Hip and Knee Clinic

Support for pain, stiffness and reduced mobility

Hip and knee problems can affect walking, stairs, exercise, work and everyday activities such as getting in and out of a chair. Symptoms may develop after an injury, following surgery or gradually over time.

A hip and knee assessment looks at how the joints move, how the surrounding muscles are working and how your symptoms affect daily activity. Physiotherapy may include exercise, mobility work, strength training and practical advice based on the underlying problem and your goals.

When a hip or knee assessment may help

You may benefit from an assessment if you are experiencing:

• Hip or groin pain
• Pain around the outside of the hip
• Knee pain during walking or exercise
• Pain when using stairs
• Stiffness after sitting or resting
• Difficulty getting in or out of a chair
• Reduced movement in the hip or knee
• Weakness in the leg
• Swelling around the knee
• Pain during running or gym activity
• Difficulty squatting, kneeling or bending
• Reduced confidence following an injury
• Recurring hip or knee problems
• Difficulty returning to activity after surgery
• Changes in walking or balance

Hip and knee symptoms can have different causes, so treatment is based on how the problem presents rather than using the same programme for everyone.

Understanding hip and knee pain

The hips and knees work together during many everyday movements, including walking, standing, climbing stairs and getting up from a chair.

Pain in one area can sometimes change the way you move through the whole leg. For example, reduced hip strength or movement may affect how you walk or manage stairs, while knee pain may lead you to place more weight through the other side.

Assessment therefore considers the movement and strength of the whole lower limb rather than focusing only on the painful joint.

What happens during your first appointment?

Your first appointment begins with a discussion about your symptoms and how they affect your routine.

The physiotherapist may ask:

• When the problem started
• Whether there was an injury
• Where you feel the pain
• Which activities make symptoms worse
• Whether you experience swelling, clicking or instability
• How symptoms affect walking or stairs
• Whether pain affects sleep
• Whether you exercise or play sport
• Whether you have had previous injuries or surgery
• What treatment or investigations you have already had
• What activities you would like to return to

The physical assessment may include:

• Hip and knee movement
• Muscle strength
• Balance and coordination
• Walking
• Squatting or stepping
• Getting up from a chair
• Joint mobility
• Areas of pain or tenderness
• Sport or work-related movements where relevant

The findings help identify which areas may need attention and whether physiotherapy is appropriate.

What treatment may include

Treatment will depend on your symptoms, current ability and the findings from the assessment.

Strengthening exercises

Exercises may focus on the hips, thighs, calves and other muscles that support movement through the lower limb.

Strengthening is commonly used for hip and knee problems and forms a key part of recommended management for osteoarthritis.

Movement and mobility exercises

Exercises may help maintain or improve movement in a stiff hip or knee and make activities such as walking, bending or getting up from a chair easier.

Balance and control

Balance exercises may be included where pain, weakness or injury has affected stability or confidence when standing and walking.

Walking rehabilitation

Treatment may include walking practice if symptoms have changed the way you move or if you are recovering from surgery or a period of reduced activity.

Manual therapy

Hands-on treatment may sometimes be used for stiffness or restricted movement where appropriate, usually alongside exercise and active rehabilitation.

Activity advice

You may receive guidance on temporarily modifying activities that aggravate symptoms while continuing with movement that remains manageable.

Home exercise programme

Exercises to complete between appointments are commonly included and can be progressed as your movement and strength improve.

Hip pain

Hip pain may be felt around the groin, front of the hip, side of the hip or buttock.

Symptoms may be noticeable during:

• Walking
• Climbing stairs
• Getting in or out of a car
• Putting on shoes or socks
• Standing from a chair
• Lying on one side
• Running
• Squatting
• Prolonged standing

Physiotherapy may focus on improving strength and movement around the hip while gradually increasing your tolerance to everyday activity. Exercise and stretching are commonly used as part of physiotherapy for hip pain.

Outer hip pain

Pain around the outside of the hip can sometimes be related to the muscles and tendons around the side of the joint rather than the hip joint itself.

It may be noticeable when:

• Lying on the affected side
• Walking for longer periods
• Climbing stairs
• Standing on one leg
• Getting out of a chair
• Increasing running or exercise

Rehabilitation may include strengthening the muscles around the hip and temporarily modifying activities that place higher demands on the area. Strengthening is commonly recommended for greater trochanteric pain syndrome and related outer-hip symptoms.

Knee pain

Knee pain can affect people of different ages and activity levels.

Symptoms may occur during:

• Walking
• Running
• Using stairs
• Squatting
• Kneeling
• Standing from a chair
• Jumping or landing
• Gym exercises
• Longer periods of sitting

Treatment may focus on building strength around the knee and hip, improving movement and gradually returning to the activities that currently aggravate the problem.

Hip and knee osteoarthritis

Osteoarthritis can cause pain, stiffness and reduced mobility in the hip or knee.

Symptoms may be more noticeable after rest, during longer periods of walking or when performing activities that place greater demand on the joint.

Exercise remains an important part of management. NICE recommends tailored therapeutic exercise, including local strengthening and general aerobic activity, for people with osteoarthritis.

Physiotherapy may include:

• Strengthening
• Mobility exercises
• Walking or aerobic activity
• Advice on pacing activity
• Gradually increasing physical activity
• A home exercise programme

Some discomfort when beginning exercise does not necessarily mean the joint is being damaged. The programme can be adjusted according to how symptoms respond.

Knee pain during running or exercise

Knee symptoms may appear when running distance, training frequency or exercise intensity increases.

Rather than stopping all activity, rehabilitation may involve temporarily reducing the movements that aggravate symptoms while improving strength and gradually rebuilding tolerance.

For some common knee problems, the amount of exercise needs to be increased progressively rather than too quickly.

Treatment may include:

• Hip and knee strengthening
• Single-leg exercises
• Balance work
• Squatting and stepping
• Running-specific exercises
• Gradual return to training

Hip and knee injuries

Injuries may occur during sport, falls, twisting movements or other physical activities.

Depending on the injury, symptoms may include:

• Pain
• Swelling
• Reduced movement
• Weakness
• Difficulty walking
• Instability
• Reduced confidence in the leg

Rehabilitation may begin with restoring movement and basic strength before progressing towards more demanding activities.

More significant injuries, inability to put weight through the leg or major swelling following trauma may require further medical assessment.

Returning to walking and stairs

Hip and knee problems often become particularly noticeable during walking or on stairs.

Rehabilitation may include:

• Leg strengthening
• Step exercises
• Balance work
• Walking practice
• Improving control when lowering down a step
• Gradually increasing walking distance
• Practising uneven surfaces where appropriate

The aim is to improve the strength and confidence needed for the places and situations you encounter in everyday life.

Returning to exercise and sport

Once everyday movement becomes more comfortable, rehabilitation can progress towards higher-level activities.

Depending on your goals, this may include:

• Longer-distance walking
• Running
• Cycling
• Gym training
• Squatting
• Lunging
• Jumping and landing
• Changes of direction
• Recreational or competitive sport

The progression should reflect the demands of the activity you want to return to rather than following a fixed exercise programme.

Rehabilitation after hip or knee surgery

Physiotherapy often forms part of recovery after procedures involving the hip or knee.

Treatment will depend on the operation and any guidance from the surgical team.

Rehabilitation may include:

• Restoring movement
• Rebuilding strength
• Walking practice
• Using and gradually reducing mobility aids
• Improving balance
• Managing stairs
• Returning to work
• Returning to exercise

After knee replacement surgery, physiotherapists commonly help patients begin walking soon after the operation, initially with crutches or a walking frame where required.

Recovery following surgery is gradual, and the programme should progress according to healing, movement and strength.

Weakness after pain or inactivity

When hip or knee pain has limited activity for some time, the muscles around the leg can lose strength.

This may make activities such as standing from a chair, climbing stairs or walking longer distances more difficult even when the original pain has started to settle.

A strengthening programme can help rebuild capacity gradually so that the leg is better prepared for everyday activity.

Balance and confidence

Pain, weakness or a previous injury can sometimes make people less confident when putting weight through one leg.

You may become cautious when:

• Walking outdoors
• Using stairs
• Stepping off a kerb
• Turning quickly
• Standing on one leg
• Moving over uneven ground

Balance and lower-limb strengthening exercises may be included to help improve confidence and control.

Recurring hip or knee problems

If symptoms repeatedly return, the assessment may consider what happens around each episode.

This may include:

• Changes in exercise levels
• Previous injury
• Strength
• Movement patterns
• Work demands
• Sudden increases in walking or running
• Long periods of inactivity
• Incomplete rehabilitation

Treatment may then focus on building a longer-term exercise programme and gradually increasing the amount of activity the joint can tolerate.

Do I need a scan?

Not every hip or knee problem requires an X-ray, MRI or other scan.

The need for imaging depends on the symptoms, injury history and findings from the assessment. In many common musculoskeletal problems, treatment can begin based on clinical assessment.

If your symptoms suggest that further investigation may be useful, you may be advised to speak with your GP or another healthcare professional.

When to seek further medical assessment

Some symptoms require medical assessment rather than routine physiotherapy alone.

Seek appropriate medical advice if you experience:

• Severe pain after a significant injury
• An inability to put weight through the leg
• Major or rapidly increasing swelling
• A visibly deformed joint
• A hot, swollen joint accompanied by feeling unwell
• Sudden major weakness
• Persistent numbness or loss of sensation
• Rapidly worsening symptoms

If concerns are identified during your physiotherapy assessment, further investigation or referral may be recommended.

Treatment based on your everyday goals

The aim of treatment depends on what you need your hip or knee to do.

Your goal may be to:

• Walk further
• Manage stairs comfortably
• Get up from a chair more easily
• Return to work
• Exercise in the gym
• Run again
• Return to sport
• Recover after surgery
• Feel more confident using the affected leg

Your rehabilitation plan can be developed around these practical goals and adjusted as your movement and strength improve.

How many sessions will I need?

The number of sessions varies depending on the type of problem, how long symptoms have been present and the level of activity you want to return to.

Some conditions may improve with a relatively short period of advice and exercise. Others, particularly after significant injury or surgery, may require a longer period of rehabilitation.

Your progress can be reviewed throughout treatment so that exercises continue to match your current ability.