Hip Arthritis:  How Exercise Can Help

Hip arthritis is a condition where the protective cartilage of the joint surfaces break down.  The cartilage serves as a pad or cushion to the bone beneath it.  This can occur on the end of the thigh bone (ball), the pelvis (socket), or both.  Bare bone can be exposed within the joint. This is where the phrase “bone on bone” comes from.  This sounds worse than it actually is.

bone on bone

Often times, hip arthritis is not associated with any pain.  Also, “severe” arthritis viewed on x-rays may result in only mild pain.  Likewise, mild arthritis may result in higher pain reports.  The experience of pain is more complex than “bone on bone”.   Joint inflammation, joint stiffness, muscle weakness, muscle tightness, and changes within the nervous system can contribute to pain experienced from hip arthritis.

Symptoms of Hip Arthritis

Hip arthritis typically affects patients over 50 years of age.  Common symptoms include stiffness early in the morning or when initiating walking after prolonged sitting.  Pain is most often felt in the groin but can also occur in the back of the hip, the side of the hip, or radiate down the thigh towards the knee.  The pain is generally worse with weight-bearing activities (e.g., walking, standing, or twisting).  Most people experience “flare-ups” of increased pain and stiffness interspersed with periods of little or no pain.

Physical Therapy for Hip Arthritis

Recent research shows several types of exercise are effective for improving pain, function, and quality of life in people with hip arthritis.  This includes aerobic exercise, mind-body exercise, strengthening exercise and stretching.

Common forms of mind-body exercise are tai chi and yoga.  These exercises are characterized by low to moderate intensity exercise performed with an intentional awareness (mindfulness) on breathing and slow controlled movement.  Physical therapists incorporate these principles when prescribing therapeutic exercise for patients with hip arthritis.  Those seeking more concentrated instruction in these forms of exercise are referred elsewhere – Hot or Not Yoga and Bay Avenue Community Center.

Aerobic exercise for people with hip arthritis is backed by the most research. Regular walking for 30 minutes five days per week is recommended.  Continuous walking is preferred but if a person is unable to perform one 30-minute walk, multiple shorter walks totaling 30 minutes can be employed.  Physical therapists help patients begin and progress an individualized walking program.  Cycling, swimming, and other forms of aerobic exercise can also be incorporated.  However, walking programs show the greatest improvements.

Patients with hip arthritis are prescribed an individualized muscle strengthening program.  The gluteus maximus and gluteus medius muscles are often targeted.  These muscles are important for walking, climbing stairs, and transferring from sitting to standing.  Weakness of the hip muscles results in increased forces through the hip joint.  Also strengthening the core muscles will improve function in people with hip arthritis.  Common exercises prescribed includes bridging, the clam shell, and hip extension exercises.

Hip arthritis results in stiffness of the hip joint capsule and ligaments.  The surrounding muscles shorten further limiting the range of motion.  Stretching exercises to improve hip extension and rotation range of motion is important to restore normal walking patterns.  Common exercises prescribed include hip flexor stretching and self-mobilizations for hip internal rotation.

Closing Thoughts

Hip arthritis does not have to be a disabling condition.  Exercise can be very effective for improving pain, function, and quality of life.  Many people are unsure how to start and what type of exercise is best for their personal goals.  Meet with your physical therapist to develop an individualized exercise program that meets your needs.

References

1.  Goh SL, Persson MSM, Stocks J, et al. Relative efficacy of different exercises for pain, function, performance, and quality of life in knee and hip osteoarthritis: Systematic review and network meta ‑analysis. Sports Med. 2019;49(5):743-761.