Hip osteoarthritis exercises is almost always what someone searches for after they have just received a diagnosis, have an X-ray report that says "coxarthrosis" and want to know what they can do on their own. The honest answer is that exercise really is the first thing to do (international guidelines list it among the basic treatments), but the benefit it produces is smaller than it is usually made out to be, and some of the promises you will read elsewhere have no evidence behind them.
This guide gives you the full programme, but first it tells you what stands up to scrutiny and what does not: how much they really reduce pain, why "they slow down arthritis" is a phrase the data do not support, what it means exactly that they are worth as much as an anti-inflammatory, and what the only study that measured the postponement of a replacement actually says.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Everyone has a unique clinical history: what works for others could be counterproductive for you.
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First of all: when hip pain should not be trained
The hip is a transit area. In front pass the intestines, the urinary and genital tracts, the large vessels and the abdominal wall; behind there is the lumbar spine. It is no coincidence that, in reviews on assessing hip pain in adults, anterior pain explicitly includes pain referred from abdominal or pelvic causes, and posterior pain includes lumbar spine pathology, deep gluteal syndrome with entrapment of the sciatic nerve and hamstring tendinopathy. Before attributing everything to osteoarthritis and starting any exercise, rule out these signals.
- Fever, chills or feeling generally unwell together with a painful, hot or swollen hip, especially if the pain has increased quickly: an infected joint is an emergency.
- Inability to bear weight on the leg after a fall, even a minor one, if you have osteoporosis or are over a certain age: a fracture must be ruled out before any exercise.
- Night pain that wakes you and does not change in any position, pain that does not shift with anything you do, unexplained weight loss, a personal history of cancer.
- Groin pain that has appeared or worsened rapidly in people who have had high-dose steroid courses or who drink heavily: these are the two classic profiles in which involvement of the femoral head must be ruled out.
- Neurological symptoms in the leg (loss of strength, tingling that does not go away) or bladder and bowel control problems: these are signs of the spine, not the hip.
- A groin swelling that appears when coughing or straining, with associated urinary or gynaecological symptoms: a painful groin is not automatically joint-related.
In all these cases the first step is the doctor. The starting investigation for a painful hip is an X-ray of the hip and pelvis, and the diagnosis is built by putting together the history, the clinical examination and, when needed, targeted imaging.
The X-ray is not the pain: why it matters to know this
This is the point that changes how you will read everything else. A study published in the BMJ in 2015 compared hip pain and osteoarthritis visible on X-ray in two large American cohorts. In the Framingham cohort (946 participants) only 15.6% of the hips of people with frequent pain showed radiographic signs of osteoarthritis, and just 20.7% of hips with radiographic osteoarthritis were painful frequently. In the Osteoarthritis Initiative cohort (4,366 participants) the picture is the same: only 9.1% of painful hips showed radiographic osteoarthritis, an even lower figure, and 23.8% of osteoarthritic hips were painful frequently, that is, just over one in four.
In plain terms: most hips that hurt have no osteoarthritis on the X-ray, and most osteoarthritic hips do not hurt. If your pain has been explained by the X-ray alone, the explanation may be incomplete. And at the same time, if you have an "ugly" X-ray, you are not condemned to feel bad. These are two faces of the same news, and the second is good news.
No diagnosis of osteoarthritis? If your hip bothers you but nobody has mentioned osteoarthritis, the starting point is a different one: hip exercises in general, where the work is set up around mobility and strengthening without the specific precautions of an arthritic joint.
What physiotherapy can do for the hip
Put in one line, because it is the question that brings most people here: hip physiotherapy does not regenerate cartilage and does not change what is seen on the X-ray. It does other things, and they are not little: it reduces pain, recovers the range of movement you have lost, strengthens what you need to walk and get up without helping yourself with your arms, and moves forward the moment when replacement is discussed.
What studies really say about exercise
The best synthesis we have on exercises for hip osteoarthritis is a Cochrane review dedicated to land-based exercise, which gathered ten randomised trials comparing exercise programmes with groups that did no exercise.
The main result, with high-quality evidence (nine studies, 549 participants): exercise reduces pain and improves physical function immediately after treatment. How much? On a scale from 0 to 100, where the control group sat at 29 points of pain, exercise reduced pain by the equivalent of 8 points (95% confidence interval: from 4 to 11) and improved physical function by 7 points (from 1 to 12). The number of people to treat for one more person to benefit is 6.
Four other elements of that review deserve to be stated, because they usually disappear from summaries:
- The improvement lasts. In five studies (391 participants) the pain reduction was maintained from three to six months after the end of the supervised programme, again around 8 points (from 4 to 12); in as many studies (367 participants) the gain in physical function also remained, at 7 points (from 4 to 13). This is perhaps the most useful figure in practice: the work done does not evaporate as soon as you stop being followed.
- No benefit on quality of life has been demonstrated. Only three small studies (183 participants) measured it, with low-quality evidence, and the improvement came out at zero points. That does not mean there is none; it means none has been shown.
- Adverse events were few and mild. Of the five studies that reported them, each recorded one or two, all attributable to an increase in pain attributed to the programme. Put differently: the risk of exercising with an arthritic hip is low, and the worst that usually happens is a temporary increase in discomfort.
- Those assigned to exercise drop out a little more often. This is the step that is usually not reported, and it should be said: in seven studies (715 participants), with moderate-quality evidence, 6% of those who had to train left the study compared with 3% of the controls. The difference, one percentage point, with a 95% confidence interval running from -1% to 4%, was not significant, so it is compatible with chance. It remains a realistic reminder: the difficulty of exercise is not starting it, it is continuing.
Two limitations must be added, and neither is minor. The first: only five of the ten studies recruited exclusively people with symptomatic hip osteoarthritis (419 participants); the other five mixed hip and knee (130 participants). For fairness, the authors compared the two groups of studies and found no significant differences in pain and function, but the fact remains that the hip literature is thinner than the knee literature, and this should be kept in mind every time a number is read.
The second limitation is declared by the authors themselves: in none of the ten studies was it possible to keep participants unaware of the group they had been assigned to, and pain, function and quality of life were all self-reported by participants. Someone who knows they are in the group that trains tends to report a better result: the figures above should be read knowing that part of the effect may come from there.
"Worth as much as an anti-inflammatory": what it means exactly
This is a phrase that circulates widely, and for once it has a solid basis. A network meta-analysis published in the British Journal of Sports Medicine in 2023 gathered 152 randomised trials and 17,431 participants with knee or hip osteoarthritis, comparing exercise against oral anti-inflammatories and paracetamol. On pain it found no differences at 4, 8 or 24 weeks; the same for function. The authors' conclusion is that exercise has similar effects and, given its excellent safety profile, should have more room in clinical practice, especially in older people with other diseases or at risk of drug side effects.
Be careful, however, with how a "no difference" is read. The credibility intervals of that comparison are very wide: at 4 weeks they run from -1.74 to 1.50, at 24 weeks from -0.77 to 1.12. This means the studies cannot tell the two routes apart, not that they have been proven identical. And the comparison at 8 weeks, the only one with a narrow interval, rests on just 2 randomised trials (against the 47 available at 4 weeks): it is the most precise figure and at the same time the most fragile. Above all: this is not permission to stop a therapy. It is an argument to bring to your doctor, not to apply on your own.
"They slow the progression of osteoarthritis": this is not proven
Here the literature does not support the promise, and it is worth being explicit. Studies of exercise for hip osteoarthritis set themselves the declared aim of measuring pain, physical function and quality of life: not cartilage thickness, not the evolution of the X-ray. So "exercise slows osteoarthritis" is a phrase that finds no confirmation, for a simple reason: in the available studies, the question was almost never asked.
This does not cancel anything practical. Osteoarthritis is a chronic condition for which there is today no cure that restores the joint, and the realistic target of treatment is symptoms and function: exactly what exercise has the best evidence for. The correct way to use this information is to change the expectation, not the habit: keep moving because you feel better and do more things, not because you are repairing the cartilage.
"They postpone the replacement": one study, to be read in full
The only direct figure comes from a long-term follow-up of a Norwegian randomised trial, published in Annals of the Rheumatic Diseases. It followed 109 people with symptomatic, radiographically confirmed hip osteoarthritis, assigned to therapeutic exercise plus education or to education alone. At six years, 22 people in the first group and 31 in the second had been operated on for a replacement: native hip survival was 41% against 25%, with a hazard ratio of 0.56 (confidence interval: 0.32-0.96). The median time to replacement was 5.4 years against 3.5.
It is an important result, and the authors themselves put it cautiously: they write that their findings suggest a 44% reduction in the need for replacement. Three clarifications are needed so as not to make it say more than it does. First, it is a single study of just over a hundred people, and the need for replacement was not the main aim of the original study: that was pain reported at 16 months, published earlier, while the replacement outcome belongs to this six-year analysis. Second, the comparison is not with "doing nothing": the control group also received education, so the benefit measured is that of exercise in addition, not of exercise alone. Third, the group that had trained reported better hip function, but there were no significant differences on pain and stiffness. It is useful to know: a replacement, when needed, remains an effective operation, and postponing it is not an aim in itself.
An important point: before trying these exercises, make sure you have received a correct diagnosis. People often assume they have one problem, but the real cause of the pain is something else. Doing the wrong exercises can make things worse instead of better.
How to set up the work
Before going into detail, four principles that count more than the choice of any single movement in exercises for hip osteoarthritis.
Start gradually. A few repetitions at first, increasing progressively. An arthritic hip tolerates load well if the load arrives in stages.
Respect the pain, but do not fear it. Mild discomfort during and after the exercise is normal and is not a sign of damage; intense pain, or pain that is still worse the next day, says you have asked for too much. The practical rule is that what you feel should return to its starting level by the following day.
Consistency is worth more than intensity. Ten minutes a day is better than an hour once a week. It is the principle on which a habit is built, though it should be stated precisely: in the Cochrane review the benefit was found three to six months after the end of the followed programme, and the review did not measure those who had kept training in the meantime. That the benefit lasts because you keep going is a reasonable inference, not a result of the study.
Move with control. Slowly, without momentum, without chasing maximum range at all costs.
On the repetitions and timings you will read below, a note of transparency: they are conventional starting points, used in clinical practice, not dosages derived from the studies. The studies tested programmes, not individual repetition numbers. Take them as a base to adapt, not as a prescription.
Mobility exercises
Six movements to maintain joint range. These are the part to do every day, and usually the most tolerated even on bad days.
Supine hip flexion. Lying on your back, bend one knee and bring it towards your chest using your hands to help. Hold for 5 seconds, lower. 10 repetitions per side.
Hip rotation. Supine, knee bent, foot on the floor. Let the knee fall inwards, then outwards. 10 repetitions per direction. Internal rotation is often the first to reduce in an arthritic hip: it is the direction not to neglect.
Supine abduction. Supine, leg straight, slide the leg out to the side keeping it in contact with the floor. 10 repetitions per side.
Hip pendulum. Standing, holding on to a support for balance, swing the leg forward and back like a pendulum, then sideways. 20 swings per direction. It is the gentlest option on days when the hip is irritated.
Circles. Standing, lift one foot slightly and draw circles with the knee. 10 circles per direction.
Lying bicycle. Supine, mimic pedalling for 30 seconds. Useful as a general warm-up before strengthening.
Strengthening exercises
Seven exercises for the muscles that govern the hip. This is the part that in the studied programmes does most of the work, together with daily movement.
Bridge. Supine, knees bent, feet on the floor at hip width. Lift the pelvis by squeezing the glutes, hold for 3 seconds, lower slowly. 15 repetitions.
Clamshell. On your side, knees bent, feet together. Open the upper knee while keeping the feet in contact. 20 repetitions per side. It works the gluteus medius, the muscle that keeps your pelvis stable when you walk.
Side leg raise. On your side, lower leg bent for stability, lift the upper leg straight. 15 repetitions per side.
Prone hip extension. Face down, lift a straight leg without rotating the pelvis. 15 repetitions per side.
Mini squat. Standing, feet at shoulder width, go down only as far as you can without pain (roughly 30-45 degrees). 15 repetitions.
Step up. On a low step, step up with one leg, then the other, and step down. 15 repetitions per leg. It is the exercise that most resembles a real staircase.
Sit to stand. From seated, stand up without using your hands and sit down with control of the descent. 10 repetitions. Of all the exercises in this programme, it is the one that translates most directly into everyday independence: getting up from an armchair, a seat, the bed.
Stretching: what it is for and what it is not
Five stretches. It is worth being clear: stretching is the part with the fewest specific trials in hip osteoarthritis, because the programmes studied were made up mostly of strengthening and movement. It serves to be more comfortable and to work better on the rest, it is not the engine of the result.
Hip flexors. In a lunge with one knee on the floor, push the pelvis forward, feeling the stretch at the front of the hip of the back leg. 30 seconds per side. These are the muscles that shorten most in people who sit a lot.
Piriformis. Supine, right ankle resting on the left knee to form a "4", hold the left thigh and draw it towards you. 30 seconds per side.
Adductors. Seated, soles of the feet together, knees open, gently press the knees downwards. 30 seconds.
Glutes. Supine, bring one knee to the chest and pull with your hands. 30 seconds per side.
Hamstrings. Supine, straight leg raised (use a belt or towel if you cannot reach), pull gently. 30 seconds per side.
Walking, cycling, swimming
Low-impact aerobic activity is the part that brings exercises for hip osteoarthritis into the day, instead of leaving them confined to the mat.
Walking. It is the simplest choice and the most sustainable over time. Comfortable shoes, a route without too many gradients at the start.
Cycling. Low impact, excellent for keeping hip flexion mobility. Set the saddle high enough not to close the hip too much at each pedal stroke.
Elliptical. Continuous movement without impact, useful if long walks bother you.
Water. Here an honest clarification is needed, because almost all articles on the subject present swimming and water aerobics as the ideal choice for the hip. The 2019 OARSI guidelines include water-based exercise among the recommended options for knee osteoarthritis, at a level that changes depending on other diseases present, but they do not recommend it for hip osteoarthritis or for polyarticular osteoarthritis. This does not mean that swimming does harm, nor that you should stop if you enjoy it: it means that, when it comes to choosing where to put your time, the structured land-based programme has better evidence. Water remains an excellent alternative in periods when load is poorly tolerated.
It is also worth remembering, from the same guidelines, what the expert group placed among the basic treatments for the hip: education about osteoarthritis and structured land-based exercise programmes. Not an injection, not a supplement. Opioids, oral or patch, are strongly discouraged.
A sample weekly programme
Every day: mobility, 5-10 minutes. It is the base.
Three times a week: strengthening, alternating days. It is the part that asks for the most energy and the most recovery.
After each session: stretching, 5-10 minutes.
Almost every day: low-impact aerobic activity, 20-30 minutes, split into two sessions if needed.
If a week gets missed, it is not lost: you pick up from where you were, not from zero. That is the criterion for judging a programme of exercises for hip osteoarthritis: not how complete it is, but how repeatable it is for months. The good news, if anything, is the opposite of what you usually hear: in the studies the gain was still there at three to six months after the end of the supervised programme, so it does not vanish at the first setback.
Hip osteoarthritis: exercises to avoid, and what there is no reason to avoid
To limit or modify:
- Running on hard surfaces, especially if the hip is already irritated: not because the movement "wears out" the joint, but because it is a load that often leaves a pain lasting beyond the day.
- Very deep squats and lunges: extreme flexion is the position in which the arthritic hip bothers you most. Limit the depth instead of eliminating the exercise.
- Sudden, jerky movements, and loads that force you to compensate with the pelvis or the back. In initial strengthening, body weight is almost always enough.
And now the part that is rarely said: there is no reason to avoid movement out of fear of "wearing out" the hip. The worry that activity will make osteoarthritis progress is understandable, but in the available studies the adverse events linked to exercise were few and limited to an increase in pain. No study has shown that training worsens the joint; what the guidelines recommend for the hip is exactly the opposite of stopping.
When exercise is not enough
It happens, and it is normal. If after weeks of consistent work the pain does not move, if you walk less and less, if you wake up at night, if you have stopped doing things that matter to you: it is time to reassess, not to push harder. The options exist, from revising the programme, to pharmacological management with your doctor, up to surgical assessment when quality of life is compromised. A hip replacement is not a failure of rehabilitation: it is an operation that, when indicated, works well.
On our side, in teleRehabilitation the added value is not the list of exercises for hip osteoarthritis, which you have already read above, but the part that studies always supervise and self-directed programmes almost never do: choosing which movements suit your case, progressing them over time and correcting how they are performed.
In short
Exercises for hip osteoarthritis remain the first thing to do, with three corrections to how they are usually presented. First: the benefit is real but modest, about 8 points out of 100 on pain, and it lasts over months, which is perhaps the best part of the news. Second: "they slow osteoarthritis" is not proven, because almost no study has measured the joint; the realistic target is symptoms and function. Third: they are worth as much as an anti-inflammatory in direct comparisons, but with a better safety profile: an argument to bring to your doctor, not to apply on your own.
And above all: if the pain appeared in an odd way, does not change with anything, wakes you at night or comes with fever or weight loss, the X-ray and the mat come after the visit. Anyone who wants to go deeper into the clinical picture can read the article on coxarthrosis, or the one on what can and cannot be done about osteoarthritis.
Sources
- Exercise for osteoarthritis of the hip, Cochrane Database of Systematic Reviews, 2014
- Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials, British Journal of Sports Medicine, 2023
- Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial, Annals of the Rheumatic Diseases, 2015
- OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis, Osteoarthritis and Cartilage, 2019
- Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study, BMJ, 2015
- Hip Pain in Adults: Evaluation and Differential Diagnosis, American Family Physician, 2021
Last source check: August 2026.
