Physical Therapy For the Hip

Hip pain can arise from the joint itself, the surrounding muscles, or even be referred from other areas of the body, such as the knee or lower back.

There are many reasons you might experience hip pain: osteoarthritis, tendinopathy, fractures, overuse injuries, and more. Whether it’s a chronic condition, an acute injury, or post-surgery recovery, physical therapy is effective for easing pain and improving mobility. Hip therapy focuses on strengthening the muscles that support the joint, improving stability, and increasing coordination.

Several muscle groups in the lower back, hips, thighs, and buttocks work together to keep the hip joint functioning smoothly. Strengthening exercises for these muscle groups help build stability; flexibility exercises help maintain range of motion (ROM) and reduce stiffness; and stretching after activity can ease soreness and keep muscles resilient.

What Conditions Does It Treat?

• Hip fractures: PT focuses on regaining flexibility, strength, stability, and safe weight-bearing, as well as gait training if walking is affected.
• Tendonitis: Exercises that strengthen and stretch the surrounding muscles can help relieve pain when the tendons attached to the hip flexors become irritated.
• Osteoarthritis: PT can alleviate pain and improve ROM due to joint breakdown, and it can help with joint loading strategies and functional movement to reduce pain during daily activities.
• Strains and tears: When muscles are stretched beyond their limit or torn, PT can include gradual strengthening, neuromuscular re-education, and flexibility work.
• Bursitis: The bursa is a fluid-filled sac that cushions the joint space and reduces friction between muscle, tendons, and bones; inflammation (bursitis) leads to pain. PT uses manual therapy, stretching, and activity modification to reduce friction and, therefore, inflammation and pain.
• Post-surgery rehabilitation: PT exercises and activities strengthen the hip abductors and assist in gait retraining after hip replacement or major surgery.

How PT Helps

A Physical Therapist assesses each patient’s needs based on a medical history and physical exam. Treatment programs are customized to help each patient return to their pre-injury function and resume normal activities without pain.

Passive range of motion (PROM): The Physical Therapist will manually perform PROM (i.e., muscles are not activated by the patient) by flexing, extending, and rotating the leg and hip joint. PROM is used when movement is restricted due to pain, injury, or post-surgery to maintain joint mobility and prevent stiffness.

Active range of motion (AROM): The opposite of passive ROM, in which the patient actively moves the leg through flexion, extension, and rotation, with guidance from the Physical Therapist. AROM exercises strengthen the supporting muscles, maintain or restore function, and reduce the risk of re-injury.

Stretching: Exercises that stretch the musculature surrounding the hip can improve hip pain and function; they can also improve knee and lower back pain and function.

Strengthening: Exercises that target the muscles supporting the hip reduce strain on the joint, improve function, and help relieve pain. Strong hip muscles also support proper knee alignment, which can further decrease discomfort. The muscles that support the function of the hip are:

• Flexors (support hip flexion): psoas major, iliacus, pectineus, and (variably) psoas minor.
• Extensors (support hip extension and posterior stabilization): gluteus maximus, obturator externus
• External rotators (support lateral rotation of the hip): piriformis, superior gemellus, obturator internus, inferior gemellus, and quadratus femoris.
• Abductors (support leg movement away from the body): tensor fascia latae, gluteus medius, and gluteus minimus.
• Adductors (support leg movement toward the body): adductor magnus, adductor longus, adductor brevis, and gracilis.

Other treatment recommendations may include activity modification, heat and/or ice, and assistive devices such as a cane, walker, or crutches.

Walking, bending, climbing stairs – hip pain can make even simple daily activities challenging. Physical therapy works to restore strength, flexibility, and stability to the hip and surrounding muscles by improving joint support, coordinating movement, and reducing strain on the hip. With guided exercises, stretching, and strengthening, patients can rebuild function, improve balance, and move more confidently.