Physical Therapy for Hip Arthritis: Osteoarthritis Care

Why should the assessment look beyond a painful hip?

Osteoarthritis involves changes in the joint, including the cartilage covering the ends of the bones. Cartilage is normally smooth and helps the joint surfaces move with little friction; changes in the joint can be accompanied by pain and stiffness. Hip pain can interfere with bending, walking and changing position. It may be felt in the groin or thigh and can spread toward the buttock or knee, as the AAOS hip osteoarthritis guide explains. Knee discomfort does not always mean that only the knee needs assessment.

Describe the tasks affected and when they become difficult. Is the first part of a walk uncomfortable, does distance become the problem, or is reaching the foot to put on a sock the main limitation? These are different questions. The therapist can assess relevant hip movement, strength, walking and functional ability, alongside your health history and medical restrictions.

Bring reports you already have, medicines and previous exercise instructions. Confirm which diagnosis is being treated rather than using “arthritis” as one exercise category for every joint or inflammatory condition.

Which physical therapy exercises may be used for hip OA?

The 2025 hip OA physical therapy guideline recommends an individualized program that may include flexibility, strengthening and endurance exercise to improve motion, strength, function and pain. The starting point should reflect what limits you, rather than requiring every person to complete the same circuit.

For example, chair-rise practice may use a seat height and support you can manage. Whether to add resistance, repetitions or a more demanding task depends on the assessment and response. Someone whose main problem is reaching the foot may need a different emphasis from someone who can move comfortably but tires during a walk.

What can strength and daily-task practice look like?

The AAOS hip conditioning guide illustrates side-lying hip abduction. This and chair-rise practice are examples to select and adapt after assessment, with a suitable position, range, resistance, repetitions and frequency. An uncomfortable lying position or inability to stand safely calls for another version.

1. For selected side-lying hip abduction, lie with the leg to be trained on top and the lower knee bent for support. Keep the top knee straight without locking it, lift the leg slowly within the agreed range and lower with control. Keep the leg facing forward rather than turning it to gain height.
2. For chair-rise practice, use a stable chair at a height you can manage, with armrests or other agreed support. Place both feet on the floor, bring the trunk forward comfortably and push through the feet, using the armrests as needed, to stand. Lower back onto the chair with control. The therapist checks support and balance before reducing assistance or using a lower seat.

The side-lying action trains muscles around the outer hip. Chair-rise practice combines hip and leg strength with balance and movement control under body weight. Endurance practice instead gradually builds the time or distance you can sustain. Increase one demand at a time and compare the task and later symptoms, rather than judging progress by soreness or by completing the hardest version.

What if the hip aches when you start exercising?

Some discomfort can occur when people with OA begin therapeutic exercise. NICE osteoarthritis guidance explains that regular, consistent exercise can improve pain and function over time, even if there is initial discomfort. That does not mean every new pain should be ignored or that you should force a stiff hip to its furthest range.

The plan specifies acceptable responses and when to contact the therapist. Describe the activity, amount and afterward response. Harder ordinary tasks, worsening symptoms or an unmanageable plan need review. New severe symptoms follow the medical-assessment advice below.

How can walking aids and daily-task changes fit?

The 2025 guideline includes assessment-based functional, gait and balance training, with walking aids when relevant limitations are present. A cane, crutches or a walker may be discussed if walking is difficult. Ask a clinician about an appropriate device and fit rather than assuming that any borrowed support will meet your needs.

Be specific about the environment: stairs, a low sofa, a long commute or difficulty putting on shoes. Practice and practical adjustments should relate to those demands. A shorter manageable walk and repeated trips on stairs create different loads, even if the exercise session itself has not changed.

Tell the therapist if an instruction is impractical at home. The plan may need a different setup or support. Describing the obstacle is more useful than silently replacing a prescribed movement with a harder online exercise.

Where does hands-on treatment belong?

Manual treatment may be considered for appropriate mobility and pain limitations. The 2025 guideline recommends it for mild-to-moderate hip OA with relevant impairments. NICE places manual therapy alongside therapeutic exercise, so hands-on treatment should fit an active rehabilitation plan rather than become the entire OA program.

A more comfortable session is useful information, but it does not replace checking walking, strength and the home plan. Guidance describing a treatment option also does not establish that every clinic offers that procedure or equipment.

What makes the home program usable?

The therapist demonstrates unfamiliar movements and observes you repeat them. The home plan explains purpose, position, range, amount and frequency, with adjustments for difficult days and a review point. Our home-exercise guide explains these instructions.

Keep a simple record of one or two familiar tasks, such as a usual walk or getting up from your chair. Note symptoms and how the task feels later, not just the exercise repetitions. This helps connect follow-up with the activities that matter to you.

When should you discuss another stage of care?

Review persistent limitations rather than assuming that more visits must be the answer. OA care may also involve the medical team’s advice about medicines or weight-management support when appropriate. PT is one part of a broader care discussion.

NICE recommends considering joint-replacement referral when symptoms substantially affect quality of life and nonsurgical management is ineffective or unsuitable. There is no single exercise result that decides this for everyone. If surgery is proposed, discuss your remaining difficulties, preferences and options with the treating team. Postoperative rehabilitation will follow the actual operation and its instructions.

Which symptoms need earlier medical assessment?

Seek urgent medical advice for sudden severe hip pain without an injury, or a hot, swollen hip, especially with fever or feeling unwell. Severe pain after a fall, inability to walk or bear weight, or loss of sensation after injury needs emergency assessment. These signs should not be treated as an ordinary exercise flare. The NHS hip-pain guidance describes these distinctions.

Plan the next assessment around a useful task

Wongs Acupuncture & Angel Alliance Physical Therapy provides physical therapy in Manhattan, Forest Hills and Great Neck. Bring your diagnosis, relevant instructions and the tasks you want to improve. For a pain concern, you can also discuss a separate acupuncture assessment, explaining the current diagnosis and care plan.