Move Forward Guide
Physical Therapist's Guide to
Osteoarthritis of the Hip
Hip osteoarthritis is inflammation of the hip joint. It can develop at any age, although it is more commonly diagnosed in older adults. Hip osteoarthritis can make everyday activities such as walking or climbing stairs difficult.
The Centers for Disease Control and Prevention reports that 25% of all people may develop painful hip osteoarthritis by age 85. There is no known specific cause of the condition; everyone is at equal risk of developing it. Recent research found no difference in the rate of occurrence of hip osteoarthritis in the general public based on race, gender, weight, or educational level.
More severe cases may require hip joint replacement surgery. Whether or not patients have surgery, however, physical therapists design specific exercise and treatment programs to get people with hip osteoarthritis moving again.
Other Arthritis Resources:
The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.
What is Osteoarthritis of the Hip?
Hip osteoarthritis is inflammation of the hip joint, a condition that is more likely to develop as people age. Osteoarthritis results when injury or inflammation in a joint causes the soft, shock-absorbing cartilage that lines and cushions the joint surfaces to break down. When the cartilage is damaged, the joint can become painful and swollen. Over time, this condition can cause stiffness and more pain.
How Does it Feel?
Hip osteoarthritis may cause:
- Sharp, shooting pain or dull, achy pain in the hip, groin, thigh, knee, or buttocks
- Stiffness in the hip joint, which is worse after sleeping or sitting
- A "crunching"; sound when the hip joint is moved, caused by bone rubbing on bone
- Difficulty and pain when getting out of bed, standing up from a sitting position, walking, or climbing stairs
- Difficulty performing normal daily activities, such as putting on socks and shoes
How Is It Diagnosed?
If you see your physical therapist first, the therapist will conduct a full evaluation that includes your medical history, and will ask you questions such as:
- When and how frequently do you feel pain and/or stiffness?
- What activities in your life are made difficult by this pain and stiffness?
He or she will perform special tests to help determine whether you have hip osteoarthritis, such as:
- Gently moving your leg in all directions (range of motion test)
- Asking you to resist against her hand as she tries to gently push your leg and hip in different directions (muscle strength test)
- Watching you walk to check for limping
- Asking you to balance while standing (balance test)
Your physical therapist may use additional tests to look for problems in other parts of your body, such as your lower back. He or she may recommend that you consult with an orthopedist, who can order diagnostic testing such as an x-ray or MRI, to confirm the diagnosis.
How Can a Physical Therapist Help?
Your physical therapist will explain what hip osteoarthritis is, how it is treated, the benefits of exercise, the importance of increasing overall daily physical activity, and how to protect the hip joint while walking, sitting, stair climbing, standing, load carrying, and lying in bed.
Testing will reveal any specific physical problems you have that are related to hip osteoarthritis, such as loss of motion, muscle weakness, or balance problems.
The pain of hip osteoarthritis can be reduced through simple, safe, and effective physical activities such as walking, riding a bike, or swimming.
Although physical activity can delay the onset of disability from osteoarthritis, people may avoid being physically active because of their pain and stiffness, confusion about how much and what to do, and not knowing when they will see benefits. Your physical therapist will be able to guide you in learning a personal exercise program that will help reduce your pain and stiffness.
Your physical therapist will work with you to:
- Reduce your pain
- Improve your leg, hip, and back motion
- Improve your strength, standing balance, and walking ability
- Speed healing and your return to activity and sport
Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on (manual) therapy techniques, such as massage.
Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might begin with "passive" motions that the therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself. The physical therapist may use sustained stretches and manual therapy techniques that gently move the joint and stretch the muscles around the joint.
Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose and teach you the appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, stretchy resistance bands, weight-lifting equipment, and cardio exercise equipment such as treadmills or stationary bicycles.
Speed Recovery Time
Your physical therapist will design a specific treatment program to speed your recovery. He or she is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
Return to Activities
Your physical therapist will design your treatment program to help you return to work or sport in the safest, fastest, and most effective way possible. You may engage in work re-training activities, or learn sport-specific techniques and drills to help you achieve your goals.
If Surgery Is Necessary
In severe cases of hip osteoarthritis, the hip joint degenerates until bone is rubbing on bone. This condition can require hip joint replacement surgery. Physical therapy is an essential part of postsurgical recovery, which can take several months.
If you undergo hip joint replacement surgery, your physical therapist will visit you in your hospital room to help you get out of bed and walk, and will explain any movements that you must avoid to protect the healing hip area.
He or she will work with you daily in the hospital and then in the clinic once you are discharged. He or she will be an integral part of your treatment and recoveries – helping you minimize pain, restore motion and strength, and return to normal activities in the speediest yet safest manner possible after surgery.
Can this Injury or Condition be Prevented?
Hip osteoarthritis may be prevented or limited by keeping the hip and leg muscles strong and flexible, maintaining a healthy body weight, and using proper balance skills. Research shows that strengthening and stretching exercises for the hip, core and leg can minimize and reduce osteoarthritis pain and stiffness, so it is reasonable to conclude that keeping those muscles strong and limber will help prevent painful osteoarthritis symptoms and problems.
When you seek help once hip osteoarthritis develops, your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent future hip pain and problems. These may include strength and flexibility exercises.
Real Life Experiences
Daniel is a 55-year-old office manager and former football player. He competes in triathlons 2-3 times per year. He recently noticed his right hip was very stiff in the morning, although it loosened up as he performed activities around the house. He has been bothered by some hip pain after his running workouts, but that pain eases after he rests for a few hours. He decides to contact his physical therapist.
Daniel's physical therapist performs a range of tests and determines that his hip and leg muscles have weakened, and there is a minimal loss of hip joint motion. She concludes that Daniel may be experiencing the early stages of hip osteoarthritis. She advises him to follow up with an orthopedic physician at his convenience.
Daniel's physician orders x-rays, which show mild hip osteoarthritis and confirms the physical therapist’s diagnosis. The physician says the osteoarthritis is “slightly more than normal for his age”, but assures Daniel that it is safe and wise to continue with his physical therapy program.
Daniel's physical therapist designs and teaches him a comprehensive exercise program that addresses each of the strength and motion problems she has found in his hip and leg. She assembles a handout of illustrations of simple exercises he can do at home, and teaches them to him. She performs gentle movements of the hip joint, called joint mobilizations, to help restore motion. She uses ice and electrical stimulation to address his pain.
Daniel performs his home exercises every day, and works with his physical therapist at the clinic 2-3 times per week, for 3 weeks. At that time, he notes a 50% reduction in his joint stiffness in the morning, and much less-frequent pain during his running workout. His physical therapist adjusts and increases his home program and clinic routine at each session. Daniel performs his exercises consistently at home and in the clinic, and works with his physical therapist to achieve just the right combination of exercise and treatment for his condition. After 2 months, he experiences a significant reduction in his symptoms and is able to enjoy his daily activities much more. Daniel signs up for the mini-triathlon in 2 months, with plans to return to a full triathlon 3 months after that.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat hip osteoarthritis and people with hip replacements. However, you may want to consider:
- A physical therapist who is experienced in treating people with hip osteoarthritis and after hip replacement surgery. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified orthopedic clinical specialist. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have hip osteoarthritis or hip replacement.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of hip osteoarthritis and hip replacement. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
French HP, Cusack T, Brennan A, et al. Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial. Arch Phys Med Rehabil. 2013;94:302-314. Article Summary on PubMed.
Brantingham JW, Parkin-Smith G, Cassa TK, et al. Full kinetic chain manual and manipulative therapy plus exercise compared with targeted manual and manipulative therapy plus exercise for symptomatic osteoarthritis of the hip: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93:259-267. Free Article.
Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64:465-474. Article Summary on PubMed.
Bennell KL, Egerton T, Pua YH, et al. Building the rationale and structure for a complex physical therapy intervention within the context of a clinical trial: a multimodal individualized treatment for patients with hip osteoarthritis. Phys Ther. 2011;91:1525-1541. Free Article.
Peter WF, Jansen MJ, Hurkmans EJ, et al. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port. 2011;36:268-281. Free Article.
Murphy LB, Helmick CG, Schwartz TA, et al. One in four people may develop symptomatic hip osteoarthritis in his or her lifetime. Osteoarthritis Cartilage. 2010;18:1372–1379. Free Article.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.