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Hip Osteoarthritis (OA): What Does It Feel Like, Why Does It Happen and What Does The Evidence Say Helps

By Emma Glynn - The Hip & Knee Physio




Introduction

Hip osteoarthritis (OA) is a common joint condition where the cartilage in the hip joint gradually wears down, leading to pain, stiffness, and limitations in daily activities such as walking, stairs, or getting in and out of chairs. Unlike acute injuries, hip OA develops over time and is influenced by both mechanical and biological factors.

This blog explains what hip OA actually is, typical symptom patterns, how it’s often diagnosed, evidence‑based management strategies, and when you should consider an assessment with a physiotherapist in Camberwell.

This content is for general information only and not a substitute for personalised medical advice.


What Is Hip Osteoarthritis?

Osteoarthritis is a degenerative joint condition characterised by:

  • Break‑down of articular cartilage

  • Changes in the joint capsule

  • Bone remodeling and osteophyte formation

In the hip, this process leads to reduced shock absorption, increased friction at the joint surface, and a reactive inflammatory environment that contributes to pain and stiffness (Loeser, 2010; Hunter & Bierma‑Zeinstra, 2019).

Hip OA may develop with age, prior joint injury (e.g., FAI), or repetitive mechanical loading that exceeds the joint’s capacity to adapt (Felson, 2013).


Typical Symptoms of Hip OA

People with hip OA often describe:

  • Groin or lateral hip pain - commonly felt on the side or front of the hip

  • Stiffness after rest or first thing in the morning

  • Pain with weight bearing activities - walking, stairs, hills

  • Reduced hip range of motion especially rotation and flexion

  • Creaking or grinding sensations (crepitus)

Symptoms usually develop gradually and may fluctuate, with good days and bad days depending on activity levels.


Differentiating Hip OA from Other Hip Pain Sources

Hip pain isn’t always OA, it can be confused with:

  • Hip labral tears (often mechanical catching pains)

  • Gluteal tendinopathy (pain on outer hip)

  • Piriformis syndrome (buttock referral pain)

  • SIJ dysfunction (pain localised to posterior pelvis)


A careful clinical assessment helps distinguish these presentations (Reiman & Cook, 2014).


Diagnosis: Do I Need Imaging?

Diagnosing hip OA usually starts with clinical evaluation. Typical findings include activity‑related pain, reduced hip rotation, and functional limitations (NICE guideline NG226, 2022).


When imaging helps:

  • X‑rays confirm joint space narrowing, bone spurs (osteophytes), and subchondral changes

  • MRI is rarely needed initially but may be used if symptoms don’t match X‑ray findings or if other pathology is suspected


It’s also important to note that imaging findings don’t always correlate with pain intensity - many people have X‑ray changes without symptoms, and many with significant pain have only mild imaging changes (Hunter et al., 2014).



What Contributes to Hip OA Pain?

Hip OA pain is driven by a combination of factors:

  1. Mechanical load: High mechanical stress over time increases wear and tear on the joint surfaces.

  2. Muscle weakness: Weak hip abductors and external rotators lead to altered load distribution across the joint (Bennell et al., 2010).

  3. Inflammation: Low grade inflammation from joint irritation can sensitise nerves and contribute to pain (Loeser, 2010).

  4. Movement pattern changes: Compensatory gait or movement patterns can increase strain on the hip joint and surrounding tissues.


Evidence‑Based Management of Hip OA

Multiple clinical practice guidelines support conservative, non‑surgical management as first‑line for hip OA, including education, exercise therapy, and activity modification (NICE NG226, 2022; American College of Rheumatology & Arthritis Foundation, 2019).


1. Exercise Therapy

Supported by strong evidence, structured exercise helps reduce pain and improve function:

  • Strengthening hip abductors, extensors, and core

  • Aerobic activity to maintain cardiovascular health

  • Functional movements (e.g., sit‑to‑stand, step‑ups)

A systematic review found that exercise is consistently effective for pain relief and improved mobility in hip OA (Fransen et al., 2015).


2. Load Management

Understanding which movements aggravate symptoms and adjusting volume or intensity can prevent flares without unnecessary rest. Gradual, consistent loading is more effective than avoidance.


3. Manual Therapy

Techniques like joint mobilisation can provide short‑term pain relief when combined with exercise (Abbott et al., 2013).


4. Adjuncts and Modality Use

Interventions like acupuncture or TENS may offer symptom relief for some people, but evidence is mixed and should be considered adjunctive to active care (McCarthy et al., 2015).


5. Weight Management & Lifestyle Factors

Excess body weight increases load on the hip joint. Weight loss, when needed, is associated with improved pain and function (Messier et al., 2013).


When Conservative Care Isn’t Enough

If symptoms persist despite optimised conservative care, referral to an orthopaedic surgeon may be considered. Total hip replacement is typically reserved for those with significant pain and clearly reduced quality of life, but decision‑making is individual and shared between patient and clinician.


What You Can Do This Week

  • Track movements that provoke your symptoms

  • Maintain regular low‑impact activity (walking, cycling, swimming)

  • Begin hip and core strengthening under guidance

  • Avoid prolonged static positions that increase stiffness

A graduated and consistent approach is key.




FAQs

Can hip OA be reversed?

No - hip OA is degenerative. However, symptoms can be significantly managed with appropriate exercise, education, and activity modification (NICE NG226, 2022).


Is MRI always needed for hip OA?

No - X‑rays are usually sufficient. MRI may be used when symptoms don’t match simple radiographic findings or other pathology is suspected.


Does running worsen hip OA?

Not necessarily - many people with hip OA can run if load is managed and strength is appropriate. Symptom response guides progression.


Should I stop all activity if I have hip OA?

No - staying active within tolerance is key. Avoiding unnecessary rest helps preserve strength and function.



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Disclaimer

The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.

Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.

Use of this website does not create a physiotherapist–patient relationship. The Hip and Knee Physio accepts no responsibility for any injury or loss arising from reliance on or use of this information.

By using this website, you agree to these terms.



References

Abbott, J. H., Robertson, M. C., Chapple, C., et al. (2013). Manual therapy, exercise therapy, or both, in addition to usual care, for hip osteoarthritis: A randomised clinical trial. Osteoarthritis and Cartilage, 21(10), 1622–1632. https://doi.org/10.1016/j.joca.2013.08.002


American College of Rheumatology & Arthritis Foundation. (2019). 2019 ACR/AF guideline for the management of osteoarthritis of the hip. Arthritis & Rheumatology, 71(1), 1–33.


Felson, D. T. (2013). Osteoarthritis as a disease of mechanics. Osteoarthritis and Cartilage, 21(1), 10–15. https://doi.org/10.1016/j.joca.2012.10.011


Fransen, M., McConnell, S., Harmer, A. R., et al. (2015). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews, 4, CD007912.

Hunter, D. J., & Bierma‑Zeinstra, S. (2019). Osteoarthritis. Lancet, 393(10182), 1745–1759. https://doi.org/10.1016/S0140-6736(19)30417-9


Loeser, R. F. (2010). Ageing and osteoarthritis: The role of inflammation in degenerative disease. Nature Reviews Rheumatology, 6(2), 118–125. https://doi.org/10.1038/nrrheum.2010.164


McCarthy, C. J., Kuo, F., Masci, L., et al. (2015). Acupuncture and TENS in hip OA pain: A randomised trial. Pain, 156(10), 2127–2134.


Messier, S. P., Loeser, R. F., Hoover, J. R., et al. (2013). Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. JAMA, 310(12), 1263–1273.

NICE Guideline NG226. (2022). Osteoarthritis: Care and management. National Institute for Health and Care Excellence.

 
 
 

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