New Research On Hip Pain Reveals The Most Overlooked Factor In Recovery
When hip pain becomes a persistent problem, the instinct is often to find the most targeted, specialized treatment possible (as quickly as possible!). The more intensive the rehab, the better the outcome. Right?
A new randomized controlled trial1 is pushing back on that assumption. Researchers compared two very different physical therapy-led programs for people with a common hip condition and found that both produced nearly identical improvements in hip-related quality of life.
What is FAI & how may physical therapy help?
Femoroacetabular impingement (FAI) syndrome, which is a condition where the hip joint doesn't move quite as it should, causing pain and stiffness. It is one of the most common causes of hip pain in younger and middle-aged adults. It involves a combination of pain symptoms, reduced strength and range of motion, and structural changes at the hip joint. Up to 40% of young adults with hip pain have FAI syndrome, and the condition can significantly affect quality of life. People with FAI syndrome also face a higher risk of developing hip osteoarthritis (joint wear and tear) within 10 years.
Physical therapy is often recommended as a first-line approach. But until this trial, no large-scale study had actually put it to the test.
The study recruited 154 adults aged 18 to 50 with confirmed FAI syndrome across Victoria, Australia. Participants were randomly assigned to one of two six-month physical therapist-led programs: a targeted strengthening program (STRENGTH) or a standardized stretching program (STRETCH).
- The STRENGTH program was personalized to each participant's physical limitations and goals, incorporating progressive hip and trunk muscle strengthening, functional movement, and individualized education.
- The STRETCH program involved generalized hip and lower limb stretching exercises, varied weekly according to a set plan, with equal therapist contact time. Both groups received up to 15 sessions across two treatment phases, education on staying physically active, and access to a three-month gym membership in the second phase.
Stretching and strengthening both moved the needle
The main thing researchers were measuring was change in hip-related quality of life, using a validated questionnaire called the International Hip Outcome Tool-33 (iHOT-33). It's scored from 0 to 100, and a change of 9 points or more is considered meaningful to a person's daily life.
At six months, both groups improved by well above that threshold. The STRETCH group improved by 20.8 points and the STRENGTH group by 19.2 points. There was no statistically significant difference between the two.
Where the programs diverged was on pain. When participants were asked whether their pain had improved, 72% of the STRENGTH group said yes, compared with 52% of the STRETCH group. That means people in the strengthening group were more than twice as likely to report meaningful pain relief. The STRENGTH group also made greater gains in hip muscle strength across four muscle groups. No treatment-related adverse events occurred in either group.
Why showing up may matter more than what you're doing
Here's the thought-provoking part: the researchers raised the possibility that any exercise-based program might produce improvement in FAI syndrom; not just the specific type of exercise.
Both groups attended around 80% of their scheduled sessions. That level of consistency was notably higher than in previous studies comparing surgery to therapy. Showing up regularly to guided movement, combined with the education and support of working with a physcial therapist, may have contributed meaningfully to both groups' outcomes.
It's important to note that there was no "no treatment" comparison group in this study. That means it's not possible to rule out that some of the improvement in both groups would have happened naturally over time. Future research comparing expert-led treatment against no treatment would help clarify this.
Still, the pattern is consistent with a growing body of evidence suggesting that for joint and muscle conditions, moving consistently under guidance may matter as much as the precise type of movement you're doing.
Where to start if hip pain is holding you back
If you've been putting off addressing hip pain (or you're worried it might mean surgery) these findings offer some reassurance.
A few practical takeaways from the research:
- Guided movement is a strong first step: Both programs produced meaningful improvements in hip-related quality of life. Working with a physical therapist, even on a relatively simple movement program, may be an effective first-line option before considering more invasive treatments.
- Strength training offers extra benefits for pain: If you have access to a targeted strengthening program, the data suggest it may give you a better chance of experiencing meaningful pain relief alongside quality of life improvements. Building lean muscle also supports broader physical function as you age.
- Consistency matters. The high session attendance in both groups likely played a role in the outcomes. Showing up regularly to a structured program (whatever form it takes) appears to be a key ingredient.
- Staying active more broadly supports recovery: Both groups received guidance on meeting general physical activity recommendations. Keeping active beyond your rehab sessions may support recovery, and there's good reason to prioritize mobility and longevity well beyond any single treatment window.
- Surgery isn't necessarily the next step. The study's authors note that this type of expert-guided treatment could be considered a genuine first-line treatment option for FAI syndrome. None of the 154 participants underwent surgery during the trial, and both groups saw clinically meaningful improvements.
The takeaway
This trial found that both targeted strengthening and standardized stretching produced meaningful improvements in hip-related quality of life for people with FAI syndrome, with no significant difference between the two programs on the primary outcome. Strengthening offered a meaningful edge for pain relief and muscle function. While it may be tempting to push through the pain or think that it will resolve without intervention, it's best to consult a professional for personalized support.