Physiotherapy for Hip Pain

Physiotherapy is the first-line treatment for most hip pain. The 2025 clinical guidelines give it a Grade A recommendation, which is the highest level of evidence. Between 70% and 90% of people report significant improvement with this type of treatment.

Here's the good news: unlike passive approaches such as injections, physiotherapy addresses the root causes of your pain. This guide explains how the treatment works, what you can expect, and why this active approach leads to better long-term results. If you first want to understand the different causes of hip pain, consult our complete guide to hip pain.

How Does Physiotherapy Help Relieve Hip Pain?

Physiotherapy treats the causes of your pain, not just the symptoms. It combines targeted exercises, manual techniques, and education to improve your function and reduce pain long-term.

Here are the three pillars of treatment:

Therapeutic Exercise is at the heart of the treatment. The 2025 clinical guidelines give exercises a Grade A recommendation for hip osteoarthritis. Programs supervised by a physiotherapist yield better results than exercises done alone at home. Why? Because a professional adapts the exercises to your specific condition and progresses them at the right pace. Manual therapy completes the exercises. Joint mobilizations, soft tissue techniques, and hip traction relieve pain and improve mobility. These techniques are particularly effective when combined with exercise. Education plays a crucial role. Understanding your condition reduces fear and improves your results. Your physiotherapist will explain what causes your pain, why movement helps, and how to manage your daily activities.

An important point: physiotherapy is an active treatment. You are at the center of your recovery. This differs from passive approaches like injections, which provide temporary relief without addressing the causes. This active involvement explains why physiotherapy results last longer.

What happens during a physiotherapy assessment?

Your first session begins with a comprehensive assessment. The physiotherapist needs to understand your condition before proposing a treatment plan. This assessment typically lasts 45 to 60 minutes.

The initial consultation

Your physiotherapist will ask you several questions:

• Where do you feel the pain? The location provides important clues. Pain in the groin suggests an issue with the joint. Pain on the side points towards the gluteal tendons.
• How did it start? A sudden injury or gradual onset do not indicate the same conditions.
• What makes it worse or better? This information helps identify the structures involved.
• How is your pain over 24 hours? Morning stiffness, night pain, and how it changes throughout the day are diagnostic clues.
• What treatments have you tried? Knowing what has worked or not helps guide therapeutic choices.

Physical examination

After the interview, the physiotherapist examines your hip:

Observation : We observe your posture, your walking pattern, and the alignment of your limbs. A pelvis that tilts when you stand on one leg (Trendelenburg sign) indicates weakness in the gluteal muscles. Mobility tests : We measure the full range of motion of your hip in all directions. A loss of internal rotation is often the first sign of a joint problem. Specific tests : Specific maneuvers help identify the source of the problem. The FADIR test (flexion, adduction, internal rotation) assesses femoroacetabular impingement. The FABER test examines the sacroiliac joint and the hip. The lateral compression test evaluates the gluteal tendons. Strength tests : We assess the strength of your hip flexor, extensor, abductor, and rotator muscles. This information guides your exercise program. Palpation : Palpation of different structures (greater trochanter, tendons, muscles) helps locate the source of pain.

This comprehensive assessment allows for the creation of a personalized treatment plan. Each person receives a program tailored to their specific condition, fitness level, and goals.

What Techniques Does a Physiotherapist Use to Treat the Hip?

Physiotherapists have several techniques at their disposal, each supported by different levels of scientific evidence. Here are the main approaches.

Manual Therapy (Grade A)

Manual therapy includes techniques where the physiotherapist uses their hands to treat your hip.

Joint mobilization : Gentle to moderate movements applied to the hip joint. These techniques improve mobility and reduce pain. Different grades of intensity are used depending on your condition. Axial Distraction : A gentle traction of the hip that creates space within the joint. Studies show significant effects on pain and mobility. Mobilization with Movement : A technique where the physiotherapist guides your hip movement while you actively move. This approach shows significant effects on pain and range of motion. Soft Tissue Work : Massage, myofascial release, and pressure techniques on tense muscles around the hip.

Therapeutic Exercise (Grade A)

Exercise is the cornerstone of treatment. Typical programs include:

• Frequency: 1 to 5 times per week
• Duration: 30 to 120 minutes per session
• Period: 5 to 16 weeks

Progressive strengthening is more effective than aerobic exercises by themselves. The exercises target the gluteal muscles, hip flexors, core, and stabilizing muscles.

Aquatic therapy : Exercises in water are an excellent option. Buoyancy reduces stress on the joint while allowing for effective strengthening.

Dry Needling (Grade A, new in 2025)

The 2025 guidelines now give a Grade A recommendation to dry needling for hip osteoarthritis. This technique uses fine needles to treat trigger points (muscle tension knots) in the muscles.

Targeted muscles include the iliopsoas, rectus femoris, tensor fasciae latae, and gluteal muscles. Dry needling improves muscle flexibility, reduces pain, and enhances short-term mobility (3 weeks).

Patient education

Education is an integral part of the treatment. Your physiotherapist will teach you:

• To understand your condition and its natural progression
• How to manage the load on your hip daily
• How to recognize when to push yourself and when to slow down
• Self-management strategies for the long term

What exercises are part of a hip rehabilitation program?

A well-designed rehabilitation program targets several muscle groups. Here are the typical exercise categories.

Gluteal muscle strengthening

The gluteal muscles are essential for hip stability. Their weakness contributes to several conditions, including gluteal tendinopathy and lateral pain.

Exercise Examples :

• Side leg raises (lying on your side)
• Glute bridge with single-leg progression
• Side walk with resistance band
• Clamshell
• Lunge with knee control

Mobility exercises

Mobility exercises help maintain or improve your hip's range of motion.

Examples :

• Controlled hip rotations
• Seated hip flexion
• Gentle hip flexor stretches
• Figure-4 movements

Trunk stability

A stable core helps control your pelvis during hip movements.

Examples :

• Plank (with progressions)
• Dead bug
• Bird dog
• Diaphragmatic breathing with pelvic floor activation

Functional exercises

These exercises mimic everyday movements to prepare you for returning to your activities.

Examples :

• Squats with progression
• Going up and down stairs
• Sit-to-stand transfers
• Walking with resistance

Key Principles

Gradual Progression : We start gently and gradually increase intensity. Doing too much, too soon often worsens symptoms. Pain-Guided : A slight increase in pain during exercise is acceptable if it returns to baseline within 24 hours. Pain that persists or increases indicates that adjustments are needed. Supervised First : Exercises supervised by a physiotherapist yield better results than exercises performed alone. Once you've mastered the technique, you can continue at home.

How does physiotherapy treat different hip conditions?

Each condition requires a tailored approach. Here's how physiotherapy treats common hip conditions.

Hip osteoarthritis

Exercise is the first-line treatment for hip osteoarthritis. Guidelines recommend a 6 to 16-week program with 2 to 3 sessions per week initially.

The program includes:

• Progressive strengthening (quadriceps, abductors, hip extensors)
• Flexibility exercises
• Manual therapy as a complement
• Aquatic therapy as an effective alternative

The good news is that most people experience improvement in their pain and function. Many are able to delay or avoid surgery for years with this approach.

Gluteal bursitis and tendinopathy (GTPS)

Both hip bursitis and gluteal tendinopathy are treated with a similar approach. Treatment focuses on gradually loading the tendons, not on rest.

Key Principles :

• Avoid positions that compress the tendons (such as crossing your legs or IT band stretches).
• Start with isometric exercises (contractions without movement)
• Progress to isotonic exercises (with movement)
• Gradually add functional exercises

Typical Program : 8 to 14 sessions over 8 to 12 weeks with daily exercises at home.

Studies show that exercise is more effective than cortisone injections in the long term. At 1 month, injections appear to work better (75% success rate versus 7%). However, at 15 months, the situation reverses: exercise shows an 80% success rate compared to 48% for injections.

Femoroacetabular Impingement (FAI)

Conservative treatment for femoroacetabular impingement focuses on:

• Modifying activities that cause impingement
• Strengthening hip muscles (abductors, external rotators, core)
• Optimizing range of motion
• Movement re-education to avoid impingement positions

A 6 to 12-week trial of physiotherapy is recommended before considering surgery. Many individuals manage their condition well long-term without surgical intervention.

Hip impingement syndrome

Treatment for snapping hip syndrome depends on the type:

• External type (iliotibial band): IT band stretches, gluteal strengthening
• Internal type (iliopsoas): Iliopsoas stretches, eccentric exercises

The success rate of conservative treatment is high for both external and internal types. If the snapping is not painful, no treatment is usually necessary.

Adductor Tendinopathy

Adductor tendinopathy requires a step-by-step progression:

• Isometric exercises (without movement)
• Concentric exercises (contraction with shortening)
• Eccentric exercises (contraction with lengthening)
• Sport-specific loading

Recovery time varies: 2 to 3 weeks for mild cases, up to 3 to 6 months for chronic cases.

Adductor Strain

An adductor strain is an acute injury that requires a different approach:

• Acute Phase: Protection, relative rest, ice, compression
• Rehabilitation Phase: Gradual progression of exercises
• Return to Sport Phase: Activity-specific exercises

Recovery time depends on severity: 2 to 3 weeks for grades 1-2, up to 3 months for grade 3.

Post-Fracture Rehabilitation

After a hip fracture, physiotherapy is essential:

• Early mobilization (as soon as medically cleared)
• Progressive weight-bearing
• Strength and balance training
• Fall prevention

How long does hip physiotherapy treatment last?

The duration of treatment varies depending on your condition. Here are some realistic estimates.

Factors influencing duration :

• The severity of your condition
• How long you have had symptoms
• Your baseline physical activity level
• Your adherence to home exercises
• Your general health status

Key Point : Tendinopathies require patience. Unlike muscle injuries that heal in weeks, tendons take months to adapt. Progressing too quickly often sets back treatment.

Is physiotherapy as effective as injections or surgery?

Studies regularly compare physiotherapy to other treatments. The results are often surprising.

Exercise vs. Injection for Lateral Hip Pain (GTPS)

A significant study compared exercise, cortisone injections, and watchful waiting for people with lateral hip pain.

At 1 month :

• Injection: 75% success
• Exercise: 7% success
• Watchful Waiting: 17% success

At 15 months :

• Injection: 48% success
• Exercise: 80% success
• Watchful Waiting: 52% success

The message is clear: injections provide quick relief, but the effect diminishes. Exercise takes more time but yields better, lasting results.

Physiotherapy vs. Surgery for Osteoarthritis

Guidelines recommend at least 6 months of conservative treatment before considering hip replacement. The reason? Many people improve enough to delay or avoid surgery.

When conservative treatment is no longer enough, hip replacement is a very successful procedure. This is not a failure of physiotherapy; it's simply the right tool at the right time.

Physiotherapy vs. Surgery for FAI

A 6 to 12-week trial of physiotherapy is recommended before arthroscopy for femoroacetabular impingement (FAI). An important fact: 37% of adults without pain have a cam deformity on imaging. Therefore, an abnormal structure doesn't always cause problems.

When Does Surgery Become Necessary?

Physiotherapy is not the solution for all cases. Some situations require surgical intervention.

Clear Indications for Surgery :

• Hip Fracture: This is a medical emergency that generally requires prompt surgery.
• Failure of Conservative Treatment: After an adequate trial of physiotherapy (generally 3 to 6 months), if symptoms persist and significantly limit your function.
• Significant Mechanical Symptoms: Frequent locking, hip instability.
• Advanced Osteoarthritis with Severe Pain: When your quality of life is significantly affected.

Hip replacement is a very successful procedure when it's recommended. Over 95% of people are satisfied with the outcome. Physiotherapy remains important both before and after surgery to achieve the best results.

Rest assured: needing surgery is not a failure. It's about using the right tool for your situation. Pre-operative physiotherapy improves surgical outcomes, and post-operative rehabilitation is essential for optimal recovery.

What can you do at home between physiotherapy sessions?

Your active participation between sessions largely determines your results. Here's how to maximize your recovery.

Home exercise program

Your physiotherapist will prescribe exercises for you to do at home. These exercises are essential, not optional.

Practical Tips :

• Schedule a fixed time in your day
• Start with 15 to 20 minutes per day
• Consistency matters more than intensity
• Use an app or a journal to track your sessions

Managing daily activities

Some simple adjustments can reduce irritation in your hip.

For lateral hip pain (GTPS/gluteal tendinopathy) :

• Avoid crossing your legs
• Sleep with a pillow between your knees
• Avoid standing on one leg for long periods
• Avoid stretching the iliotibial band

For all conditions :

• Alternate positions (sitting, standing, walking)
• Avoid prolonged positions that increase pain
• Gradually increase your activities

What to Avoid

Complete rest is rarely the solution. Appropriate movement helps with healing. Prolonged rest can weaken muscles and worsen the problem in the long run. Too much too soon is also problematic. Listening to your pain is important. A slight increase in pain during exercise is acceptable. However, pain that persists or increases after exercise indicates that adjustments are needed. Ignoring the signals from your body can delay healing. Communicate with your physiotherapist if something doesn't feel right.

What results can you expect from physiotherapy?

Scientific data is encouraging. A meta-analysis of 18 clinical trials shows that physiotherapy has a beneficial effect on pain and function for hip problems.

Encouraging statistics :

• 70% to 90% of people report significant improvement
• Supervised programs show significant short-term and long-term improvements
• Exercise is superior to injections for lasting results

Realistic Expectations

Gradual improvement : Don't expect changes overnight. Improvement usually happens over several weeks. Normal fluctuations : You will have good days and less good days. This is normal. The overall trend is what matters. Ongoing care : For many conditions, especially osteoarthritis and tendinopathies, a long-term maintenance program is beneficial.

Factors that contribute to success

• Active participation: Doing your exercises regularly
• Positive attitude: Believing in your ability to recover
• Understanding your condition: Knowing why you are doing what you are doing
• Open communication: Telling your physiotherapist what is working and what isn't
• Patience: Accepting that some conditions take time

Key takeaways

Physiotherapy offers an effective and lasting approach to treating hip pain. Here are the key messages.

1. Physiotherapy is the first-line treatment. The 2025 clinical guidelines give it a Grade A recommendation, which is the highest level of evidence. 2. Treatment is personalized. A comprehensive assessment allows for the creation of a program tailored to your specific condition. 3. Exercise is the cornerstone of treatment. Supervised programs yield better results than exercises performed alone. 4. Each condition requires a specific approach. Osteoarthritis, tendinopathies, and femoroacetabular impingement each require different strategies. 5. Your active participation is essential. Home exercises and daily management make a significant difference. 6. Lasting results take time. Physiotherapy requires patience, but its benefits last longer than passive approaches. 7. Surgery remains an option when necessary. It's not a failure. It's the right tool at the right time.

If you are experiencing hip pain, a physiotherapist can assess your condition and suggest a tailored treatment plan. The sooner you start, the better the results generally are.