Hip Arthritis Flare Up: What It Feels Like and What to Do

By Emma Glynn - The Hip & Knee Physio

A hip arthritis flare up can feel like your hip has suddenly changed the rules. One week you are managing your walking, exercise, work or golf reasonably well. The next, your groin is aching, your hip feels stiff, getting out of a chair is harder, and walking the usual distance feels like a poor life choice.

That sudden change can be unsettling. Many people worry that a flare means their hip osteoarthritis has suddenly worsened, or that they have caused permanent damage.

That is not always the case.

A hip arthritis flare up usually means the hip has become more irritable for a period of time, not that the joint has necessarily deteriorated overnight.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist in Camberwell. I work exclusively with hip and knee conditions, and I often see active adults over 40 who are managing hip osteoarthritis but become stuck when flare-ups keep interrupting walking, exercise, travel, golf, hiking or daily life.

For a broader overview of hip OA, you can visit my hip osteoarthritis page. If you are still working out whether your symptoms fit hip arthritis, start with this guide to hip osteoarthritis symptoms.

What is a hip arthritis flare up?

A flare up is a temporary increase in symptoms above your usual baseline. With hip osteoarthritis, this may mean more pain, more stiffness, less range of motion, poorer walking tolerance, or more difficulty with everyday tasks.

The key word is temporary. Flares can last hours, days or sometimes longer, but they are not always a sign that the underlying joint structure has suddenly changed.

A flare is best understood as a period where the hip is more sensitive and less tolerant of load than usual.

During a hip arthritis flare up, you may notice:

• More groin or front-of-hip pain

• More aching into the thigh

• Increased stiffness after sitting or sleeping

• Difficulty walking your usual distance

• Trouble getting out of low chairs or cars

• More pain with stairs or hills

• A limp that was not there before

• Pain that is more noticeable at night

• Less confidence loading the hip

The hip may feel less predictable. One day you can manage a walk. The next day, the same route feels too much. Deeply annoying behaviour from a joint that does not even pay rent.

What does a hip arthritis flare up feel like?

Hip arthritis commonly causes pain in the groin, front of the hip, inner thigh or sometimes the buttock or thigh. During a flare, those same symptoms may become louder or appear earlier than usual during activity.

The most common pattern is a hip that becomes more painful, stiff and load-sensitive than its usual baseline.

People often describe:

• A deep ache in the groin

• A sharper catch when turning or pivoting

• Stiffness when first standing

• Pain after a longer walk

• A hip that feels blocked or restricted

• More difficulty putting on shoes or socks

• A shorter walking stride

• More discomfort getting in and out of the car

A flare can also make the hip feel more reactive. Activities that were previously manageable may suddenly feel provocative. This does not automatically mean those activities are now banned forever. It usually means the dose needs adjusting while the flare settles.

What can trigger a hip arthritis flare up?

Sometimes there is an obvious trigger. Other times, the hip seems to flare for no clear reason, because apparently mystery is part of the package. Still, many flares follow a change in load.

Hip arthritis flare ups often happen when the total load on the hip exceeds what it can currently recover from.

Common triggers can include:

• A longer walk than usual

• More hills or stairs

• Travel or prolonged sitting

• Gardening or housework

• A sudden increase in gym load

• Returning to running or sport too quickly

• Repeated deep squatting or lunging

• Low chairs or awkward sitting positions

• Carrying heavy loads

• Poor sleep or high stress

• A busy week with not enough recovery

The trigger is not always one dramatic event. It is often the accumulation. A long walk, then stairs, then gardening, then sitting in a low chair, then a poor night’s sleep. The hip eventually lodges a complaint. Rudely.

Is a hip arthritis flare up the same as progression?

Not necessarily. This is one of the most important points.

Hip OA can progress over time, but a flare is not the same thing as permanent worsening. A flare is a symptom spike. Progression is a longer-term change in structure, symptoms or function.

A flare tells us the hip is irritated now; it does not automatically tell us the arthritis has permanently worsened.

Signs that suggest a flare rather than clear progression include:

• Symptoms increased after a load spike

• The hip is more irritable but gradually settles

• Walking tolerance temporarily drops, then improves

• Pain returns toward your usual baseline

• The flare lasts days rather than steadily worsening for months

Signs that deserve a closer look include:

• Flares becoming more frequent

• Symptoms not returning to baseline

• Walking distance steadily reducing

• Increasing night pain

• New limp that persists

• Rapid loss of hip range

• Pain that no longer matches your usual pattern

If things are changing over weeks or months, it is worth reassessing the hip rather than assuming it is “just a flare”.

What not to do during a hip arthritis flare up

When the hip flares, the instinct is usually one of two extremes: stop everything, or push through and prove dominance over cartilage. Neither is especially helpful.

The goal during a hip arthritis flare up is to reduce irritation without letting the hip become deconditioned and stiff.

Things to avoid during a flare may include:

• Pushing through long walks that clearly worsen symptoms

• Increasing gym load while symptoms are rising

• Repeated deep squats or lunges into pain

• Aggressive hip stretching into painful end range

• Testing the hip repeatedly to “see if it still hurts”

• Complete bed rest unless medically required

• Assuming all pain means damage

• Ignoring new or unusual symptoms

Rest can be useful in the short term, but total rest for too long can make the hip feel stiffer, weaker and less confident. The better option is usually temporary load reduction plus gentle movement.

What to do in the first few days

The first job is to calm the hip enough that normal movement starts to feel manageable again. This does not need to be dramatic. No heroic rehabilitation montage required. Just sensible decisions, which humans occasionally manage.

In the first few days of a hip arthritis flare up, reduce the aggravating load but keep the hip moving within tolerance.

Helpful options may include:

• Shorter, flatter walks

• Avoiding hills temporarily

• Reducing stair volume where practical

• Using a higher chair instead of a low couch

• Taking breaks from prolonged sitting

• Gentle hip range of motion

• Easy stationary cycling if tolerated

• Heat for stiffness

• Cold if the joint feels hot or reactive

• A walking stick temporarily if walking is painful

• Speaking with your GP or pharmacist about medication options if needed

A walking stick can be useful for a short period if you are limping. It is usually held in the opposite hand to the sore hip. This is not a personality failure. It is physics.

How much should you reduce activity?

The answer is usually “enough to stop feeding the flare, but not so much that the hip forgets how to be a hip”.

The aim is relative rest, not full shutdown. If walking 40 minutes flared you, try 10 to 15 minutes on flat ground. If gym lunges aggravated it, swap temporarily to bridges, sit-to-stand from a higher chair, or lower-depth strengthening. If sitting makes it worse, break sitting into shorter blocks.

During a flare, adjust the dose before you abandon the activity.

You can modify:

• Distance

• Speed

• Step length

• Hills

• Exercise depth

• Exercise load

• Sets and reps

• Frequency

• Recovery days

• Sitting time

• Chair height

The hip’s response over the next 24 hours is useful. If symptoms are settling, you are probably closer to the right dose. If pain is escalating or the hip is worse the next morning, the dose is still too high.

Should you stretch a hip arthritis flare up?

This depends on the stretch and the hip. Gentle movement can be useful. Aggressive stretching into compression or end range can aggravate some arthritic hips, especially during a flare.

Mobility work during a hip arthritis flare should make the hip feel easier to move, not more irritated afterwards.

Be careful with:

• Deep hip flexor stretches if they pinch the front of the hip

• Pigeon pose

• Deep figure-four stretches

• Forced rotation

• Deep squat holds

• Long aggressive stretching sessions

Better options during a flare may include:

• Gentle hip flexion within comfort

• Small range hip rotations

• Easy walking

• Supported weight shifts

• Low-resistance cycling

• Gentle glute bridges if tolerated

Stretching is not morally superior to strengthening. It is just one tool. And sometimes, for hip OA, it is the wrong tool at the wrong time.

When to restart strengthening

Once the flare starts settling, strengthening should usually come back in gradually. Do not wait until the hip is perfect. Perfection is a scam. But do wait until the hip is not becoming clearly worse with basic daily activity.

Strength work should return at a level the hip can tolerate, then build gradually as the flare settles.

A return-to-strength plan may involve:

• Starting with easier exercises

• Reducing range of motion

• Reducing load

• Reducing sets

• Avoiding deep hip flexion initially

• Using more support

• Separating strength and longer walks on different days

• Progressing one variable at a time

Examples may include:

• Sit-to-stand from a higher chair

• Glute bridges

• Supported squats to a comfortable depth

• Standing hip abduction

• Standing hip extension

• Calf raises

• Low step-ups when tolerated

If you want a broader guide, this article on hip arthritis exercises explains what tends to help and what may need modifying.

When a hip arthritis flare up needs medical review

Most hip OA flares are not emergencies, but some symptoms deserve prompt medical review. Do not force everything into the arthritis bucket. That bucket is already overworked.

Seek medical review if your hip pain is severe, unusual, worsening, or associated with symptoms that do not fit your normal pattern.

Get medical advice promptly if you have:

• Recent trauma or a fall

• Inability to weight-bear

• Fever or feeling generally unwell

• Severe night pain that is worsening

• Unexplained weight loss

• New numbness, weakness or bladder or bowel symptoms

• Sudden severe groin pain

• Significant pain with every step that does not settle

• A history of cancer or infection risk

• Symptoms that feel very different from your usual hip arthritis pattern

It is also worth reassessing if your “flare” is not settling, keeps returning, or is steadily reducing what you can do.

How physio can help during a flare

A good physio assessment should not just tell you that your hip hurts. You knew that. Very impressive diagnostic breakthrough. The useful part is working out why the hip is flaring and what needs to change.

The aim is to identify the flare pattern, calm symptoms, then rebuild capacity so the same flare is less likely to keep repeating.

In clinic, I may look at:

• Hip range of motion

• Pain location and behaviour

• Walking pattern

• Strength around the hip and knee

• Sit-to-stand tolerance

• Stairs or step control

• Current walking and exercise load

• Sleep and sitting patterns

• Flare triggers

• Whether imaging or medical review is needed

From there, the plan may include temporary load modification, exercise regression, a gradual return to walking or gym, and clearer rules for what to do if symptoms rise again.

What to do next

If you are in the middle of a hip arthritis flare up, start by reducing the specific loads that are provoking the hip. Keep gentle movement in the plan. Avoid aggressively stretching or testing the hip. Watch the 24-hour response. Then rebuild gradually once symptoms settle.

The goal is not just to get through this flare, but to understand why it happened and reduce the chance of the same pattern repeating.

You may benefit from an assessment if:

• Your hip flare is not settling

• Flares are becoming more frequent

• Walking tolerance is reducing

• You are unsure what exercises are safe

• You have groin pain and stiffness but no clear plan

• You want to keep walking, hiking, travelling, golfing, running or training

• You have been told you have hip arthritis but do not know what to do next

If you are based in Melbourne’s inner east, including Camberwell, Hawthorn, Kew, Canterbury, Surrey Hills, Glen Iris or nearby, you can book an in-person hip assessment. I will assess your hip, explain what I think is driving your symptoms, and help you build a plan that fits your current capacity.

Emma

References

Arthritis Australia. (2024). Flares action plan. https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/flares-action-plan/

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P. G., Costa, D., Doherty, M., Finney, A. G., Georgiev, T., Gobbo, M., Kennedy, N., Kjeken, I., Kroon, F. P. B., Lohmander, L. S., Lund, H., Mallen, C. D., Pavelka, K., Pitsillidou, I. A., … Østerås, N. (2024). EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Annals of the Rheumatic Diseases, 83(6), 730–740. https://doi.org/10.1136/ard-2023-225041

Thomas, M. J., et al. (2022). Osteoarthritis flares. Clinical Rheumatology. https://pmc.ncbi.nlm.nih.gov/articles/PMC10523485/

University of Melbourne Centre for Health, Exercise and Sports Medicine. (n.d.). Hip Osteoarthritis Pain Exacerbation risk factors (iHOAP). https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/research-overview/ihoap

Medical disclaimer

This blog is general educational information only and is not a substitute for individual medical advice, diagnosis or treatment. If you have severe or worsening pain, recent trauma, inability to weight-bear, fever, unexplained weight loss, severe or progressive night pain, new neurological symptoms, sudden severe groin pain, or symptoms that concern you, please seek medical review promptly.