Hip Pain: Complete Guide

Hip pain can make it difficult to walk, climb stairs, and sleep. Many causes can be treated without surgery. However, severe pain after a fall, an inability to put weight on the hip, or a warm hip accompanied by a fever require prompt evaluation.

For osteoarthritis, which affects joint tissues, international guidelines include education and exercise among the basic treatments¹. Femoroacetabular impingement, which involves a specific bony configuration along with symptoms and physical examination findings, can also be treated without surgery². This guide outlines possible causes, warning signs, and care options. Our physical therapy guide for hip pain explains follow-up care. To learn about the approaches used, see our comprehensive guide to physical therapy.

What is hip pain, and what causes it?

Hip pain is felt in the groin, on the side of the hip, or in the buttock, and may originate in the joint, muscles, tendons, or back. A tendon is the tissue that connects a muscle to a bone. The location of the pain provides a clue, but it is not enough on its own to make a diagnosis.

Pain in the groin may indicate a problem with the joint. Pain on the side may indicate a problem with the gluteal tendons. Pain in the buttock may also originate in the back. However, several problems can occur at the same time. Questions about your symptoms and a physical exam can help distinguish between these^{causes.³, ⁴}

Depending on the cause, treatment may include advice, exercises, physical therapy, or medical treatment. The choice takes into account your pain, limited range of motion, and the activities you wish to resume.

How does the anatomy of the hip help us understand pain?

Understanding the anatomy of the hip helps explain the various possible sources of pain: the joint is located deep within the body and is surrounded by muscles, tendons, and small fluid-filled sacs. The location of the pain guides the examination but does not, on its own, identify the specific structure involved. Our page onhip anatomy describes these structures in detail.

The hip joint connects the round head of the femur, the thigh bone, to a socket in the pelvis called the acetabulum. This structure allows the thigh to be lifted, moved backward, abducted, and rotated. The joint also supports the body’s weight while walking, as described in this chapter on hip anatomy.

Cartilage is a smooth tissue that covers the bony surfaces within the joint and allows them to glide smoothly. The labrum is a ring of strong tissue around the edge of the acetabulum. It contributes to hip stability and helps keep the joint fluid between the surfaces⁵. In osteoarthritis, the cartilage, bone, and surrounding tissues can change⁶.

Several muscle groups surround the hip:

• The gluteal muscles, located at the back and sides of the hips, help extend the thigh, abduct it, and keep the pelvis stable while walking.

• The flexor muscles, located at the front, lift the thigh toward the trunk. The iliopsoas is part of this group.

• The adductor muscles, located on the inner thigh, pull the leg toward the other leg.

• The deep rotator muscles, located beneath the glutes, help rotate the thigh.

Synovial bursae are small sacs of fluid that facilitate movement between bones, muscles, and tendons⁷. The trochanteric bursa is located on the side of the hip, near the greater trochanter—the protruding bony part where several gluteal tendons attach.

The evaluation may consider the joint, muscles, tendons, bursae, and adjacent structures, without attributing the pain to any one of them based solely on its location.

Where do you feel your pain?

The location of your pain provides important clues about its cause. Pain in the groin may point to the joint, and pain on the side may point to the gluteal tendons, although this alone is not enough to make a diagnosis.

Pain may be felt at a distance from the structure causing it.

Hip osteoarthritis can cause pain that radiates down to the knee. A group of 21 people illustrates this problem: they had sought treatment for their knees, but the problem actually originated in their hips. Of the 17 people who underwent hip surgery at this facility, 14 reported that their knee pain had disappeared⁸. This small study does not allow us to predict the outcome for all cases of knee pain.

A lower back problem can also cause pain in the buttock or the back of the hip³. The examination therefore checks the surrounding areas. The thigh may also have its own issues, which are explained in our guide on thigh pain.

What are the main causes of hip pain?

The main causes of hip pain include osteoarthritis, problems with the gluteal or adductor tendons, bursitis, and certain muscle or bone injuries. Femoroacetabular impingement and a “clicking” hip are also possible causes. The following sections explain these conditions, their symptoms, and possible treatments.

What is hip bursitis?

Hip bursitis is an inflammation of a bursa, which can become painful and swollen. When it affects the greater trochanter region, the pain is located on the side of the hip.

Greater trochanter pain syndrome encompasses several causes of pain on the side of the hip, including problems with the gluteal tendons and, in some cases, bursitis. Therefore, it is not always caused by an inflamed bursa. In a study of 877 people examined by ultrasound—a test that produces images using sound waves—nearly 80% had no visible bursitis⁹. Other studies use different definitions of ultrasound abnormalities, which partly explains the discrepancies in their results¹⁰.

Typical symptoms include:

• Pain on the side of the hip

• Increased pain when sleeping on the affected side

• Pain when climbing stairs or walking for long periods

• Tenderness to the touch on the side of the hip

Pain on the side of the hip can last a long time. In a study conducted in primary care, 76% of respondents still reported pain after one year, and 63% after five years¹¹. Nearly half of those surveyed did not respond. These figures therefore do not accurately reflect the entire population of people affected.

Options include, among other things, exercises, counseling, and, in some cases, an injection or surgery. A 2011 review reports improvements with several treatments, but it is based primarily on small groups that were followed without a control group, with few robust comparisons between treatments¹². The trial on gluteal tendinopathy, presented below, allows for a more precise comparison between exercises, injections, and a “wait-and-see” approach. Our comprehensive guide on hip bursitis details the options.

What is hip osteoarthritis?

Hip osteoarthritis, also known as coxarthrosis, affects the cartilage, bone, and other tissues of the joint⁶. Its prevalence increases with age. It can cause groin pain, stiffness, or difficulty walking¹³.

Signs of osteoarthritis may also appear on X-rays even in the absence of pain. In the Framingham Study of 978 adults aged 50 and older, the age-adjusted prevalence was approximately 20% for radiographically evident osteoarthritis and 4% for osteoarthritis accompanied by pain¹⁴. Age adjustment accounts for the age distribution within the study population.

Physical therapy aims to reduce symptoms and make it easier to perform daily activities, though it does not promise to cure osteoarthritis. Physical activity can help alleviate pain and improve function in people with hip or knee osteoarthritis¹⁵. The effects on joint structures are less well established. Possible symptoms include:

• Groin pain that can spread to the thigh

• Morning stiffness, often lasting less than one hour according to the 2017 clinical criteria¹⁶. The older 1991 criteria specified 60 minutes or less¹⁷. This duration is one indicator among others, not a rule that applies to every person.

• Progressive loss of mobility

• Pain that increases with activity

An X-ray does not fully reflect a person’s pain. In two large studies, many hips with signs of osteoarthritis were not frequently painful, and many painful hips did not have these signs¹⁸. A physical examination therefore remains important.

Magnetic resonance imaging, or MRI, produces detailed images of the inside of the body. A review of nine studies on hip osteoarthritis found a fairly consistent link between certain lesions in the bone marrow—the tissue inside the bone—and pain. The links are less clear for several other findings¹⁹. An image can help explain the symptoms, though it cannot explain them on its own.

For symptomatic hip osteoarthritis, exercise may help. The 2026 Cochrane review included 18 studies. Compared with no treatment, usual care, or brief advice, exercise likely reduces pain and physical limitations slightly immediately after the program. The average improvements are about 7 and 9 points out of 100, which the authors consider likely too small to be meaningful in daily life. Compared with a sham treatment or a comparable amount of time spent with healthcare providers, the benefit for pain is less clear, and the benefit for physical function remains small²⁰.

The 2023 review also found small benefits, the significance of which for individuals remained uncertain²¹. These average results do not preclude individual improvement. The follow-up therefore compares your pain and activities before and after the program. The 2014 review also found a reduction in pain and an improvement in functional ability after the program and three to six months later²².

Hip replacement may be considered when pain and functional limitations remain significant despite non-surgical treatment. Our comprehensive guide to hip osteoarthritis explores the options.

What is femoroacetabular impingement?

Femoroacetabular impingement involves hip pain, physical examination findings, and a bony configuration that can cause premature contact between the femur and the pelvis during certain movements. A diagnosis requires that all three of these elements be present².

The presence of this bony formation alone does not predict pain or deterioration. Cam-shaped or pincer-shaped formations and labral tears are also observed in people without pain²³. This does not prove that these structures can never contribute to symptoms. In a study of 720 people with symptoms suggestive of early osteoarthritis, the pincer-type shape was not associated with the development of osteoarthritis over a five-year period, as assessed by X-rays or hip replacement²⁴. This finding pertains to the pincer-shaped deformity in this population.

There are three types:

• Came: a bump at the junction between the head of the femur and its neck, the narrowed portion that connects the head to the rest of the bone²⁵.

• Clamp: The rim of the acetabular cavity covers a larger portion of the femoral head²⁵.

• Hybrid: Combination of cam and clamp types

Symptoms include:

• Groin pain during or after activity

• A rattling or catching sensation

• Stiffness after prolonged sitting

• Restricted movement, such as difficulty lifting or rotating the thigh.

A review of 26 studies involving 2,114 asymptomatic hips found a cam-like shape in 37% of the hips, on average. The proportion varied widely: approximately 55% among athletes and 23% in the general populations studied²³. A specific bony shape does not, therefore, automatically indicate a painful condition. Non-surgical management may be considered depending on symptoms, examination findings, and treatment goals. Our comprehensive guide to femoroacetabular impingement also explains the situations in which surgery may be considered.

What is a clicking hip?

A clicking hip, also known as coxa saltans, produces a clicking sound that you can hear or feel during movement. This clicking is often painless. It is referred to as a syndrome when the clicking is accompanied by pain or discomfort²⁶.

There are three types:

• External: the iliotibial band, a band of firm tissue on the side of the thigh, or the edge of the gluteus maximus passes over the greater trochanter²⁷.

• Medial: The iliopsoas tendon, which helps lift the thigh, runs over the structures in front of the hip, including the head of the femur²⁷.

• Inside the joint: a labral tear or a loose fragment of cartilage or bone within the joint can cause catching. Physical examination and, if necessary, imaging help determine the cause²⁷.

Activities and movements that reproduce the clicking sound are documented during the evaluation. The clicking sound typically occurs with specific movements, such as standing up from a chair or turning around.

If the snapping sensation is not painful, it generally does not require treatment. When the snapping sensation is painful, activities, strength, and range of motion can be assessed before selecting exercises. Our comprehensive guide to snapping syndrome details the various treatment approaches.

What is a Hip Fracture?

A hip fracture is a break in the bone near the joint, usually in the upper part of the femur. It requires urgent medical evaluation. In older adults, it most often occurs after a fall. A 2024 review notes that more than 90% of hip fractures are related to a fall²⁸. The medical team then determines the appropriate treatment and timing.

Risk factors identified in systematic reviews include, in particular, age, falls, muscle weakness, and low bone density—that is, bones with lower mineral content²⁹ :

• Osteoporosis (weakened bones)

• Advanced age

• Falls

• Muscle weakness

Certain signs may suggest a fracture, but their absence does not rule out a hidden fracture—that is, a fracture that does not show up on the first X-ray³⁰; an older adult who is unable to bear weight after a fall should be re-evaluated even if their X-rays are normal³¹ :

• Severe hip or groin pain after a fall

• Inability to bear weight on the leg

• Leg appears shortened and turned outward

Action Required: After a fall or injury, call emergency services if the person cannot get up, cannot put weight on the leg, or has an obvious deformity. The timing of any surgery is determined by the medical team based on the person’s health status and the necessary medical preparations.

After a hip fracture, rehabilitation helps patients resume mobility and daily activities. It takes into account the patient’s medical condition, their abilities prior to the fracture, and their personal goals. Our comprehensive guide to hip fractures explains this process.

What is Adductor Tendinopathy?

Adductor tendinopathy is pain associated with the tendons of the inner thigh muscles, often near where they attach to the pubic bone, the bone at the front of the pelvis. It can interfere with kicking, running, and changes of direction.

The term “tendinopathy” describes a painful condition affecting a tendon. It does not mean that inflammation or tissue damage alone accounts for all the symptoms. The diagnosis is based on your symptoms and the physical exam³².

Symptoms include:

• Pain in the groin or inner thigh

• Pain that increases with kicking, sprinting, or changes in direction

• Morning Stiffness

• Tenderness to touch near the pubic bone

Among athletes, several factors are associated with groin injuries. They do not predict with certainty what will happen to an individual³³ :

• A previous groin injury.
• Reduced strength of the adductor muscles.
• A high level of competition or less sport-specific training.

A program can gradually strengthen the adductors and train the movements required for sports. In a study involving 68 athletes with persistent adductor pain, 23 participants in the strength and coordination group resumed their sport without groin pain, compared with 4 in the group receiving physical therapy without active training. The follow-up took place four months after treatment³⁴. Coordination here refers to how muscles work together during movements. The exercises are tailored to the athlete’s strength, symptoms, and the sport they plan to resume. Our comprehensive guide to adductor tendinopathy describes this progression.

What is gluteal tendinopathy?

Gluteal tendinopathy is pain associated with the tendons of the gluteus medius and gluteus minimus muscles, on the side of the hip. It is part of the greater trochanter pain syndrome. A study of 3,026 adults aged 50 to 79 found this syndrome to be more common in women: 15% had pain on one side and 8.5% on both sides, compared with 6.6% and 1.9% in men³⁵. These figures describe the syndrome as a whole, not just the tendinopathies.

The gluteus medius and gluteus minimus attach to the greater trochanter. They help abduct the thigh and stabilize the pelvis while walking or standing on one leg³⁶.

Typical symptoms include:

• Pain on the side of the hip

• Pain when sleeping on the affected side

• Pain when climbing stairs

• Pain when walking for extended periods

• Nighttime pain that disrupts sleep

Pain can interfere with sleep, climbing stairs, and walking. An increase in symptoms alone does not prove that the tendon is deteriorating. An MRI may reveal abnormalities in both painful and pain-free hips³⁷. These findings should be interpreted in light of your symptoms and physical examination.

A trial randomly assigned 204 people aged 35 to 70 with gluteal tendinopathy and pain lasting more than three months. The program combined 14 sessions of counseling and exercises over eight weeks. At eight weeks, this group reported less pain and greater overall improvement than the groups that received a cortisone injection or a “wait-and-see” approach. Cortisone is a medication that reduces inflammation. At 52 weeks, overall improvement remained greater in the counseling and exercise group, but the average pain score did not differ significantly from that of the injection group³⁸. Overall improvement reflects participants’ assessment of how their condition has progressed, not just their pain levels. Our comprehensive guide to gluteal tendinopathy explains the exercises and possible adaptations.

What is an Adductor Strain?

An adductor strain is a sudden injury to the muscles on the inner thigh. It can occur during a sprint, a soccer shot, or a change of direction. A video analysis of 17 professional soccer players with long adductor injuries primarily identified changes of direction, kicking motions, movements to reach the ball, and jumps³⁹. In these situations, the muscle can contract rapidly while it is lengthening.

Grades 1 through 3 are typically used to describe the severity of a muscle injury. However, their meaning varies depending on the classification system used. A review identified 24 classification systems and found inconsistent results in predicting a return to sports⁴⁰. MRI provides useful information, but decisions also take into account pain, strength, and range of motion⁴¹ :

• Grade 1: mild injury, with generally limited pain and loss of function.

• Grade 2: a partial tear, in which part of the muscle or its attachment remains intact.

• Grade 3: A complete tear of the muscle or its attachment. A medical evaluation is necessary.

Symptoms include:

• Sudden, sharp pain in the groin or inner thigh

• You may feel a popping sensation at the moment of the injury.

• Bruising that may appear after a few days

• Difficulty walking or spreading the leg

At first, avoid movements that cause significant pain in the affected area. A return to normal activity should be approached gradually, depending on the severity of the injury, walking, and other possible movements.

The decision to resume activities is based on gait, strength, the required movements, and the body’s response to exertion:

• Mild to moderate tear: Follow-up involves assessing walking, strength, and tolerance for sports-related movements, such as accelerating, changing direction, or kicking the ball.

• Complete tear: The doctor will outline the treatment and follow-up care before the patient resumes strenuous activity.

Returning to activity too soon can worsen symptoms. Decisions about returning to activity are based on sports-specific movements and restored functional abilities, along with physical examination and imaging when appropriate⁴¹. Our comprehensive guide to adductor strains describes the progression.

When should you see a doctor?

You should see a doctor if your hip pain persists, worsens, or is accompanied by concerning symptoms, such as a fever, unexplained weight loss, or pain following a fall. Pain that wakes you up and isn’t relieved by changing positions, or new pain in someone with a history of cancer, also warrants evaluation.

After a fall, an inability to bear weight, a shortened leg, or a leg that turns outward are warning signs that may indicate a hip fracture and warrant urgent evaluation; the absence of these signs does not rule out a hidden fracture.

Sudden, severe pain without an injury, a swollen and warm hip, or hip pain accompanied by a fever and general malaise requires urgent medical attention. Go to the emergency room if you cannot walk or put weight on your leg, even if you have not been injured. After a fall or injury, severe pain, new tingling or numbness, or a loss of sensation in the hip or leg also require evaluation in the emergency room. Call 911 if you cannot get there safely. Sudden weakness must also be evaluated immediately. These guidelines follow the warning signs outlined by the UK’s National Health Service. Other concerning signs include:

• Severe night pain that doesn't change with position

• Unexplained weight loss with hip pain

• History of cancer with new hip pain

Rest assured: Many types of hip pain are not emergencies, but the signs mentioned above require the appropriate evaluation.

How do professionals diagnose hip pain?

Healthcare professionals determine the likely cause of hip pain based on your symptoms, a physical exam, and, if necessary, medical imaging. Imaging is especially useful when the results can influence treatment. Your healthcare professional will ask you questions about:

• Where exactly you feel the pain

• When it started

• What makes it worse and what relieves it

• Your activities and sports

The physical examination includes several specific tests:

• FADIR Test: The healthcare professional bends your hip, brings your thigh closer to the other leg, and rotates it inward. They check to see if these movements trigger your pain. This test alone does not confirm a diagnosis.

• FABER Test: The practitioner places your ankle near the opposite knee and allows the tested knee to open to the side. They observe the movement and the location of the pain, then compare this information with the other results.

• Trendelenburg test: The healthcare professional checks to see if your pelvis tilts toward the side of your raised leg when you are standing on one leg. This sign alone does not measure muscle strength or the condition of a tendon.

• Palpation: The practitioner feels the muscles, tendons, and greater trochanter to identify tender areas.

A study of 72 people over the age of 40 with pain on one side proposed a set of five signs to identify osteoarthritis visible on X-rays⁴² :

• The person reports that squatting increases their pain.
• Lifting your own thigh causes pain on the side of your hip.
• A movement guided by the therapist—involving pressure along the center of the thigh and bringing the leg toward the other side—causes pain in the groin or on the side.
• Pulling your thigh back causes hip pain.
• The inward rotation of the thigh, performed by the professional, does not exceed 25 degrees.

In this study, the presence of at least four of these five signs increased the probability of radiographic osteoarthritis from 29% to 91%. This estimate was imprecise, and the authors called for validation before the panel is put into routine use. These tests must be interpreted by a healthcare professional.

Imaging is not always necessary. It is indicated when:

• Warning signs may indicate a fracture, an infection, or another condition that requires medical evaluation.

• The pain or functional abilities are not progressing as expected, and the outcome could lead to a change in treatment.

• A surgical decision needs to be made

X-rays show the bones and certain signs of osteoarthritis. An MRI can also show the muscles, tendons, labrum, and other tissues. The healthcare professional always compares the images to the symptoms and the physical exam³.

Why doesn't imaging always predict pain?

Cam-like or pincer-like deformities are present in people without pain. A review of 26 studies on asymptomatic hips shows that imaging findings should be interpreted in conjunction with symptoms and physical examination²³. Our article, “Does Medical Imaging Really Help with Your Aches and Pains?”, explains this distinction.

For example:

• A cam-like shape was present in an average of 37% of the hips, with wide variations among the studies²³.

• A pincer-like shape was present in approximately 67% of the hips in the studies that measured it. Only four studies described it, using different definitions²³.

• A labral tear was visible in approximately 68% of the hips in the seven studies that evaluated this using MRI²³.

These observations alone are not sufficient to explain a person’s pain. Nor do they rule out the possibility that a specific structure might contribute to their symptoms.

Pain involves sensations and emotions. It can be influenced not only by tissues and nerves, but also by stress, expectations, work, and^{relationships .⁴³, ⁴⁴} This does not mean that pain is imaginary. The same observation of an image can be accompanied by different experiences.

If your imaging report mentions wear and tear, osteoarthritis, or degenerative changes—that is, changes in the tissues—ask how these findings relate to your symptoms and the physical exam. Our article, “Is It Really Your Osteoarthritis That’s Causing Your Pain?” explores this issue in greater depth.

How do physical therapy and exercise help manage hip pain?

Physical therapy helps manage certain types of hip pain through guidance, tailored exercises, and—depending on the problem—manual techniques. For osteoarthritis, education and exercises are among the recommended basic treatments¹. For gluteal tendinopathy, a program of advice and exercises improved pain and the participants’ reported outcomes³⁸. Other conditions require tailored care.

The main components of physiotherapy treatment:

Education

The physical therapist explains the likely cause, your options, and the signs to watch for. He or she helps you decide which activities to continue or modify. For example, the plan might suggest breaking walks into shorter outings if a long walk causes lasting pain.

Progressive Exercises

The exercises target the specific abilities assessed in the exam. They can strengthen the glutes, improve hip mobility, and help with movements such as standing up from a chair or climbing a step.

Manual therapy

The physical therapist can use their hands to gently mobilize the hip—that is, to guide its movements. For mild to moderate osteoarthritis with pain or limited movement, the 2017 guidelines recommend manual therapy to improve pain and mobility¹⁶. However, adding it to your exercise routine does not always provide additional benefit. Its usefulness is reassessed based on your response. Our comprehensive guide to manual therapy describes these techniques.

Load management

Load management involves adjusting the amount and intensity of activities. Monitoring involves paying attention to symptoms during and after exercise. The plan may temporarily reduce walking distance, the number of stairs, or the intensity of an exercise, and then gradually increase the effort based on tolerance.

For gluteal tendinopathy, counseling focuses in particular on activities and positions that exacerbate symptoms. In the comparative trial, the counseling and exercise program resulted in greater overall improvement at 52 weeks than the injection, although there was no clear difference in average pain between the two groups³⁸. These results do not indicate a universal effect of cortisone on the condition of the tendon.

What specific exercises help?

Exercises can strengthen the glutes and adductors, improve hip mobility, and help develop core control. The choice of exercises depends on the range of motion limitations and the activities you plan to resume. The following examples should be adapted in consultation with a physical therapist; they are not automatically suitable after a fracture or complete tear.

Gluteal muscle strengthening

To work the glutes on the side of the hip, you can slowly lift your top leg while lying on your side, then lower it back down. Keep your pelvis stable. The American Academy of Orthopaedic Surgeons includes this exercise in its hip-strengthening program. Other options include standing leg raises, side steps with a resistance band, and supported single-leg squats. Our guide to strength and endurance exercises explains how to progress through these exercises.

Adductor Exercises

To work the adductors, one example is to lie on your side, bend the top leg in front of you, and then gently lift the bottom leg, which remains extended. Lower it slowly. This movement is included in the American Academy of Orthopaedic Surgeons’ hip exercise program. Depending on your symptoms, the physical therapist may also choose to start with a static contraction and then add resistance.

Hip Mobility

Mobility exercises target restricted movements. For example, while lying on your back, you can bend at the hip and gently bring your knee toward your chest, within a comfortable range (see the hip exercise program for an example). The choice of exercise depends on the assessment, as certain positions may trigger impingement or tendon pain.

Trunk stability

Core control helps keep the pelvis stable during a movement. For example, the physical therapist may have you practice stepping up onto a step while observing your pelvis and core, and then adjust the support or the height of the step.

Important Points to Remember:

• For pain on the side of the hip: Identify positions that worsen the pain, such as sleeping on the affected side. Temporarily change your position if it bothers you, then reassess your tolerance. Advice on positions and exercise progression was part of the program designed for gluteal tendinopathy³⁸.

• For tendinopathies: Increase the intensity of your workout based on your symptoms and the activities you’re targeting. A noticeable and persistent worsening of symptoms is a sign that you should reduce or modify your next workout. Our guide on progressing through rehabilitation exercises explains how to adjust your exercises.

• For osteoarthritis: Exercise is still recommended, even though the average improvements in pain relief and functional ability are often modest²⁰. An analysis of hip and knee osteoarthritis shows that people with more pain and functional limitations at the start generally benefited more from exercise, especially in the short term⁴⁵. Not all of the precise mechanisms behind these improvements are known.

A physical therapist can assess your symptoms and recommend a tailored treatment plan. Our guide to physical therapy for hip pain describes the assessment and follow-up process.

Can you treat hip pain on your own?

You can sometimes reduce discomfort by sticking to movements you can tolerate and temporarily cutting back on activities that significantly worsen the pain. Taking a shorter walk or taking breaks between tasks can be helpful strategies. Pain that worsens, interferes with sleep, or does not improve after two weeks of home care warrants a doctor’s visit (according to the UK National Health Service guidelines). After an injury or if you notice a warning sign, follow the urgent assessment guidelines outlined above.

The physical therapist determines whether the pain appears to be coming from the joint, a tendon, a muscle, or a nearby area. He or she looks for signs that require medical attention and selects exercises tailored to your situation.

Our approach includes an assessment and a home exercise program that is adjusted based on the changes we observe.

Does physical therapy really work for hip pain?

Physical therapy can improve pain and functional ability in several hip conditions, with results depending on the diagnosis and treatment program. In osteoarthritis, exercises provide, on average, modest benefits compared to no treatment, standard care, or brief counseling²⁰. For gluteal tendinopathy, the counseling and exercise program yielded better outcomes in terms of pain relief and overall improvement at eight weeks than injection or a wait-and-see approach³⁸. In femoroacetabular impingement, physical therapy can improve pain and function and may be tried before considering surgery²⁵. Our page on physical therapy for hip pain provides detailed information on follow-up care.

Exercises, education, or manual therapy may be used separately or in combination, depending on the diagnosis, the goals, and the observed response.

Follow-up care takes into account changes in symptoms, target activities, and response to the program. A comprehensive evaluation allows us to tailor treatment to your specific situation.

What Are Common Myths About Hip Pain?

The most common myths about hip pain are the belief that the hip is a fragile joint, that an abnormality seen on imaging necessarily explains the pain, that rest is better than movement, and that surgery is always the ultimate solution. These ideas must be considered in the context of the diagnosis, imaging results, treatment options, and the individual’s goals.

“My sore hip must be weak.” Pain alone isn’t a reliable indicator of how strong a bone or tendon is. The exam looks for signs of an injury, especially after a fall.

“The image must explain my pain.” Cam-like or pincer-like deformities and labral tears are present in people who are pain-free²³. The findings must be compared with the symptoms.

“Complete rest is always better than movement.” In cases of osteoarthritis and gluteal tendinopathy, appropriate exercises can^{help.²⁰, ³⁸} However, a fracture or complete tear requires an evaluation before resuming activity.

“Surgery is unavoidable.” Several nonsurgical treatment options are available. Surgery remains an option when indicated, depending on the diagnosis, limitations^, and patient^{preferences.², ⁶}

How does hip pain progress?

The progression of hip pain depends on its cause: tendinopathies can last several months, osteoarthritis can fluctuate, and a fracture requires recovery under the supervision of a healthcare team. Your ability to walk, sleep, and resume your activities helps track these changes.

Gluteal Tendinopathy: Course and Follow-Up

Gluteal tendinopathy can last several months. In the trial involving advice and exercises, improvement was already observed at eight weeks, but follow-up continued for up to one year³⁸. Individualized follow-up assesses pain, sleep, and important activities, without setting a single recovery date for everyone.

Hip osteoarthritis

Hip osteoarthritis does not progress in the same way for everyone. A review of 57 articles examining 154 factors found results that were mostly limited or contradictory. However, it did identify more consistent associations between certain other diseases and clinical worsening, as well as between advanced radiographic findings and the need for hip replacement⁴⁶. Treatment decisions take into account pain, activity limitations, overall health, and patient preferences.

Femoroacetabular Impingement

Non-surgical treatments can improve pain and function in femoroacetabular impingement²⁵. If functional limitations remain significant, surgical intervention may be considered after confirming the diagnosis and reviewing the treatments that have been tried.

Gluteal tendinopathy: a 52-week comparison

At 52 weeks, counseling and exercises had resulted in a better overall outcome than a cortisone injection or watchful waiting. This overall outcome does not predict individual outcomes.

Hip Fracture

After a hip fracture, many people do not regain their full previous mobility. A review of 29 trials highlights that studies primarily measure walking speed in a clinical setting, which does not fully reflect mobility in daily life⁴⁷. Follow-up takes into account walking ability prior to the fracture, medical status, and goals to tailor rehabilitation.

Topics to discuss and monitor with your healthcare provider:

• Goals and preferences discussed with the individual

• Activities the person wishes to continue

• Information Understood and Remaining Questions

• Support is available as needed

• Thoughts and concerns about pain, described without blaming the person

What should you remember and what should you do?

The key steps to take when experiencing hip pain are to continue with activities that are tolerable, to have persistent pain evaluated, and to seek prompt medical attention if any warning signs appear. Treatment depends on the cause. Pain alone does not indicate that the hip is weak. Surgery remains a useful option in certain situations.

How to prevent hip pain?

Physical activity and strength training support hip function, but no program can guarantee that you’ll avoid pain entirely. The following tips will help you plan your activities and adjust the intensity to suit your situation.

Choose an appropriate activity

Regular physical activity can help maintain strength and mobility. For people with hip or knee osteoarthritis, it can reduce pain and improve physical function compared to a less active lifestyle¹⁵. Walking, swimming, or cycling are options you can choose based on your health, abilities, and preferences.

Build strength as needed

Strengthening your glutes can help you prepare for activities such as climbing stairs or getting up from a chair. The exercises and how often you do them depend on your abilities and goals. This training does not guarantee that you will be pain-free.

Adjust for changes in load

Gradually increase the duration or intensity of your activities based on your tolerance. If you experience pain after a significant change in your exercise routine, discuss this adjustment with your healthcare provider.

Talk about weight without singling it out

Weight can be discussed respectfully based on the diagnosis and goals. It is one of several factors and does not, on its own, explain a person’s pain.

Prepare for athletic movements

A warm-up gradually introduces the planned movements, such as walking before running. Its effect on injuries depends on the program and the sport. A 2006 review of five trials found fewer injuries in three trials and no clear effect in two. The results suggested a benefit, but the authors deemed the evidence insufficient to systematically recommend or rule out warm-ups for preventive purposes⁴⁸.

Have persistent pain re-evaluated

Pain that persists, recurs frequently, or limits your activities warrants a follow-up evaluation. The healthcare professional will review the diagnosis, monitor your progress, and discuss possible adjustments.

Questions to Ask Your Healthcare Professional

These questions can help you participate in decision-making. Here are some helpful questions:

• What is the most likely cause of my pain? Ask for a clear explanation.

• What evidence supports this diagnosis? Is it based on a physical exam? Imaging? Ask how the patient's history, physical exam, and imaging results support or limit this hypothesis.

• How might my problem evolve? What changes should we monitor, and when should we reassess the plan?

• What warning signs should I watch for? What symptoms should prompt me to see a doctor?

• How can I stay active safely? What activities can I continue? Which ones should I temporarily modify?

• Why do you recommend this treatment? What are the alternatives? What is the evidence of its effectiveness?

• When should I return if it doesn't improve? How long should I give the treatment before re-evaluation?

What are the key takeaways?

1. The evaluation takes your abilities into account. Walking, climbing stairs, and hip movements help determine the appropriate treatment.
2. Several treatment options are available without surgery. Exercises, advice, and certain medical treatments are selected based on the diagnosis.
3. Movement can be adapted. Adjust your activity based on your abilities and how your body responds to exertion.
4. Imaging does not explain all pain. Some findings are also present in people without symptoms.
5. Benefits depend on the condition being treated. The results of exercises for osteoarthritis are not the same as those for a gluteal tendinopathy program.
6. Warning signs require action. An inability to walk or bear weight requires an evaluation in the emergency room, even without an injury. A swollen, warm hip, or hip pain accompanied by fever and malaise also requires urgent medical attention.
7. Tendinopathy is managed using concrete benchmarks. Focus on pain levels, sleep, and activities rather than a fixed recovery date.
8. Your preferences matter. Discuss your goals, concerns, and possible adjustments without taking sole responsibility for the outcome.

These principles do not guarantee a quick recovery for everyone. Hip pain remains a complex and sometimes persistent condition. These guidelines can help support more informed decisions during follow-up care.

References

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