Best Exercises for Hip Pain (Women 40+)
Relieve perimenopause hip pain with targeted strengthening exercises. Why hip bursitis and tendinopathy spike after 40 and what to do about it.
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The short answer
What exercises help with hip pain? The most effective approach for hip pain in women 40+ combines isometric glute holds (side-lying hip abduction holds) with bridge progressions (bilateral → single-leg) to strengthen glutes in a low-compression position. Stretching the IT band by crossing your legs is a common mistake. Focus on progressive resistance training 2–3 times per week for best results.
Why hip pain happens in perimenopause
Hip pain in perimenopausal women most commonly involves gluteal tendinopathy (formerly called trochanteric bursitis) or hip osteoarthritis. Gluteal tendinopathy is 3x more common in women than men, peaking between ages 40–60. Estrogen decline reduces tendon collagen synthesis and repair capacity, making the gluteal tendons (gluteus medius and minimus) more vulnerable to compressive load at the greater trochanter.
The wider female pelvis creates a larger angle of pull on these tendons, and weakened hip abductors allow the pelvis to drop during walking (Trendelenburg gait), increasing compressive stress. Declining estrogen also accelerates cartilage degeneration in the hip joint proper, contributing to early osteoarthritis.
What actually works
- Isometric glute holds (side-lying hip abduction holds) — reduce tendon pain and build gluteal strength without compressive loading
- Bridge progressions (bilateral → single-leg) to strengthen glutes in a low-compression position
- Lateral band walks to activate gluteus medius and improve pelvic stability
- Hip flexor stretching and mobilization — tight hip flexors alter hip mechanics and increase trochanteric compression
- Progressive loading — once pain settles, gradually add resistance to rebuild tendon tolerance
What doesn't work (and why)
- Stretching the IT band by crossing your legs — this position compresses the gluteal tendons against the trochanter, worsening tendinopathy
- Foam rolling the lateral hip directly over the trochanter — this applies direct compression to inflamed tendons
- Complete rest — tendon deconditioning leads to lower load tolerance and recurring pain
- Running or stair climbing before rebuilding glute strength — both involve high compressive loads on weakened tendons
Recommended exercises
A sample routine
| Exercise | Sets | Reps | Rest |
|---|---|---|---|
| Side-Lying Hip Abduction Hold | 3 | 20s hold | 45s |
| Glute Bridge | 3 | 12 | 60s |
| Lateral Band Walk | 3 | 15 each direction | 60s |
| Hip Flexor Half-Kneel Stretch | 2 | 30s each side | 30s |
| Single-Leg Romanian Deadlift (light) | 3 | 8 each side | 60s |
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Get my planFrequently asked
Side-lying compresses the gluteal tendons against the greater trochanter. In perimenopause, these tendons have reduced collagen integrity due to estrogen decline. Use a pillow between your knees to reduce compression.
Most "hip bursitis" is actually gluteal tendinopathy — the tendons, not the bursa, are the primary pain source. Imaging studies have shown that isolated bursitis is rare; tendon degeneration is almost always present.
Yes, but modify the distance and terrain. Start with flat surfaces, shorter walks (15–20 minutes), and build up. Avoid hills and stairs until gluteal strength improves and pain decreases.
Hip pain after 40 does not mean you need a hip replacement. Most midlife hip pain responds to targeted strengthening. Joint replacement is only considered for advanced osteoarthritis that doesn't respond to conservative treatment.
Key takeaways
- Hip Pain in perimenopause is driven by hormonal changes, not personal failing — understanding the physiology helps you train smarter.
- Isometric glute holds (side-lying hip abduction holds) — reduce tendon pain and build gluteal strength without compressive loading
- Avoid common traps: stretching the it band by crossing your legs.
- Consistency over intensity — 2–3 sessions per week with progressive overload produces better results than daily exhausting workouts.