Hip pain needs more than a generic stretch.
Pain at the side of the hip, groin or buttock can come from different areas. The first step is working out what movements and loads are actually provoking it.
At Flow Clinic in Wairau Valley, we assess hip movement, glute strength, walking and single-leg control, as well as possible lower-back or nerve involvement. Treatment is then built around progressive strengthening and a practical return to normal activity.
Hip pain often shows up during everyday loading.
Symptoms may begin after a fall or sporting injury, but they can also develop gradually after a change in walking, running, gym training, work demands or sitting time.
Pain when lying on one side
Pain over the outside of the hip may become noticeable at night, when crossing the legs, walking up hills or repeatedly standing on one leg.
Pain with single-leg loading
Walking, running, stairs and step-down movements can expose reduced hip strength or poor tolerance to repeated load through one side.
Pain that travels or changes
Buttock pain that spreads into the thigh or lower leg may require screening of the lumbar spine and nervous system, especially when numbness, tingling or weakness is present.
“Hip pain” can describe several different clinical patterns.
Pain location does not give a diagnosis by itself, but it helps guide what needs to be tested and how rehabilitation should begin.
Lateral hip and gluteal tendon pain
Greater trochanteric pain syndrome is a common description for pain over the outside of the hip. The gluteus medius and minimus tendons, surrounding bursa and sensitivity to compression may all be relevant.
- Pain directly over the outside of the hip
- Difficulty lying on the painful side
- Pain with stairs, hills or longer walks
- Discomfort while standing on one leg
- Symptoms after an increase in running or gym load
Anterior hip and groin pain
Pain at the front of the hip or groin can relate to the hip joint, hip flexor, adductor region or another local structure. Deep flexion and twisting movements are often relevant during assessment.
- Pain at the front of the hip or groin
- Discomfort with deep squatting
- Pain when turning or changing direction
- Symptoms during running, kicking or lunging
- Pain or restriction during hip rotation
Buttock and posterior hip pain
Pain around the buttock may involve local gluteal muscle, proximal hamstring, deep gluteal structures or symptoms referred from the lower back.
- Pain around the buttock or sitting bone
- Symptoms with prolonged sitting
- Pain during hip hinging or acceleration
- Reduced tolerance to uphill running
- Possible overlap with lumbar symptoms
Lumbar or sciatic-type pain
Symptoms felt around the hip are not always generated by the hip itself. A nerve or the lumbar spine may contribute when pain travels or is associated with sensory or strength changes.
- Burning, electric or shooting pain
- Tingling or numbness in the leg
- Symptoms extending below the knee
- Changes in leg or foot strength
- Pain affected by spinal position or prolonged sitting
The painful area is only one part of the assessment.
The hip is a ball-and-socket joint surrounded by muscles and tendons that control the pelvis and lower limb. Pain may come from the joint itself, the surrounding gluteal tendons, local muscles or a nearby structure.
We also look beyond the painful point. Walking and single-leg movement involve the trunk, pelvis, knee, ankle and foot, so reduced capacity elsewhere can affect how the hip is loaded.
- Hip flexion, extension and rotation
- Gluteal and hip muscle strength
- Pelvic and trunk control
- Single-leg balance and step control
- Walking, running and footwear demands
Glute strengthening should progress beyond basic activation.
A bridge can be a useful starting exercise, but it is not the final goal. Rehabilitation should gradually prepare the hip for the amount and type of load it needs to handle in daily life.
- Begin at a level that does not repeatedly flare symptoms
- Build hip abductor and extensor strength
- Progress into standing and single-leg exercises
- Add speed, running or sport demands when appropriate
A hip programme should change as your capacity improves.
Exercise selection is based on pain irritability, current strength and what you need to return to. Not every person needs every stage, and progression is adjusted according to symptom response.
Early strength and pain control
Early rehabilitation may include hip abduction isometrics, supported bridges, controlled sit-to-stand exercises and gentle hip movement. The aim is to maintain activity while reducing repeated irritation.
Glute and hip strength
Resistance can then be increased through bridges, standing hip abduction, banded side steps, squats, hip hinges and other exercises selected for the individual presentation.
Single-leg control
Step-ups, controlled step-downs, split squats and single-leg balance tasks help connect hip strength with pelvic, knee, ankle and foot control during functional movement.
Heavier functional loading
Later rehabilitation may include heavier squats, Romanian deadlifts, lunges, loaded step-ups and single-leg strength work to prepare for work, gym training or longer walking.
Running and impact preparation
People returning to running or sport may need calf strength, faster step work, hopping, landing and gradual exposure to hills, acceleration and changes of direction.
Return to normal activity
Walking, training and sport volume are rebuilt gradually. Progress is based on function and the symptom response later that day and the following morning, not pain during one exercise alone.
Strength is important, but the assessment is broader than a muscle test.
We use the history and physical examination to decide whether the main issue appears local to the hip or whether another area needs to be considered.
Range and symptom response
Hip flexion, extension, internal and external rotation may be assessed alongside resisted muscle testing and palpation of the relevant area.
Walking and single-leg tasks
Gait, standing balance, squat, step-down and single-leg movement can show how the trunk, pelvis and lower limb behave under load.
Referred and neural symptoms
When symptoms travel, change with spinal movement or include numbness or weakness, lumbar movement and neurological findings may need to be screened.
A clear plan from assessment to stronger movement.
Treatment is organised around your pain pattern, current capacity and the activities you need to return to.
Understand the history
We review how symptoms began, what makes them worse, your current walking or training load, previous injuries and any signs suggesting referral or imaging may be needed.
Test the relevant areas
Assessment may include hip movement, strength, gait, balance, squat and step tasks, as well as lumbar or neurological screening when indicated.
Start at the right load
Exercises are chosen according to symptom irritability and current capacity. Load, range, repetitions and resistance are adjusted rather than using one standard programme.
Build back to function
Strength and activity are progressed toward walking, stairs, work, gym training, running or sport with regular reassessment of function and symptom response.
Buttock pain can come from the hip, the back or the nervous system.
These patterns can overlap. The aim is not to label every buttock pain as a tight piriformis or every leg symptom as a hip problem.
Features more consistent with local hip pain
A local pattern becomes more likely when pain is consistently reproduced by direct pressure, hip movement, resisted hip muscle loading or specific single-leg tasks.
- Local tenderness around the hip
- Pain when lying on the affected side
- Pain during resisted hip muscle testing
- Symptoms with stairs or single-leg loading
- No clear numbness or neurological change
Features suggesting referred or nerve-related pain
Lumbar or nerve involvement is more relevant when symptoms travel down the leg or include altered sensation, burning, electrical pain or measurable weakness.
- Pain extending below the knee
- Tingling, numbness or burning
- Symptoms affected by spinal position
- New leg or foot weakness
- Changes in reflexes or sensation
Seek urgent medical care for new bladder or bowel control problems, numbness around the genital or saddle region, rapidly worsening leg weakness, severe symptoms affecting both legs, major trauma with inability to bear weight, or a hot and swollen hip with fever.
Treatment should help you tolerate more useful activity.
The exact combination depends on the pain pattern, duration, strength, activity goals and whether another area is contributing.
Manage the irritating loads
We identify positions, work tasks and training loads that repeatedly flare the hip, then modify them without automatically stopping all movement.
Progressive hip and lower-limb strength
Strengthening is progressed from controlled early exercises into standing, single-leg and activity-specific work as symptoms and capacity allow.
Shockwave, footwear or referral
Shockwave may be considered for selected persistent lateral hip presentations. Footwear modification, imaging or onward referral is considered when the assessment indicates a relevant need.
X-ray, ultrasound or MRI may be considered after significant trauma, inability to bear weight, concerning clinical findings, persistent unexplained symptoms or when the result is likely to change treatment or referral.
Why education and progressive exercise sit at the centre of rehab.
Treatment is based on the best available research alongside the clinical examination, symptom response and individual goals.
Education and exercise for gluteal tendinopathy
A large clinical trial found that education about tendon load combined with targeted hip exercise produced better short-term outcomes than waiting for symptoms to settle and better long-term global improvement than corticosteroid injection.
Review the BMJ studyExercise programmes should be individualised
Exercise therapy is generally helpful for tendinopathy, but there is no single exercise or loading method that is best for every person. Programmes need to reflect current capacity and the activity being restored.
Review the exercise evidenceRemain active with low-back or sciatic symptoms
Guidelines for low-back pain and sciatica support advice, self-management and continued normal activity where appropriate. Routine imaging is not recommended unless the result is likely to change management.
Review the NICE guidanceShockwave may help selected lateral hip pain
Shockwave has shown benefit in some studies of persistent greater trochanteric pain syndrome, but results vary between trials. It is best considered as an adjunct to an appropriate rehabilitation plan.
Review the shockwave trialCommon questions about hip and glute rehabilitation.
Is pain on the outside of the hip always bursitis?
No. The gluteal tendons, surrounding bursa, local muscles and referred lumbar pain can produce symptoms around the outside of the hip. The term greater trochanteric pain syndrome is often used because more than one structure may be involved.
Are bridges and clamshells enough?
They can be useful early exercises, but they are rarely the whole programme. Later rehabilitation usually needs stronger standing exercises, step work, single-leg control and loading that reflects the person’s normal activity.
Should I stretch the outside of my hip?
It depends. Strong stretching into hip adduction can increase compression around the lateral hip in some gluteal tendon presentations. Stretching should be selected according to the pain pattern and response.
Can sciatica feel like hip pain?
Yes. Lumbar or nerve-related symptoms can be felt around the buttock, hip, thigh or lower leg. Burning pain, electric pain, numbness, tingling or weakness may indicate that neurological screening is needed.
Do I need an X-ray or MRI?
Not everyone needs imaging. It may be considered after significant trauma, inability to bear weight, concerning findings, persistent unexplained symptoms or when the result would change treatment or referral.
Can I continue walking or training?
This depends on symptom severity and the response later that day and the following morning. Some people can continue with a reduced volume or intensity, while others need a temporary reduction followed by graded return.
How long does hip rehabilitation take?
Recovery time varies with the condition, duration of symptoms, strength, training load and general health. A recent mild injury may settle relatively quickly, while persistent tendon or strength-related presentations often require a longer progressive loading period.
Can shockwave help lateral hip pain?
It may help selected persistent lateral hip or gluteal tendon presentations. It is normally considered alongside progressive strengthening and load management rather than as a stand-alone treatment.
Hip or glute pain not settling?
Book an assessment to check whether your symptoms fit a lateral hip, gluteal tendon, anterior hip, posterior hip or referred sciatic-type pattern, then build a rehabilitation plan around your current strength and activity goals.