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What you'll learn
Don’t say the “a-word”. Don’t do it, don’t even think about it. We can’t be using language like that in these blog posts.
What’s the “a-word”?
ARTHRITIS.
Arthritis has a reputation amongst many as being bad, scary, or an activity-limiting diagnosis. And while it certainly can be all of these things and it's completely valid to feel these emotions towards it, we also have an understanding of how to manage arthritis through exercise and movement. The hip is one of the most common joints in the body that can be affected by osteoarthritis (1). This ball and socket joint plays an integral role in just about every task from standing to going up stairs to sprinting across a field. So what are we to do if one of our most utilized joints is also more directly impacted by the “a-word”?
Well, we don’t panic and we read this blog! Let’s discuss what osteoarthritis is, why exercise is important in the management of hip osteoarthritis (OA), and some exercises for hip osteoarthritis.
What is Hip Osteoarthritis?
Osteoarthritis can be found in many joints throughout the body, with the hip being one of the joints more commonly affected. Hip osteoarthritis refers to progressive deterioration of the cartilage in the hip, changes to the structure of the bone in the joint, as well as inflammation of the fluid that is within the joint. This can lead to swelling, pain, and changes to the available range of motion in the hip joint (1). In the United States, approximately 54 million people (23% of adults) have osteoarthritis (2). And while this may seem like an alarming statistic, it brings to attention that this is not an uncommon diagnosis.
The hip joint structure - appreciate the mobility that is allowed at the joint due to its ball and socket anatomy.
In severe cases of hip osteoarthritis, an individual may elect to have a total hip arthroplasty, which is a surgical replacement of the hip joint. While there are cases where a total hip arthroplasty is appropriate, surgery is not the only answer when it comes to managing hip osteoarthritis or even knee osteoarthritis - check out the video below to learn more about hip arthritis!
The word "arthritis" can seem intimidating and scary to many - let us help you take the fear out of this word and put the power in your hands with managing your arthritis! Check out this video to learn what you can do for your arthritis!
Exercise can play an integral role in managing symptoms of hip OA, improving strength, and challenging range of motion. Many studies have shown that education and exercise, often delivered by PTs, should be a first-line approach to hip OA. Exercise has been shown to provide pain relief that is at least as effective as pain medications, and the benefit of exercise for hip OA is consistent regardless of pain intensity and OA severity (4).
So what kind of exercise is most beneficial for hip OA? Keep reading to find out! Pssst....the below exercises can be found in our Hip Rehab Program if looking to take the guesswork out of managing your hip OA!
Exercises for Hip Osteoarthritis
Exercise is seemingly effective for all joints affected by osteoarthritis, but is extremely beneficial for hip osteoarthritis (1). Both aerobic exercise, as well as strength training, have been studied, and a combination of the two is most beneficial in the management of symptoms. Several studies have demonstrated walking and cycling to be the preferred method of aerobic exercise for those with hip OA. However, there is greater evidence to support that aerobic exercise preferred and elected by the patient is the right choice. To cut to the chase, aerobic exercise is aerobic exercise and as long as the selected activity is not recreating symptoms, the dosage, intensity, or type of aerobic exercise is not crucial to client success (1).
READ: IS EXERCISE THE BEST OPTION FOR OSTEOARTHRITIS?
Strength exercises that have been studied for those with hip OA have ranged from the use of machines at the gym to exercises with resistance bands and weights, to the use of isometrics. All of these forms of strength training are beneficial in the management of hip osteoarthritis symptoms (1).
Some of our favorite exercises for hip osteoarthritis are seen below!
Exercise 01 of 03
Exercise demonstration
Staggered Bridge
View exercise instructions
- HOW: Start on your back with your legs spread and both knees bent, bend the knee in which you want to bias more - meaning that heel is closer to your butt. Tighten up your stomach first, then your glutes. Next, drive your heels into the ground and lift your hips up towards the ceiling. At the end position your knee, hip, and shoulder should be in one straight line. Hold the end position and squeeze the glutes, then slowly return to starting position. The leg of the knee bent more should be working harder here.
- FEEL: You should feel your glutes work to control this motion, particularly of the leg you are biasing. At no point should you feel your low back muscles doing the lifting motion.
- COMPENSATION: Avoid arching at the low back as you perform this.
We love this Staggered Bridge for a few reasons - it helps us strengthen our posterior chain through our hamstrings, gluteal muscles, and low back muscles and the staggered position allows us to work one side a bit more than the other! It's a great way to progress from a traditional bridge if you are looking for that extra challenge! What's next? Let's get squatting!
Exercise 02 of 03
Exercise demonstration
Air Squat
View exercise instructions
- HOW: Stand with your feet about shoulder-width apart. Keep both feet entirely on the ground throughout the movement. Place your hands in front of you about shoulder height to help counterbalance your weight. Hinge forward at the hips, and bend your knees as you sink your hips down. Bring them back up and repeat.
- FEEL: You should feel all of the thigh muscles and butt muscles working.
- COMPENSATION: Avoid letting the knees cave in or bow out. Keep equal weight distribution in both feet, and try not to let your hips shift left or right. Keep a neutral spine by keeping your core engaged to avoid having an over-arched or rounded back.
You can never go wrong with an Air Squat if able to perform this type of movement! You have the choice to add weights if you would like but always respect where you are at - this type of exercise should be asymptomatic and feel like a comfortable way to work on lower extremity strength and mobility!
Exercise 03 of 03
Exercise demonstration
Quadruped Fire Hydrant
View exercise instructions
- HOW: Get set-up in a quadruped position on your hands and knees. Start strong in your shoulder blades by pushing your body away from the floor. From here you will lift one leg off the floor and drive your knee out to the side and back while keeping your knee bent at 90 degrees. This motion is driven by the hip.
- FEEL: You should feel this exercise in your hip muscles, particularly your butt (glute) muscles of the leg that is moving.
- COMPENSATION: Avoid rotating your entire trunk with this exercise, avoid arching your back, do not bend or straighten your knee, maintain knee position.
Time to work a bit on that core strength as well as those smaller hip rotational muscles! If your hip routine does not involve some sort of core strengthening then you are truly missing out! We love the Quadruped Fire Hydrant because it works those core muscles and helps to strengthen those rotational muscles in our hip which are crucial to healthy joint mechanics! Give this one a try - you'll be thanking us later.
LEARN MORE ABOUT OUR HIP REHAB PROGRAM
Now, here’s the cool thing about exercise and hip OA…research has not found one type of aerobic exercise or any one strength exercise to be better than others. Instead, there is a conclusion that an aerobic and strength program catered towards an individual’s interests, one that is easily self-managed, is supervised, or promotes self-efficacy is most effective (3). In a study that looked at the effectiveness of exercise on hip OA, it was determined that 12 sessions performed two times per week allowed for sufficient clinical benefit (4).
Lean on your healthcare team to determine what exercises make the most sense for you! There are so many opportunities to strengthen the muscles around the hip, manage pain, and improve the range of motion to help with any associated stiffness. A physical therapist can assess for weakness, asymmetry, and lack of mobility in the joint and help guide you toward the best options for you!
Closing Thoughts
Hip OA can certainly be a scary and intimidating diagnosis. Changes to the cartilage, bone, and synovial fluid in the joint can lead to pain and loss of range of motion leading many to feel the need to step away from the activities that they enjoy. Luckily, aerobic exercise and strength training, often guided by a PT, has proven to be effective in the management of symptoms associated with hip OA. The best news is that an exercise program, aka one that you enjoy most, is the program that will work best for you! Research does not demonstrate a preferred dose, intensity, strength exercise, or stretch…just move, and find a rad PT and care team who can help support you through it (5).
Next time you want to say the “a-word”, think about changing that language for the “e-word” instead.
EXERCISE.
References
- Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. doi: 10.1002/acr.24131. Epub 2020 Jan 6. Erratum in: Arthritis Care Res (Hoboken). 2021 May;73(5):764. PMID: 31908149.
- Konnyu KJ, Thoma LM, Cao W, Aaron RK, Panagiotou OA, Bhuma MR, Adam GP, Pinto D, Balk EM. Prehabilitation for Total Knee or Total Hip Arthroplasty: A Systematic Review. Am J Phys Med Rehabil. 2023 Jan 1;102(1):1-10. doi: 10.1097/PHM.0000000000002006. Epub 2022 Mar 12. PMID: 35302954; PMCID: PMC9464791.
- van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020 Dec;18(4):575-595. doi: 10.1002/msc.1492. Epub 2020 Jul 9. PMID: 32643252.
- Skou ST, Roos EM. Physical therapy for patients with knee and hip osteoarthritis: supervised, active treatment is current best practice. Clin Exp Rheumatol. 2019 Sep-Oct;37 Suppl 120(5):112-117. Epub 2019 Oct 15. Erratum in: Clin Exp Rheumatol. 2020 Sep-Oct;38(5):1036. PMID: 31621559.
- Gay C, Chabaud A, Guilley E, Coudeyre E. Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Ann Phys Rehabil Med. 2016 Jun;59(3):174-183. doi: 10.1016/j.rehab.2016.02.005. Epub 2016 Apr 1. PMID: 27053003.
About The Author
Lyndsay Provencio, PT, DPT
[P]rehab Writer & Content Creator
Dr. Lyndsay Provencio graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports-related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy. An avid runner herself, she has a particular interest in working with high school, recreational, and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation, postpartum care, and management of the female athlete to better serve her clientele. Through this specialty training, she has acquired a Certificate of Achievement in Pelvic Health Physical Therapy through the American Physical Therapy Association. Lyndsay now owns her own practice StrongHER in Park City, UT where she specializes in female athletics and care of pregnant and postpartum individuals. Additionally, Lyndsay is BSPTS C2 certified in scoliosis specific exercises and has found a niche working with adolescents with scoliosis to improve overall spinal health. No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native of Colorado, Lyndsay is an adventure seeker who loves to hike, camp, and race her twin sister on the mountain trails. When she isn't exploring Park City's outdoor playground, you can find her curled up with a cup of tea and a good book. Follow along @strongher_dpt on Instagram!