Hip pain can present in many ways. It may show up as a runner who feels a sharp pinch in the front of the hip during speed work, a desk worker who feels stiff every time they stand up or an older adult who says the first few steps in the morning feel like the hinges are rusty. Clients may point to the groin, outside of the hip, low back, glutes or knee and describe tightness, weakness, pinching or aching.

Your first response should be to ask questions. Hip pain is a symptom with many possible causes. As a health and exercise professional, you can gather information, observe movement and modify training within your scope, without naming the condition, promising a fix or offering care beyond your qualifications. Your value is in helping the client keep moving safely, building capacity over time and recognizing when medical evaluation should take priority over training.

Consider the client’s training history, recovery, health conditions, previous injuries, goals and daily environment, then match the training dose to the client’s current tolerance.

When in Doubt, Refer Out

A client should be encouraged to seek medical care promptly when hip pain follows a fall or trauma; when the client cannot walk or put weight on the leg; when pain is severe or sudden; when the joint appears swollen or hot; when the client has a fever, chills or generally doesn’t feel well; or when there is tingling, loss of feeling or a change in skin color after an injury. A referral is also appropriate when pain is worsening, repeatedly returning, interrupting sleep, limiting normal activities or not improving after a reasonable period of conservative self-care. Under these circumstances, prioritize the client’s safety and your scope of practice, and refer the client for appropriate evaluation.

In addition, refer when the presentation is unclear or raises concerns beyond your scope of practice. A client with deep groin pain, mechanical catching, unexplained weight loss, a history of cancer, persistent night pain, a suspected stress fracture, a new limp, unexplained neurological symptoms or pain that does not behave like a typical training issue requires a clinician’s evaluation. When explaining the referral, use direct, reassuring language: “I do not want to guess about what is causing this. Let’s have a physician or physical therapist evaluate it so we know how to train safely.”

Use the Pain Map Without Playing Doctor

A practical tool for exercise professionals is to pay careful attention to where the client points. Medical providers commonly think of adult hip pain by location: anterior, lateral or posterior. Anterior hip and groin pain may involve the joint itself, the hip flexor muscles and tendons, or pain referred from other areas. Lateral hip pain is often associated with greater trochanteric pain syndrome, a term that can include gluteal tendinopathy, bursitis and iliotibial band irritation. Posterior hip and buttock pain may involve the lumbar spine, deep gluteal region, sacroiliac joint or hamstring tendons.

Use that information to ask better questions and choose less-demanding exercise options while leaving diagnosis to licensed providers. For example, a client with front-of-hip pinching in deep flexion may not be a good candidate for deep squats, aggressive knee-to-chest stretches or high-volume mountain climbers that day. Likewise, a client with lateral hip pain that worsens when lying on the affected side or sitting cross-legged may benefit from positions that place less pressure on the outside of the hip. And a client with buttock pain and symptoms down the leg should be referred, especially if neurological symptoms are present.

The Sitting Story Is Bigger Than Hip Flexors

It is tempting to blame hip pain on chronic sitting and short hip flexors. Sitting deserves attention as one part of a broader pattern that includes long periods of low muscle activity, reduced daily movement and limited exposure to varied ranges of motion.

The Physical Activity Guidelines for Americans tell adults to move more and sit less throughout the day, and to accumulate 150 to 300 minutes of moderate-intensity aerobic activity, 75 to 150 minutes of vigorous-intensity aerobic activity or an equivalent combination of both each week, and to strengthen major muscle groups at least two days per week. These guidelines can provide general context when helping clients set realistic movement goals.

A client who trains with you two or three hours per week but spends most waking hours seated still needs movement outside the session, often through manageable changes. Consider asking for one to three minutes of movement every 30 to 60 minutes during the workday. Table 1 offers brief options that can be adapted to the client’s routine.

A standing desk can add variety during the workday, although prolonged standing is still a static posture. Encourage brief, regular position changes rather than sitting or standing for long periods.

Table 1. Movement Break Options

Use these examples to help clients interrupt long periods of sitting. Adjust the timing and dose to the client’s symptoms, abilities and environment.

Consider the Full Load Picture

A strength imbalance is a useful concept, but it is only part of the picture. Many clients lack preparation for specific loads, angles, speeds or volumes. For example, a runner may have enough capacity for straight-ahead mileage yet lack lateral strength for uneven terrain. A desk worker may experience hip discomfort during a weekend hike after a week with little lower-body activity.

In practice, training load is influenced by range of motion, resistance, speed, volume, frequency, surface, recovery and novelty. When pain occurs, adjust one or two of these variables to make the session more tolerable. Replace deep lunges with shorter split squats. Trade running hills for flat walking intervals. Move from single-leg work to supported bilateral work. Use a slower tempo, a smaller range, fewer sets or more recovery. If the movement continues to cause pain or worsen symptoms, choose a different pattern and refer when needed.

Pain can help guide what to do next during an exercise. For clients who have been cleared to exercise, consider establishing a simple traffic-light system before the session. Explain what each color means and invite the client to say “green,” “yellow” or “red” during an exercise. You can also ask, “What color is this movement right now?”

Green means the movement feels comfortable. Continue at the current level and progress gradually. Yellow means the client has mild, tolerable symptoms that do not change the way they move and that settle soon after the exercise. Reduce the range, resistance or number of repetitions, then ask again. Red means pain increases, changes the way the client moves, causes a limp or makes the client want to stop. Stop that exercise and select a more comfortable option. At the next check-in, ask how the client felt later that day and the following morning. Symptoms that linger or worsen may change an earlier green or yellow response to red and may indicate a need for referral.

Mobility: Earn the Range

Mobility is one component of the plan. Focus mobility work on helping the client develop a comfortable, useful range to move better in life and training.

For a client with no red flags, use the warm-up to observe squat, hinge, step, lunge and rotation patterns in small doses. Table 2 offers supported starting options and progressions. Watch for breath-holding, guarding, loss of pelvic control, inward knee movement or facial expressions that suggest discomfort.

Table 2. Movement Pattern Progressions

Select the variation that allows a comfortable range and good control, then progress one variable at a time.

For a client with known hip osteoarthritis, begin with a gradual warm-up and allow several minutes of comfortable movement before increasing the training demand. Many people with osteoarthritis feel stiff after rest and may tolerate smaller ranges and slower transitions early in the session. Start with smaller ranges, repeat them consistently and progress gradually. Current osteoarthritis guidance recommends individualized exercise programs that may include strengthening, aerobic, flexibility or movement-control exercises, with the amount and progression tailored to the client’s physical function and preferences.

For lateral hip pain, avoid stretches that place added pressure on irritated tissues. Some positions that feel like a “good stretch” to a client may also compress tissues on the outside of the hip, particularly when the client holds the leg across the body, crosses the legs or shifts most of their weight onto one hip. When in doubt, choose neutral, supported positions and gradual strengthening over aggressive stretching.

Build Tissue Tolerance

Exercise programming should help clients develop the capacity to tolerate the demands their activities place on the hip. This includes managing force during movement and recovering afterward. Exercise selection, range of motion, load, speed and volume should reflect the client’s abilities, symptoms and goals.

Begin with controlled movements through a comfortable range. Exercises such as a lateral step and reach, sled push, step-down or split-stance hinge can help coordinate the hip, trunk, foot and opposite leg. As the client’s tolerance improves, adjust the tempo, expand the range of motion, increase the load or introduce movement in additional directions. Add speed, hopping and impact only after the client has developed adequate control and tolerance.

Build Strength Progressively

Strength training can build the muscles that support the hip, pelvis and trunk while increasing a client’s capacity for everyday and recreational activities. Squats, hinges, step-ups, deadlifts, carries and split-stance exercises can all contribute when selected and progressed appropriately.

For a client returning from hip pain, begin with movements the client can perform with control and tolerable symptoms. Use the progressions in Table 2 as options rather than a required sequence. Exercises for the muscles on the outside of the hip may begin with a standing wall press or banded lateral walk and advance to more demanding single-leg tasks. Choose exercises based on the client’s goals, abilities and response during and after training.

For runners, strength training can complement a tolerable running program by developing calf and hip strength, trunk control and single-leg stability. Review recent changes in distance, frequency, speed, terrain, recovery and daily life, then adjust the program gradually rather than attributing symptoms to one variable.

For older adults and clients with osteoarthritis, connect strengthening to daily goals. For example, you might tell the client, “We are going to strengthen the muscles around your hip so walking, climbing stairs and getting out of a chair require less effort.” This explanation shows how resistance-training exercises support activities that matter to the client.

Build the Session Around Confidence

When a client has hip pain, a clear session structure helps build confidence. Begin with a brief check-in: What has changed since the last session? What activities flared symptoms? What felt better? Did symptoms settle after training? Use the warm-up and the client’s response to select or modify the next exercise.

A practical session might include low-level aerobic work, controlled mobility, strength in comfortable ranges and conditioning if appropriate. Finish with one or two exercises to perform at home that fit the client’s life. A short plan the client follows is more useful than a long list of corrective exercises.

Track function alongside pain. Pain scores can be useful, but clients care about walking the dog, sleeping through the night, climbing stairs, running three miles, getting out of the car, kneeling in the garden or playing 18 holes. Choose one or two meaningful markers and revisit them. Progress can be quieter than a personal record. Sometimes the win is that the client no longer thinks about the hip every time they stand up.

Your words can either reassure clients or increase their concern. Avoid telling clients their hips are “out,” “jammed,” “bone-on-bone” or “not firing.” Translate clinical language carefully, even when it comes from a licensed clinician. Better coaching language sounds like this: “This range is sensitive today, so we will train around it.” “Your hip handled that well, so next week we can add a little.” “We’ll focus on strength today and revisit impact when your hip is ready.”

Stay Inside Scope and Still Be Invaluable

Develop a referral network before you need it. Know local clinicians who respect active clients and understand the role of exercise. When a client is already working with a clinician, ask the client for permission to coordinate. A simple message can be enough: “We are currently avoiding deep hip flexion and high-impact work. Are there any restrictions or priorities you want me to follow in training?” That kind of communication keeps the client safe and makes you a better part of the care team.

Keep documentation simple by recording what the client reported, what you observed, what you modified and what you recommended. If you refer out, note why. If the client returns with guidance from a clinician, keep that guidance with the program. The more complex the client’s pain history, the more valuable simple documentation becomes.

The Takeaway

As a health and exercise professional, the practical path is clear. Listen to what your client is telling you. Refer when the client’s concerns are outside your scope of practice. Use pain location to guide questions while leaving the diagnosis to a qualified clinician. Break up sedentary time with realistic movement. Build capacity through progressive strength, controlled mobility and gradual exposure to the movements the client wants to reclaim. Keep the program simple enough to follow and flexible enough to adjust.

Thoughtfully programmed movement can help clients with hip pain regain strength, confidence and participation without relying on cure-all promises.