Physical Therapy for Hip Osteoarthritis

Physical therapy can help those with hip osteoarthritis manage arthritic pain and regain function, strength, and mobility in the hip through therapeutic exercise and manual therapy. Osteoarthritis of the hip causes the protective cartilage lining the bones of the hip joint to progressively break down, causing the bones to rub against each other and leading to intense pain and inflammation within the hip joint. Numerous studies have shown that physical therapy treatment for hip osteoarthritis reduces pain and stiffness in the affected hip and improves hip function and the patient’s ability to perform daily activities.

What is Hip Osteoarthritis?

Hip osteoarthritis involves changes to the cartilage, ligaments, bones, and muscles surrounding the hip joint. Cartilage at the femur and pelvis absorbs the shock of movement on the hip joint and minimizes friction between the ball and socket of the hip joint. Osteoarthritis causes the protective cartilage lining the bones of the hip joint to progressively break down, causing the bones to rub against each other and leading to intense pain and inflammation within the hip joint. This contributes to structural and functional dysfunction at the hip joint and muscle weakness and disability.

Osteoarthritis is the leading cause of musculoskeletal pain and disability and is more prevalent among older adults. It is also more likely to develop in those who have had previous hip injuries, a history of hip dysplasia (a condition in which the hip socket does not fully cover the ball joint of the thigh bone), obesity, or femoroacetabular impingements.

Symptoms of osteoarthritis of the hip include:

• Pain in the hip joint or groin; pain may radiate through the thigh, buttocks, and knee

• Stiffness in the hip joint that worsens when sleeping or sitting

• Weakness of the muscles in the lower extremity, such as the quadriceps, hamstring, and hip adductor muscles

• Difficulty getting out of bed, standing up from sitting, walking, or climbing stairs

• Altered gait pattern to reduce loading on the painful hip

• Balance impairments and reduced lower limb proprioception, which increases the risk of falling

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Physical Therapy for Hip Osteoarthritis

Physical therapy can help those with hip osteoarthritis manage arthritic pain and regain function, strength, and mobility in the hip through therapeutic exercise and manual therapy. Physical therapy-based therapeutic exercise is recommended as the first-line conservative treatment for osteoarthritis. A physical therapist begins the treatment program with a thorough assessment of the patient’s medical history as well as their hip strength and range of motion, balance and gait pattern, ability to move from sitting to standing, and how they navigate stairs.

From there, the therapist designs a customized treatment program based on the patient’s condition to improve strength, standing balance and walking ability, and leg and hip mobility, and reduce pain. Numerous studies have shown that physical therapy treatment for hip osteoarthritis reduces pain and stiffness in the affected hip and improves hip function and the patient’s ability to perform daily activities.

Physical therapy treatment for hip osteoarthritis can include:

• Pain management using ice, heat, ultrasound, or electrical stimulation as well activity modifications to minimize stress on the hip

• Manual therapy using soft tissue and joint mobilizations to improve flexibility and increase range of motion in the hip joint

• Structured exercise program:

  • Strength training using body weight, weights, resistance bands, and equipment to build muscle strength in the legs, hips, and core.

  • Aerobic conditioning such as walking on a treadmill or cycling on a stationary bike to build aerobic capacity for overall fitness.

  • Balance training such as single leg balance exercises and dynamic balance exercises over various obstacles to relearn proprioception in the lower extremity.

  • Gait training to help patient relearn proper walking patterns and avoid compensating for the affected hip through abnormal gait.

• Aquatic therapy involving exercise in our warm water therapy pool to gently build strength and mobility. Water provides resistance to the body when exercising while reducing stress on the affected joint and improving pain.

If the osteoarthritis has progressed to a severe stage, the patient may require hip surgery, such as a total hip replacement which involves replacing the damaged bone and cartilage with prosthetic components. Post-surgery physical therapy after a hip replacement is essential for optimal recovery and to regain function, strength, and mobility in the hip.

Research has shown that physical therapy is an effective first-line treatment for hip osteoarthritis. A 2014 review of 10 studies investigating exercise treatment for hip osteoarthritis found a statistically significant and clinically relevant reductions in pain and disability following exercise therapy and these benefits persisted 3-6 months post-treatment. In a recent 2023 review of 18 randomized control trials on exercise therapy for hip osteoarthritis, researchers also found that patients experienced beneficial effects on pain and function after exercise therapy as well as 6-9 months after treatment.

In 2017, researchers conducted a 12-week pilot study of 13 women over age 65 with hip osteoarthritis who received an exercise intervention for their treatment. Among the 13 women, pain declined significantly (over 30%) from baseline and joint function and health-related quality of life improved. Researchers found that the women’s maximal isometric leg extensor strength improved by 20% and hip extension range of motion improved by 30%, enhancing the women’s overall physical function. The exercise intervention included range of motion exercises, lower limb muscle strengthening, and balance, agility, and mobility training.

In a 6-year follow-up study of a previous randomized control trial of 109 patients who were divided into an exercise plus patient education program vs. patient education only, researchers found that the exercise plus patient education intervention provided a protective effect against requiring hip surgery compared with the patient education only group.

Hip osteoarthritis can be debilitating and limit your function and mobility in your hip. Work with a physical therapist to manage osteoarthritic pain and regain function and strength in your hip!