Physical therapy for
hip pain

Does physical therapy help for groin pain?

For many people, yes.

Guidelines for hip osteoarthritis and other hip conditions recommend education, exercise, and activity changes as core treatments, not as last resorts. These approaches can:

• Reduce pain
• Improve walking and daily function
• Build strength and balance
• Delay or sometimes avoid the need for surgery in some people⁵ ⁶ ⁹ ¹³

For problems like femoroacetabular impingement syndrome (FAI or abnormal bone contact due to shape variations) and gluteal tendinopathy, high quality studies show that structured physiotherapy can lead to meaningful improvement, and even when surgery is considered, having good strength and movement patterns first improves overall outcomes.² ³ ⁴ ⁷ ⁸

Physical therapy may not “fix” advanced joint damage, but it can often help you do more with less pain, and plays a key role before and after any procedures.² ³ ⁵ ⁶

Goals of physical therapy for hip pain

Physical therapy goals depend on what is driving your pain, your daily demands, and whether you are trying to return to sport, work, or simply move comfortably again.¹

Your plan is tailored to your diagnosis and goals, but common aims include:

• Reduce pain and stiffness in the hip, groin, or outer thigh
• Improve walking, stairs, and sit-to-stand from chairs or the floor
• Build strength in the hip, thigh, and core muscles
• Improve balance and confidence on the affected leg
• Support joint health in osteoarthritis with the right kind and amount of movement⁵ ⁶ ¹³
• Prepare for or recover from surgery when needed (such as a hip replacement or arthroscopy)
• Help you return to the activities and sports that matter to you, in a safe, graded way

What does physical therapy for hip pain involve?

Your exact program depends on what is driving your hip pain. A typical plan includes a mix of education, exercise, and activity changes, with options added for more complex cases.

1. Education and activity changes

Your clinician may help you:

• Understand whether your pain is more likely from osteoarthritis, outer hip tendons, FAI / labral (related to the hip flexible cartilage) problems, stress injury, or referred pain that starts in the back
• Adjust day to day activities such as breaking up long walks or standing, temporarily reducing deep squats, lunges, or high impact sessions, or using cushions or changing sleep positions if lying on the side is painful ⁵ ⁷ ⁸ ¹⁵
• Use a simple pain monitoring rule knowing that mild pain during exercise (up to 3 out of 10) that settles within 24 hours is usually acceptable, however pain that builds, lingers, or makes you limp usually means you did too much
• Education is not just “talking about it.” It is about giving you clear, practical rules so you can self-manage with confidence.⁵ ⁶ ⁹ ¹³

2. Exercise based rehabilitation

Hip osteoarthritis

For hip osteoarthritis, guidelines strongly recommend land based exercise and weight management when needed.⁵ ⁶ ¹³Your program will usually include:

Strengthening

• Hip abductors and extensors (side steps, bridges, hip thrusts)
• Quadriceps and hamstrings (sit-to-stand, step-ups, mini squats)

Neuromuscular and balance training

• Single leg balance, step and reach, gentle direction changes

Aerobic activity

• Walking, cycling, or water based exercise most days of the week

Weight management support

• if body mass index is high, since extra body weight increases joint load⁵ ⁶ ¹³

People often notice meaningful improvements in 6 to 12 weeks with a structured program, with further gains if they keep going.⁵ ⁶ ¹³

Femoroacetabular impingement syndrome and labral pain

Femoroacetabular impingement syndrome (FAI) happens when certain hip bone shapes and positions irritate the labrum and cartilage. Not everyone with “FAI shape” on a scan has symptoms. It is only called a syndrome when your symptoms, exam, and imaging all match.⁴ ¹⁴ First line care usually includes:² ³ ⁴

• Education about helpful and unhelpful hip positions
• Activity modification: Reducing deep, loaded hip flexion and twisting at first (for example very deep squats, long sitting in low chairs)
• Hip and trunk strengthening: Working on hip flexion, rotation control, and core stability
• Movement retraining: Adjusting squat depth, lunge patterns, and running or cutting mechanics

Randomised trials show that both arthroscopic surgery and structured physiotherapy can improve symptoms. In selected patients, surgery produced greater improvement at 12 months on patient reported scores, but people in the physiotherapy group also improved and not everyone needs surgery.² ³

Greater trochanteric pain syndrome / gluteal tendinopathy

Outer hip pain is often due to gluteal tendinopathy with or without bursitis.⁷ ⁸ Physical therapy here focuses on:

• Reducing compressive positions by avoiding lying on the painful side, avoiding standing with the hip “hanging” out to the side, and using a pillow between the knees in side lying⁷ ⁸ ¹⁵
• Progressive loading for the gluteal tendons, starting with lower load positions (for example side lying hip abduction, supported standing hip abduction) and progressing to heavier resistance and functional single leg tasks over time⁷ ⁸
• Lateral chain strength and control with step downs, side steps with bands, single leg stance progression

In the LEAP lateral hip pain trial, people with gluteal tendinopathy who did education plus hip strengthening had better global improvement and satisfaction at 52 weeks than those who had a corticosteroid injection or a “wait and see” approach.⁷ ⁸

Femoral neck stress injuries

For stress reactions or stress fractures at the neck of the femur, your plan will look quite different. Key elements may include:¹¹ ¹²

• Strict reduction or pause in impact load (and sometimes using crutches)
• Non impact exercise like cycling or swimming while bone heals
• Gradual, criteria based return to walking and running, guided by symptoms and imaging
• Addressing risk factors like training spikes, low energy availability or menstrual disturbance, low vitamin D, or bone density problems¹¹ ¹²

Tension side or displaced fractures (an unstable tiny crack in the bone) usually require urgent surgical fixation and close follow up.¹¹ ¹²

3. Medications and injections (alongside exercise)

Physical therapists do not prescribe medicine, but they work alongside your medical team.

Pain relief and anti inflammatories

• Short courses of non steroidal anti inflammatory drugs or simple pain relief can help during flares when used safely
• Paracetamol on its own has limited benefit for osteoarthritis, and long term opioids are discouraged.⁵ ⁶

Injections

• Hip osteoarthritis: Ultrasound guided corticosteroid injections can reduce pain for the short term and may help you take part in exercise. The effect often fades over weeks to months. Hyaluronic acid (substance found in the fluids in the eyes and joints that act like a lubricant) injections are not generally recommended.⁵ ⁶ ⁹ ¹⁶
• Gluteal tendinopathy: Corticosteroid injections can help short term but have worse outcomes than education plus exercise at one year.⁷ A platelet-rich plasma injection is a therapeutic treatment derived from your blood that can reduce tendon inflammation.
• Injections are usually seen as short term helpers, not stand alone solutions.

4. Surgery and physical therapy

Physical therapy is important before and after surgery:

Hip arthroscopy for FAI or labral problems

• Prehabilitation builds strength and prepares you for surgery
• After surgery, a structured plan restores motion, then strength and sport skills² ³ ⁴

Total hip replacement

• Before surgery, staying as strong and active as you can supports easier recovery
• After surgery, rehab focuses on walking, stairs, hip and leg strength, balance, and safe return to work and daily activities⁵ ⁶

Even when surgery is planned, good rehab is never wasted. It improves recovery and often your confidence in managing your hip long term.

What to expect from recovery

Everyone’s timeline is different, but typical patterns are:

Gluteal tendinopathy / GTPS: Many people with outer hip pain notice clear improvement in 8 to 12 weeks, with further gains over the year if they keep doing their exercises.⁷ ⁸

Hip osteoarthritis: Symptoms often fluctuate over years. With regular exercise and weight management when needed, many people can reduce pain and delay or avoid surgery for some time.⁵ ⁶ ¹³

FAI syndrome: Some improve well with a 3 month block of targeted physiotherapy. Others choose surgery after this, with both groups usually improving compared with their starting point.² ³ ⁴

Femoral neck stress injuries: Recovery can take months and must be guided carefully to avoid non union or complications.¹¹ ¹²

Your clinician will help set expectations based on your diagnosis, imaging (if any), general health, and activity goals.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

Clinical insight

Modern hip care has shifted away from a “wait until it is bad enough for surgery” mindset. Guidelines from NICE, AAOS, and OARSI all stress that exercise, education, neuromuscular training, and weight management are core treatments for hip osteoarthritis and should be offered to everyone, regardless of age or imaging severity. ⁵ ⁶ ⁹ ¹³