What is Hip Osteoarthritis? Hip osteoarthritis (OA) is the most common cause of hip pain in adults over the age of 50. But, let me add, hip OA is not always associated with pain and does NOT mean you need to have a hip replacement. Why is that? Because the evidence for physical therapy and exercise as management for OA is incredible!What is Hip Osteoarthritis? Hip osteoarthritis (OA) is the most common cause of hip pain in adults over the age of 50. But, let me add, hip OA is not always associated with pain and does NOT mean you need to have a hip replacement. Why is that? Because the evidence for physical therapy and exercise as management for OA is incredible!
First, let’s talk about what OA is.
OA manifests as changes in the shape, density, length, and function of bones. This also includes the cartilage and fibrous tissue within a joint. Upon first exposure to this term, most people hear OA referred to as “bone-on-bone,” which is unnecessarily dramatic, and does not cover the whole picture. While there is a narrowing of joint space (what the unwarranted term “bone-on-bone” is referring to), there are also changes to the joint capsule – such as shortening, that can be managed well conservatively.
The term “bone-on-bone” tends to evoke a fear response, so I challenge you to spread the word that OA is better known as “age-related change,” or “gray hairs on the inside.”
X-rays do an excellent job picking up on bony changes. But….while they do a great job, you probably don’t need them. Hip OA has a clear clinical pattern and there have been different clusters of tests published with research to back them. Any diagnostic test can have some degree of error, but when we cluster tests together, the chance of a current condition being present is higher. We, as physical therapists, are trained on how to administer these physical tests and draw conclusions from their findings.
For example, one of the test clusters is as follows:
- Hip internal rotation range of motion <15 degrees
- Pain with hip internal rotation
- Duration of morning stiffness <60 minutes
- Age >50 years
Okay great, so what now? Say we have decided that your hip pain is most likely related to some age-related changes in your hip. What do we do? The good news is that there is A-level (aka very good) evidence for manual therapy and exercise to decrease pain and improve function. I have personally seen immediate improvement in pain with hip joint mobilizations and manipulations with the goal of stretching out the joint capsule and improving movement at the hip. When manual therapy is used, it should always be followed up with exercises that use the new range of motion in order to maintain what has been gained.
Hip OA is also associated with relative muscle weakness, especially in the abductors, aka your glutes! There is substantial evidence that working on strengthening the muscles around the hip will help with getting people back to the activities they love pain free.
All of this is to say that we at MOTION RX are well equipped to help you get out of pain and live the life you want to live regardless of those gray hairs popping up in your joints. Hope to see you at the squat rack soon!
Cibulka MT, White DM, Woehrle J, Harris-Hayes M, Enseki K, Fagerson TL, Slover J, Godges JJ. Hip pain and mobility deficits–hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2009 Apr;39(4):A1-25.
Cibulka MT, Bloom NJ, Enseki KR, Macdonald CW, Woehrle J, McDonough CM. Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(6):A1-A37.