Hip osteoarthritis has been identified as a major cause of disability among the older population.¹ Advanced hip arthritis is associated with a reduction in health-related quality of life, including severe mobility restrictions secondary to pain and poor general health.^1,2 Physical therapy management is directed at improving functional mobility, decreasing pain, prevention of deformity, and patient education on activity modification and joint protection techniques. Patients often exhibit hip pain with weightbearing, loss of motion, and strength deficits to the hip, all of which impacts their functional mobility, such as rising from a chair, bathing, dressing, and the use of stairs.³ Adaptive equipment such as canes and walkers and home modifications may benefit the patient through improving their independence at home and in the community.

The use of an assistive device can reduce the amount of joint stress/reaction force when placed in the contralateral extremity (Fig. 74-1). This requires less activity of the hip abductors, and loads placed on the involved hip are reduced with the use of a cane. Education on weight loss is also important for this population, as for every pound of body weight reduced, there is a 3-pound decrease in load through the hip. This population may want to consider activities that minimize weightbearing stress on the hip joint (i.e., swimming, pool exercises, biking).

Exercise has been shown to reduce pain and disability in patients with osteoarthritis and should focus on improving the patient’s hip range of motion (ROM) while avoiding pain and symptoms.^4,5 The heel slide description in Chapter 75 shows an example of a gentle hip and knee ROM exercise. Hip flexor stretching is also important, as tight hip flexors can impair the kinematics between the lumbar spine, pelvis, and hips.

Strengthening of the hip joint should emphasize the gluteus medius, hip adductors, and hip extensors as well as the remainder of the lower extremity and core musculature.¹ The gluteus medius acts as the primary stabilizer of the hip and pelvis in single-limb stance and is important for gait. Side-lying hip abduction is performed by having the patient lie on their side with the top leg straight and then raising the top leg up toward the ceiling (Fig. 74-2). The leg should be raised to approximately 25 to 40 degrees and held for 2 to 3 seconds, repeating ten repetitions in one to three sets. It is important to keep the leg neutral (in line) with the trunk and not to deviate into hip flexion, in addition to keeping the pelvis stable. The “clamshell exercise” is another exercise to strengthen the hip abductors and external rotators. The patient is again in a side-lying position with both legs bent and the heels together. The top knee is raised by rotating the hip, keeping the heels together while preventing the pelvis from rolling (Fig. 74-3). Have the patient hold this position for 2 to 3 seconds, repeating ten repetitions in one to three sets. Hip extensor strengthening can be performed with the patient supine with the knees bent (Fig. 74-4A). The patient then raises the hips upward while keeping the feet on the bed, creating a “bridge” (Fig. 74-4B). The bridge position is held for 2 to 3 seconds, then the patient lowers the pelvis and hips down. With all of these strengthening exercises, it is recommended that patients perform 1 to 3 sets of 10 to 12 repetitions to fatigue for 2 to 3 times per week. It is advised that strengthening exercises be performed on nonconsecutive days and resistance should be progressed as able to maximize strength gains.

A referral to physical therapy may consist of patient education, gait assessment and training, modalities to assist with pain, joint mobilization techniques and stretching to improve hip ROM, and strengthening exercises to address areas of weakness. Specific manual physical therapy techniques have been shown to decrease pain, improve ROM, and increase functional activity in patients with hip osteoarthritis.^6,7