Hip Osteoarthritis & Bursitis

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Hip Osteoarthritis & Bursitis

Talk to your doctor first. General education, not medical advice.This content is general education, not medical advice, diagnosis or treatment. Get approval from your physician or another qualified healthcare provider before starting any exercise program, especially if you have a medical condition, a recent injury or surgery, are pregnant, or take medication. Stop and seek medical advice if an exercise causes pain, dizziness, chest discomfort or shortness of breath. You choose to exercise at your own risk. Read the full medical disclaimer.

Movement programs for hip joint degeneration and trochanteric pain syndrome
Last updated: October 29, 2026 • Protocol Archive Editorial
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Free daily checklist

Follow this routine day by day

Open a checklist on your phone with the videos, a tick box for each exercise and your last 7 days. You can print a tracker too. No sign-up: your check marks stay on your device.

Start phase 1Phase 2Phase 3Phase 4

Start with phase 1 unless your clinician tells you otherwise, and move on when it feels easy. Physical therapist or assistant? Customize this routine for a patient.

Start with gentle range-of-motion exercises and progress to weight-bearing hip strengthening. Avoid deep stretching in positions that compress the lateral hip if trochanteric pain is present.

Phase 1 — Gentle MobilityWindshield Wiper Hip Mobility
Beginner · Hip, Knee & Extremity · Mobility
Inner Thigh & Hip Flexor Stretch
Beginner · Hip, Knee & Extremity · Flexibility
Pelvic Tilts
Beginner · Spine & Core · Stabilization
Heel Slides
Beginner · Hip, Knee & Extremity · Mobility
Phase 2 — Gluteal ActivationBridge Pose for Glute Activation
Beginner–Intermediate · Spine & Core · Strength
Clamshells for Glute Medius
Beginner–Intermediate · Hip, Knee & Extremity · Isolation
Seated Leg Extensions
Beginner · Hip, Knee & Extremity · Seated
Standing Hip Abduction
Beginner–Intermediate · Hip, Knee & Extremity · Strength
Phase 3 — Functional StrengtheningHip & Knee Strength Routine
Intermediate · Hip, Knee & Extremity · Protocol
Wall Squats for Quadricep Strength
Intermediate · Hip, Knee & Extremity · Strength
Lower Body Strength for Arthritis
Intermediate · Hip, Knee & Extremity · Comprehensive
Step-Ups
Intermediate · Hip, Knee & Extremity · Functional
Phase 4 — Balance & MaintenanceHeel-to-Toe Balance Walk
Beginner–Intermediate · Balance · Fall Prevention
Tai Chi: 30-Minute Full Routine
Intermediate · Whole Health · Full Practice

Related decisions & resources

If you’re working through hip OA, these related guides may help:

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Video Demonstrations

Watch these exercise demonstrations from the protocols referenced above to ensure proper form.

Play video

Windshield Wiper Hip Mobility

Phase 1 gentle mobility exercise for hip joint range of motion

Why this exercise for hip osteoarthritis

Clinical rationale

Windshield wiper hip mobility moves the femur through internal and external rotation in a non-weight-bearing position. Hip OA patients lose rotational range of motion first — usually internal rotation — and this loss compensates into the lumbar spine and SI joint. Restoring even 5-10 degrees of pain-free rotation improves gait and reduces compensatory low back pain.

Modifications

  • Keep the movement within pain-free range — small motion is therapeutic
  • Place a small pillow between knees if hip clicks at end range
  • Stay flat on your back — do not lift the head, which tenses the hip flexors

Safety

  • Stop if you feel sharp groin pain (possible labral or joint surface involvement)
  • Avoid after hip replacement until cleared by surgeon for rotation

Pairs with: Phase 1 – Range of Motion. See the full Windshield Wiper protocol.

Play video

Clamshells for Glute Medius

Phase 2 strengthening exercise for hip stabilization

Why this exercise for hip osteoarthritis

Clinical rationale

Clamshells isolate the gluteus medius — the hip abductor that stabilizes the pelvis during single-leg stance and gait. In hip OA, gluteus medius weakness produces a Trendelenburg-pattern lurch that increases joint loading and accelerates degeneration. Strengthening this muscle reduces hip pain at the trochanteric bursa and improves walking mechanics.

Modifications

  • Lie on your side with knees bent at 90 degrees, feet stacked
  • Keep heels together — only the top knee rotates open
  • Add a resistance band above the knees once 15 reps feel easy

Safety

  • Stop if you feel pinching deep in the hip (possible cam/pincer impingement)
  • Avoid lying on the painful hip if you have trochanteric bursitis — switch sides

Pairs with: Phase 2 – Strengthening. See the full Clamshells protocol.

Exercise Tips for Success

Warm up the joint first. Apply a warm compress for 5–10 minutes before exercising, or perform exercises after a warm shower. Warm cartilage is more pliable and exercises will feel more comfortable.

Move within your pain-free range. Hip OA exercises should work through available range of motion without forcing. A gentle stretch sensation is appropriate; sharp groin pain means you have gone too far.

Strengthen the muscles around the joint. Strong glute, quadricep, and hip stabilizer muscles absorb shock and reduce load on the arthritic joint. Phase 2 exercises are critical for long-term pain management.

Low-impact cardio complements your protocol. Swimming, cycling, and walking are ideal aerobic exercises that maintain joint health without excessive impact. Aim for 150 minutes per week of moderate activity.

What to Expect

Improvement is usually gradual over several weeks to a few months. Pain on the outside of the hip (gluteal tendinopathy) can take longer to settle than arthritis pain. Exercises should be pain-free or cause only mild discomfort (about 3 out of 10 or less) that settles within 24 hours. For pain on the outside of the hip, avoid crossing your legs and lying on the sore side for now.

When to See a Provider

  • Sudden inability to bear weight on the leg (possible fracture)
  • Severe groin pain with inability to rotate the hip (possible avascular necrosis)
  • Hot, swollen joint with fever (possible septic arthritis — seek emergency care)
  • Rapidly progressive pain and stiffness unresponsive to exercise
  • Numbness or tingling radiating down the leg
  • Night pain that consistently wakes you from sleep
BackgroundAbout Hip Osteoarthritis & Bursitis: overview, why exercise helps, symptoms and risk factors

Condition Overview

Hip osteoarthritis affects approximately 10% of adults over 60, causing groin or lateral hip pain, stiffness, and progressive loss of range of motion. Greater trochanteric pain syndrome (formerly “trochanteric bursitis”) involves tendinopathy and inflammation of the gluteal tendons and bursa, producing lateral hip pain that worsens with side-lying and stair climbing. Both conditions respond well to targeted exercise: hip OA benefits from strengthening and mobility work, while trochanteric pain syndrome specifically requires gluteal strengthening with careful load management to promote tendon healing.

Why Exercise Helps

  • Reduces joint stiffness — Controlled hip mobility exercises maintain synovial fluid circulation and preserve functional range of motion.
  • Strengthens hip stabilizers — Gluteus medius and minimus weakness is directly linked to both hip OA progression and trochanteric pain syndrome.
  • Decreases compensatory strain — Hip dysfunction leads to abnormal gait patterns that stress the low back and knees; strengthening corrects these compensations.
  • Improves tendon health — Progressive loading through isometric and isotonic exercise stimulates collagen remodeling in gluteal tendons.
  • Maintains independence — Hip-strengthening programs significantly improve ability to walk, climb stairs, and rise from chairs.

Common Symptoms

Hip osteoarthritis typically presents as a deep, aching pain in the groin, front of the thigh, or side of the hip that develops gradually over months to years. Stiffness is most noticeable in the morning or after prolonged sitting, usually lasting less than 30 minutes. Many people experience a progressive loss of range of motion, particularly with internal rotation and hip flexion, making activities like putting on shoes, getting in and out of cars, and climbing stairs increasingly difficult. Trochanteric bursitis presents as sharp, point-tender pain on the outer hip that worsens with lying on the affected side, climbing stairs, or prolonged standing. Both conditions may cause a limp or altered gait pattern.

Risk Factors

  • Age — Cartilage wear increases significantly after age 50
  • Previous hip injury — Fractures, labral tears, or sports injuries accelerate joint degeneration
  • Obesity — Every pound of body weight translates to 3–6 pounds of force on the hip joint
  • Genetics — Family history of osteoarthritis increases susceptibility
  • Repetitive occupational stress — Jobs requiring heavy lifting, squatting, or stair climbing
  • Hip dysplasia — Structural abnormalities from birth create uneven cartilage loading
  • Female sex — Women are disproportionately affected, especially post-menopause

Frequently Asked Questions

What is the difference between hip osteoarthritis and hip bursitis?

Hip osteoarthritis affects the joint itself and usually causes pain in the groin or front of the thigh. Pain on the outside of the hip, once called trochanteric bursitis, is now often called greater trochanteric pain syndrome; it usually involves the gluteal tendons more than the bursa. Both usually respond well to targeted exercise.

Is walking good for hip osteoarthritis?

Yes, walking is one of the most recommended activities for hip osteoarthritis. Start with shorter distances on flat ground and build up gradually. A walking stick, held in the hand opposite the sore hip, can help if needed.

Are there exercises I should avoid with hip arthritis?

Avoid high-impact activities like running and jumping, deep squats that force the hip into extreme flexion, and exercises that cause sharp or worsening pain. Cross-legged sitting and exercises that involve bringing the knee across the body may aggravate bursitis specifically.

Is exercise better than cortisone injections for hip bursitis?

Research by Mellor et al. published in the BMJ found that education combined with exercise produced better long-term outcomes than corticosteroid injections for gluteal tendinopathy. Exercise addresses the underlying muscle weakness and biomechanical factors, while injections only provide temporary symptom relief.

How often should I exercise with hip osteoarthritis?

Many programs use gentle mobility on most days and strengthening 2–3 times a week, with rest days in between. Benefits build over months of regular exercise.

Will exercise wear my hip out faster?

No. Guidelines are clear that exercise does not speed up hip osteoarthritis, and staying active is linked with better pain and function.

Are steroid injections a good idea?

For hip osteoarthritis, steroid injections can give short-term relief (weeks to a few months) but don’t change the course of the disease, so they are usually used sparingly. For pain on the outside of the hip, the LEAP trial (BMJ, 2018) found education plus exercise did better than a steroid injection at one year.

Is strengthening or stretching better for hip OA?

Strengthening is the dominant intervention, by a wide margin. Stretching has a smaller supporting role. The principle is the same as for knee OA — see the detailed comparison: Strengthening vs Stretching for Joint OA.

Can I avoid hip replacement?

Many people can, at least for a time. Hip osteoarthritis progresses at different rates, and many people manage their symptoms without surgery for years. Keeping to a healthy weight, building hip and gluteal strength, staying active and getting assessed early are the steps most consistently linked with less pain and better function. A structured exercise program may help delay or avoid surgery for some people with moderate hip OA. If pain and stiffness keep limiting daily life despite good non-surgical care, replacement is a reasonable option to discuss with your doctor.

Should I sleep on my painful side?

For greater trochanteric pain (gluteal tendinopathy), avoid direct side-lying on the painful hip until symptoms settle. Use a pillow between the knees if you must lie on that side. For hip OA, position changes through the night are normal — just listen to what reduces pain.

What about glucosamine, chondroitin, or collagen supplements?

The high-quality evidence does not support them for hip OA. The ACR strongly recommends against glucosamine. Some patients report relief, which may be a real placebo effect. They are generally safe but typically not a high-value spend.

References

  1. Bennell KL, et al. Effect of physical therapy on pain and function in hip osteoarthritis. JAMA. 2014;311(19):1987-1997. PubMed
  2. Fransen M, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;4:CD007912. PubMed
  3. Mellor R, et al. Education plus exercise versus corticosteroid injection for gluteal tendinopathy. BMJ. 2018;361:k1662. PubMed
  4. NICE Guideline CG177: Osteoarthritis: care and management. Updated 2022. NICE.org.uk
  5. Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features. J Orthop Sports Phys Ther. 2015;45(11):910-922. PubMed

Explore exercise protocols for conditions commonly associated with hip osteoarthritis:

Deep dive

What the evidence says about hip osteoarthritis and bursitis

Hip pain in adults over 45 has three common drivers: hip osteoarthritis (degenerative joint changes), greater trochanteric pain syndrome / “bursitis” (the older name for what we now know is mostly a gluteal tendinopathy), and referred pain from the lumbar spine. Sorting out which is which matters because the treatments differ — and the wrong protocol can prolong the problem. The good news: each of these responds well to targeted strengthening and graded loading. The misconception that hip OA is purely “wear and tear” leading inevitably to replacement is wrong; the evidence base for non-surgical management is robust.

What the major guidelines recommend

OARSI 2019 Guidelines: Strong recommendation for land-based exercise, structured education, and self-management as core treatments for all hip OA patients, regardless of disease severity. Weight management is conditionally recommended when relevant. Exercise reduces pain and improves function with effect sizes comparable to NSAIDs.

NICE (UK, 2022): Therapeutic exercise is the first-line management for hip OA. Specifically supports both targeted hip-strengthening programs and general aerobic activity. Joint replacement is reserved for severe symptoms not responding to non-surgical care.

2018 BMJ (LEAP Trial) on gluteal tendinopathy: Education plus targeted exercise outperformed corticosteroid injection AND wait-and-see at 8 weeks AND at 52 weeks for greater trochanteric pain syndrome. This was the trial that changed thinking on “hip bursitis” — strengthening the glutes is the answer, not steroid injections.

Why exercise works for hip OA (and why “rest” makes it worse)

The intuition that a painful, arthritic hip should be rested is one of the most damaging beliefs in conservative care of hip OA. Rest produces:

  • Quadriceps and gluteal atrophy, which transfers more load to the joint capsule and cartilage during normal activities
  • Cartilage thinning — synovial joint cartilage depends on cyclic loading for nutrition
  • Capsular stiffness, which limits range of motion and produces compensatory low-back loading
  • Loss of confidence in movement, which becomes a self-reinforcing cycle of avoidance

What strengthens the hip is loaded, progressive, multi-joint movement: bridges, clamshells, hip abduction, squats progressing from chair-supported to bodyweight, and walking. Pain during exercise that stays under 4/10 and returns to baseline within 24 hours is acceptable and not damaging the joint.

Hip OA vs greater trochanteric pain (“bursitis”) vs referred lumbar pain

Quick differential pointers — useful for self-assessment, not a substitute for medical evaluation:

  • Hip OA pain is felt deep in the groin, may refer to the front of the thigh, worsens with weight-bearing, prolonged standing, or rising from a chair. Morning stiffness lasts under 30 minutes. Internal rotation is the first motion to lose.
  • Greater trochanteric pain syndrome (gluteal tendinopathy) is felt on the OUTSIDE of the hip over the greater trochanter, worsens with lying on that side at night, walking up stairs, and crossing the legs. The joint itself is not the source — the gluteus medius/minimus tendon attachment is.
  • Lumbar-referred hip pain typically follows a dermatome (L1-L3 most commonly), reproduces with spine movements rather than hip movements, and often coexists with low back pain. Hip range of motion is preserved.

When hip pain needs medical evaluation before starting exercises

  • Severe pain following a fall, especially with inability to bear weight (possible hip fracture — ER immediately)
  • Hip that is hot, red, and swollen with fever (possible septic joint — medical emergency)
  • Night pain that wakes you from sleep and is not relieved by changing position (consider tumor, infection, avascular necrosis)
  • Progressive limping or marked loss of range of motion in a few weeks
  • History of long-term steroid use, sickle cell disease, heavy alcohol use, or HIV with new hip pain (avascular necrosis risk)
  • Hip pain in someone under 40 with sudden onset (rule out labral tear, femoroacetabular impingement, inflammatory arthritis)

What to expect from a 12-week hip strengthening program

  • Weeks 1-2: The gluteus medius and minimus often haven’t been working at full capacity for years. Expect rapid fatigue and some muscle soreness. Pain during exercises typically stays low if dose is appropriate.
  • Weeks 3-4: Walking endurance and stair tolerance improve before resting pain does. Trendelenburg sign (hip drop on the unsupported side during single-leg stance) reduces.
  • Weeks 5-8: Pain reductions become consistent. Many people notice a meaningful reduction in hip OA pain by this point if they have stayed consistent.
  • Weeks 9-12: Functional improvements expand — getting in and out of cars, putting on socks, lifting and carrying. For greater trochanteric pain, night-side-lying tolerance returns.
  • Maintenance: A 2-3 session per week maintenance dose preserves gains indefinitely. Stopping for 4-6 weeks tends to bring symptoms back.

Want a printable plan you can stick to the fridge?

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Considering a hip injection, replacement or shockwave? (UK and Ireland)

Whether the NHS, private health insurance or the HSE usually pays, what self-pay costs, and what to ask first.

In the US? Medicare and insurance coverage in the US

In Canada or Australia? Coverage in Canada · Coverage in Australia

Having surgery? Exercises before a hip or knee replacement, after a knee replacement, after a hip replacement (all recovery guides).

Evidence checks

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