Pain guide
Most hip pain that is not from an injury gets better with the right exercise, and for the common causes exercise is the first treatment guidelines recommend. Where you feel the pain is the best first clue to what is going on.
Start with the warning signs below. Then find your pain on the map, read what helps, and follow the plan from stage 1.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Often the hip joint itself: arthritis from mid-life, impingement or a labral problem in younger active people. Pain lifting the knee or kicking points to the hip flexors.
Read: Hip arthritis →Outside of the hipThe bony point you lie on. Usually the gluteal tendons (often called hip bursitis): worse lying on that side, on stairs and after sitting cross-legged.
Read: Outer hip pain (hip bursitis) →Groin in someone young and activeA deep pinch with deep bending, sitting low or getting out of a car suggests hip impingement or a labral problem.
Read: Hip impingement and labral tears →Front of the hip when lifting the kneePain when you sprint, kick or climb stairs, often after a sudden effort, points to the hip flexors.
Read: Hip flexor pain →Inner thigh or pubic boneWorse with kicking, sprinting, cutting and squeezing the knees together: usually adductor-related groin pain.
Read: Groin strain →ButtockCan come from the hip joint, the lower back, the sacroiliac joint or the hamstring tendon. Pain below the knee or pins and needles suggests a nerve.
Read: Piriformis syndrome and buttock pain →In a study of people whose pain was confirmed to come from the hip joint, 71% felt it in the buttock, 57% in the thigh and 55% in the groin; it never spread to the low back. The reverse is also true: back problems often send pain into the buttock and leg.
So use the map to choose a starting point, not to diagnose yourself. If the pain does not settle, or does not fit, get it assessed.
Hip and groin pain in pregnancy is often pelvic girdle pain. The NHS advises staying active within comfort, keeping the knees together getting in and out of a car, a pillow between the knees in bed, and asking for a physiotherapy referral. This guide's plan is not written for pregnancy.
Source 19
NICE, the American College of Rheumatology and OARSI all make exercise a core treatment for hip osteoarthritis. On average it lowers pain by about 8 points on a 0 to 100 scale and improves daily function: a real but modest effect that lasts while you keep it up.
In the LEAP trial, people with gluteal tendon pain who learned to avoid compressing the tendon and did a progressive exercise programme did better at 8 weeks than those given a steroid injection or told to wait and see.
Source 11
An international consensus recommends at least 3 months of exercise-based treatment for hip-related pain (impingement and labral problems) in young and middle-aged active adults, while noting that strong trial evidence is still lacking.
Source 13
A meta-analysis found strength training through a full range improves flexibility about as much as stretching does. Stretch if it feels good, but do not rely on stretching alone to fix a painful hip.
Source 14
During the exercise, pain up to about 5 out of 10 is acceptable. It should settle within an hour or so, and your hip should be no worse that night or the next morning. If it is, do less next time (fewer repetitions, a smaller range, a lighter load), not nothing.
Pain can go up a little when you start a new exercise programme; guidelines for arthritis say so and still recommend keeping going. If pain climbs week after week, or a warning sign appears, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
For the first one to two weeks, or while it is flared up. Gentle movement through a comfortable range, once or twice a day.
3D demoGlute bridgeBeginner · No equipment2 sets of 8 to 10, small range
Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)
3D demoStanding marchBeginner · No equipment10 each side, holding a counter
Harder: Standing band hip flexion
3D demoSit to stand from a chairBeginner · A bench or box2 sets of 5 to 8, hands allowed
Harder: Bodyweight squat
3D demoSingle-leg standBeginner · A wall3 holds of 10 to 20 s each side, fingertips on a support
Easier: Tandem stance and heel-to-toe walk · Harder: Single Leg Reach Matrix
Move on when: These feel easy, and your hip is no worse the next morning.
Weeks 2 to 6. Two or three days a week, plus walking or cycling on most days.
3D demoStaggered-stance bridge (offset bridge)Beginner · No equipment2 to 3 sets of 8 each side
Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)
3D demoSide-lying leg raiseBeginner · No equipment2 to 3 sets of 8 to 12 · Clamshells if this irritates
Easier: Lateral band walk · Harder: Step-up with knee raise
3D demoSit to stand from a chairBeginner · A bench or box3 sets of 8 to 10, lower seat, no hands
Harder: Bodyweight squat
3D demoLateral band walkBeginner · A band2 sets of 10 steps each way
Easier: Hip abduction machine · Harder: Side-lying leg raise
Move on when: You can do every set with good control and only mild pain that settles by the next day.
From about week 6. Keep two strength days a week going once the pain has settled.
3D demoDumbbell goblet squatIntermediate · A dumbbell3 sets of 8 to 10, to a box or chair
Easier: Bodyweight squat · Harder: Back squat with bands
3D demoSplit squatIntermediate · No equipment3 sets of 6 to 10 each side
Easier: Bodyweight squat · Harder: Reverse lunge
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell3 sets of 8 to 10
Easier: Hip-hinge practice · Harder: Single-leg Romanian deadlift
3D demoSingle-leg glute bridgeIntermediate · No equipment2 to 3 sets of 8 each side
Easier: Glute bridge · Harder: Alternate-leg bounding
3D demoPatrick step-downIntermediate · A step2 to 3 sets of 8 each side
Easier: Bodyweight squat · Harder: Skater squat
Move on when: Add load or move to the harder option listed under each exercise, one change at a time.
Hold 2 to 3 times for 20 to 30 seconds, a mild stretch, never sharp.
| Stretch | Reasonable for | Take care or skip | Why |
|---|---|---|---|
| Half-kneeling hip flexor stretch | General stiffness; arthritis if kneeling is comfortable | A fresh hip flexor strain; impingement if it pinches at the front | A mild stretch at the front of the hip. Tuck the pelvis rather than lunging deeper. |
| Pigeon preparation (Eka Pada Rajakapotasana prep) | General hip stiffness; some deep buttock pain | Outer hip pain if it hurts on the outside; impingement if it pinches the groin; knee pain | Deep bending and turning out. It may feel good, but it does not treat a nerve. |
| Reclined figure four (eye of the needle, Sucirandhrasana) | Deep buttock pain; general stiffness | Outer hip pain if it provokes the outside of the hip | Similar to a position clinicians use to provoke gluteal tendons. |
| Knee Across The Body | Low back stiffness only | Skip with outer hip pain | Pulling the thigh across the body compresses the gluteal tendons. |
| Bound angle pose (Baddha Konasana) | Inner thigh stiffness; arthritis, gently | A fresh adductor strain | An adductor stretch with the hips bent. |
| Hip Windshield Wipers | Arthritis; impingement in a small range; general stiffness | After a hip replacement, check with your surgeon | Gentle rotation that is easy to keep pain-free. |
| Supine heel slide | Arthritis flares; stretching in bed | None within comfort | Bends the hip with almost no load. |
| Supine hamstring stretch with a strap | Most people | Keep it gentle with sciatica-type nerve symptoms | Can tension the sciatic nerve. |
Exercise is the first treatment for hip osteoarthritis in NICE, ACR and OARSI guidelines. A 3-stage plan with 3D demos, starting doses and what to avoid.
Pain guideOuter hip pain is usually the gluteal tendons, not just a bursa. The trial-tested approach: what to avoid, then a staged exercise plan with 3D demos.
Pain guideHip impingement and labral tears in active adults: what a scan does and does not mean, a 3-month exercise plan with 3D demos, and what trials say about surgery.
Pain guidePain at the front of the hip when you lift your knee or sprint. A staged strengthening plan with 3D demos, and what sitting really does to your hip flexors.
Pain guideGroin strain rehab that works: active strengthening beat passive care, and one exercise cut footballers' groin problems by 41%. A staged plan with 3D demos.
Pain guideMost buttock pain isn't the piriformis. How to tell hip, back and nerve pain apart, gentle stretches that may help, and a staged plan with 3D demos.
A 15-minute hip opener: 90/90 switches, windshield wipers, CARs, Cossack squats, frog and pigeon.
15 minIntermediate8 movesA wallA 25-minute glute workout with bodyweight and a mini band: bridges, clamshells, band walks, kickbacks and lunges.
25 minBeginner9 movesA wall, A bandA gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepFor most hip pain without warning signs, yes. Guidelines for hip arthritis recommend aerobic activity such as walking alongside strengthening. Start with short, comfortable walks, break them up if needed, and build the time gradually. Outer hip pain is the exception that needs care: walk with your weight even on both feet rather than hanging on the sore hip.
The most common reason is lying on a sore outer hip, which presses on the gluteal tendons; a pillow between the knees and lying on the other side usually helps. Pain that is constant, does not change with position, and comes with weight loss, fever or a history of cancer is different and needs checking.
Low chairs bend the hip deeply, which can pinch an arthritic or impinging hip, and sitting cross-legged compresses the outer hip tendons. A higher seat, knees apart and hips a little higher than the knees often helps. Pain at the sitting bone with hamstring use is a different problem (hamstring tendon).
Strengthen first. The trials that helped hip pain were built on strengthening and education, and strength training improves range about as much as stretching does. Stretches are fine if they feel good, but some, such as pulling the knee across the body, aggravate outer hip pain.
It depends on the cause. People in exercise programmes for arthritis are usually measured at 6 to 12 weeks; outer hip tendon pain often takes months. Steady progress over weeks matters more than any single day.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
