Hip Osteoarthritis: Why Exercise Comes First, and How to Get Started
Quick summary
- Hip osteoarthritis commonly causes pain in the groin or front of the thigh, morning stiffness, and trouble with socks, shoes or getting out of the car.
- The RACGP guideline strongly recommends exercise for all people with hip osteoarthritis, regardless of age, severity on X-ray or pain level (RACGP, 2018).
- The same guideline strongly recommends weight management where relevant, and recommends against opioids for osteoarthritis.
- A short course of manual therapy may be considered as an add-on to exercise and lifestyle changes, not as a stand-alone treatment.
Hip osteoarthritis (OA) tends to creep up. It might start with stiffness getting out of bed, an ache in the groin after a long walk, or noticing that putting on socks has become a project. Many people assume the only real fix is a hip replacement and that, until then, they should rest the joint. Current Australian guidance says close to the opposite: exercise is the first-line treatment for everyone with hip OA.
Is It Really Your Hip?
"Hip pain" means different things to different people. Pain from the hip joint itself is most often felt in the groin or front of the thigh, sometimes down towards the knee. Pain on the outside of the hip is often from the tendons and bursa there, and pain in the buttock frequently comes from the lower back or sacroiliac joint. Typical features of hip OA include:
- groin or thigh pain with walking, standing or stairs
- stiffness after rest, particularly first thing in the morning, that eases with movement
- difficulty with tasks that need hip rotation and bending, such as putting on socks and shoes, cutting toenails or getting in and out of a car
- gradually reduced range of movement
The RACGP guideline notes that OA can usually be diagnosed clinically in people over 45 with typical symptoms, without routine imaging.
What the Guideline Recommends
The Royal Australian College of General Practitioners' guideline for knee and hip OA sets out these key points (RACGP, 2018):
- Exercise: land-based exercise is strongly recommended for all people with hip OA to improve pain and function, regardless of age, structural severity, function or pain levels. The best type of exercise couldn't be determined, so the right program is one you'll actually do.
- Weight management: strongly recommended for people with knee or hip OA who are above a healthy weight.
- Aquatic exercise: may suit some people, depending on preference and access.
- Manual therapy or massage: a short course could be considered for some people as an adjunct to exercise and lifestyle changes.
- Opioids: strongly recommended against for osteoarthritis.
The European League Against Rheumatism (EULAR) similarly recommends regular physical activity as an integral part of care for people with hip and knee OA (Rausch Osthoff et al., 2018).
Getting Started Safely
- Start where you are. If walking 20 minutes flares your hip, start with 10 and build up. Some discomfort during exercise is acceptable. As a common rule of thumb, it should settle back to your usual level within about a day.
- Strengthen the hip and thigh muscles. Sit-to-stands from a chair, step-ups, bridges and side-lying leg lifts are simple starting points.
- Keep the joint moving through the range you have, with gentle daily mobility.
- Mix in low-impact fitness such as cycling, swimming or water walking if land-based walking is limited.
- Pace your week. Spread heavier jobs like gardening or shopping across days rather than doing everything at once.
How We Help With Hip OA in Kogarah
At Spirit Chiropractic we start by working out whether your pain is really coming from the hip joint, the surrounding tendons or your lower back, since that changes the plan. For hip OA, care focuses on an exercise program built around your goals, advice on pacing and daily tasks, and, where helpful, a short course of manual therapy to ease stiffness while you build strength. We'll work alongside your GP, and if a surgical opinion is appropriate we'll say so.
If you also have knee pain, see our article on knee pain and osteoarthritis.
See a doctor promptly if you have: a hot, swollen joint, fever, sudden severe hip pain or inability to bear weight (especially after a fall), or hip pain with unexplained weight loss.
Stiff, sore hip slowing you down?
We can help work out whether the hip joint is the source and set up an exercise-first plan that fits your day and builds your confidence to keep moving.
Spirit Chiropractic is at Shop 23/6 Belgrave Street, Kogarah. If your GP has put you on a chronic condition management plan, here's how Medicare works for chiropractic.
Request an appointment Call 0410 420 856Frequently Asked Questions
What is the best exercise for hip osteoarthritis?
The RACGP guideline strongly recommends land-based exercise for everyone with hip osteoarthritis but found no single best type. Strengthening, walking, cycling, Tai Chi and water exercise are all reasonable. The best program is one you can do consistently.
Should I rest my hip if I have arthritis?
Long periods of rest usually make stiffness and weakness worse. Guidelines recommend staying active and exercising, adjusting the amount so that any increase in pain settles within about a day.
Where is hip arthritis pain usually felt?
Pain from the hip joint itself is most commonly felt in the groin or front of the thigh, sometimes spreading towards the knee. Pain on the outside of the hip or in the buttock often has other causes.
Can chiropractic help hip osteoarthritis?
The RACGP guideline says a short course of manual therapy could be considered for some people as an add-on to exercise and lifestyle changes. A chiropractor can also help set up and progress an exercise program.
Do I need an X-ray to diagnose hip osteoarthritis?
Not always. The RACGP guideline notes that osteoarthritis can usually be diagnosed clinically in people over 45 with typical symptoms. Imaging may be useful when the picture is unclear or surgery is being considered.
References
- The Royal Australian College of General Practitioners. (2018). Guideline for the management of knee and hip osteoarthritis (2nd ed.). East Melbourne, Vic: RACGP.
- Rausch Osthoff, A.K., Niedermann, K., Braun, J., et al. (2018). 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases, 77(9), 1251–1260. https://doi.org/10.1136/annrheumdis-2018-213585
This article is general information, not a diagnosis or a substitute for an individual assessment. If you have new or worsening symptoms, see a registered health practitioner.
