Physical Therapist's Guide to Osteoarthritis of the Hip
Hip osteoarthritis (hip OA) is the wearing down of the cartilage (lining over the bones) of the hip joint. It can develop at any age, although it is more commonly diagnosed in older adults. Hip OA can make everyday activities, such as walking or climbing stairs, difficult.
There is no one reason to develop hip OA. The incidence of developing symptoms from hip OA increase with age; and is greater in white (compared to African American) females (compared to men), and people who have injured their hip in the past. The impact of obesity on developing hip OA is not yet clear. The lifetime risk, the probability of developing symptomatic hip OA over the lifetime, is 25%.
Recent research found no difference in the rate of occurrence of hip OA in the general public based on race, gender, weight, or educational level.
More severe cases of hip OA may require hip joint replacement surgery. Whether or not patients have surgery, physical therapists design specific exercise and treatment programs to manage pain and get people with hip OA moving again.
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What is Osteoarthritis of the Hip?
Hip osteoarthritis is the inflammation and wearing away of the cartilage 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, muscle weakness, and increasing pain, leading to limited function.
How Does it Feel?
Hip OA may cause symptoms including:
- 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
- Weakness of the muscles in the lower extremity
- 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 examination 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?
Your physical therapist will perform special tests to help determine whether you have hip OA, such as:
- Gently moving your leg in all directions (range-of-motion test)
- Asking you to resist as the physical therapist 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)
- Testing the mobility of the hip joint
- Watching how you climb stairs, how you move from one position to another, etc.
Your physical therapist may use additional tests to look for problems in other parts of your body, such as your lower back. The therapist may recommend that you consult with an orthopedist, who can order diagnostic testing such as an X-ray or magnetic resonance imaging (MRI) to confirm the diagnosis.
How Can a Physical Therapist Help?
Your physical therapist will explain what hip OA 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, climbing stairs, standing, carrying loads, and lying in bed.
Testing will reveal any specific physical problems you have that are related to hip OA, such as loss of motion, muscle weakness, or balance problems. Addressing the problems in surrounding body regions, such as the spine and the lower extremity, is important to the treatment of hip OA.
The pain of hip OA can be reduced through simple, safe, and effective physical activities like walking, riding a bike, or swimming.
Although physical activity can delay the onset of disability from hip OA, people may avoid being physically active because of their pain and stiffness, confusion about how much and what exercise 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 particular 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
Reduce pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, electrical stimulation, taping, exercises, and hands-on (manual) therapy techniques, such as joint mobilization and soft-tissue mobilization.
Improve motion. 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 physical therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Your physical therapist also may use sustained stretches and manual therapy techniques that gently move the joint and stretch the muscles around the joint.
Improve strength. 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 your own body weight as resistance, or using weights, resistance bands, weight-lifting equipment, and cardio (heart) exercise equipment, such as treadmills or stationary bicycles.
Speed recovery time. Your physical therapist will design a specific treatment program to speed your recovery. Your therapist 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 retraining activities, or learn sport-specific techniques and drills to help you achieve your goals. Activity modification is essential for a safe return to activity, and to help control symptoms that may hinder your return.
If Surgery Is Necessary
In severe cases of hip OA, 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, a physical therapist will visit you in your hospital room to help you get out of bed and teach you how to walk, and will explain any movements that you must avoid to protect the healing hip area.
Physical therapists will work with you daily in the hospital and then in the clinic once you are discharged. They will be an integral part of your care and recovery, 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 OA may be prevented or limited by keeping the hip and leg muscles strong and flexible, maintaining a healthy body weight and lifestyle, and having good balance and body mechanics. 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 OA 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.
Real Life Experiences
Daniel is a 55-year-old office manager and former football player. He competes in triathlons 2 to 3 times per year. Daniel 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 an examination 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 OA, and confirms the physical therapist’s diagnosis.
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 that 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 to 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 workouts.
Daniel’s physical therapist adjusts and modifies his home-exercise program and clinic routine at each session, as his strength and flexibility improve. 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, Daniel reports a significant reduction in his symptoms and is able to enjoy his daily activities much more. He signs up for his local mini-triathlon in 2 months and, if his physical therapist approves, plans to return to a full triathlon 3 months after that!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
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 people who have had hip replacement surgery. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified orthopaedic clinical specialist. This physical 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.
Poquet N, Williams M, Bennell KL. Exercise for osteoarthritis of the hip. Phys Ther. 2016;96:1689–1694. Article Summary.
Tan SS, Teirlinck CH, Dekker J, et al. Cost-utility of exercise therapy in patients with hip osteoarthritis in primary care. Osteoarthritis Cartilage. 2016;24:581–588. Free Article.
Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;(4):CD007912. Article Summary in PubMed.
Bennell K. Physiotherapy management of hip osteoarthritis. J Physiother. 2013;59:145–157. Free Article.
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 [published correction appears in: Arch Phys Med Rehabil. 2013;94:600]. 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 (Hoboken). 2012;64:465–474. Article Summary in 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.
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