Hip Pain: What the Research Says About Exercise, Injections and Surgery

This article summarises published research and guidelines. It is not medical advice and can't tell you what is causing your pain or what suits you. Get hip pain assessed by a physiotherapist or doctor, especially if it is new, severe or getting worse.

VettedVids rates videos and books by what people report happened after using them. Research is different: we don't score it. We summarise what each study found, who it studied and its limits, and we show disagreements rather than settle them. Every claim below links to its source. The same findings, with more detail, are in the Research tab of our hip pain page.

First: when guidance says to get checked promptly

Health services list these as reasons to get hip pain assessed quickly rather than manage it at home:

• severe pain after a fall or injury, being unable to walk or put weight on the leg, tingling or loss of feeling in the hip or leg after an injury, or a leg that looks deformed, badly bruised or is bleeding (NHS; MedlinePlus);
• sudden, severe pain without an injury, or a hot, swollen hip, a change in skin colour, or hip pain while feeling unwell with a high temperature (NHS; healthdirect, which notes that a joint infection is a medical emergency);
• worsening pain together with difficulty passing urine or opening the bowels (MedlinePlus).

What is causing it? Scans tell only part of the story

Patient guides describe a few common patterns in adults: osteoarthritis of the joint, pain on the outside of the hip (greater trochanteric pain syndrome, often called hip bursitis; also known as gluteal tendinopathy) and pain referred from the lower back (Arthritis UK; healthdirect), plus impingement of the hip joint, often with a labral tear, in active people (OrthoInfo). Telling them apart is a job for a clinician's examination, and scans alone can mislead:

• Arthritis on X-ray and pain often don't match. In two large US cohorts, only 9–16% of hips in people with frequent hip pain showed osteoarthritis on X-ray, and only about a fifth to a quarter of hips with X-ray osteoarthritis were frequently painful (Kim 2015, BMJ). England's NICE guideline says osteoarthritis can be diagnosed without imaging in people aged 45 or over with activity-related joint pain and either no morning stiffness or stiffness lasting no more than 30 minutes (NICE NG226).
• Impingement shapes and labral tears are common in hips that don't hurt. A review of 26 studies of people without hip symptoms found a cam-type bone shape in 37% of hips, and MRI showed labral damage in 68% of hips in the studies that looked (Frank 2015).
• That is why "FAI syndrome" needs symptoms, examination signs and imaging together, according to an international consensus of clinicians and researchers (Griffin 2016, Warwick Agreement).

Hip osteoarthritis

What guidelines put first. International (OARSI), US (ACR/Arthritis Foundation) and English (NICE) guidelines all put education and exercise at the centre of care for hip osteoarthritis (Bannuru 2019; Kolasinski 2020; NICE NG226). NICE adds that joint pain may increase when exercise starts.

But the measured benefit is modest. The 2026 Cochrane review update (18 trials, 1,368 people) found exercise probably reduces pain and improves function slightly, by amounts it judged unlikely to be clinically meaningful. The previous 2014 version had been more positive (Hall 2026; Fransen 2014). Guidelines written before 2026 relied on the earlier evidence.

Education-and-exercise programmes. In the Danish GLA:D registry, pain improved by about 12–14 points on a 0–100 scale over the following year in people with knee or hip osteoarthritis, though with no comparison group the improvement can't be credited to the programme alone (Skou 2017). In a later registry study, 30% of people with hip osteoarthritis had a hip replacement within 2 years (Ackerman 2024).

Injections. Guidelines disagree on steroid injections into the hip joint: the ACR strongly recommends them, OARSI does not, and NICE and the AAOS describe them as short-term relief (NICE says 2 to 10 weeks) (Kolasinski 2020; Bannuru 2019; NICE NG226; AAOS 2023). The ACR strongly recommends against hyaluronic acid, platelet-rich plasma (PRP) and stem-cell injections for hip osteoarthritis, and NICE says not to offer hyaluronan injections (Kolasinski 2020; NICE NG226).

Keyhole surgery in an arthritic hip. People with hip osteoarthritis reported less improvement after arthroscopy than people without it, and NICE says not to offer arthroscopic washout or debridement for osteoarthritis (Kemp 2015; NICE NG226).

Weight. Higher body mass index is linked to a higher risk of hip osteoarthritis, but most evidence that losing weight relieves symptoms comes from knees, and guidelines differ on how far it carries over to hips (Jiang 2011; NICE NG226; Bannuru 2019; Kolasinski 2020).

Hip replacement. In the PROHIP trial of 109 Danish adults with severe osteoarthritis who were already eligible for surgery, hip replacement improved the Oxford Hip Score by 15.9 points at 6 months, against 4.5 points with resistance training (Frydendal 2024, NEJM). NICE says to consider referral when symptoms substantially affect quality of life and non-surgical care hasn't worked, judged clinically rather than by age or weight (NICE NG226). In national registries, about 58% of hip replacements were still in place after 25 years (Evans 2019, Lancet). After surgery, a US guideline found that formal physical therapy and unsupervised home exercise both have high-quality support (AAOS 2023).

Outer-hip pain (gluteal tendon pain, often called hip bursitis)

• Education and exercise. In the LEAP trial of 204 Australians with gluteal tendon pain lasting over 3 months, an 8-week physiotherapist-led education and exercise programme gave more people an overall improvement at 8 weeks than one steroid injection or wait-and-see. At a year it still had more people improved than injection, with similar pain levels (Mellor 2018, BMJ).
• Steroid injections. In a Dutch trial, more people had recovered 3 months after an injection than with usual care (55% vs 34%), but by 12 months recovery was the same. A German study found injection best at 1 month but less often successful than home training at 15 months (Brinks 2011; Rompe 2009).

Hip impingement (FAI syndrome) and labral tears

• Surgery or physiotherapy. Two UK trials (UK FASHIoN, FAIT) found hip arthroscopy ahead of physiotherapist-led care at 8–12 months; both groups improved, and in UK FASHIoN the difference was just above the smallest change patients notice (Griffin 2018, Lancet; Palmer 2019, BMJ). An Australian trial found no difference in cartilage health on MRI at 12 months, though symptoms improved more with surgery (Hunter 2021).
• Longer term. Pooled trials showed surgery's advantage at 12 months but similar outcomes at 24 months, although the 24-month data came from one small trial in which many people in the physiotherapy group went on to have surgery (Ferreira 2021; Mansell 2018).
• No placebo-surgery result yet. None of these trials compared surgery with placebo surgery. A sham-controlled trial from Norway (HIPARTI, NCT02692807) had not posted results when we checked in October 2026.
• Physiotherapist-led care. A review of 14 studies in young and middle-aged adults found physiotherapist-led treatment might improve pain and function (Kemp 2020).

Persistent pain

In chronic back pain, researchers think fear, avoidance and the belief that pain signals damage can help keep pain going (Ashar 2022). No trial has tested pain reprocessing therapy for hip pain. In a trial of 151 US adults with chronic back pain for which no specific physical cause had been found, 66% were pain-free or nearly so after 4 weeks of this psychological treatment, compared with 20% after an open-label placebo injection (participants knew it was saline) and 10% with usual care, and pain stayed lower at a year (Ashar 2022, JAMA Psychiatry). The therapy's developer co-authored the trial, and it doesn't apply to pain from arthritis, injury or infection, which needs a clinician's assessment.

Staying active

Recreational runners did not have more hip or knee osteoarthritis than non-runners in a review of 17 studies (114,829 people), though competitive runners had more than recreational runners. These studies can't show whether running suits someone who already has hip pain (Alentorn-Geli 2017).

How we put this together

We searched guidelines and trials on the main causes of adult hip pain, read each abstract or guideline page, and kept findings that answer a question people face: what to try first, whether to have an injection or surgery, and what to expect afterwards. Each finding is listed with who was studied and its limits in the Research tab of the hip pain page, alongside rated videos, rated books, patient guides and a directory for finding a physiotherapist. Last checked 17 October 2026.