Hip Pain Relief & Recovery: How an Exercise Physiologist Can Help
Hip pain can make everyday movements—like walking, standing, or sitting—uncomfortable or even unbearable. Whether caused by arthritis, injury, or muscle imbalances, hip pain often worsens without proper treatment.
As an Exercise Physiologist, Nick designs targeted rehabilitation programs to help patients reduce pain, restore mobility, and improve strength. This guide covers common hip conditions and how exercise therapy can support recovery.
​​
​Hip Osteoarthritis
The hip joint is made up of the femoral head (a ball shape) and the acetabulum (the joint’s socket). The weight-bearing nature of the hip joints predisposes the hips to gradual wear and tear, which can impact the articular cartilage of the ball and socket joint, leading to osteoarthritis (OA).
Signs and Symptoms
-
Pain around the hip joint, groin or referring pain down to the knee
-
Pain after long walks, or after standing for a long duration
-
Joint stiffness, usually in the morning
-
Pinching type pain with particular movements
-
Pain is usually intermittent, off/on pain, of varying severity
Treatment approach:
Keep Moving! When people experience pain from OA, they can become less active, which often makes their pain worse. Light stretching, walking, and general exercise decreases stiffness and weakness and improves pain, and preserves the strength of the hip joint!
Tailored Clinical Exercise will help to strengthen the muscles that support your hip (including your gluteals [buttock muscles], hip stabilisers and rotators, and other supporting muscles of the joint), thus decreasing the severity and re-occurrence of your hip pain. Osteoarthritis in general is an irreversible condition, BUT building muscle bulk and strength around the affected joints can help reduce the symptoms of OA.
Referral – If the hip OA pain is unrelenting, or the joint degeneration is severe enough, referral to an orthopaedic surgeon may be indicated, for a potential Total Hip Replacement.
​
Other things to be aware of:
Flare ups: Re-occurrences of osteoarthritic pain often occur, but it is important to remember that this is a normal pain behaviour for the condition. Complete rest (such as bed rest) is NEVER the answer – keep moving, keep positive – your symptoms will eventually settle down.
Take medication:
During acute flare ups, painkillers and anti-inflammatories can help control the severity of your symptoms. Ask your doctor or pharmacist what medication is right for you and be aware of possible side effects. In severe cases, medication can control the pain so that physical activity can begin.
gluteal tendinopathy & Hip Bursitis
Gluteal tendinopathy and hip bursitis fall under the category of Greater Trochanteric Pain Syndrome (or GTPS). This is an umbrella term for a range of conditions causing pain in the lateral hip.
This includes conditions such as trochanteric bursitis, and gluteal tendinopathy.
The exercise-based treatment for these conditions is very similar.
What is hip bursitis?
The greater trochanteric bursa is a small sac of fluid which acts as a lubricant for the tendons of the lateral hip over the thigh bone (femur). If this structure is irritated, it can become inflamed, leading to bursitis. This can cause pain locally at the greater trochanter (the bony part of the lateral hip), or refer pain down the lateral thigh. As this is an inflammatory issue, pain is generally worse at night, and can be painful to sleep on that hip as it causes direct pressure on the bursa.
What is gluteal tendinopathy?
Gluteal tendinopathy is generally thought to be caused by improper or excessive load on the gluteus minimus and/or medius tendons, leading to pain with use/load. The tendons’ fibre can become disarrayed and therefore can lose their regular load-bearing capacity. Pain is generally felt with pressure on the tendon itself on the lateral hip, and in the gluteus medius muscle belly (closer to the middle of the buttock). Pain for this issue is proportionate to load or activity – if the load or activity exceeds the current capacity of the tendon(s), this leads to pain either during or following the activity. Pain is generally worse in the morning upon rising from bed, as the tendon hasn’t “warmed up” yet.
Factors that can contribute to GTPS
-
Poor gluteal strength and capacity to tolerate load
-
Being overweight
-
Rushing headfirst into a full-on exercise program, without gradually building exercise capacity.
-
Direct falls or blows to the lateral hip
-
Poor exercise technique or biomechanical faults
-
Prolonged sitting
Treatment approach
Activity modification – Reducing or modifying any aggravating activities or exercises. As a general rule, pain shouldn’t be higher than 3-4 out of 10 either during or after any given activity or exercise. If this is higher, the load/intensity of this exercise needs to be reduced.
Abduction ISOs – Isometrics, or ISOs of the lateral hip muscles can help gradually build-up load capacity again with low risk of re-injury or pain flare-ups. In fact, ISOs can also have an analgesic effect on the lateral hip, reducing pain immediately after the exercise. An Exercise Physiologist or Physiotherapist can help guide you on the correct dosage and intensity of your ISO exercises.
Gradual return to full activity – As pain permits, slow re-introduction into full muscle contractions of the lateral hip muscles, with a focus on technique. Again, pain levels should not rise to higher than 3 or 4 out of 10 when these types of exercises get introduced. Once these are more tolerable, a gradual return to full activity can start to occur. If you are returning to sport, introduction of plyometric (jumping and landing) exercises is strongly recommended.
Other things to be aware of:
Avoid compression and stretching – a tightness feeling can occur in the lateral hip when you have GTPS. If this happens, avoid stretching the area, as the tendons and bursa DO NOT tolerate stretching well! Instead, try some ISOs. Avoid compression of the area too – sitting with legs crossed, sitting with hips flexed past 90degrees, and long periods of sitting can aggravate this issue.
Injections – for bursitis only, guided corticosteroid injections can be indicated if the hip pain doesn’t improve after a period of exercise-based treatment. Keep in mind though – injections only mask pain, so exercise is still paramount to build up the capacity of the lateral hip to tolerate loads again.
Hip Labral Tears
The hip joint is made up of the femoral head (a ball shape) and the acetabulum (the joint’s socket). This joint is deepened by a labrum (a sort-of joint covering) and stabilised with numerous ligaments, including the ligament of the head of the femur, or ligamentum teres.
Tears of these structures can lead to hip instability, when there is uncontrolled gliding of the hip joint during movement, which puts pressure on the supporting structures of the hip, causing irritation and pain.
What causes it?
Labral or lig teres tears usually occur as a result of a trauma or injury of the hip. This can be common in jumping sports such as football, basketball, netball and gymnastics, or in people who have been involved in car accidents.
Signs and symptoms
-
Anterior hip pain, mostly with certain movements such as bending, or twisting on the hips
-
Groin pain
-
Clicking hips, with the click being felt at the anterior hip
-
Periods of anterior hip irritation, particularly if the joint has been stressed repetitively (e.g. doing repeated squats)
-
Poor lifting technique and hip control with movements such as squats
-
Prolonged sitting
Treatment approach
Activity modification – avoid or modify activities that flare up your hip pain – change the height of your seat at work, avoid deep squatting at the gym, or use a mirror for feedback to ensure your hips are remaining steady through this movement. This will ensure that you keep any hip pain at bay whilst you strengthen up the stabilising muscles of the hips!
Referral – referral to a specialist hip surgeon is generally indicated for symptomatic hip labral or lig. Teres tears, to help repair the area. This, combined with some physiotherapy/exercise physiology led exercises, has the best outcomes long-term.
Tailored Clinical Exercise will help to strengthen the deep gluteal muscles which help provide a suction effect on the hip joint. This improves the glide of the femoral head (the ball) in the acetabulum (the socket), reducing any pressure on the other sensitive structures of the hip. This will help prepare you for any hip surgery (pre-habilitiation), can help reduce any pain associated with hip instability, and improve your long-term recovery!
Hip Impingement (FAI)
The head of the major thigh bone (femur) can impact or “impinge” on the rim of the of the acetabulum (hip socket). This irritates the surrounding joint structures, causing pain in the front of the hip, the groin and sometimes into the bottom and low back.
What causes FAI?
FAI is usually caused by bony abnormalities formed on either the femoral head or hip acetabulum (socket). These are called CAM or Pincer lesions, leading to FAI symptoms. Other factors such as previous hip injury, developing hip osteoarthritis, or hip instability can lead to FAI symptoms as well.
Signs and symptoms of FAI
-
Anterior/lateral hip pain, groin pain
-
Pain with particular movements, i.e. bending/crossing legs, getting in/out of car, bending to touch toes
-
Pain or stiffness after activity or in the morning
-
Irritation of the gluteal muscles (a secondary issue)
Treatment approach
Manual treatment – Utilising hip mobilisation with movement (or MWM) to try to restore the normal gliding motion of the hip joint in its socket. This may be combined with hip traction or other soft tissue work to help control your symptoms. This should not be solely relied upon, as evidence shows this approach works best in conjunction with strength training/exercise.
Tailored Clinical Exercise will help to strengthen the hip stabilising muscles that support and control the movement of your affected hip. This is the most important part of your hip rehab! This itself can often relieve pain, and works best to reduce pain in the long-term.
Referral – if your symptoms do not reduce after about 3 months of exercise-based rehab, our staff may choose to refer you to a hip surgeon to explore further options.
Hip pain doesn’t have to limit your life.
With the right exercise therapy and rehabilitation program, you can regain strength, mobility, and confidence in movement.
Book an assessment with Nick to start your recovery journey today.