Hip Joint Problems: Responsible Diagnosis, Total-Body Care, and the Truth About the “Bone on Bone”

By Dr. Donald Liebell

Hip pain is one of the most consistently misdiagnosed and mistreated problems in musculoskeletal healthcare. Too many people are told that their pain is just “arthritis,” or that they are “bone on bone,” simply because of an X-ray. Others are advised to stretch, strengthen, take anti-inflammatory drugs, or undergo physical therapy without ever being given a complete diagnostic evaluation. I have seen this pattern for more than thirty-three years: people being treated without evidence, without imaging, and without clarity—and suffering because of it.

At the Liebell Clinic, our approach is entirely different. We do not guess. We do not assume. We do not treat blindly. We insist on proper diagnosis, and we help every patient obtain the medical information needed to determine what is truly wrong. This includes hip and lumbar MRI when appropriate, which often reveals the actual mechanical, structural, or neurological cause of pain—something X-rays simply cannot do. This is not just our policy. It is our family’s commitment.

Our clinic is run by four members of the Liebell family—myself (Dr. Donald Liebell), my wife Sheila, and our two sons, Dr. Breiten Liebell and Evan Liebell. The methods we use for you are the very methods we use for ourselves, our parents, our extended family, and our closest friends. When we recommend a treatment for your hip, it is because it is the same approach we have used for the people who matter most to us. Case in point: the foundation of the methods Dr. Breiten Liebell uses today are the very techniques I used on my own father, whose hips were as “bone on bone” as a person could be—yet he remained pain-free for decades because the mechanics were properly corrected.

This is the standard of care we bring to every patient who comes through our doors.

By the time patients arrive at the Liebell Clinic, they have typically been through a predictable series of events:

They start with a primary care visit. An X-ray is taken. They are told they have arthritis, that it is “wear and tear,” or that pain is “normal for their age.” They receive anti-inflammatory medications or painkillers. Some are given muscle relaxants. Most are sent for physical therapy—even when nobody knows what the structural problem actually is.

When symptoms persist, they visit an orthopedic office. More X-rays are taken. Steroid injections are administered. NSAIDs are continued. They are told to keep doing physical therapy. MRI is often delayed until conservative care “fails,” even though many conditions cannot be diagnosed without it. 

When MRI finally is performed, it frequently reveals the true causes: labral tears, femoroacetabular impingement, tendon damage, bursitis, cartilage defects, or referred pain from the lumbar spine.

Physical therapy can be tremendously helpful, but only when substantiated by proper diagnosis. Without MRI, patients may unknowingly be stretching a torn structure, strengthening muscles around a damaged joint, or irritating a partially degenerated tendon. The problem is not physical therapy—the problem is therapy without evidence.

This pattern is why so many people arrive at our clinic discouraged, confused, and still in pain. They did everything they were told. They followed instructions, completed exercises, took medications, and even tried injections. Yet their pain persisted because the underlying cause was never truly identified.

We consistently see people who've been put through previous treatments such as physical therapy, steroid injections, medications, etc. without knowing what's wrong with their hip joint. It's common to hear they had a hip x-ray, were told it's arthritis and given those "standard" treatments. 

At the Liebell Clinic, we insist on accuracy. A doctor must know what the problem is with the hip before treating it. Anything less is guesswork. Anything less is unacceptable.  MRI gives essential information that an X-ray can never provide. It identifies:

• Labral tears
• Femoroacetabular impingement (FAI)
• Tendon tears and degeneration
• Gluteus medius and minimus weakness or injury
• Bursitis
• Stress fractures
• Cartilage loss
• Early avascular necrosis
• Hip-spine referral patterns

• Structural imbalance from altered gait or foot mechanics
• Pelvic rotation and lumbar joint dysfunction

One can have structural problems invisible on x-ray. This is why we regularly order MRI—often the MRI that should have been ordered months or even years earlier. You cannot correct a problem without identifying it. You cannot stretch your way out of a structural tear. You cannot rehabilitate a tendon properly if you do not know whether it is injured. The path to recovery begins with accurate diagnosis and responsible care.

When you become a patient at the Liebell Clinic, Dr. Breiten Liebell becomes your advocate. His work is grounded in responsibility. He ensures that you get the medical imaging and consultations you truly need. He helps determine whether surgery is necessary by responsibly ordering MRI when appropriate (it quite often is!)—and if so, ensures that you are directed to seek consultation with an orthopedic surgeon for proper evaluation. We are strong supporters of hip replacement surgery and other orthopedic procedures when they are legitimately warranted. Many patients we refer for surgical consultation do exceptionally well because the referral is driven by accurate diagnosis, not premature assumptions.

The good news is that most of the time, surgery is not necessary. Dr. Breiten applies a total-body, mechanics-driven, neurology-based system of care that restores function, improves motion, and reduces pain.

Once a proper diagnosis has been established, treatment may include:

• Manual joint mobilization
• Low-force handheld instrument adjustments
• Soft tissue treatment
• Neurological activation techniques
• Cold laser therapy to support tissue repair and reduce inflammation
• Chiropractic structural care, including upper cervical integration
• Gait and movement assessment
• Restoration of proper mechanical loading throughout the entire body

Hip pain rarely comes from the hip alone. Compensation patterns involving the pelvis, spine, knees, ankles, and feet are almost always involved. Dr. Breiten’s approach recognizes the interconnectedness of the entire system. Your hip is not viewed as an isolated problem—it is evaluated as part of your total body mechanics.

He uses a handheld microcurrent TENS stimulator as part of his comprehensive treatment system. This device delivers precise, low-frequency electrical impulses through a small probe, allowing highly targeted stimulation of irritated nerves, tense muscles, and sensitive soft tissues without discomfort or force. It is especially useful for calming overactive pain pathways, improving local circulation, and supporting neuromuscular balance in difficult-to-reach areas such as the shoulder girdle, forearm, hip stabilizers, knee support structures, and the smaller muscles of the hand and wrist. The handheld TENS instrument works in harmony with Dr. Breiten’s manual joint mobilization, handheld instrument techniques, and cold laser therapy, enhancing the overall

Cold laser therapy is an important component of hip care at the Liebell Clinic. Hip problems frequently involve a combination of joint inflammation, irritated tendons, gluteal and pelvic muscle strain, and nerve-related pain patterns—all of which respond exceptionally well to carefully applied low-level laser light. 

Cold laser therapy is non-invasive and non-thermal; it uses precise red and near-infrared wavelengths to support cellular energy production, reduce inflammatory chemicals, and promote tissue repair rather than merely masking pain.

Research supports the use of photobiomodulation in musculoskeletal and arthritic conditions. Reviews of low-level laser therapy for osteoarthritis have shown meaningful reductions in pain and improvements in function, with an excellent safety profile and potential to reduce reliance on medications. Randomized controlled trials involving patients recovering from total hip arthroplasty have demonstrated decreased pain intensity and reduced postoperative inflammation when photobiomodulation was included as part of recovery. 

Additional work with cold lasers in orthopedic and neurological conditions—including low back pain—has shown clinically significant improvements versus placebo, reinforcing that laser therapy is a scientifically supported modality rather than a novelty.

At the Liebell Clinic, cold laser therapy is provided by our laser therapist, Evan Liebell, as an integrated part of the family-based care we deliver. This is among the same methods and technologies we use for ourselves and our own family. Laser therapy works in concert with Dr. Breiten Liebell’s manual chiropractic treatment, handheld instrument techniques, auricular therapy, and total-body mechanical evaluation.

Cold laser is particularly valuable for patients with hip osteoarthritis, chronic bursitis around the greater trochanter, tendon irritation, and persistent soft tissue pain that has not responded to other conservative care. It is also helpful for patients recovering from hip surgery, supporting comfort, mobility, and tissue healing while mechanical and neurological aspects of movement are being corrected.

One unique advantage of cold laser therapy is the diagnostic insight it can provide. When a patient’s hip discomfort improves quickly during or soon after laser application—not only at the hip itself, but at related structures such as the pelvis or lower back—it often confirms the interconnected mechanical and neurological relationships influencing the hip. This helps guide further evaluation and treatment, ensuring that care is directed not only at the painful area, but at the entire system supporting the hip.

At the Liebell Clinic, the goal is not simply to relieve pain—it is to bring clarity, restore structure, support the nervous system, and provide treatment based on evidence, experience, and a family tradition of responsibility. 

The methods we recommend for you are the methods we use for ourselves and the people we love. This is not merely a family practice. It is a practice powered by a family, dedicated to providing you the highest level of safe, responsible, total-body care. 

If you would like to schedule an evaluation or receive guidance on obtaining the proper imaging before beginning treatment, the Liebell Clinic will be pleased to assist you.