Hip osteoarthritis: exercise, pain relief and outlook

What hip osteoarthritis is

The hip is a ball and socket joint, lined with smooth cartilage and surrounded by a strong capsule and powerful muscles. In osteoarthritis, the joint's normal repair process becomes less efficient, leading to cartilage thinning, changes in the bone underneath and bony outgrowths around the edges. The joint can become stiffer and more painful, particularly with certain movements.

Like knee osteoarthritis, it is not simply wear and tear. The amount of change on an X-ray does not closely match how much pain someone has, and well-dosed activity usually helps rather than harms the joint.

Who gets it

Hip OA becomes more common from middle age onwards. Risk factors include age, family history, the shape of the hip joint (such as hip dysplasia or femoroacetabular impingement), previous hip injury, and higher body weight. Some jobs involving heavy lifting over many years may also contribute.

It often affects people who have been active all their lives and want to stay that way. A diagnosis of hip OA does not mean you have to stop walking, lifting or playing sport, although some adjustments may help.

It is worth knowing that hip OA progresses at very different rates in different people. Some notice few changes for many years, while others progress faster. Your symptoms and how you function day to day are a better guide to what you need than the X-ray alone.

Typical symptoms

• Pain in the groin or front of the hip, sometimes spreading down the front of the thigh to the knee
• Stiffness first thing in the morning or after sitting, usually easing within 30 minutes
• Difficulty putting on socks and shoes, cutting toenails or getting in and out of the car
• Pain with walking longer distances, stairs or getting up from low chairs
• A limp or reduced walking distance
• Reduced hip movement, especially turning the leg inwards

Pain on the outside of the hip is more often from the tendons than the joint itself, and buttock pain is often from the lower back. Our guide to hip pain explains the differences. Knee pain can come from the hip, so if your knee hurts but examines normally, the hip is worth checking.

What a physio assessment looks at

UK guidance allows osteoarthritis to be diagnosed clinically, without an X-ray, in people aged 45 or over with activity-related joint pain and short-lived morning stiffness. Your physio will ask about your symptoms and goals, then examine hip movement, strength, balance and how you walk, stand from a chair and climb stairs.

They will check your lower back and knee, screen for warning signs, and discuss what you want to get back to doing. An X-ray may be arranged if the diagnosis is uncertain or surgery is being considered.

Many people arrive worried by the words on an X-ray report, such as severe joint space narrowing. Those words describe the picture, not your future. People with similar X-rays can have very different levels of pain and function, and exercise helps across the range.

What usually helps

UK guidance recommends exercise for everyone with hip OA, including strengthening and general aerobic activity, alongside education and weight management where needed. Structured programmes that combine education and exercise have been shown to reduce pain and improve function, and many people notice benefits within 6 to 12 weeks.

Useful exercises include glute bridges, sit to stand, step-ups, side-lying leg raises and, as confidence grows, gym exercises like leg press and goblet squats to a comfortable depth. Cycling, swimming and walking are good for general fitness. Manual therapy may be used alongside exercise to help with stiffness.

Practical changes help day to day: a higher chair, a long-handled shoe horn, and using a walking stick in the opposite hand if you are limping. Pain relief is worth discussing with a pharmacist or GP. A hip replacement is considered when symptoms are severe and affecting quality of life despite good non-surgical care.

What you can start with at home

1. Sit to stand from a chair, 3 sets of 10, using your hands at first if you need to.
2. Glute bridges, 3 sets of 10 to 15.
3. Standing hip movements holding a worktop: leg out to the side, and leg back, 2 sets of 10 to 15 each.
4. Step-ups onto a low step, 2 to 3 sets of 8 each side.
5. Walk most days at a comfortable distance, adding a little each week.

Aim for strengthening two or three times a week and some aerobic activity most days, building up gradually. Our guide to starting the gym over 50 covers building confidence with gym-based training.

Outlook and when to get help

Hip OA is a long-term condition, but many people manage it well for years with exercise and adjustments. If surgery becomes the right choice, being stronger beforehand usually helps recovery; see our guide to rehab after a hip replacement. The on-site physio at Lycan Strength can build a plan around your goals, with 20% off for members; book a physio appointment online.

• Call 999 or go to A&E if you cannot bear weight after a fall, or the leg looks shortened or turned out.
• Go to A&E if the hip is very painful, hot and hard to move, especially with a fever.
• See your GP promptly for sudden, severe hip pain without injury, especially if you take long-term steroids or drink heavily.
• See your GP if you have unexplained weight loss, a history of cancer or severe pain at night.

Questions