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Hip Pain: Causes, Symptoms, and When to See a Physical Therapist

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Does your hip hurt when you sit with your legs crossed? Does it ache when you lie on your side, or catch when you stand up from a low chair? Hip pain is one of the most common reasons people come to Therapy Excellence, and the right next step depends on how the pain started and what it feels like.

Hip pain can begin suddenly, from a fall, a car accident, or a new activity, or it can build gradually with no clear starting point. The cause is not always obvious from the symptoms alone, which is why an evaluation by a physical therapist is often the fastest way to get a clear answer and a plan.

Common Causes of Hip Pain

Most hip pain falls into one of a few categories:

  • Trauma. A fall, a car crash, or a direct blow to the hip. If your pain started this way, especially if you have osteoporosis, imaging is often a prudent first step to rule out a fracture before starting physical therapy.
  • Overuse or a recent change in activity. Starting a new sport, increasing how much weight you lift, or ramping up running distance can all irritate the muscles and tendons around the hip faster than they can adapt.
  • Gradual onset with no clear cause. Sometimes hip pain develops slowly, without an obvious trigger. This is common and does not mean the cause is unclear forever. It usually points to a movement pattern, muscle imbalance, or joint issue that a physical therapy evaluation can identify.

Symptoms That Point to a Specific Cause

Where you feel the pain, and what brings it on, often narrows down what is happening. These patterns are not a diagnosis on their own, but they are useful to describe to your therapist:
  • Pain over the outer hip, especially with pressure or lying on that side, can point toward hip bursitis.
  • Pain deep in the groin, especially with twisting, pivoting, or deep hip flexion, can point toward hip impingement.
  • A catching, clicking, or locking sensation in the hip can point toward a labral tear.
  • A deep, diffuse ache with stiffness that is worse in the morning or after sitting can point toward hip arthritis.
If one of these sounds like what you are experiencing, our Conditions We Treat section has a dedicated page for each one with more specific detail.

When to Seek Physical Therapy

  • Your pain follows a fall, car accident, or other trauma, and a fracture has been ruled out.
  • You recently changed your activity level and the pain has not settled within a week or two.
  • Hip pain is limiting what you can do day to day, such as walking, sleeping on your side, or sitting comfortably.
  • The pain has been present for a while with no clear cause, and you want a clear answer about what is driving it.
In most cases, earlier evaluation leads to a faster recovery. Waiting to see if hip pain resolves on its own often means more time spent compensating with other joints. This can create a second problem on top of the first.

What Treatment Looks Like at Therapy Excellence

Every plan starts with a thorough evaluation. Our physical therapists take the time to understand how and when your pain started. Our therapists assess your gait, movement patterns, strength, and balance to identify what is actually driving your symptoms, rather than just treating the area that hurts.

After a thorough evaluation and a good understanding of YOUR goals, a treatment is developed. The treatment plan may include manual therapy techniques such as cupping, functional dry needling, and joint mobilization to reduce pain and restore movement. These techniques will be paired with a customized strengthening program to address the underlying weakness or muscle imbalance. If we suspect something beyond what physical therapy can address, we will refer you to the right physician. We regularly coordinate with physicians, coaches, chiropractors, massage therapists, and trainers to keep your care aligned.

Frequently Asked Questions

Do I need an X-ray or MRI before starting physical therapy for hip pain?
Not usually. Imaging is most useful when pain followed a trauma, such as a fall or accident, or when there is a history of severe osteoporosis. For most gradual-onset or activity-related hip pain, a physical therapy evaluation is an appropriate first step.
It depends on the cause and how long the pain has been present, but many patients notice meaningful improvement within a few weeks of starting a consistent plan. Your therapist will give you a more specific expectation after your evaluation.
Often, yes, with modifications. Part of what we assess during your evaluation is which activities are safe to continue and which need to be adjusted or paused temporarily while you recover.
If we find signs during your evaluation that point to something beyond what physical therapy addresses, we will refer you to the right physician and coordinate your care with them directly.
Yes, this is common, especially with overuse-related pain that flares with certain activities and settles with rest. Intermittent pain is still worth having evaluated, since the underlying cause tends to persist even when symptoms are quiet.
Clinically reviewed by: Jodi Blacketer, PT, MS