Physiotherapy Management for Hip Osteoarthritis
For hip osteoarthritis, patients should follow a daily individualized exercise regimen that includes strengthening exercises for hip girdle muscles, aerobic activity, and range of motion exercises, with initial professional instruction followed by self-management. 1
Core Exercise Components
- A comprehensive exercise program should include three main components: strengthening exercises, aerobic activity, and range of motion/stretching exercises 1
- Strengthening exercises should target both legs, focusing on quadriceps and proximal hip girdle muscles (especially gluteus medius) 1, 2
- Progressive strengthening should be performed at least 2 days per week at moderate to vigorous intensity (60-80% of one repetition maximum) for 8-12 repetitions 1, 2
- Both isometric (sustained) and dynamic strengthening exercises are beneficial for hip OA 1, 2
- Aerobic activity should be performed daily for at least 30 minutes, or up to 60 minutes for greater benefit 1, 2
- Low-impact activities such as walking, stationary cycling, or aquatic exercises are particularly beneficial for hip conditions 1, 2
Implementation Strategy
- Exercise programs are more effective when supervised, particularly by physical therapists, rather than performed alone at home 1
- At least 12 directly supervised sessions have been shown to be more effective than fewer sessions for improving pain and physical function 1, 3
- Start with exercises within the individual's capability and gradually increase intensity over several months 1, 4
- Follow the principle of "small amounts often" (pacing) and link exercise regimens to daily activities to make them part of lifestyle 1, 3
- The mode of delivery (individual sessions, group classes, pool-based) should be selected according to patient preference and local availability 1, 5
Additional Management Strategies
- Weight loss is strongly recommended for patients who are overweight or obese, with a target of ≥5% body weight reduction for clinical improvements 1, 2
- Greater benefits are seen with weight loss of 5-10%, 10-20%, and >20% of body weight 1
- Self-efficacy and self-management programs that include goal-setting, problem-solving, and education about OA are strongly recommended 1
- Use appropriate and comfortable shoes with shock-absorbing properties 1
- Consider walking aids (walking stick used on the contralateral side, walking frames) to reduce pain and increase participation 1, 6
- Home adaptations may help, such as increasing the height of chairs, beds, and toilet seats, installing hand-rails for stairs, and replacing baths with walk-in showers 1
Expected Outcomes
- Pain reduction of approximately 30% can be expected with a properly designed 12-week exercise program 6, 4
- Improvements in joint function, health-related quality of life, and physical functioning can be achieved 6, 5
- Specific physical improvements include increased isometric leg extensor strength (up to 20%) and hip extension range of motion (up to 30%) 6, 4
- Benefits from therapeutic exercise appear greater when dosage recommendations from general exercise guidelines are met 3, 5
Common Pitfalls and How to Avoid Them
- Pain during exercise: While some discomfort during exercise is normal, exercise should not significantly increase pain. If pain persists for more than 2 hours after exercise, reduce intensity or modify the exercise 1, 3
- Poor adherence: Maximize adherence through supervised initial sessions, followed by home exercises with intermittent follow-up or "refresher" classes 3, 5
- Inadequate progression: Failure to progressively increase exercise intensity may limit benefits. Track improvements and adjust the program accordingly 2, 4
- Focusing only on the affected joint: Include exercises for both legs, as this provides better overall function and joint stability 1, 7
- Neglecting balance exercises: Include balance exercises to improve stability and potentially reduce fall risk 1