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Pain Library/Hip pain

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Hip pain. Moveable.

Hip pain can stem from the joint itself, surrounding muscles, or referred pain from the lumbar spine. Identifying the source is the first step — then targeted corrective exercise can make a significant difference.

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Person performing a deep hip mobility drill and hip flexor stretch movement

Quick facts

  • Hip pain affects up to 14% of adults over 60
  • Hip osteoarthritis is the most common cause in older adults
  • Hip flexor tightness is extremely common in people who sit for long periods

Pain Library

Understanding hip pain

The hip is a ball-and-socket joint designed for both stability and mobility. Pain can arise from the joint itself (osteoarthritis, labral tears, femoroacetabular impingement), the surrounding soft tissues (bursitis, tendinopathy, hip flexor strain), or be referred from the lumbar spine.

Hip osteoarthritis — the most common cause of hip pain in adults over 50 — is characterized by gradual loss of cartilage and joint space. Despite what many people believe, exercise does not accelerate cartilage loss and is the most evidence-supported treatment for managing symptoms and maintaining function.

Hip flexor tightness is extremely common in people who spend long hours sitting. Tight hip flexors increase anterior pelvic tilt, which loads the lumbar spine and can contribute to both hip and back pain. NASM identifies this as a key component of lower crossed syndrome.

Important: Red flags: hip pain following a fall or trauma (possible fracture), groin pain with fever (possible infection), or sudden severe hip pain with inability to bear weight. These require urgent medical assessment.

NASM-based corrective exercises

Movements that help.

  • Lengthen — Hip Flexors

    Kneeling Hip Flexor Stretch

    NASM identifies the iliopsoas and rectus femoris as the primary overactive muscles in lower crossed syndrome — a postural distortion pattern that drives hip and low back pain. The kneeling lunge stretch is the most effective technique for lengthening these muscles and restoring neutral pelvic alignment.

    • Kneel on one knee with the other foot forward in a lunge position — use a mat for comfort
    • Shift your weight forward until you feel a stretch in the front of the back hip and thigh
    • Keep your torso upright and your core gently braced — do not let the lower back arch excessively
    • Hold 30 to 45 seconds, 3 repetitions per side — perform daily, especially after prolonged sitting
    See full exercise guide

  • Activate — Hip Abductors

    Clamshell

    The clamshell isolates and activates the gluteus medius and minimus — the hip abductors that are consistently underactive in people with hip pain, knee pain, and IT band syndrome. NASM includes this as a primary activation exercise for lower extremity dysfunction.

    • Lie on your side with your hips and knees bent to approximately 45 degrees
    • Keep your feet together and rotate your top knee upward like a clamshell opening
    • Do not let your pelvis roll backward — the movement should come entirely from the hip
    • 15 repetitions, 3 sets — add a resistance band above the knees when the exercise becomes easy
    See full exercise guide

  • Integrate — Hip Mobility

    90/90 Hip Stretch

    A comprehensive hip mobility exercise that addresses both internal and external rotation — often the most restricted movements in people with hip pain and osteoarthritis. The 90/90 position allows you to work both hips simultaneously and identify asymmetries in range of motion.

    • Sit on the floor with both legs bent at 90 degrees — one leg in front, one behind you
    • Sit tall and lean gently forward over the front leg to deepen the external rotation stretch
    • Switch sides by rotating through the hips — keep your hands on the floor for support
    • Hold 30 seconds each side, 3 repetitions — perform daily for hip mobility maintenance
    See full exercise guide

Physical therapy equipment

Tools that support your recovery

Affiliate disclosure: links below go to Amazon. If you purchase through them, we may earn a small commission at no extra cost to you. We only recommend equipment used in physical therapy practice.

Hip Activation$12 – $28

Resistance Loop Bands

Fabric loop resistance bands for clamshell, lateral band walk, and hip abductor activation exercises. Fabric bands stay in place better than latex during hip-focused movements.

Why it helps: Provides progressive resistance for gluteus medius activation — the most commonly underactive muscle in hip pain and lower extremity dysfunction.

Self-Myofascial Release$20 – $45

Foam Roller (Full-Length)

Full-length foam roller for IT band, TFL, and hip flexor SMR. Rolling these overactive tissues before stretching is the NASM inhibition step for hip pain correction.

Why it helps: Reduces hypertonicity in the TFL and IT band that causes lateral hip pain and alters hip joint mechanics.

Training Surface$25 – $60

Exercise Mat (Thick)

Extra-thick (1/2 inch or more) exercise mat for floor-based hip mobility work. The 90/90 stretch, clamshell, and hip flexor stretch all require comfortable, cushioned floor contact.

Why it helps: Allows sustained holds in hip mobility positions without discomfort from hard floors — critical for achieving the 30-45 second stretch durations needed for tissue change.

Mobility Aid$10 – $25

Hip Flexor Stretching Block

Foam yoga block or kneeling pad for supported hip flexor and 90/90 stretching. Reduces knee discomfort during kneeling lunge stretches, allowing longer, more effective holds.

Why it helps: Removes the barrier of knee discomfort that causes people to cut hip flexor stretches short before the tissue has time to lengthen.

Common questions

Common questions.

Answers to the questions we hear most often about hip pain.

  • Yes — walking is one of the best exercises for hip osteoarthritis. It maintains joint mobility, strengthens surrounding muscles, and has been shown to reduce pain and improve function. Start with comfortable distances and gradually increase. Swimming and cycling are excellent low-impact alternatives if walking is initially painful.

  • Hip bursitis (trochanteric bursitis) is inflammation of the bursa on the outer hip, causing pain on the side of the hip that is worse with lying on that side or climbing stairs. Hip osteoarthritis causes groin pain and stiffness that is worse with weight-bearing and improves with rest. Both respond well to corrective exercise, though the specific exercises differ.

    Outer hip pain is more likely bursitis or gluteal tendinopathy. Groin pain is more likely the hip joint itself. A physical therapist can help distinguish between the two.

  • Hip replacement is typically considered when: pain significantly limits daily activities, conservative management (corrective exercise, physical therapy, medication) has been tried for at least 3 to 6 months without adequate relief, and quality of life is substantially affected. Modern hip replacements have excellent outcomes, with most people returning to full activity within 3 to 6 months.

  • Yes — hip weakness (particularly the hip abductors) is a common cause of knee pain. When the hip abductors are weak, the femur drops inward during weight-bearing, increasing stress on the knee. This is a common cause of patellofemoral pain syndrome and IT band syndrome. Strengthening the hips often resolves knee pain without treating the knee directly.

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Next steps

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Medical disclaimer: The information on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting any exercise program, particularly if you have a medical condition or have recently been injured. Read our full disclaimer.