Hip Pain: Causes and Home Exercises

Hip pain is common, especially as you get older, and in most cases it can be eased with simple steps you take at home ^[1]. The NHS notes that there are many possible causes — from a sudden injury to a longer-lasting problem such as arthritis — and advises you not to try to diagnose the cause yourself, and to see a doctor if the pain is stopping your normal activities or has not improved after two weeks of home treatment ^[1]. The good news: evidence shows that strengthening the muscles that support the hip helps reduce pain, makes the joint more stable, and can prevent further injury ^[2].

This article explains where hip pain comes from (bursitis, hip impingement, arthritis, and other causes), the step-by-step stretching and gluteal/hip strengthening movements you can do at home, and when you should see a professional. The information below is for general education only; personalized assessment and a tailored program require a doctor or physical therapist ^[1].

What are the most common causes of hip pain?

Hip pain rarely has a single cause; the location of the pain, when it gets worse, and any accompanying symptoms all help narrow down the likely cause. The NHS lists the most common causes of hip pain in adults as follows ^[1]:

• ·Osteoarthritis: Typically over the age of 45, with pain that is worse when walking and stiffness after moving ^[1].
• ·Sprain or strain, or tendonitis: Pain, swelling, or bruising after intense or repetitive exercise ^[1].
• ·Rheumatoid arthritis: Pain and stiffness that are worse after not moving (for example, when you wake up) ^[1].
• ·Bursitis: Pain that may spread to the upper leg (thigh) and may feel worse when moving or lying on the affected side ^[1].
• ·Joint infection (septic arthritis): A hot, swollen hip and a high temperature; this is an emergency ^[1].
• ·Hip fracture: Severe pain and being unable to walk after a fall or injury; this needs emergency assessment ^[1].

Keep in mind that the location of hip pain is an important clue to its cause: pain in the groin region is usually related to the joint itself (osteoarthritis, impingement), while pain on the outer (lateral) side of the hip is most often soft-tissue related (bursitis, gluteal tendon problems).

Trochanteric bursitis and lateral hip pain

Pain felt on the outer side of the hip, around the bony prominence of the thigh bone (the greater trochanter), is often grouped under greater trochanteric pain syndrome (GTPS). Physiopedia describes this as an umbrella term covering conditions such as inflammation of the bursa near the trochanter (trochanteric bursitis), wear of the gluteus medius/minimus tendons (tendinopathy), or friction of the iliotibial band ^[5]. The pain typically gets worse when lying on the affected side, climbing stairs, or after sitting and then standing for a long time. What was once simply called "bursitis" is now understood to be largely related to gluteal tendon loading ^[5]. For more detail, see our content on trochanteric bursitis.

Femoroacetabular impingement (FAI)

Pain in the groin and the front of the hip, especially with movement, is sometimes related to femoroacetabular impingement (FAI). Physiopedia describes FAI as a motion-related clinical disorder involving premature or abnormal contact between the acetabulum (socket) and the femoral head (ball) that make up the hip joint ^[6]. The pain is felt most often when the hip is flexed forward, brought inward (adduction), and forced into internal rotation; prolonged sitting or squatting can increase symptoms ^[6]. FAI can also occur in younger, active people. For details, our content on femoroacetabular impingement may help.

Hip osteoarthritis

Hip osteoarthritis is one of the most common causes of pain and stiffness in the hip over the age of 50. Mayo Clinic explains that in osteoarthritis the joint cartilage gradually wears down, and the symptoms include pain during or after movement, stiffness after being inactive (especially in the morning), loss of flexibility, and a grating sensation or popping when you use the joint ^[4]. According to OrthoInfo, the foundation of treatment for hip osteoarthritis is switching to lower-impact activities, weight management, and physical therapy exercises that increase range of motion and strength ^[3]. Mayo Clinic likewise stresses that exercise is one of the most effective interventions for hip pain; low-impact movements such as walking, cycling, or water exercise strengthen the muscles around the joint and make it more stable ^[4]. Although osteoarthritis damage cannot be reversed, staying active, maintaining a healthy weight, and appropriate treatments can slow progression and improve pain and function ^[4].

Why does exercise help with hip pain?

The role of exercise in hip pain is supported by strong evidence. The NHS states that one of the most important pieces of advice for easing hip pain is to "keep moving if you can," and that doing gentle hip stretching exercises — without overdoing it — can help ^[1]. OrthoInfo notes that strengthening the muscles that support the hip keeps the joint stable, can relieve pain, and can prevent further injury, and that stretching the muscles you strengthen helps restore range of motion and reduces muscle soreness ^[2].

When it comes to lateral hip pain (gluteal tendinopathy / GTPS), the evidence is especially interesting. The LEAP randomized controlled trial in Australia reported that a program of load-management education plus exercise delivered over 8 weeks produced better patient-reported global improvement and pain outcomes — at both 8 and 52 weeks — than a corticosteroid injection or a "wait and see" approach ^[7]. In other words, for many people a well-structured exercise program can provide a more lasting benefit than an injection.

The goal of exercise is not just to "build" muscle. The gluteal muscles in particular help keep the pelvis level during walking and single-leg stance; when this control weakens, the outer structures of the hip get overloaded. For this reason, gluteal strengthening aims both to reduce pain and to help the hip carry daily loads better ^[2][5].

What should you check before starting exercises?

OrthoInfo's hip conditioning program highlights a few ground rules before you begin ^[2]:

• ·Warm up: Before the exercises, warm up with 5 to 10 minutes of low-impact activity such as walking or riding a stationary bicycle.
• ·Stretch order: Do the stretching exercises first, then move on to strengthening; finish the program with stretching again.
• ·Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.
• ·Ask questions: If you are not sure how to do an exercise or how often to do it, contact your doctor or physical therapist before proceeding.

The NHS similarly advises avoiding too much strain on the hip, not carrying anything heavy, and not sitting in low chairs that put extra pressure on the hips; wearing comfortable, shock-absorbing shoes with a soft sole and losing weight if you are overweight also help ^[1]. The program below is adapted from OrthoInfo's general hip conditioning program; it is not a personalized prescription, and it should be performed under a professional's supervision to be safe and effective ^[2].

Step-by-step stretching exercises

Stretching keeps the muscles around the hip flexible and prepares the ground for strengthening exercises. The movements below are based on the descriptions in OrthoInfo's hip conditioning program and are generally done daily ^[2].

1. ·

   Standing iliotibial band stretch. Stand next to a wall for support. Cross the leg that is closest to the wall behind your other leg. Lean your hip gently toward the wall until you feel a stretch at the outside of your hip, and hold for 30 seconds. Repeat on the opposite side; repeat the entire sequence 4 times. Do not lean forward or twist at the waist. OrthoInfo recommends 2 sets of 4, daily ^[2]. You should feel this stretch at the outside of your hip.

2. ·

   Seated rotation (piriformis) stretch. Sit on the floor with both legs straight in front of you. Cross one leg over the other. Slowly twist toward your bent leg, placing one hand behind you for support; rest your opposite arm on your bent thigh and use it to twist further. Look over your shoulder and hold for 30 seconds, then slowly return to center. Reverse leg positions and repeat on the other side; repeat the entire sequence 4 times. OrthoInfo lists 2 sets of 4, daily ^[2]. You should feel this stretch in your buttocks as well as at your sides.

3. ·

   Knee to chest. Lie on your back with your legs straight. Bend one knee and grasp your shinbone with both hands. Gently pull your knee toward your chest as far as it will go. Hold for 30 seconds, then relax for 30 seconds. Repeat on the other side, then pull both legs in together. Keep your lower back pressed into the floor. OrthoInfo recommends 2 sets of 4, daily ^[2]. You should feel this stretch in your buttocks.

4. ·

   Supine hamstring stretch. Lie on the floor with both knees bent. Lift one leg off the floor and bring the knee toward your chest, clasping your hands behind your thigh below the knee. Straighten your leg and gently pull it toward your head until you feel a stretch. (If clasping your hands is difficult, loop a towel around your thigh and pull on the ends.) Hold for 30 to 60 seconds, then relax for 30 seconds. Repeat on the other side; repeat the entire sequence 4 times. Do not pull at your knee joint. OrthoInfo lists 2 sets of 4, daily ^[2]. You should feel this stretch at the back of your thigh and behind your knee.

Step-by-step gluteal and hip strengthening exercises

After stretching, strengthening the muscles that support the hip — especially the gluteus maximus, gluteus medius, abductors, and adductors — helps the hip carry loads better. The movements below are again based on the descriptions in OrthoInfo's hip conditioning program ^[2].

1. ·

   Side-lying hip abduction. Lie on your side with your injured leg on top and the bottom leg bent to provide support. Straighten your top leg and slowly raise it to about 45 degrees, keeping your knee straight but not locked. Hold for 5 seconds, slowly lower it, and relax for 2 seconds. Repeat, then do the other side. Do not turn your leg inward to lift it higher; the outside of your thigh should lift toward the ceiling. OrthoInfo recommends starting with 8 repetitions and progressing to 12 as it gets easier, 2 to 3 days per week ^[2]. You should feel this at your outer thigh and buttocks; it targets the gluteus medius and abductors.

2. ·

   Side-lying hip adduction. Lie on the side of your injured leg with both legs straight. Bend your top leg and cross it over your injured leg. Raise your injured (bottom) leg 6 to 8 inches off the floor, hold for 5 seconds, slowly lower it, and rest for 2 seconds. Repeat, then do the other side. Place your hand on the floor in front of your abdomen to keep from leaning backward. OrthoInfo recommends starting with 8 repetitions and progressing to 12, 2 to 3 days per week ^[2]. You should feel this at your inner thigh; it targets the adductors.

3. ·

   Prone hip extension. Lie on your stomach on a firm, flat surface with a pillow under your hips. Bend one knee 90 degrees. Lift your leg straight up, then slowly lower it to the floor while counting to 5. Repeat, then do the other side. Keep your head, neck, and upper body relaxed. OrthoInfo recommends starting with 8 repetitions and progressing to 12, 2 to 3 days per week ^[2]. You should feel this in your buttocks; it targets the gluteus maximus.

4. ·

   Clamshell. Lie on your side with your injured leg on top, your hips slightly bent, and your knees bent about 90 degrees. Stack your feet, knees, and hips on top of each other, and support your head with your arm. Keeping your feet together, slowly lift your top knee as high as you can without moving your pelvis, and hold for 5 seconds. Lower it back to the start while counting to 5. Repeat, then do the other side. Stay centered on your side and do not lean forward or backward. OrthoInfo recommends 1 set of 10 to 15 reps per side, daily ^[2]. This targets the gluteus medius, maximus, and minimus and the tensor fasciae latae, and is a key exercise for gluteal control.

5. ·

   Reverse clamshell. Lie on your side with your injured leg on top, your hips slightly bent, and your knees bent at 45 degrees. Stack your feet, knees, and hips on top of each other, and support your head with your arm. Keeping your knees together, rotate your top foot upward toward the ceiling. Slowly lower your leg back to the start while counting to 5. Repeat, then do the other side. Lightly engage your core throughout each movement. OrthoInfo recommends 1 set of 10 to 15 reps per side, daily ^[2]. This works the gluteus medius, tensor fasciae latae, and adductors.

According to OrthoInfo, this hip conditioning program should be continued for 4 to 6 weeks unless your doctor or physical therapist specifies otherwise; after recovery, it can be continued 2 to 3 days per week as a maintenance program to protect the long-term health of your hips and thighs ^[2]. If you are looking for individualized program support at home, you can read about our in-home orthopedic rehabilitation service.

When should you see a professional?

While steps you take at home help many people, some situations call for professional assessment. The NHS recommends seeing a doctor (GP) in the following situations ^[1]:

• ·Hip pain is stopping you from doing normal activities or affecting your sleep
• ·The pain is getting worse or keeps coming back
• ·The pain has not improved after treating it at home for 2 weeks
• ·You have hip stiffness for more than 30 minutes after waking up

Some symptoms call for more urgent assessment. The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have severe hip pain that started suddenly without a fall or injury, a hip that is swollen and feels hot, a change in skin color around the hip, or hip pain together with feeling generally unwell and a high temperature ^[1]. If you have severe hip pain after a fall or injury, are unable to walk or put weight on your leg, or have tingling or loss of feeling in your hip or leg after an injury, this is an emergency and you should go to A&E ^[1].

Pain that appears during exercise is also a warning sign. OrthoInfo states that you should not feel pain during an exercise and advises talking to your doctor or physical therapist if you do ^[2]. A physical therapist's supervision is important to confirm the diagnosis and tailor the program to you; the NHS also notes that physiotherapy, which helps with exercises and stretches, is one of the main treatments for hip pain ^[1].

Short Summary

• ·Hip pain has many causes — osteoarthritis, sprain/tendonitis, rheumatoid arthritis, bursitis, joint infection, and fracture are among the main ones; do not try to diagnose the cause yourself ^[1].
• ·Location gives a clue: groin pain is often related to the joint (osteoarthritis, FAI), while lateral hip pain most often comes from the gluteal tendons/bursa (GTPS) ^[5][6].
• ·Exercise is a first-line approach for many people; strengthening the muscles that support the hip stabilizes the joint, can reduce pain, and can prevent further injury ^[2].
• ·For gluteal tendinopathy (GTPS), education plus exercise has been reported to produce better long-term outcomes than a corticosteroid injection ^[7].
• ·The program should be done with a warm-up and stretching, kept at a pain-free threshold, and progressed gradually; OrthoInfo's program is typically continued for 4 to 6 weeks ^[2].
• ·Severe sudden pain, a hot and swollen hip, a high temperature, or being unable to walk after an injury all call for emergency assessment ^[1].

Frequently Asked Questions

Is it safe to exercise with hip pain?

In most cases yes, and it is even recommended. The NHS advises keeping moving if you can and doing gentle stretching exercises to ease hip pain, while being careful not to overdo it ^[1]. However, if the cause of the pain is unclear or the pain increases with exercise, it is best to check with a doctor or physical therapist before starting a program ^[2].

Is my lateral hip pain caused by bursitis?

Not necessarily. Pain on the outer side of the hip used to be called "trochanteric bursitis," but it is now grouped under greater trochanteric pain syndrome (GTPS) and is largely related to gluteal tendon loading ^[5]. A professional assessment is needed to determine the exact cause.

Does exercise wear out the joint more in hip osteoarthritis?

No. OrthoInfo and Mayo Clinic note that low-impact exercise is a core part of treatment for hip osteoarthritis; it strengthens the muscles around the joint, makes it more stable, and can improve pain and function ^[3][4]. The key is to avoid high-impact activities and stick to an appropriate, gradual program.

How many times per week should I do the exercises?

It depends on the movement. In OrthoInfo's program, stretches are recommended daily, some of the strengthening movements (abduction, adduction, extension) 2 to 3 days per week, and the clamshell and reverse clamshell daily ^[2]. After recovery, a maintenance program can be continued 2 to 3 days per week. Ask your physical therapist about a frequency tailored to you.

How long does it take to see results from the exercises?

It varies from person to person. OrthoInfo's hip conditioning program is typically continued for 4 to 6 weeks ^[2]. Studies on gluteal tendinopathy have reported that an education-plus-exercise program can produce clear improvement by week 8, with the benefit sustained at week 52 ^[7].

Is an injection better than exercise?

For most people, no. The LEAP trial showed that an education-plus-exercise program produced better outcomes than a corticosteroid injection in gluteal tendinopathy, over both the short and long term ^[7]. The NHS notes that injections can help in some cases, but exercise and physiotherapy are first-line treatments for most hip pain ^[1].

When should I stop exercising and see a doctor?

If you feel pain during an exercise, stop and talk to your doctor or physical therapist ^[2]. Also see a doctor if the pain has not improved after two weeks of home treatment, is getting worse, is affecting your sleep, or causes stiffness for more than 30 minutes in the morning ^[1].

How do I suspect a hip fracture?

According to the NHS, severe hip pain and being unable to walk after a fall or injury are typical signs of a hip fracture and require emergency assessment ^[1]. In that case, do not try to put weight on your leg; go to A&E and call for emergency help if needed ^[1].