If you have already spent several weeks or months doing physiotherapy for hip pain but are still struggling with walking, stairs, sleeping, getting out of a chair or exercising, it is reasonable to ask:

Why am I not getting better?

Physiotherapy is useful for many causes of hip pain.

But persistent pain does not always mean you simply need more sessions.

Sometimes:

• The exercise programme needs to change
• The original diagnosis needs to be reconsidered
• The pain may actually be coming from the lower back
• Arthritis or another joint problem may be contributing
• A tendon or labral problem may need to be investigated
• Imaging may provide useful additional information

Mayo Clinic notes that ongoing hip symptoms that have not improved with conservative treatment such as physical therapy or activity modification can justify further evaluation.

How Long Should Physiotherapy Take to Help Hip Pain?

There is no fixed number of sessions.

Recovery depends on:

• The underlying diagnosis
• How long the pain has been present
• Whether the problem involves the joint or surrounding tendons
• Your strength
• Walking demands
• Age
• Previous injury
• Exercise tolerance

The more useful question is:

Are you actually making measurable progress?

For example:

• Can you walk farther?
• Is climbing stairs easier?
• Is night pain improving?
• Can you get up from a chair more comfortably?
• Is hip movement improving?
• Is strength increasing?
• Are pain flares becoming less frequent?

If there has been little meaningful change, reassessment may be appropriate.

Why Might Physiotherapy Not Be Working?

There are several possible reasons.

1. The Original Diagnosis May Need to Be Reconsidered

“Hip pain” is not one diagnosis.

Possible causes include:

• Hip osteoarthritis
• Gluteal tendon problems
• Trochanteric bursitis
• Muscle strain
• Labral injury
• Femoroacetabular impingement
• Stress injury or fracture
• Pain referred from the lower back
• Other musculoskeletal conditions

The NHS notes that hip pain can result from arthritis, strain, tendon problems, bursitis and other causes, and treatment depends on what is actually causing the symptoms.

2. The Pain May Actually Be Coming From Your Lower Back

This is an important possibility.

Pain around the:

• Buttock
• Outer hip
• Upper thigh

can sometimes originate from the lumbar spine or sacroiliac region.

This becomes more important if you also have:

• Lower-back pain
• Pain travelling farther down the leg
• Tingling
• Numbness
• Burning pain
• Shooting pain

Mayo Clinic notes that hip pain can be confused with pain arising from the lower back, and a thorough assessment is important to identify the true source.

3. The Exercise Programme May Be Too Aggressive

More exercise is not always better.

If every session causes:

• Several days of increased pain
• Much worse night pain
• Reduced walking distance
• More difficulty climbing stairs

the current load may exceed what the hip tolerates.

The programme may need changes to:

• Resistance
• Number of repetitions
• Exercise frequency
• Range of movement
• Recovery time

The goal is progressive improvement, not repeated major flares.

4. The Programme May Not Be Challenging Enough

The opposite can also happen.

If exercises never progress, the hip may not regain enough strength or capacity for:

• Walking longer distances
• Climbing stairs
• Running
• Gym work
• Carrying loads
• Returning to sport

Rehabilitation generally needs to progress as the hip improves.

5. There May Be Significant Hip Arthritis

Hip osteoarthritis may cause:

• Groin pain
• Pain walking
• Stiffness
• Reduced range of movement
• Difficulty getting out of a chair
• Difficulty putting on shoes or socks

The NHS notes that hip pain that is worse with walking and associated with stiffness can be consistent with osteoarthritis.

If significant arthritis is present, the treatment strategy may need to be adjusted.

6. There May Be a Gluteal Tendon Problem

Pain mainly over the outside of the hip may involve the gluteal tendons.

Typical symptoms can include:

• Outer hip pain
• Pain lying on that side
• Pain climbing stairs
• Pain walking
• Pain when standing on one leg

If tendon symptoms are persistent despite appropriate loading and rehabilitation, ultrasound or MRI may sometimes provide useful information.

7. There May Be a Hip Labral Problem

A labral problem may cause:

• Groin pain
• Clicking
• Catching
• Pain after prolonged sitting
• Pain after walking
• Pain with twisting

Mayo Clinic notes that labral tears may initially be treated with activity modification and physical therapy, but persistent symptoms can sometimes lead to further investigation or arthroscopic treatment.

What if Physiotherapy Makes My Hip Pain Worse?

A temporary increase in soreness can happen after exercise.

But repeated substantial deterioration deserves reassessment.

Be particularly cautious if physiotherapy consistently causes:

• Severe groin pain
• Significant limping
• Reduced ability to bear weight
• Major night pain
• Increasing loss of movement

The answer is not always to “push through”.

Should I Stop Physiotherapy?

Not necessarily.

The better next step may be to:

• Modify the programme
• Change the loading
• Reassess the diagnosis
• Obtain imaging
• Add another treatment approach

Physiotherapy may still be useful even if the original plan was not producing sufficient improvement.

Should I See a Doctor?

A medical reassessment is reasonable when:

• Pain is stopping normal activities
• Walking remains difficult
• Sleep is affected
• Symptoms are getting worse
• Pain keeps returning
• Physiotherapy has not helped

The NHS advises medical review when hip pain affects normal activities or sleep, worsens or keeps returning, or has not improved after a period of self-management.

Should I Get an X-Ray?

For persistent hip pain, X-ray is often the first imaging investigation when the suspected problem involves:

• Osteoarthritis
• Joint-space narrowing
• Bone abnormalities
• Fracture

The American College of Radiology states that hip and pelvis radiographs are usually appropriate as the initial imaging test for chronic hip pain.

Does Everyone With Persistent Hip Pain Need MRI?

No.

MRI is not usually the first scan for uncomplicated chronic hip pain.

The ACR recommends starting with radiographs in most chronic hip-pain situations, then selecting further imaging based on what the examination and X-rays show.

When Is Ultrasound Useful?

Ultrasound can be useful when the main concern is an extra-articular soft-tissue problem such as:

• Gluteal tendon disease
• Bursitis
• Other superficial tendon abnormalities

The ACR states that when initial X-rays are negative or inconclusive and a tendon or other extra-articular soft-tissue problem is suspected, ultrasound or MRI can be appropriate next tests.

When Is MRI Useful?

MRI becomes more useful when:

• X-rays do not explain the symptoms
• A tendon problem is suspected
• A labral or cartilage problem is suspected
• Symptoms persist despite appropriate treatment
• A hidden fracture is suspected
• The diagnosis remains uncertain

The ACR notes that MRI is appropriate after nondiagnostic X-rays in several chronic hip-pain scenarios, including suspected soft-tissue, impingement and cartilage problems.

What Can a Hip MRI Show?

Hip MRI can provide detailed images of:

• Tendons
• Muscles
• Cartilage
• Labrum
• Bone marrow
• Joint structures
• Surrounding soft tissues

This can be useful when an ordinary X-ray does not adequately explain persistent symptoms.

Can MRI Show a Labral Tear?

Yes.

When a labral abnormality is suspected and radiographs are nondiagnostic, advanced imaging such as MRI or MR arthrography may be used depending on the clinical question.

Can MRI Show Tendon Problems?

Yes.

MRI can assess gluteal tendon disease and other soft-tissue abnormalities.

Ultrasound can also be useful, particularly when the suspected problem is focused around superficial tendons or the bursa.

What if My X-Ray Shows Arthritis?

An X-ray finding of arthritis does not automatically mean hip replacement is required.

Treatment can still include:

• Exercise
• Physiotherapy
• Activity modification
• Medication where appropriate
• Weight management where relevant
• Selected injections

Hip replacement is usually considered when symptoms remain severe and significantly affect daily life despite appropriate non-surgical treatment. The NHS notes that some people with a damaged hip joint may eventually need replacement when other treatments do not help.

Does Failed Physiotherapy Mean I Need Surgery?

No.

Persistent symptoms may simply mean that:

• The diagnosis needs refining
• Rehabilitation needs modification
• Another non-surgical treatment should be considered
• Imaging is needed before making the next decision

Mayo Clinic notes that treatment for persistent hip problems can range from physiotherapy and medication to injections and, in selected cases, surgery when non-surgical treatment no longer provides sufficient relief.

Can an Injection Help?

In selected patients, injections may be considered for symptom relief or to help clarify the pain source.

The usefulness depends on the diagnosis.

For example, an injection into:

• The hip joint
• A bursa
• Another specific structure

may have very different purposes.

The decision should follow an appropriate clinical assessment.

What if My Hip Pain Is Mainly on the Outside?

Outer hip pain more often involves surrounding soft tissues.

If pain is worse when:

• Lying on that side
• Walking
• Climbing stairs

a gluteal tendon or bursal problem may be worth reconsidering.

Ultrasound or MRI may sometimes help if symptoms persist despite appropriate treatment.

What if My Hip Pain Is Mainly in the Groin?

Groin pain is more suggestive of the hip joint itself.

Possible causes include:

• Osteoarthritis
• Labral problems
• Impingement
• Other joint abnormalities

In persistent cases, X-ray is commonly the initial imaging test.

What if Pain Travels Down the Leg?

Pain travelling down the leg can raise the possibility that the symptoms are coming from the lower back or nerves rather than solely from the hip.

This becomes especially important if you also have:

• Tingling
• Numbness
• Burning pain
• Lower-back pain

The correct anatomical region needs to be identified before ordering imaging.

What if My Hip Pain Keeps Waking Me at Night?

Persistent night pain deserves reassessment, particularly if it:

• Keeps worsening
• Is affecting sleep substantially
• Is accompanied by reduced movement
• Has not improved with physiotherapy

Night pain can occur with several hip conditions, including tendon problems, bursitis and arthritis.

When Should I Seek Urgent Medical Attention?

Seek urgent medical assessment if:

• You suddenly develop severe hip pain without a clear reason
• The hip is hot and swollen
• You have fever or feel systemically unwell
• You cannot walk or bear weight after an injury
• There is significant trauma

The NHS identifies these as situations requiring urgent or emergency evaluation.

If fracture is suspected after a fall or injury, X-ray is generally the first imaging test. If the X-ray is negative but clinical suspicion remains high, MRI is an appropriate next test.

How Much Does a Hip MRI Cost in Singapore?

For many patients arranging a hip MRI through The Pain Relief Clinic, the current price is approximately:

S$1,000

This generally includes:

• MRI examination
• MRI images
• Formal radiologist’s report

Eligible outpatient diagnostic scans may qualify for up to:

S$600 per patient per year from MediSave

subject to prevailing requirements and the patient’s remaining annual limit.

How Quickly Can I Get a Hip MRI?

When MRI is medically appropriate, The Pain Relief Clinic can often arrange hip imaging:

Within one working day

subject to:

• MRI safety screening
• Correct imaging protocol
• Appointment availability

Frequently Asked Questions About Hip Pain Not Improving After Physiotherapy

How long should I try physiotherapy?

There is no fixed number of sessions. The important issue is whether pain, strength, movement and function are gradually improving.

Why might physiotherapy not be working?

Possible reasons include an incomplete diagnosis, inappropriate loading, hip arthritis, tendon disease, labral problems, or pain actually originating from the lower back.

Should I get an X-ray?

For persistent chronic hip pain, X-rays are usually the appropriate first imaging test.

Should I get an ultrasound?

Ultrasound can be useful when a tendon or bursal problem is suspected, particularly after X-rays are negative or inconclusive.

Should I get an MRI?

Not automatically. MRI becomes more useful when X-rays do not explain persistent symptoms or a tendon, labral, cartilage or other deeper structural problem is suspected.

Does persistent hip pain mean I need surgery?

No. Many hip conditions can still be treated non-surgically. Surgery is generally considered only in selected cases when symptoms remain significantly limiting despite appropriate conservative care.

Could my hip pain really be coming from my back?

Yes. Pain felt around the hip can sometimes originate from the lower back, so the source should be assessed before choosing the scan or treatment.

How much does a hip MRI cost?

A hip MRI arranged through The Pain Relief Clinic is currently approximately S$1,000, including scan images and a formal radiologist’s report.

Hip Pain Still Not Improving Despite Physiotherapy?

If you have already invested weeks or months in physiotherapy but hip pain is still affecting walking, stairs, sleep or normal daily activities, it may be useful to reassess why progress has stalled.

At The Pain Relief Clinic, we can assess:

• Whether the original diagnosis still fits
• Whether the pain is actually coming from the hip or lower back
• Hip movement and strength
• Whether arthritis, tendon or labral problems should be considered
• Whether X-ray, ultrasound, MRI or no additional imaging is most appropriate
• Whether the rehabilitation programme should change
• Which non-surgical treatment options may be appropriate

When MRI is medically indicated, hip imaging can often be arranged within one working day.

Hip reassessment through The Pain Relief Clinic

• Medical assessment by a licensed medical doctor
• In-house physiotherapy
• Review of previous rehabilitation
• Assessment of hip and lower-back causes
• Fast access to imaging when appropriate
• Hip MRI often available within one working day
• Approximately S$1,000 for many hip MRI examinations
• Up to S$600 MediSave for eligible outpatient diagnostic scans
• Formal radiologist’s report
• Non-surgical treatment options where appropriate
• Specialist referral when appropriate

Arrange a Hip Pain Reassessment

The Pain Relief Clinic

Call / WhatsApp: +65 9068 9605

If your hip pain has not improved despite physiotherapy, contact us for an assessment of whether the diagnosis, imaging or treatment plan should be reconsidered.

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References

1. NHS — Hip Pain in Adults.
2. American College of Radiology — ACR Appropriateness Criteria: Chronic Hip Pain, 2022 Update.
3. Mayo Clinic Health System — Hip Pain and Injury.
4. Mayo Clinic Healthcare — Hip Orthopaedics.
5. Mayo Clinic — Hip Labral Tear: Diagnosis and Treatment.
6. RadiologyInfo.org — Acute Hip Pain: Suspected Fracture.

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Important Medical Information

This article provides general educational information and does not replace an individual medical consultation.

Lack of improvement with physiotherapy does not necessarily mean physiotherapy was inappropriate or that MRI, injections or surgery are required. The appropriate next step depends on the suspected diagnosis, pain location, examination findings, duration, previous treatment and functional limitations.

Seek urgent medical attention for sudden severe hip pain, a hot swollen hip with fever, inability to walk or bear weight after injury, or significant trauma.

Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 18 September 2026