Physical therapy for hip pain

Physical therapy is the first-line treatment for most hip pain. The 2025 clinical guidelines give it a grade A recommendation, 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, physical therapy addresses the root causes of your pain. This guide explains how the treatment works, what you can expect, and why this active approach yields better long-term results. If you want to understand the different causes of hip pain first, check out our comprehensive guide to hip pain.

How does physical therapy help relieve hip pain?

Physical therapy 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 in a lasting way.

Here are the three pillars of treatment:

Therapeutic exercise is at the heart of treatment. The 2025 clinical guidelines give exercises a grade A recommendation for hip osteoarthritis. Programs supervised by a physical therapist 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 complete the exercises. Joint mobilization, 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 physical therapist explains what causes your pain, why movement helps, and how to manage your daily activities.

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

What happens during a physical therapy evaluation?

Your first session begins with a comprehensive assessment. The physical therapist needs to understand your condition before proposing a treatment plan. This assessment usually takes 45 to 60 minutes.

The initial interview

Your physical therapist will ask you several questions:

• Where do you feel the pain? The location provides important clues. Pain in the groin suggests a joint problem. Pain on the side points to the gluteal tendons.
• How did it start? A sudden injury or gradual onset indicates different conditions.
• What makes it worse or better? This information helps identify the structures involved.
• How would you rate your pain over a 24-hour period? Morning stiffness, nighttime pain, and changes throughout the day are diagnostic indicators.
• What treatments have you tried? Knowing what has worked and what hasn't guides therapeutic choices.

The physical examination

After the interview, the physical therapist examines your hip:

Observation We look at your posture, the way you walk, 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 how far your hip can move in all directions. A loss of internal rotation is often the first sign of a problem with the joint. 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 hip. The lateral compression test assesses the gluteal tendons. Strength tests : We assess the strength of your hip flexors, extensors, abductors, and rotators. This information guides the exercise program. Palpation Touching different structures (greater trochanter, tendons, muscles) helps to locate the source of pain.

This comprehensive assessment allows us to create a personalized treatment plan. Each person receives a program tailored to their specific condition, fitness level, and goals.

What techniques does a physical therapist use to treat the hip?

Physical therapists use several techniques, each supported by varying levels of scientific evidence. Here are the main approaches.

Manual therapy (Grade A)

Manual therapy includes techniques where the physical therapist 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 degrees of intensity are used depending on your condition. Axial distraction : Gentle traction of the hip that creates space in the joint. Studies show significant effects on pain and mobility. Mobilization with movement A technique where the physical therapist guides the movement of your hip while you actively move. This approach has been shown to have significant effects on pain and range of motion. Soft tissue work Massage, myofascial release, and pressure techniques on tight 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 yields better results than aerobic exercises alone. The exercises target the gluteal muscles, hip flexors, core, and stabilizing muscles.

Aquatic therapy Exercising in water is an excellent option. Buoyancy reduces stress on the joint while allowing for effective strengthening.

Dry puncture (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.

The targeted muscles include the iliopsoas, rectus femoris, tensor fascia lata, and gluteal muscles. Dry needling improves muscle extensibility, reduces pain, and improves mobility in the short term (3 weeks).

Patient education

Education is an integral part of treatment. Your physical therapist will teach you:

• Understanding your condition and its natural progression
• Managing the load on your hip on a daily basis
• Knowing when to push and when to slow down
• Long-term self-management strategies

What exercises are part of a hip rehabilitation program?

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

Strengthening the gluteal muscles

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

Exercise examples :

• Side leg lifts (lying on your side)
• Glute bridge with progression to one leg
• Sideways walking with elastic band
• Clamshell (opening of a clam)
• Split with knee control

Mobility work

Mobility exercises maintain or improve the range of motion in your hip.

Examples :

• Controlled hip rotations
• Hip flexion in a seated position
• Gentle stretches for the hip flexors
• Figure movements in 4

Core stability

A stable core helps control the pelvis during hip movements.

Examples :

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

Functional exercises

These exercises replicate everyday movements to prepare you to resume your activities.

Examples :

• Progressive squats
• Going up and down stairs
• Seated-standing transfers
• Walking with resistance

Important principles

Gradual progression We start slowly and gradually increase the intensity. Too much, too quickly often worsens the symptoms. Guided by pain A slight increase in pain during exercise is acceptable if it returns to baseline within 24 hours. Persistent or increasing pain signals that adjustments are needed. Supervised first Exercises supervised by a physical therapist yield better results than exercises done alone. Once you have mastered the technique, you can continue at home.

How does physical therapy treat different hip conditions?

Each condition requires a tailored approach. Here's how physical therapy treats the main hip conditions.

Hip osteoarthritis

Exercise is the first line of treatment forhip osteoarthritis. Guidelines recommend a 6- to 16-week program with 2 to 3 sessions per week at the beginning.

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: most people experience improvement in pain and function. Many delay or avoid surgery for years thanks to this approach.

Gluteal bursitis and tendinopathy (GTPS)

Hip bursitis and gluteal tendinopathy share a similar approach. Treatment is based on gradually loading the tendons, not resting them.

Key principles :

• Avoid positions that compress the tendons (crossing your legs, stretching the iliotibial band).
• 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 superior to cortisone injections in the long term. At 1 month, injections appear to work better (75% success rate versus 7%). But at 15 months, the situation is reversed: 80% success rate for exercise versus 48% for injections.

Femoroacetabular impingement (FAI)

Conservative treatment of femoroacetabular impingement focuses on:

• Modification of activities causing the conflict
• Strengthening the hip muscles (abductors, external rotators, core)
• Optimization of range of motion
• Movement rehabilitation to avoid conflicting positions

A trial period of 6 to 12 weeks of physical therapy is recommended before considering surgery. Many people manage their condition well in the long term without surgery.

Hip impingement syndrome

Treatment for hangover syndrome depends on the type:

• External type (iliotibial band): Stretching the band, strengthening the glutes
• Internal type (iliopsoas): Iliopsoas stretches, eccentric exercises

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

Adductor tendinopathy

Adductor tendinopathy requires a step-by-step approach:

• 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

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, physical therapy is essential:

• Early mobilization (as soon as medically cleared)
• Progression of loading
• Strength and balance training
• Fall prevention

How long does physical therapy treatment for the hip last?

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

Factors that influence duration :

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

Important point Tendinopathies require patience. Unlike muscle injuries, which heal within weeks, tendons take months to rehabilitate. Progressing too quickly often sets back treatment.

Is physical therapy as effective as injections or surgery?

Studies regularly compare physical therapy with other treatments. The results are often surprising.

Exercise against injection for lateral pain (GTPS)

A large study compared exercise, cortisone injections, and waiting in people with lateral hip pain.

At 1 month :

• Injection: 75% success rate
• Exercise: 7% success rate
• Expectation: 17% success rate

At 15 months :

• Injection: 48% success rate
• Exercise: 80% success rate
• Expectation: 52% success rate

The message is clear: injections provide quick relief, but the effect wears off. Exercise takes longer but gives better, longer-lasting results.

Physical therapy versus surgery for osteoarthritis

The 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 sufficient, hip replacement is a very successful procedure. It is not a failure of physical therapy. It is simply the right tool at the right time.

Physical therapy versus surgery for FAI

A 6- to 12-week trial of physical therapy is recommended before arthroscopy for femoroacetabular impingement. An important fact: 37% of adults without pain have a cam deformity on imaging. The abnormal structure therefore does not always cause problems.

When does surgery become necessary?

Physical therapy is not the solution in all cases. Some situations require surgical intervention.

Clear indications for surgery :

• Hip fracture: This is a medical emergency that usually requires prompt surgery.
• Failure of conservative treatment: After an adequate trial of physical therapy (usually 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 quality of life is significantly affected.

Hip replacement is a very successful procedure when indicated. Over 95% of people are satisfied with the results. Physical therapy remains important before and after surgery to optimize results.

Rest assured: needing surgery is not a failure. It's using the right tool for your situation. Preoperative physical therapy improves surgical outcomes, and postoperative rehabilitation is essential for optimal recovery.

What can you do at home between physical therapy sessions?

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

Home exercise program

Your physical therapist 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 a day.
• Consistency matters more than intensity.
• Use an app or journal to track your sessions

Management of daily activities

Some simple adjustments can reduce hip irritation.

For lateral pain (GTPS/gluteal tendinopathy) :

• Avoid crossing your legs
• Sleep with a pillow between your knees
• Do not stand on one leg for long periods of time.
• 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 aids recovery. Prolonged rest can weaken muscles and aggravate the problem in the long term. Overloading too quickly is also problematic. Listening to pain is important. A slight increase during exercise is acceptable. Pain that persists or increases after exercise signals that adjustments are needed. Ignoring signals of your body can delay healing. Contact your physical therapist if something is wrong.

What results can you expect from physical therapy?

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

Encouraging statistics :

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

Realistic expectations

Gradual improvement Don't expect overnight change. Improvement usually takes several weeks. Normal fluctuations There will be good days and bad days. That's normal. The overall trend is what matters. Maintenance required For several conditions, especially osteoarthritis and tendinopathies, a long-term maintenance program is beneficial.

Factors that promote success

• Active participation: Do your exercises regularly
• Positive attitude: Believe in your ability to recover
• Understanding your condition: Knowing why you do what you do
• Open communication: Tell your physical therapist what works and what doesn't.
• Patience: Accepting that certain conditions take time

Key points to remember

Physical therapy offers an effective and long-lasting approach to treating hip pain. Here are the key messages.

1. Physical therapy is the first line of treatment. The 2025 clinical guidelines give it a grade A recommendation, the highest level of evidence. 2. Treatment is personalized. A comprehensive assessment allows us to create a program tailored to your specific condition. 3. Exercise is the cornerstone of treatment. Supervised programs yield better results than exercises done alone. 4. Each condition has its own approach. Osteoarthritis, tendinopathies, and femoroacetabular impingement require different strategies. 5. Your participation is essential. Home exercises and daily management make all the difference. 6. Lasting results take time. Physical therapy requires patience, but the 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 physical therapist can assess your condition and provide you with a tailored treatment plan. The sooner you begin, the better the results will generally be.