tight, causing pain and loss of movement in the hip (Eberlin et al., 2022). It can cause pain and a limp. It is similar to frozen shoulder and seems to pass through similar stages, with painful movement at first, followed by stiffness (Eberlin et al., 2022). Although it was first described in the hip in 1963, it has been studied much less than frozen shoulder (Eberlin et al., 2022). Many cases settle with time and physical therapy, but some people need further treatment, such as manipulation under anaesthetic or keyhole (arthroscopic) surgery (Eberlin et al., 2022).

Pain and stiffness of this kind can also develop after hip surgery. After keyhole surgery on the hip, for example for CAM impingement, scar tissue (adhesions) can form between the hip capsule and the labrum (the rim of cartilage around the hip socket), causing ongoing pain and reduced movement (Philippon et al., 2022).

Hip Capsulitis Anatomy

The hip is a ball and socket joint connecting the thigh bone (femur) to the pelvis socket. It allows the leg to move. The joint is enclosed in a capsule, a tough sleeve of tissue around the ball and socket. In hip capsulitis, the capsule becomes thickened and scarred, and can stick to itself, which limits how far the hip can move (Eberlin et al., 2022).

After hip surgery, the hip can stiffen as scar tissue forms. In one large study, people who did not do regular hip circling movements after keyhole hip surgery were about four times more likely to develop adhesions (Philippon et al., 2022). This is why it is important to follow the rehabilitation programme from your surgical team and physiotherapist after hip surgery. Many reported cases of hip capsulitis have settled with physical therapy (Eberlin et al., 2022).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Hip Capsulitis

You need to keep using the hip, or you risk losing movement, but timing matters: Eberlin et al. (2022) suggest avoiding stretching and range-of-movement exercises during the early, very painful stage, and starting hands-on treatment once this stage has settled, because stretching beyond what the scarred capsule allows can cause sudden, severe pain. I can guide you through the right hands-on work, stretches and exercises for each stage. See the My Approach tab for how I work.

1. Rest from Painful Activities

Avoid the activities that cause you the most pain, especially during the early painful stage.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Medicines for pain and inflammation: doctors may suggest medicines to ease pain and inflammation (Eberlin et al., 2022). Ask your family doctor, nurse practitioner or pharmacist what is suitable for you.
Steroid injection: an injection of steroid into the hip joint, which may ease pain in the early, painful stage (Eberlin et al., 2022).
Manipulation under anaesthetic: the hip is moved to stretch the tight capsule while you are under general anaesthetic (Eberlin et al., 2022).
Arthroscopic capsular release: keyhole surgery to release the tight capsule, considered when other treatments have not worked (Eberlin et al., 2022).

How I can help (see the My Approach tab)

Gentle hands-on work and joint mobilisation, matched to the stage
Stretches and exercises to get movement back
Advice on staying active without flaring the hip

Tips

Capsulitis can follow hip surgery, but it can also occur without any clear cause (Eberlin et al., 2022; Philippon et al., 2022).
Refrain from the activities that cause you the most pain.
After keyhole hip surgery, follow the movement programme from your surgeon and physiotherapist carefully, as early movement helps to prevent adhesions (Philippon et al., 2022).
Many cases improve over time, but how long recovery takes has not yet been clearly worked out for the hip (Eberlin et al., 2022).
Hip pain has many possible causes, so get your hip properly assessed by me or your family doctor or nurse practitioner.

Treatment

My Approach

Hip capsulitis moves from a painful stage to a stiff one, and the biggest mistake is pushing too hard too early. My aim is to calm your hip while it's painful, then work steadily to get movement back once it settles.

I start by assessing how your hip moves, the strength of the muscles around it and how you walk, and I check your low back and knee too. I measure your range at each visit so we can see progress, which often comes in spurts and plateaus. If your stiffness followed hip surgery, I need your surgeon's okay before we start hands-on treatment.

The Painful Stage

Gentle massage for the hip, thigh, low back and other leg, which work harder when you limp
Small, pain-free joint movements, with no forceful stretching
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Cutting back the activities that hurt most, while keeping the hip gently moving

The Stiff Stage

Warming the area first, then firmer joint mobilisation, always slow and gentle, never a quick thrust
Gentle manual traction along the leg to ease the tight capsule
Contract-relax stretches: you push gently against my hand, then relax into a little more range
Trigger point and myofascial work for the muscles around the hip
A home programme of hip circles and stretches, plus cycling or pool work
Hip and leg strength work, building to squats and deadlifts when you're ready

How you feel the next day guides the next step: if your hip is sorer 24 hours later, we did too much and I'll ease back. Work around the buttock and hip is only with your informed consent and a signed consent form. If the pain is severe or keeps getting worse, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Visits are usually once or twice a week at first, then weekly, with a reassessment at about 6 weeks, then spacing out. How long recovery takes hasn't been clearly worked out for the hip, so expect gradual progress over weeks to months rather than a quick fix.

What I Focus On

Stage-Matched Care

Joint Mobilisation

Hip Soft Tissue Release

Home Range Work

Graded Strength

Sources

References

Eberlin, C.T., Kucharik, M.P., Cherian, N.J., Meek, W.M., McInnis, K.C. and Martin, S.D. (2022) 'Adhesive capsulitis of the hip: a case presentation and review', Orthopedic Reviews, 14(4), 37679. doi: 10.52965/001c.37679
Philippon, M.J., Ryan, M., Martin, M.B. and Huard, J. (2022) 'Capsulolabral adhesions after hip arthroscopy for the treatment of femoroacetabular impingement: strategies during rehabilitation and return to sport to reduce the risk of revision', Arthroscopy, Sports Medicine, and Rehabilitation, 4(1), pp. e255–e262. doi: 10.1016/j.asmr.2021.10.031

Massage therapy · Kitchener–WaterlooHip Capsulitis

What It Is

Hip Capsulitis Anatomy

Self-Care & Treatment

How to Treat Hip Capsulitis

1. Rest from Painful Activities

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

The Painful Stage

The Stiff Stage

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooHip Capsulitis

What It Is

Hip Capsulitis Anatomy

Self-Care & Treatment

How to Treat Hip Capsulitis

1. Rest from Painful Activities

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

The Painful Stage

The Stiff Stage

Typical Course

References

Related Conditions

Greater Trochanteric Bursitis

Hip Osteoarthritis

Adductor Tear

Adductor Tendinopathy

Book a session