Degenerative joint disease causing pain and stiffness.
Osteoarthritis (OA), often called "wear-and-tear" arthritis, age-related arthritis, or degenerative joint disease, is the most common form of joint disorder in the US, affecting over 27 million Americans. It is a chronic, progressive, and multifactorial joint disease that can involve any joint, primarily affecting the articular cartilage and surrounding tissues. The hip joint is one of the body’s largest weight-bearing joints, second only to the knee, and is commonly affected by OA.
In hip OA, the entire joint is affected, not just the articular cartilage. The OA process involves progressive loss of articular cartilage, subchondral cysts, osteophyte formation (bone spurs), periarticular ligamentous laxity, muscle weakness, and potential synovial inflammation. It is increasingly understood that OA is not a singular process but results from various distinct conditions with unique etiologic factors that share a common final pathway. The effects on large lower extremity joints like the hips can lead to reduced mobility, marked physical impairment, loss of independence, and increased healthcare utilization, profoundly affecting daily activities such as walking, stair climbing, and rising from a seated position.
The most common symptom of hip OA is pain around the hip joint, typically located in the groin area.This pain often develops slowly and worsens over time, though it can also have a sudden onset. Pain and stiffness may be more pronounced in the morning or after prolonged sitting or resting. Typically, stiffness in OA lasts only a few minutes, subsiding in 30 minutes or less, and improves with movement and physical activity that loosens the joint. As the disease progresses, painful symptoms may occur more frequently, even during rest or at night.
Other symptoms and signs include:
Hip OA can be classified based on radiological assessment. The Kellgren-Lawrence (K-L) grading scale, described in 1957, is the most widely used system, although it is not specific to hip OA grading. Kellgren further described four grades of hip OA in 1963 based on:
It's important to note that there can be a significant contrast between patient symptoms and radiographic findings; patients with marked radiographic changes may be asymptomatic, and vice versa.
The hip joint is described as one of the body's largest weight-bearing joints, second only to the knee. It consists of the femoral head (the ball) and the acetabulum (the socket).
In hip OA, the entire joint is affected. The current understanding is that while articular cartilage is primarily affected, the pathological process involves a progressive loss of articular cartilage, leading to fibrillation, fissures, and ulceration, eventually resulting in the complete loss of cartilage thickness down to the subchondral bone. This is accompanied by subchondral cysts, osteophyte formation, periarticular ligamentous laxity, muscle weakness, and possible synovial inflammation.
The disease is a result of the interaction between mechanical and biological events that destabilize the equilibrium of degradation and synthesis of chondrocytes (cartilage cells) and the extracellular matrix of the articular cartilage, as well as the subchondral bone. Abnormal mechanical loading can "wake up" chondrocytes from a state of low metabolic activity, stimulating them to produce proinflammatory mediators. Synovitis (inflammation of the synovial membrane) with lymphocytic infiltration has also been identified in early-stage OA, underscoring its whole-joint nature. In its final stage, OA is manifested by morphological, biochemical, molecular, and biomechanical changes, leading to softening, fibrillation, ulceration, and loss of joint cartilage, sclerosis, and eburnation of the subchondral bone, and the formation of osteophytes and subchondral cysts.
Osteoarthritis has a multifactorial etiology, with numerous genetic risk factors, and its development is seen as an interaction between systemic and local risk factors. Hip OA can be broadly classified into primary (idiopathic, no known cause) and secondary types (resulting from a defined disorder affecting the joint articular surface, e.g., trauma). Primary OA typically affects multiple joints in an elderly population, while secondary OA is usually monoarticular. A growing consensus suggests that OA is not a single disease but rather a number of distinct conditions, each with unique etiologic factors.
Risk factors for hip OA are divided into:
Physiotherapy is considered the mainstay of conservative treatment for mild and early hip OA. It is aimed at preventing joint dysfunction and delaying the progression of degenerative changes in articular cartilage. Physiotherapy can eliminate or reduce pain by triggering internal antinociceptive mechanisms. It works by increasing the strength of muscles responsible for movements in the affected joint, improving blood circulation in the limbs, and ensuring functional compensation for any mobility limitation. For example, exercises that strengthen and stretch muscles around the hip can support the joint and ease strain. For patients with FAI, physiotherapy focuses on strengthening deep hip stabilizers to improve femoral head control and reduce impingement. In overweight patients, an individualized exercise program combined with behavioral strategies for weight loss can reduce pain.
Physiotherapy offers several advantages as a primary or adjunctive treatment:
However, the efficacy of physiotherapy in treating hip OA specifically is variable, with some reviews suggesting limited benefit beyond self-guided exercise programs or no additional benefit from manual therapy alone or combined with exercise. More high-quality research is needed to definitively establish its effectiveness
For conservative treatments like physiotherapy, a 3-week program of diverse physical therapy procedures resulted in elimination or reduction of pain and significant improvements in range of motion and quality of life. For surgical intervention like total hip arthroplasty (THA), as many as 95% of prostheses remain functional at 10 years, and over 80% can remain functional at 25 years in certain populations with good overall health and activity levels.
Recover faster, move better, and feel stronger with expert physiotherapy. Our team is here to guide you every step of the way.
Physiotherapy is a cornerstone of conservative management, often involving a multidisciplinary approach. It is aimed at preventing joint dysfunction and delaying progression of degenerative changes in joint cartilage.
A clinician should perform a focused clinical examination of the affected hip, including inspection and comparison of leg length, evaluation for joint fixed position, gait assessment, and palpation of bony prominences and tendons. A neurovascular assessment and range of motion comparison to the contralateral side should also be done. Pain severity can be assessed using tools like the Visual Analogue Scale (VAS). Radiographic imaging helps confirm diagnosis and monitor progression.
Manual therapy, including manipulation and stretching, should be considered as an adjunct to core treatments, particularly for hip OA. While some studies on hip OA have reported no benefit from manual therapy or additional benefit when combined with exercise compared to exercise alone, more high-quality research is needed in this area. Mobilization of limb joints is also a component of certain rehabilitation systems.
Exercises that strengthen muscles around the hip are advocated to support the joint and ease strain. Physical therapy aims to increase the strength of muscles responsible for movements in the affected joint. This includes cardiovascular (aerobic) and/or resistance exercises. For FAI, strengthening deep hip abductors and external rotators is key to improving femoral head control. Muscle weakness in hip and lower limb muscles, including hip and knee flexion/extension and hip abduction/adduction, is common in hip OA.
Physical activity and movement that loosens the joint generally improve OA symptoms. Maintaining and improving the range of motion in the hip joints is a key goal of physiotherapy. Stretching exercises are also recommended to improve muscle flexibility.
Patients should recognize and avoid certain activities and exercises that can aggravate the hip joint, such as prolonged inactivity, specific hip rotations (abduction, external, internal), bending, getting in and out of a car, and prolonged physical activity. High-impact activities like golf or jogging should be replaced with lower-stress activities like gentle yoga, cycling, or swimming. Proper footwear with shock-absorbing properties and assistive devices like walking sticks or canes may be considered adjuncts. Weight reduction is crucial for overweight or obese patients, as gaining 10 pounds can exert an extra 60 pounds of pressure on the hip with each step. Unloading the joint through weight loss can slow cartilage loss and decrease joint impact.
Preventive strategies for hip OA aim to reduce the impact and burden of the disease by targeting potentially modifiable risk factors
Hip OA doesn’t have to control your life. At Vaughan Physiotherapy Clinic, we’ve helped hundreds of clients reduce pain, move with confidence, and avoid surgery.
Book Your Specialized Hip Assessment Today:
Proudly serving Thornhill, Langstaff, Newtonbrook, Willowdale, North York, Markham, Richmond Hill, Concord, and North Toronto. Evening/weekend appointments available.
Whether you're struggling with morning stiffness, walking limitations, or flare-ups after activity, our 3-phase treatment system can help:
✅ Reduce pain and improve joint movement
✅ Rebuild strength and balance
✅ Protect your hips with long-term strategies that work
Let us help you stay active, mobile, and independent — without relying on surgery or injections.
Explore the latest articles written by our clinicians
.webp)
.webp)
.webp)
.png)
