Hip Arthritis Responds to Work, Not Rest

The pain sits in the front of the groin. It shows up on long walks, on the stairs, getting out of the car. Then an X-ray comes back with the word osteoarthritis on it, and the plan seems to write itself: take it easy, wait it out, start thinking about a replacement. That plan is backwards. The strongest evidence we have says an arthritic hip needs work, not rest.

What’s actually going on

Your hip is a ball-and-socket joint. The ball sits deep in the pelvis, capped in smooth cartilage that lets it glide. In this condition, that cartilage thins over years. The capsule around the joint stiffens, and the muscles that steer the hip lose strength. Clinicians call it hip osteoarthritis. Most people call it wear-and-tear arthritis, or just an arthritic hip.

The pattern is consistent. Pain lands in the front of the groin, sometimes wrapping to the side or the back of the hip, and it gets worse the more weight the joint carries. Mornings start stiff, but the stiffness usually eases within an hour. Motion shrinks in a particular order: rotating the leg inward goes first. As the joint stiffens, the muscles on the outside of the hip weaken, and the walk changes — a shorter stride, a lean, a limp.

This is a common story. In the United States, roughly 1 in 5 adults over 55 has hip arthritis. It is not a rare failure. It is a slow change that responds to the right inputs.

What the evidence says

In 2025, the American Physical Therapy Association published a revised practice guideline for hip arthritis, written by Koc and colleagues. The panel graded every treatment by the strength of the evidence behind it. Three findings matter most.

First, exercise earns the strongest grade. The guideline recommends an individualized program — on land or in a pool — running 1 to 5 sessions a week, 30 to 120 minutes each, for 5 to 16 weeks. Researchers pooled every good trial comparing exercise to no treatment, 18 in all. Exercise reduced pain and improved function, and the benefit was still there 6 to 9 months after the programs ended. The gains were modest, and the authors said so plainly. Exercise will not give you a new hip. It gives you a hip that hurts less and does more, months after the work is done. The same pooled research found almost no harm from exercising an arthritic hip.

Second, dose decides whether it works. Moseng and her colleagues pooled 12 trials covering about 1,200 people. Programs that hit the recommended dose — enough sessions, enough time, enough challenge — cut pain by a meaningful margin. Programs with vague or uncertain dosing showed no clear pain benefit at all. Same diagnosis, same idea, different dose, different result. If exercise failed your hip before, the first question is whether it was dosed like medicine or handed out like a pamphlet.

Third, format matters less than supervision. A Danish trial split 152 adults with hip arthritis into three groups: supervised strength training in a gym, supervised walking with poles in a park, and an unsupervised home program. Both supervised groups outperformed the home-alone group, and the pole-walking group posted the biggest gains on function tests like rising from a chair and walking distance. The lesson isn’t that poles are magic. It’s that guided, well-dosed movement works in more than one form — and going it alone works least.

The guideline also puts its top grade on hands-on therapy: skilled joint and soft-tissue work to restore motion and calm pain in mild-to-moderate hip arthritis, paired with exercise so the gains stick. Here is the fuller picture, in plain words:

Treatment	Evidence	What it means for you
Individualized exercise program	Strong	The core of care. Land or water, dosed properly, run for weeks.
Hands-on joint and soft-tissue therapy	Strong	Restores motion and eases pain, best paired with exercise.
Education on activity, pacing, and unloading the joint	Moderate	Knowing how to use the hip is part of treating it.
Weight loss support, when it applies	Moderate	A team effort with your physician or a dietitian.
Gait, balance, and walking-aid training	Weak	Useful when walking or balance is limited.
Therapeutic ultrasound	Conflicting	The newest good trial found no benefit over placebo.
Bracing as a first move	Expert opinion against	Not where treatment starts.

One honest note on the far end. The guideline’s own benchmark says nonsurgical care has failed when months of appropriate treatment haven’t cut pain by roughly a fifth to a quarter and the joint space keeps narrowing on X-ray. For those hips, a surgical consult is a reasonable next conversation. For most others, it is not the starting point.

What I do in clinic

My treatment for an arthritic hip is built on two pillars: hands-on work to restore motion, and progressive exercise to keep it. The 2025 guideline puts its strongest evidence behind both.

The hands-on work targets the joint and the tissue around it. I use a gentle, sustained pull along the length of the leg — therapists call it long-axis distraction — to decompress the joint and let it move with less pinch. I add joint glides and soft-tissue work through the hip flexors, glutes, and deep rotators. The goal is simple: a hip that moves farther with less guarding, today, so the exercise that follows lands on a more willing joint.

I also look past the hip. The low back, pelvis, knee, and ankle all share the hip’s workload, and a restriction in one shows up as pain in another. So I use the body’s preferred movements — the directions and regions that already move well and without pain — as tools to restore the hip’s own active motion. If moving the trunk or the opposite leg a certain way frees up the painful hip, that goes in the plan. In my practice, this approach has been effective for motion an arthritic hip doesn’t give up easily.

The exercise program is where the lasting change happens, and I dose it like a prescription. Strength work for the muscles that steer and support the hip — the glutes, the rotators, the thigh — progressed steadily as the joint tolerates more. Balance and walking practice when those are limited. And a clear schedule: most hips in my clinic train two to three days a week for a stretch of weeks, inside the guideline’s dose window, because the research says an underdosed program is the one that fails.

Education runs through all of it. How to modify the activities that flare the hip without abandoning them. How to unload the joint — a cane in the opposite hand, shorter but more frequent walks. And when extra body weight is part of the load, I bring in your physician or a dietitian rather than pretending exercise alone will handle it. The guideline backs that team approach with moderate evidence.

What this means for you

• Think in weeks, not days. The trials that worked ran 5 to 16 weeks, with sessions 1 to 5 times a week.
• Keep walking and moving daily, within tolerance. The pooled research found almost no harm from exercising an arthritic hip.
• If exercise failed you before, question the dose before you question the diagnosis. Underdosed programs were the ones that showed no benefit.
• Supervision matters early. Learn the program under guidance, then own it.
• A cane in the hand opposite the painful hip is a tool, not a surrender. It unloads the joint so you can stay active.
• Skip the brace as a first move. The evidence doesn’t support starting there.
• If extra weight is part of the picture, ask for help with it. Even a 5 percent loss changes what the hip carries every step.

When to see someone

Most arthritic hips fit the pattern above. A few things don’t, and they deserve a direct look:

• Pain that keeps worsening despite weeks of properly dosed treatment
• Morning stiffness that lasts hours instead of easing within one
• Hip pain that started with a fall or other real trauma
• Numbness, tingling, or weakness running down the leg
• Fever, unexplained weight loss, or feeling unwell alongside the hip pain
• Night pain that no position relieves

And if months of well-dosed care haven’t moved your pain, asking a surgeon’s opinion is a reasonable conversation, not a defeat. The guideline itself draws that line.

This article is education, not a diagnosis for your specific case. If your symptoms are getting worse or won’t settle, talk to your physical therapist or physician.

References

• Koc TA Jr, Cibulka M, Enseki KR, Gentile JT, MacDonald CW, Kollmorgen RC, Martin RL. Hip pain and mobility deficits—hip osteoarthritis: revision 2025. J Orthop Sports Phys Ther. 2025;55(11):CPG1–CPG31.
• Teirlinck CH, Verhagen AP, van Ravesteyn LM, et al. Effect of exercise therapy in patients with hip osteoarthritis: a systematic review and cumulative meta-analysis. Osteoarthr Cartil Open. 2023;5(1):100338.
• Moseng T, Dagfinrud H, Smedslund G, Østerås N. The importance of dose in land-based supervised exercise for people with hip osteoarthritis. A systematic review and meta-analysis. Osteoarthritis Cartilage. 2017;25(10):1563–1576.
• Bieler T, Siersma V, Magnusson SP, Kjaer M, Christensen HE, Beyer N. In hip osteoarthritis, Nordic Walking is superior to strength training and home-based exercise for improving function. Scand J Med Sci Sports. 2017;27(8):873–886.