Hip Pain When Standing Up From Sitting: Causes and What to Do

Short answer: Hip pain when standing up after sitting may come from stiffness or osteoarthritis inside the hip joint, gluteal tendons at the outer hip, hip-flexor or other muscles and tendons, hip impingement or labral irritation, or pain referred from the lower back and nerves. The most useful clues are where the pain is felt, whether it eases after the first few steps, how long the patient has been sitting, whether the hip is genuinely stiff, and whether there is weakness, clicking, trauma or pain at rest.

For some patients, the first step from a chair is painful but walking becomes easier. Others continue to limp, experience pain with every step or struggle to straighten fully. These patterns should not automatically be labelled “tight muscles” or “wear and tear”. A clinical assessment compares the hip joint, surrounding tendons and muscles, walking pattern, lower back and neurological findings.

When hip pain on standing needs urgent assessment

Seek urgent medical assessment if:

• you cannot stand or bear weight after a fall, collision or sudden injury;
• the leg appears shortened, rotated or visibly deformed;
• the hip or surrounding area is intensely painful, hot or swollen, particularly with fever or serious illness;
• pain is severe and rapidly worsening without a clear reason;
• there is new major leg weakness, loss of bladder or bowel control, or numbness around the groin or saddle area;
• the leg becomes cold, pale or blue, or suddenly develops substantial one-sided swelling;
• pain occurs with chest pain, breathlessness, fainting or coughing blood; or
• there is progressive rest or night pain, unexplained weight loss, an enlarging mass or a history of cancer.

Older adults and people with osteoporosis may sustain a hip fracture after a relatively minor fall. Being able to take a few steps does not completely exclude a fracture. For a life-threatening emergency in Singapore, call SCDF 995.^[1] The Pain Relief Clinic is not an emergency service.

First identify where the pain is felt

• Groin or front of the hip: may suggest the hip joint, hip flexors, adductors or nearby structures.
• Outer hip: may involve the gluteal tendons and tissues around the greater trochanter.
• Buttock: may arise from deep gluteal structures, the lower back, sacroiliac region or the hip joint.
• Upper thigh or knee: hip-joint pain can sometimes be felt away from the hip.
• Burning, electric pain or tingling: raises a nerve or referred-pain question.

Location helps organise the assessment but does not prove a diagnosis. Patients may also have more than one contributor—for example, hip osteoarthritis together with gluteal weakness or lower-back pain.

Why does sitting make the first movement painful?

While sitting, the hip remains flexed and relatively unloaded. Standing requires the hip to extend, the trunk to move forwards, the feet to accept weight and the hip and thigh muscles to generate force. A low or soft chair requires more hip flexion and muscular effort than a higher, firmer seat.

Pain may therefore appear because:

• a stiff or arthritic joint is moving after a period of rest;
• a load-sensitive tendon must suddenly generate force;
• the hip is compressed deeply in a low chair;
• muscle capacity is insufficient for the required chair height;
• the patient shifts weight away from one side and overloads another structure;
• the lower back or a nerve reacts to prolonged sitting or the transition to standing; or
• pain-related fear and guarding make the movement slower and more effortful.

1. Hip osteoarthritis and stiffness after rest

Hip osteoarthritis can cause groin, front-thigh, buttock or knee pain, reduced movement and stiffness after sitting. Standing from a low chair, starting to walk, putting on shoes and turning may become difficult. Symptoms often improve after a few steps, although more advanced or irritated arthritis may continue to hurt during walking.

The American Academy of Orthopaedic Surgeons describes pain and stiffness that may make walking and other everyday activities difficult.^[2] NICE advises that osteoarthritis can often be diagnosed clinically in people aged 45 or older who have activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes, unless atypical features suggest another diagnosis.^[3]

An X-ray can show joint-space narrowing and other bone changes, but scan severity and pain do not always match. Treatment decisions should consider walking, sleep, work, personal goals and previous care as well as imaging.

2. Greater trochanteric pain and gluteal tendons

Pain at the outer hip may involve the gluteus medius or minimus tendons and adjacent tissues. It may be aggravated by rising from a chair, the first steps, stairs, standing on one leg or lying on the painful side.

A patient may push through the arms, shift weight onto the other leg or lean the trunk to avoid loading the painful side. These strategies may be useful briefly but do not establish the diagnosis. Local tenderness supports a lateral-hip pattern, while the lower back and hip joint should also be considered.

Management may begin by reducing sustained compression and modifying the most provocative load, then progressively rebuilding hip strength, balance and sit-to-stand capacity.

3. Hip flexor, adductor or other muscle and tendon pain

A muscle strain or load-related tendon problem can follow sprinting, kicking, slipping, heavy lifting, unfamiliar exercise or a sudden increase in walking. Pain may be felt at the front of the hip, groin, inner thigh or buttock and reproduced when the patient initiates standing or resists a movement.

AAOS notes that hip strains may involve muscles and tendons around the joint after overuse, overstretching or direct injury.^[4] A recent muscle injury, a persistent tendon problem and a complete tear require different management. Marked bruising, a palpable gap or substantial loss of strength needs assessment.

4. Femoroacetabular impingement or labral irritation

Femoroacetabular impingement describes hip shapes that can create contact during certain movements. These shapes are also found in people without pain. When symptomatic, prolonged low sitting, deep hip flexion, twisting or rising while turning may provoke groin pain, stiffness or a sharp catching sensation.^[5]

The labrum is a ring of fibrocartilage around the hip socket. Labral symptoms may include deep groin pain, clicking or catching, but these are not specific. An MRI finding should be compared with examination and function rather than treated in isolation.

5. Reduced strength and altered sit-to-stand strategy

Standing from a chair requires coordinated hip, thigh, trunk and ankle force. Older adults, people who have been inactive, and patients recovering from pain or illness may lack the capacity to rise efficiently from a low seat.

This does not necessarily mean that weakness is the original cause of pain. Pain itself inhibits force and encourages compensations. Assessment may compare:

• high and low chair heights;
• using or not using the hands;
• foot position and weight distribution;
• trunk lean and speed;
• single-leg balance and walking; and
• hip and knee strength.

The purpose is not to enforce one perfect technique. It is to find a safe strategy and rebuild the capacity required for the patient’s own chairs, toilet, car, workplace and daily routine.

6. Pain referred from the lower back or nerves

The lower back can refer pain to the buttock, outer hip, groin or thigh. Nerve involvement may cause burning or electric pain, tingling, numbness or weakness. Prolonged sitting may aggravate some spinal or nerve-related patterns, with pain appearing during the transition to standing.

A normal hip scan does not exclude a spinal or neurological contributor. Examination may include back movement, strength, sensation, reflexes and comparison of hip and spinal symptom reproduction.

7. Bone stress injury or an occult fracture

Bone stress injury can develop when repeated loading exceeds the bone’s capacity to recover. Risk may rise after a sharp increase in running or walking and can be influenced by reduced bone density, low energy availability, menstrual disturbance, previous stress injury and certain medicines.

Deep groin or thigh pain may initially occur only during activity, then begin earlier or persist after exercise and at rest. Early stress fractures may not be visible on an initial X-ray, while MRI can show bone-marrow changes.^[6] Progressively worsening weight-bearing pain should not be repeatedly tested or treated solely as tightness.

8. Less common inflammatory, infectious or circulation-related causes

Inflammatory arthritis may cause prolonged stiffness, night symptoms or pain in several joints. Infection can cause severe pain, inability to bear weight, fever or systemic illness. Osteonecrosis—loss of blood supply to part of the femoral head—is another less common but important cause of deep hip pain.

Circulation problems can produce exertional buttock, thigh or calf pain, while a blood clot may cause sudden one-sided swelling. The history and examination determine whether musculoskeletal care is appropriate or medical investigation is needed.

Questions that help distinguish the pattern

• Is the pain in the groin, outer hip, buttock, thigh or knee?
• Does it occur after every period of sitting or only after a long time?
• Does it ease after the first few steps or continue during walking?
• Is a low sofa, toilet, car seat or office chair especially difficult?
• Does the hip click, catch, give way or feel mechanically blocked?
• Is there genuine loss of movement when putting on socks or crossing the legs?
• Is the outer hip painful when lying on that side?
• Are there back pain, tingling, numbness or weakness?
• Was there a fall, rapid exercise increase or change in health?
• How do symptoms affect walking, stairs, work, sleep and caregiving?

How hip pain when rising is assessed

A clinician may observe the patient standing from chairs of different heights, then assess walking, balance, active and passive hip movement, strength and local tenderness. Selected tests may reproduce a hip-joint, tendon or spinal pattern but are not interpreted alone.

The knee, lower back, nerves and circulation may also need examination. The assessment should identify not only a likely diagnosis but also what prevents the patient from completing the movement: pain, stiffness, weakness, poor balance, fear, low chair height or several factors together.

When may X-ray, MRI or ultrasound be considered?

X-ray

X-rays may be considered when osteoarthritis, fracture, hip shape, alignment or another bone-related cause is suspected. For chronic hip pain, the American College of Radiology rates pelvis and hip radiography as usually appropriate initial imaging.^[7]

MRI

MRI can assess bone marrow, cartilage, labrum, tendons, muscles and other soft tissues. It may be considered for persistent unexplained symptoms, suspected stress injury or occult fracture, osteonecrosis, a management-changing tendon or labral question, or concerning features not answered by X-ray.

MRI does not use ionising radiation, but it is not required for every patient whose hip hurts when standing. The scan protocol and need for contrast depend on the question and individual suitability.

Ultrasound

Ultrasound may help assess superficial gluteal or hip-flexor tendons, bursae, fluid and selected dynamic problems. It can guide certain procedures but does not provide the same overview of bone marrow, cartilage and the deep joint as MRI.

What can you try for mild symptoms without warning features?

• Use a slightly higher, firmer chair temporarily.
• Move towards the front of the seat before standing.
• Place both feet in a stable position and use the armrests if needed.
• Avoid twisting sharply on the painful leg during the first step.
• Change position regularly rather than remaining seated for prolonged periods.
• Maintain comfortable walking and movement instead of complete bed rest.
• Track whether symptoms settle after several steps and how they respond over 24 hours.

These strategies are temporary symptom-management measures, not a diagnosis or complete rehabilitation programme. Arrange assessment if pain persists, worsens, repeatedly causes a limp or limits ordinary function.

Treatment depends on the cause and the patient’s priorities

For many non-urgent hip conditions, treatment may combine education, activity modification and progressive rehabilitation. A useful programme can rebuild sit-to-stand strength, hip movement, balance, walking and stairs at a dose the patient can tolerate.

For hip osteoarthritis, NICE recommends tailored therapeutic exercise and weight management where appropriate as core care.^[3] Medication may provide a temporary window for sleep and movement, but choice depends on other medicines and stomach, kidney, heart, pregnancy and bleeding risks. An online article cannot determine a safe medicine or dose for an individual.

Manual treatment, heat, selected physical modalities, a walking aid or an injection may support symptom control for some patients. Each should have a defined purpose, expected duration of benefit and review point. Passive treatment does not automatically rebuild the strength required to stand from a chair.

Surgical assessment may be considered for fracture, selected impingement or labral conditions, advanced osteoarthritis with substantial disability, or another defined structural problem that has not responded to suitable non-surgical care. Surgery is not selected from pain severity or an imaging phrase alone.

Patient-specific treatment scenarios

If the pain is in the groin and eases after a few steps

Hip-joint stiffness or osteoarthritis may be considered. Examination of hip movement and gait, followed by X-ray where clinically appropriate, can help determine whether joint changes match the symptoms. Treatment may focus on symptom control, mobility and progressive strength for standing and walking.

If the pain is on the outer hip

A gluteal tendon-related pattern may be relevant, especially with side-lying, stair or single-leg pain. Management may reduce aggravating compression temporarily and then progressively reload the hip rather than relying on repeated stretching or massage alone.

If only low chairs are difficult

Chair height, hip mobility and strength may be the main practical constraints. A raised seat can reduce symptoms temporarily while rehabilitation rebuilds capacity. The long-term goal may be standing safely from the patient’s actual home and workplace furniture.

If there is clicking or catching in the groin

A hip-joint, impingement or labral question may need assessment. Clicking alone does not prove a tear, and imaging is most useful when the clinical findings make the result likely to change treatment.

If physiotherapy has already been tried

Review the working diagnosis, exercise dose, progression and whether the programme specifically trained sit-to-stand, walking and the patient’s real goals. Persistent deep groin pain, progressive night symptoms, marked weakness or lack of improvement after an adequate programme may justify medical reassessment and selective imaging.

If you prefer passive treatment or dislike exercise

Discuss whether pain, fear, fatigue, time or a previous bad experience is the main barrier. Medication, hands-on treatment or selected modalities may reduce symptoms for some patients, but limitations should be clear. An acceptable active component may begin with a few supported chair rises or essential daily movements rather than a conventional gym programme.

If you need to return to work quickly

Clarify the chair height, number of sit-to-stand transitions, walking, stairs, lifting and commuting required. A short-term plan may use a higher chair, armrests, position changes, temporary duty modification and symptom control. No treatment can guarantee recovery within a fixed number of days.

Integrated doctor and physiotherapy management

The Pain Relief Clinic has in-house physiotherapists for integrated management with the licensed medical doctor. Where physiotherapy is clinically appropriate, this can align the working diagnosis, hip and gait assessment, progressive strengthening, movement retraining, walking and stair rehabilitation, symptom management, imaging decisions and referral planning.

Integrated care may be useful when previous physiotherapy has not helped, symptoms may arise from the lower back, the patient has difficulty standing from ordinary chairs, or a scan needs to be interpreted alongside movement and function. Physiotherapists practising in Singapore are regulated by the Allied Health Professions Council, which maintains a public register.^[8]

Insurance referrals and supporting paperwork

The clinic can assist with clinically appropriate referrals and supporting paperwork for insurance claims. Coverage, required documents, pre-authorisation and reimbursement depend on the patient’s policy and insurer. A referral, form or medical report does not guarantee approval or payment.

Before imaging, physiotherapy, an injection or specialist consultation, patients may wish to ask whether their insurer requires a doctor’s referral, panel provider, pre-authorisation, itemised invoice, procedure code, imaging report or medical report.

Frequently asked questions

Why does my hip hurt only for the first few steps?

Stiffness after rest can occur with osteoarthritis and other load-sensitive joint or tendon conditions. The pattern is useful but not diagnostic. Pain that becomes progressively worse, persists at rest or follows trauma deserves assessment.

Is hip pain when rising always arthritis?

No. Gluteal tendons, hip-flexor or other muscles, impingement, the labrum, the lower back, nerves and bone-related conditions can create similar symptoms.

Should I use my hands to stand up?

Using armrests can be a sensible temporary strategy for safety and symptom control. If reliance on the arms is increasing, assessment can identify whether pain, weakness, stiffness or balance is limiting the movement.

Do I need an MRI?

Not necessarily. X-ray may be the appropriate first investigation when chronic joint or bone changes are suspected. MRI is considered for selected bone-marrow, tendon, labral and soft-tissue questions when the result may change management.

What if the hip also hurts when walking?

The timing and location of walking pain can provide additional clues. Read Why Does My Hip Hurt When Walking? and arrange assessment if symptoms persist or limit ordinary activity.

Key points

• Hip pain when rising may come from the joint, surrounding tendons or muscles, the lower back, nerves or less common bone and medical conditions.
• Groin, outer-hip and buttock pain suggest different clinical questions.
• Chair height, sitting duration and whether pain eases after the first steps are useful clues.
• X-ray, MRI and ultrasound answer different questions; not every patient needs imaging.
• Treatment should rebuild the standing, walking, work and daily activities that matter to the patient.
• Inability to bear weight, major trauma, fever, deformity or progressive neurological symptoms require urgent assessment.

Arrange a hip-pain assessment in Singapore

If hip pain persists, repeatedly occurs when rising, causes a limp or limits walking and daily activity, a structured assessment can help determine whether rehabilitation, imaging, symptom-relief treatment or referral may be appropriate.

The Pain Relief Clinic
350 Orchard Road, #10-00 Shaw House
Singapore 238868
Call or WhatsApp: +65 9068 9605

Not every investigation or treatment discussed on this page is required, offered or recommended by the clinic. Availability and permissible use of tests, medicines, devices, injections, procedures and emerging treatments in Singapore may change with evolving Ministry of Health, Health Sciences Authority and Singapore Medical Council requirements. Individual decisions require clinical assessment and should follow current Singapore regulations and professional guidance.

References

1. Singapore Civil Defence Force. Emergency Medical Services.
2. American Academy of Orthopaedic Surgeons. Osteoarthritis of the Hip.
3. National Institute for Health and Care Excellence. Osteoarthritis in Over 16s: Diagnosis and Management.
4. American Academy of Orthopaedic Surgeons. Hip Strains.
5. American Academy of Orthopaedic Surgeons. Femoroacetabular Impingement.
6. American Academy of Orthopaedic Surgeons. Stress Fractures.
7. American College of Radiology. ACR Appropriateness Criteria: Chronic Hip Pain.
8. Allied Health Professions Council Singapore. Registers of Allied Health Professionals.

Disclaimer: This information is provided for general reference only and should be used in consultation with your licensed medical doctor. It is not a diagnosis or a substitute for personalised medical advice. Seek urgent care for severe, rapidly worsening or warning-feature symptoms.

Reviewed by Dr Terence Tan — 13 September 2026