What conservative treatment options are effective for managing hip pain in adults before considering surgical intervention?

Effective conservative treatment options for managing hip pain in adults before considering surgical intervention include:

• Education and reassurance: Explain that conditions like greater trochanteric pain syndrome are usually self-limiting and not indicative of serious joint damage. Provide verbal and written information to support understanding and self-management ¹.
• Activity modification and load management: Advise resting the affected hip by avoiding activities that worsen pain, such as repetitive movements or lying on the affected side, and pacing activities to manage symptoms ¹,².
• Physical therapies: Refer to physiotherapy for supervised, evidence-based exercise programmes focusing on local muscle strengthening (e.g., gluteal muscles, quadriceps), stretching (e.g., iliotibial band), and aerobic fitness. Manual therapy may be considered as an adjunct in osteoarthritis ¹,²,⁴.
• Analgesia: Offer analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen according to local guidelines to manage mild to moderate pain ¹,².
• Weight management and lifestyle advice: Provide support for weight loss if overweight or obese and offer smoking cessation advice if appropriate, as these can improve symptoms and overall joint health ¹,².
• Aids and devices: Assess the need for walking aids or assistive devices to reduce joint load and improve mobility; refer to occupational therapy for advice on aids for daily activities ¹,²,⁴.
• Intra-articular or peri-trochanteric corticosteroid injections: Consider corticosteroid injections for short-term pain relief if conservative measures fail, provided there is appropriate expertise; these may be offered in primary care or musculoskeletal clinics ¹,².
• Structured combined programmes: Implement combined therapeutic exercise and education or behaviour change programmes that include pain coping skills, goal setting, and motivational coaching to enhance self-management and functional outcomes ²,⁴.

Referral considerations: Refer to secondary care if symptoms persist despite 3 months of conservative management, if there is severe pain unresponsive to analgesia, functional loss, diagnostic uncertainty, or if expertise for injections is unavailable in primary care ¹,².