Troubles douloureux de la hanche liés aux tissus mous

• Use culturally safe, trauma- and violence-informed care. Explain why questions matter, seek permission before sensitive topics, and adapt communication to the patient’s language, identity, culture, disability and previous health care experiences (Public Health Agency of Canada, 2018).
• Patient and contextual information: age; sex and gender when clinically relevant; language and communication needs; work or school; caregiving; sport and recreation; and activities, roles and cultural or community practices important to the patient.

Primary concerns

• Context and onset: gradual or sudden onset; trauma, a pop or immediate loss of strength; recent growth in an adolescent; prior hip, groin, buttock, pelvic or low back symptoms; surgery; and changes in activity, training, work, footwear, surface or other load.
• Location and pattern: lateral hip, groin, anterior hip, proximal thigh, ischial or deep buttock symptoms; duration, course, severity, irritability and 24-hour pattern; and whether symptoms are improving, fluctuating, persistent or worsening.
• Aggravating and relieving factors: walking, running, acceleration, hills, stairs, cutting, kicking, lunging, lifting, prolonged standing or sitting, rising, side-lying, crossing the legs, hip adduction, deep hip flexion, stretching, resisted movement and response to rest, position or load change.
• Associated symptoms and participation: stiffness, swelling, bruising, warmth, clicking, catching, locking, giving way, weakness, numbness or tingling; back, abdominal, pelvic or genitourinary symptoms; and effects on mobility, sleep, self-care, work, school, caregiving, sexual activity, physical activity, sport, recreation, relationships and community participation.
• Revue des systèmes corporels : constitutional and infectious; neurological; cardiovascular and peripheral vascular; respiratory; gastrointestinal and genitourinary; reproductive and pelvic; musculoskeletal and bone health; inflammatory or immune; endocrine or metabolic; skin; haematologic; sleep; cognition; and mood symptoms that may change safety, the differential diagnosis, care or referral.
• Health, lifestyle and history: past health conditions; hip dysplasia, instability or osteoarthritis; childhood hip disease; low back or pelvic conditions; fractures, cancer, inflammatory disease, infection, sickle cell disease or other blood disorder; injuries, hospitalizations and surgery; medicines and supplements, including corticosteroids and anticoagulants; physical activity, nutrition, low energy availability and recovery; sleep; smoking; alcohol or substance use; and family history relevant to hip, inflammatory or bone health.
• Social determinants of health: work and training demands, education, caregiving, income, housing, food security, discrimination, safety, social support, access to care and ability to modify activity when these may shape health, care or participation (Public Health Agency of Canada, 2026).
• Soins et interventions antérieurs : advice, activity change, rehabilitation, medication, injection, shockwave therapy, imaging, surgery or self-management tried; what helped or did not help; adverse effects; and reasons care was difficult to use or continue.
• Patient perspective: understanding of the problem, priorities, preferences, concerns about movement or imaging, expectations and previous experiences of care.
• Flag review: check Red Flags and refer to the separate fixed Orange Flags and Yellow Flags modules when relevant.

Outcome measures

• Use a small set that matters to the patient and is practical to repeat. Record a baseline and reassess often enough to guide decisions.
• Patient-specific functioning: Patient-Specific Functional Scale (PSFS).
• Disability and participation: WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
• Qualité de vie : WHOQOL-BREF when it fits the clinical question.
• Lateral hip pain and disability: the Victorian Institute of Sport Assessment-Gluteal Tendinopathy (VISA-G) can be used when GTPS or gluteal tendinopathy is the main presentation (Fearon et al., 2015).
• Symptoms and performance: a pain rating and a small number of repeatable findings or tasks linked to the presentation and goals, such as side-lying tolerance, sitting, walking, stairs, sit-to-stand, single-leg loading, running, acceleration, cutting or kicking, when safe.
• Objectifs individuels : agree on patient-defined goals and how progress will be recognized. SMART wording may be used when helpful.

Orange Flags are signs that a mental health or substance use concern may require emergency or timely assessment or shared care, and may change whether and how MSK care proceeds. They are not diagnoses. Ask directly and respectfully when concern arises, considering immediate safety, severity, change from usual, daily functioning and context. Psychosocial factors that may affect recovery but do not require separate mental health or medical assessment are addressed under Yellow Flags.

ACTION: Arrange emergency assessment now when there is immediate danger or an urgent medical need:

• Suicide, self-harm or harm to others: current intent or plan, a recent attempt, inability to stay safe, or behaviour suggesting an immediate risk of serious harm.
• Severe change in mental state: extreme agitation, confusion, disorganization, possible psychosis or mania with impaired judgment or unsafe behaviour, or inability to meet basic needs when this creates immediate danger.
• Substance-related or medical emergency: suspected overdose, severe intoxication, dangerous withdrawal, delirium or another sudden change requiring urgent medical care.

When immediate safety is uncertain, do not leave the person alone while help is arranged. Follow local emergency procedures and call 9-1-1 for immediate danger or urgent medical need. If the person is thinking about suicide, call or text 9-8-8: Suicide Crisis Helpline with them or support them to do so.

If violence, abuse or exploitation is disclosed or suspected, support immediate safety and follow applicable safety and reporting requirements.

ACTION: Arrange prompt medical or mental health assessment when there is:

• Suicide or self-harm thoughts: thoughts without immediate danger.
• Substantial symptoms or effects: severe, persistent or worsening symptoms of depression, anxiety, trauma, possible psychosis or mania, eating problems or substance use that substantially affect daily life, decision-making or safe participation in care.
• Other reasons for assessment: a marked change from usual behaviour or functioning; concern about medication or substance effects; a presentation outside the clinician’s competence; or a request for help.

Agree with the patient on who will be contacted, how soon and what to do if the situation worsens. Confirm that the person has connected with the service when clinically important.

ACTION: Adapt and coordinate MSK care:

• Safe care: care may continue when it is safe and acceptable and does not delay needed assessment. Adapt communication, examination and care; obtain ongoing consent; and coordinate with other providers with the patient’s permission.
• Continue the MSK assessment: do not assume that a mental health or substance use concern explains the MSK presentation. Continue to consider physical causes and the patient’s account.
• Questionnaires: they may support conversation and monitoring, but do not establish a diagnosis or replace direct questions, clinical judgment or action.
• Acceptable support: ask what type of help is acceptable and whether language, cultural, family, community or other supports are important to the patient.

ACTION: Document and follow up:

Record the concern; relevant questions and the patient’s responses; the safety decision and reasons; actions, advice and referrals; communication and consent; follow-up; and any unresolved concern. Follow applicable privacy, safety and reporting requirements.

For provincial, territorial and national services, see Mental health support: Get help (Public Health Agency of Canada 2026).

Yellow Flags are personal, social, work, school, healthcare, environmental or structural factors that may influence symptoms, functioning, participation or response to care. They are contextual, not diagnoses or certain predictions, and do not mean that symptoms are psychological. They guide how care is tailored and do not by themselves require urgent referral. Explore them through conversation and ongoing outcome review, with attention to the patient’s priorities, strengths and circumstances. A separate Yellow Flag score is not required. New or worsening signs of serious physical illness follow the Red Flag process. Mental health or substance use concerns that need separate assessment, or any immediate safety concern, follow the Orange Flag process and applicable emergency or safeguarding procedures.

Explore relevant factors:

• Understanding, expectations and healthcare experiences: concerns about injury or damage, uncertainty, recovery expectations, confidence, conflicting advice, previous dismissal or harm, and trust in care.
• Responses to symptoms and activity: worry, fear, avoidance, cycles of doing too much and then needing prolonged rest, difficulty pacing, coping, sleep, confidence in self-management, and return to meaningful activities.
• Emotional and life context: distress, low mood, anxiety, grief, trauma, caregiving, relationship change, job loss or other major events. Ask permission before sensitive questions and limit discussion to what is relevant and acceptable to the patient.
• Relationships, culture and strengths: supportive relationships, isolation, family and community roles, cultural or spiritual practices, identity, preferences, language and other sources of resilience.
• Work, school and administrative context: physical and psychosocial demands, control, satisfaction, job security, accommodations, return concerns, and compensation, insurance or legal processes. Explore these neutrally and in context.
• Social and structural conditions: consider social and structural determinants of health (Public Health Agency of Canada 2026), including income, housing, food security, transportation, childcare, access and cost of care, discrimination, racism, colonialism, neighbourhood and workplace conditions, and physical or digital accessibility.

ACTION: Respond with the patient:

• Ask, do not assume: use open questions to understand what helps, what gets in the way, what matters and what feels feasible. Ask about strengths and protective factors, not only difficulties. Do not treat a person’s circumstances, culture or choices as a deficit.
• Plan together: integrate relevant findings into shared goals, education, self-management, physical activity or exercise, and participation in meaningful activities. Adapt communication, setting, pace, cost and access where possible.
• Connect and coordinate: with the patient’s consent, consider appropriate clinical, social, workplace, school, community, Indigenous or culturally specific supports. Clarify who will do what and follow up when the connection is important to the plan.
• Review response to care: reassess the patient’s account and the pathway’s selected outcomes at clinically relevant points. If progress differs from expected, review the clinical impression, care plan, access and other barriers; do not automatically attribute the outcome to Yellow Flags.
• Document: record relevant factors and strengths, the patient’s priorities and preferences, agreed actions, consent, referrals or coordination, follow-up, and any change requiring the Orange Flag process.

Select examination elements that answer a clinical question or may change care. Adapt the examination to the patient’s presentation, comfort, consent and abilities.

• Consent and comfort: explain what you propose, provide choices about positioning, draping, pace and support, and confirm ongoing consent, especially before examining the groin, pelvis or another sensitive area.
• Condition-specific safety: defer provocative hip or tendon testing and arrange appropriate assessment when fracture, stress fracture, infection, slipped capital femoral epiphysis, substantial tear or another serious condition is suspected.
• Observation and gait: standing and sitting posture, gait, weight-bearing tolerance, stride, foot progression, pelvic and lower-limb movement, guarding, asymmetry, bruising, swelling and use of supports.
• Pain mapping and movement: confirm whether familiar symptoms are lateral, anterior, inguinal, proximal thigh, ischial or deep buttock; assess relevant active and passive hip movement and repeated or sustained positions, noting range, quality and symptom response rather than treating a restriction as diagnostic.
• Essais de résistance et de charge : hip abduction, extension, flexion, adduction and rotation; knee flexion; trunk and lower-limb performance; and graded tasks relevant to the presentation. Record familiar pain, force, endurance, control and tolerance to load.
• Évaluation fonctionnelle : select safe tasks linked to the person’s goals, such as walking, stairs, sit-to-stand, step-down, single-leg stance, running, acceleration, cutting, kicking or work tasks. Note symptom response, strategy, confidence and capacity.
• Lateral hip assessment: greater trochanter palpation, resisted hip abduction and selected single-leg or position tests can be interpreted as a cluster. No single positive test confirms gluteal tendon or bursal pathology (Kinsella et al., 2024).
• Groin-pain assessment in athletes: use symptom location, palpation and resisted testing to assess adductor- and iliopsoas-related presentations, and examine for inguinal-, pubic-, hip-related and other causes when relevant (Weir et al., 2015).
• Posterior hip and hamstring assessment: ischial and proximal hamstring palpation, resisted knee flexion and hip extension, and selected lengthening or hip-flexion loading can assess whether familiar deep buttock pain is reproduced. Check for sciatic or lumbar features and do not treat one test as diagnostic.
• Lumbar, pelvic and neurological examination: assess the lumbar spine, pelvis, lower-limb strength, sensation and reflexes when referred pain, coexisting symptoms or neurological involvement is plausible.
• Imagerie : not routine for every presentation. It can investigate serious pathology or a substantial traumatic injury, clarify an uncertain diagnosis or inform specialist or procedural care when the result is likely to change management. For chronic hip pain, radiographs commonly precede ultrasound or magnetic resonance imaging for suspected extra-articular tendon or bursal abnormality. Interpret imaging with the history and clinical findings (American College of Radiology, 2022).
• Repeat and adapt: review relevant findings and tasks when needed to assess progress, revisit the working presentation or decide whether further assessment or referral is appropriate.

Doha agreement classification for groin pain athletes

• Application: this history-and-examination taxonomy applies to athletes with groin pain. Categories can coexist and do not replace assessment for hip-related or other causes (Weir et al., 2015).
• Adductor-related groin pain: adductor tenderness and recognizable pain with resisted hip adduction.
• Iliopsoas-related groin pain: iliopsoas tenderness; the presentation is more likely when recognizable pain also occurs with resisted hip flexion or hip-flexor stretch.
• Categories outside this pathway: inguinal-related, pubic-related, hip-related and other causes follow the relevant assessment, medical pathway or shared care.

Working clinical presentations

Presentations can overlap or change. Use the history, examination and imaging when relevant, and do not force the person into a tissue diagnosis from pain location, tenderness, one provocative test or an imaging finding alone.

• Greater trochanteric pain syndrome or gluteal tendinopathy: lateral hip pain is commonly aggravated by side-lying, walking, stairs, hills, prolonged standing or single-leg loading, with local tenderness and familiar pain during hip-abductor loading. GTPS can involve gluteal tendons and peritrochanteric structures; it is not assumed to be isolated bursitis (Kinsella et al., 2024).
• Proximal hamstring tendinopathy: gradual or persistent deep buttock pain near the ischial tuberosity is commonly aggravated by prolonged sitting, running, acceleration, hills or hip-flexion loading and reproduced with proximal hamstring loading. Lumbar and neural causes remain part of the differential diagnosis (Nasser et al., 2021).
• Adductor-related groin pain: acute or gradual medial groin pain is linked to kicking, cutting, skating, resisted adduction or other high adductor loads, with the Doha findings above when the person is an athlete.
• Iliopsoas-related pain: anterior hip or groin pain is linked to repeated hip flexion, sprinting, kicking, rising or uphill activity, with the Doha findings above when the person is an athlete. Hip joint and abdominal or pelvic causes remain part of the differential diagnosis.
• Uncomplicated musculotendinous strain: a clear loading event causes localized pain and reduced tolerance to contraction, lengthening or task load without findings of fracture, major avulsion, serious pathology or progressive neurological change.
• Soft-tissue hip pain without a confirmed specific condition: the presentation appears extra-articular and load-related after serious, intra-articular, referred and non-musculoskeletal causes have been assessed, but available findings do not support a more specific diagnosis. Record the working impression and revisit it as the course and response to care become clearer.

Develop care with the patient. Choices reflect the working presentation, safety, goals, preferences, culture, access, other health conditions, previous responses and the burden of care. Respect the patient’s right to accept, decline, limit or stop any part of care.

Education, self-management and participation

• Explanation and shared understanding: explain the working presentation, what is known and uncertain, and why symptoms, load response and examination findings are interpreted together. Use imaging terms without implying that tendon change or fluid is damage that requires correction.
• Participation planning: build work, school, caregiving, recreation and sport around current capacity, symptoms, repeated outcomes, confidence and task demands rather than complete rest or a fixed calendar.

Protection and optimal loading

• Acute muscle or tendon injury: options include brief relative protection, temporary reduction of the provoking task and a walking aid or other support when needed for safe mobility, followed by progressive reloading as pain, strength and task tolerance permit. Suspected major tear or avulsion follows Red Flags.
• Lateral hip pain: temporary changes can reduce sustained hip-adduction compression, such as lying directly on the painful side, standing with the hip pushed outward or crossing the legs, while maintaining feasible movement and gradually restoring load (Mellor et al., 2018).
• Proximal hamstring, adductor and iliopsoas load: temporary changes to prolonged sitting, deep hip flexion, stretching, sprinting, acceleration, hills, kicking, cutting or other high-load tasks can reduce repeated provocation. Reintroduce the task according to symptoms, capacity and goals rather than avoiding it indefinitely (Nasser et al., 2021; Thorborg et al., 2023).

Physical activity and exercise

• Progressive strengthening and task practice: options include graded hip, trunk and lower-limb strengthening; mobility work for a relevant restriction; balance; aerobic activity; and practice of daily, work or sport tasks. Type, amount and progression reflect the presentation, goals, starting capacity and response (Kjeldsen et al., 2024; Nasser et al., 2021; Thorborg et al., 2023).
• Gluteal tendon loading: progressive hip-abductor and functional loading can form part of GTPS care, alongside education about compression and activity load. No single exercise program or dose fits every person (Mellor et al., 2018; Kjeldsen et al., 2024).
• Proximal hamstring loading: options include graded hamstring and lower-limb strengthening, trunk and pelvic control, and progressive exposure to hip flexion, running or other energy-storage tasks when relevant. Evidence does not establish one superior program (Nasser et al., 2021).
• Adductor and iliopsoas loading: progressive local and lower-limb strengthening can advance to running, acceleration, cutting, kicking and sport-specific practice when these match the person’s goals and presentation (Thorborg et al., 2023).

Hands-on and symptom-relieving care

• Hands-on care: soft-tissue techniques or mobilization can accompany loading and task practice when a short-term change in comfort or movement helps participation. Review the response against the agreed goal; passive care does not replace progressive loading.
• Comfort strategies: positioning, pillows for side-lying, heat or cold, pacing and short-term activity changes can be used when acceptable and safe.
• Culturally grounded and personal strategies: traditional, Indigenous, spiritual, community-based or other symptom-relieving approaches identified by the patient can be integrated when safe, acceptable and within scope.

Psychological, social and interdisciplinary support

• Psychologically informed care: supportive communication, graded exposure and coping strategies can form part of care when fear, distress, low confidence, mood or anxiety affects activity or recovery. Coordinate mental-health care when needs extend beyond the clinician’s competence or scope.
• Social and practical support: workplace, school or sport accommodations, coaching or team communication, community services and help with access barriers can support participation when they match the patient’s priorities.

Medication and procedural shared care

• Medication questions: review current use, intended benefit, adverse effects, interactions and how symptom relief relates to the person’s goals with an authorized prescriber or pharmacist. Prescribing and dosing remain with the appropriate provider.
• Corticosteroid injection for gluteal tendinopathy: can provide short-term symptom relief in selected adults but does not replace load management and exercise. The medical decision reflects the diagnosis, expected benefit, risks, previous care and the person’s goals (Mellor et al., 2018).
• Extracorporeal shockwave therapy for persistent GTPS: is a shared-care option where available after discussion of uncertain benefit, cost, burden and protocol variation. Evidence is heterogeneous and many trials have high risk of bias (Rhim et al., 2024).
• Medical or surgical opinion: can form part of shared care when a major tear or avulsion is suspected, progressive weakness or gait change develops, the diagnosis remains uncertain, or symptoms continue to limit valued activity and further imaging or procedural care may change management. Do not base referral or procedural decisions on imaging alone.

Monitoring and reassessment

• Agree on a reassessment point based on the presentation, safety, goals, care being tried, patient needs and access rather than a fixed visit schedule.
• Repeat the small outcome set recorded at baseline and review symptoms, compression and load tolerance, strength, task performance, functioning, participation, confidence, benefits, adverse effects, treatment burden and progress toward patient-defined goals.
• Continue what is useful and acceptable; adapt or stop what is not; and revisit Red Flags, the working presentation, differential diagnosis, imaging, referral or shared care when progress differs from expectations or new safety concerns emerge.

• Expected course: many people with GTPS report meaningful improvement with education, load management and exercise, but progress varies and symptoms can fluctuate. Evidence for proximal hamstring, adductor and iliopsoas presentations is less certain, so one recovery timeline does not apply across the pathway (Mellor et al., 2018; Kjeldsen et al., 2024; Nasser et al., 2021).
• Factors associated with a less favourable course: longer-standing or highly irritable symptoms, marked weakness or gait change, difficulty modifying a repeatedly aggravating load, competing hip or low back problems, distress and barriers to care may complicate progress. These features do not determine an individual’s outcome, and evidence for presentation-specific prediction remains limited (Nasser et al., 2021; Kjeldsen et al., 2024).
• Potential supports for recovery: a clear explanation, feasible load changes, progressive exercise and task practice, confidence in movement, supportive relationships and teams, suitable accommodations, access to care and timely shared care may support functioning and participation.
• Discussing prognosis: describe uncertainty in plain language, ask what the patient wants to know, and update the outlook using goals, repeated outcomes and the observed response over time. Do not use an imaging finding, one test or one outcome score as a fixed prediction.