Hip Pain: Strength and Resiliency through Exercise

Developing strength and resiliency with exercise to compliment mobility at the hip is really important for making sure you have better long term outcomes for hip pain and other issues. If you haven’t seen the post for improving mobility at the hips, take a minute to go back and review that now before addressing exercise for the hip.

Having strength surrounding a joint to control the movement that occurs is important because it takes strain off the joint itself and offers a larger margin for error during physical activity. For example, think of lying face up on the floor and attempting a simple straight leg raise — just keeping the knee straight and raising one leg as high as you can. Unless you are quite flexible already, a lot of people can only achieve a height about half way to the ceiling (making around a 45 degree angle) without extra help — like bending the knee or using your hands to help. But get somebody else to do it for you, where you just relax and somebody else moves the limb for you, and for most people your leg moves significantly farther!

The total distance your leg can move when somebody else is moving is a better indication of what your joint could do when most variables are removed. The distance you can move it yourself is what you actually have control over. Maybe most importantly, the majority of injuries tend to occur in the space beyond what you can do (raising your leg).

This is why exercise to create strength and resiliency at a joint is important — in everyday life we frequently move our joints into positions that get very close, or exceed, what we are able to do on our own. If you have more control over your movement, meaning the amount you can move a limb is nearly the same as when somebody else moves that limb, your risk of future injury will decrease.

Make sense? I hope so. If you’re a little confused, the TL;DR breakdown for injury management is still: try not to re-aggravate it and limit inflammation, keep it moving and improve mobility with activities or stretches, and then build strength and resiliency to support the joint long term.

And with that, here are a few exercises selected to engage muscles important for addressing painful hips:

A – Squat

The squat is a simple hip exercise that you see components of in many everyday activities. For example, sitting in a chair, putting on your shoes, and lifting items at home are all activities that incorporate the squat to some degree. Even better, the squat engages many of the large muscles surrounding the hip that are important for properly distributing tension and strain around the joint, and making sure that multiple body parts are able to work together (think hips and lower back).

The squat described here is a static hold — meaning you squat down and then HOLD that position for a duration of time. If you find this difficult, squats are also beneficial in a repeated fashion (ie. down-up-down-up-down-up-etc), and you are welcome to use a chair (to squat into or to hold with your arms) or a wall to offer support during the activity too.

Static Squat hip exercise

Static Squat: Stand comfortably, with feet shoulder width apart — toes can be straight or slightly turned out. Keep you chest tall, hinge at the hips, and squat down-and-back to a roughly 90-100° knee angle. Do not allow the knees to buckle inwards. Hold for 20 seconds, the return to start.

Perform this slowly, try holding for 20 seconds (vary more or less if needed), and repeat 3 times.

B – Banded Sidestep

Sidesteps are an effective hip exercise for engaging many of the muscles at the side of the hip. I find these are most effective if you have a looped band available to place just above the knee — the slight resistance these create enhances engagement of the muscles. If you don’t have a looped band available, thats ok! You will still see benefits without it as well.

A couple of tips here: (1) A tiny bend at the hips and knees is effective for increasing muscle engagement for this. (2) This is a “lateral shuffle” (a patient once told me they felt like crab on the beach when doing this) so don’t be surprised if you fatigue quicker than expected — we don’t often use these muscles for repeated movement since we nearly always walk forwards. And, (3) Mind your balance, and try to keep the knees wide (so they are directly over the ankles) throughout the activity.

Banded Side Step hip exercise

Banded Sidestep: Begin standing with feet shoulder width apart, knees over ankles, with a slight bend in the hips and knees to create a small “crouch”. (1) Step to one side (keep your crouch), about ~50% of your stance width, with the knee still over the ankle. (2) Bring your other foot back to shoulder width apart. (3) You should feel this most at the outside of your leading hip.

Perform this slowly, repeat for 6 repetitions, both directions.

C – Glute Bridge

A Glute Bridge is a great home exercise for creating gluteal activation without needing significant movement (like climbing stairs). One particularly helpful cue during this exercise is to consciously try to squeeze your buttocks throughout the exercise, as this really improves muscle activation. Much like the squat, this is intended to be static HOLD, rather than repeated movement — but you can modify your activity if needed.

No bands or additional resistance is needed for this, and please DO NOT add weights on top of your pelvis to make this more difficult — the research on weighted hip thrusts is unclear if this actually improves the exercise tangibly without more risk of injury. There are other, equally effective, ways to progress this exercise with less injury risk.

One other thing: what do you do with your hands? My preference is to clasp the hands together and raise them straight to the ceiling, but if you do need some balance support, it is perfectly fine to place the arms on the ground at your sides, palms up.

Glute Bridge Hip Exercise

Glute Bridge: Begin lying on your back with both knees bent and feet flat on the floor. Arms can either be at your sides (palms up) or pointed to the ceiling (1). Lift your hips off the ground until your knees, hips, and shoulders create a straight line (2). Push into the ground with your heels for extra activation of the glutes.

Perform this slowly, repeat for 2-3 sets, holding for 20 seconds each time.

D – Sliding ADDuction

Adduction at the hip means we are talking about the groin muscles moving the leg and thigh back to the middle. But apart from control of movement, these muscles also contribute to stability of the hip when the foot is on the ground doing other things too — like during a gait cycle. This exercise for the hip contributes to improving both functions by engaging muscles at the medial aspect of the hip.

A sliding exercise like this is best performed with a towel under the foot. Please make sure you have a solid foundation and balance with the other leg! Use chairs, or other stable objects, as supports if needed.

If you find this quite difficult, another option to engage these muscles is to lie face up on the floor, knees bent and feet flat on the floor, and squeeze the knees together with an object between them — a towel, a couple of pillows, a soccer ball, etc. This is also an effective way to activate the groin muscles, although I prefer the dynamic aspect of the slide described below if it is possible for patient’s to complete it.

Sliding Adduction

Sliding Adduction: Begin with the feet shoulder width apart, and the sliding leg standing on a towel (or other slidable object) (1). Slowly slide the leg out to the side as much as is comfortable, away from your centre of balance (2). Then slide the leg back to its starting position, keeping moderate pressure into the floor (3). The other leg never moves. (Hold a chair with your hands for support as needed).

Perform this slowly, repeat for 2-3 sets of 10-15 repetitions, both legs.

E – Clamshell

This is a favourite exercise for lateral hip engagement, and is useful for many conditions of the hip — and even the knee. The Clamshell has even taken the place in my ranks of the more traditional sidelying straight leg raise because it reduces creates less strain on the hip flexors, which are frequently over-activated in hip issues to begin with.

A couple tips to improve your clamshell, because the movement can feel rather foreign if you haven’t done this before: (1) A slight bend at the hips is needed (~45 degrees) and the knee bends to 90 degrees. (2) Keep your hips “stacked” on top of each other, so no rolling the hips forwards or backwards to get extra height. And, (3) Keep the inner edge of the feet together throughout — this should help make sure you are rotating the hip instead of lifting it up into the air.

Clamshell hip exercise

Clamshell: Use a band wrapped around both thighs just above the knee if possible (this exercise still works great without a band too). Begin on your side with the knees and feet together (1). Keeping the inside edge of the feet together, raise the top knee/leg into the air by rotating outwards at the hip (2). Hold this rotated/raised position for 2-3 seconds, and return to the start. Do your best not to move the rest of your body too much when rotating at the hip!

Perform this slowly, repeat for 2-3 sets of 10-15 repetitions, both legs.

F – Walking Lunge

Finally, the Walking Lunge is a great consolidation exercise for the hip — many things are happening at once! Hip range of motion, activation of muscles, integration with other body parts (knees, lower back), and control of motion (coordination, balance) are all needed! These are transferable integrations for many everyday movements that give people with hip trouble difficulty.

Take these slow — it is such a similar movement to walking that patient’s frequently rush through it — and really focus on balance, squeezing through the muscles of the hip, and consistent speed of movement (ie. don’t fall into a step forward, lower yourself with control).

Once again, use a balance aid if needed — like a countertop, chair, or wall.

Walking Lunge

Walking Lunge: Two basic steps here, which repeat: (1) Begin standing with feet slightly apart. Take a controlled step forward with your lead leg, and drop the hips towards the ground until the back knee touches the floor (this should make both knees bent to roughly 90 degrees). (2) Push through the heel of the lead leg to stand back up, and bring the trail leg back to the start — continuing through to repeat (1) with the other leg.

Perform this slowly, repeat for 2-3 sets of 10-15 alternating reps per leg.

As discussed with the shoulder series, it is important to note that there are a number of different hip exercises that you could complete, so please don’t consider this a comprehensive list. Having said that, the six exercises above were selected for their ability to selectively activate the areas most important for hip function, without further compounding frequent problem areas that come with hip pain (like the hip flexors) — and of course doing so in an efficient manner so it doesn’t take several hours to complete.

As always, if you have concerns or further discomfort with your hip while trying to go through a series of activities like these, seek an assessment with a health practitioner who can offer further review specific to your current needs.
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