A Guide to Physical Therapy for Hip Osteoarthritis
If you suffer from osteoarthritis (OA), know that you are not alone. More than 32 million adults in the US suffer from OA. As we age, degenerative changes happen at our joints, which can cause the cartilage in our joints to wear away. These changes can affect how a joint moves, and can result in pain. The hip is one joint that is frequently affected by osteoarthritis (OA).1
Hip osteoarthritis can lead to frustrating limitations that make it difficult to participate in a life that you want. For example, hip OA can make it difficult to walk, go up and down stairs, squat, and get in and out of a car. Thankfully, physical therapy can help get you on track.
Pain from hip osteoarthritis does not have to keep you on the sidelines of your own life. Working with a CityPT physical therapist can help you to effectively manage your pain and return to the activities that you love.
- Understanding Hip Osteoarthritis
- Symptoms of Hip OA
- What are the Most Common Causes of Hip OA?
- Diagnosing Hip Osteoarthritis
- What to Expect from Physical Therapy
- What If Conservative Treatment Doesn't Work?
- Preventing Hip OA
- Is It Time to Seek Treatment?
The hip joint is a ball and socket joint. The head of the femur (end of the thigh bone) is the ball. The acetabulum (a part of the pelvis) forms the socket. For the hip joint in the body to function optimally, it requires a layer of articular cartilage. Articular cartilage is a soft, smooth substance that covers each end of the bone in a joint. It is designed to decrease friction with movement.
Osteoarthritis (OA) is a type of non-inflammatory arthritic disease that affects the integrity of the articular cartilage (and bone underneath) due to wear. The hips, knees, hands and spine are commonly affected by osteoarthritis.2 Due to it's nature, it is most common in aging populations. Since the hip joint is a load bearing joint, it is more susceptible to osteoarthritis that other joints.
Many people with hip osteoarthritis will only have one hip that is affected. However, some individuals may experience hip OA on both sides. The most common symptoms of hip OA include:
- Pain around the hip, but primarily at the groin
- Stiffness around the hip joint
- Loss of range of movement, or range of motion at the hip
Pain associated with hip osteoarthritis typically occurs:
- In the morning
- After sitting or resting
Movement and activity can typically loosen the hip joint and improve pain and stiffness. Symptoms may not be noticeable during the early stages of hip OA. As hip OA progresses, pain may occur more often. In later stages of hip osteoarthritis, pain may be experienced while at rest, or at night.3
Osteoarthritis typically occurs as we age, and therefore age is a risk factor for OA, with those over 60 typically at risk. Other risk factors for developing hip osteoarthritis include:3
- Joint dysplasia: A congenital condition where the structure of the hip joint is abnormal.
- Trauma: Fractures involving the surface of the hip joint can often lead to OA later in life.
- Obesity: Excess body weight can put an increased load on joints, predisposing them to osteoarthritis. There may also be metabolic factors that can predispose someone with obesity to OA.4
- Gender: Women have a higher prevalence of hip OA after 50 years of age. This may be due to post-menopausal changes.5
- Genetics: Some studies show that having a relative with hip osteoarthritis increases then risk of an individual developing hip OA.
- Occupation: Some jobs that involve heavy manual work, as well as high-impact sports, are linked to hip osteoarthritis later in life.
- Hip Injuries: Some injuries such as hip impingement (also known as Femoral Acetabular Impingement) and or a labral tear (tearing of the cartilage ring at the acetabulum) can predispose someone to developing hip OA later in life.
A diagnosis of hip OA is often made after performing a clinical examination. A clinician such as a physician or physical therapist may perform the following:3
- An in-depth interview: Asking questions to learn more about the symptoms, how they started, and how they behave
- A physical examination: The physician or physical therapist may assess the range of motion and strength at your hips and spine. They may also perform special tests to rule out other causes of your hip or groin pain.
- Observation of movement: Assess how you perform activities such as squatting, or walking to better understand how your symptoms impact your movement.
If needed, the physician may also order an x-ray where they can see the hip joint. The x-ray can confirm the diagnosis of hip osteoarthritis, as well as monitor the progression of the disease.3
A physical therapist can help to determine if your hip pain is due to osteoarthritis, or another cause. They can also guide you on appropriate exercises to help manage your hip OA.
When you see a CityPT clinician for hip pain, you can expect the following:
- A detailed interview: In addition to asking about your symptoms, a CityPT physical therapist will also discuss the activities that you want to return to doing.
- A physical examination: This can help to determine if your pain is due to hip osteoarthritis, or another cause.
- Guidance on exercises: A CityPT physical therapist can recommend exercises to help manage your hip OA. These exercises can include strengthening and stretching of the muscles around the hip and core.6
- Manual therapy: Techniques such as joint mobilization, massage and stretching may be utilized for short-term pain relief. However, current literature does not support it for long-term benefits.
- Modalities to help with pain: Modalities such as heat, ice, electrical stimulation can help with pain. The physical therapist can advise you on which modalities may be right for you.
- Advice on activity modification: A CityPT physical therapist can help you to understand which movements make you feel worse. They can give recommendation on how to perform some activities without increasing your pain.
- A plan: A CityPT physical therapist can work with you on a plan to return to the activities that you enjoy.
Physical therapy and pain medications such as acetaminophen or NSAIDs (non-steroidal anti-inflammatories like ibuprofen or naproxen) can be most helpful for those with early, or mid-stage hip osteoarthritis.
If conservative treatment does not work, your orthopedic doctor may recommend that you get a steroid injection at your hip, or undergo a hip replacement. Should you have a hip replacement, the medical doctor will recommend that you work with a physical therapist post surgery to help you to return to your previous activity levels.3
Some people are more at risk for developing hip osteoarthritis than others (as discussed above). If you think you may be at risk for hip osteoarthritis, you may be able to manage that risk. A physical therapist can work with you to:
- Maintain an active lifestyle
- Maintain a healthy body weight
- Perform exercises to help strengthen the hips
- Perform exercises to improve or maintain mobility at your hips
Is your hip pain keeping you from doing the things you enjoy? If you are concerned that you may have hip OA, or would like to manage your risk of developing hip OA, our physical therapists at CityPT are here to help.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis. JAMA. 2021 February; 325(6):568-578 ttps://jamanetwork.com/journals/jama/Article-Abstract/2776205 ↩
Sinusas K. Osteoarthritis: Diagnosis and Treatment. Am Fam Physician. 2012 January; 85(1): 49-56 https://www.aafp.org/pubs/afp/issues/2012/0101/p49.html ↩
Sellam J, Berenbaum F. Is Osteoarthritis a Metabolic Disease?. J Bone Spine. 2013 December; 80(6): 568-573. https://www.sciencedirect.com/science/article/abs/pii/S1297319X13002169?via%3Dihub ↩
Felson DT. Epidemiology of Hip and Knee Osteoarthritis. Epidemiologic Reviews. 1988; 10(1): 1-28. https://academic.oup.com/epirev/article-abstract/10/1/1/553513?redirectedFrom=fulltext&login=false ↩
Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane. 2014 April; 4: 1-47 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007912.pub2/full ↩