Hip Osteoarthritis

Both get called "my hip", and they're managed differently. Osteoarthritis tends to be felt in the groin, buttock or front of the thigh, gets worse with activity, and brings stiffness after rest, sometimes with a grinding, sticking or locking feeling ².

Pain on the outside of the hip, over the bony point, worst lying on that side, fits hip bursitis better: a problem in the tissues outside the joint, not the joint itself. Working out which is driving your pain is what an assessment is for.

Most people don't need a scan to be told they have hip osteoarthritis. Tests usually aren't needed for the diagnosis ¹. Your clinician asks about your symptoms, then examines the hip: how far it moves, how strong the muscles around it are, and whether the joint is tender ^{1 2}.

An X-ray comes into it sometimes, mainly when it isn't clear what type of arthritis you're dealing with ^{1 2}. Now and then a further examination is needed to rule out other health conditions ².

The honest version. Exercise helps, but modestly: roughly 8 points on a 100-point pain scale, and no clear improvement in quality of life in the few small trials that measured it. A few people found exercise increased their pain ³. And a Melbourne trial of 102 people found that 12 weeks of education, hands-on treatment, home exercise and a walking aid did no better than a sham treatment, with more mild side effects ⁴.

What we take from that: nobody should sell you a magic technique. The part worth investing in is a program you'll keep doing, pitched to your hip and adjusted as it changes.

Hip osteoarthritis has no cure ¹, so here The Well Motion Recovery Path™ is about managing the hip, not healing it. You move up a phase when the hip copes with more, not on a date.

• Reset: the first visits, and any flare later. Pacing, higher seats and cushioned footwear ², a walking stick if distance is the limit ^1,2, and manual therapy only to get you moving. Expect stiffness after rest to linger ². We move you on once your daily pain has stopped climbing.
• Rebuild: the long middle. Exercise prescription to strengthen the muscles around the hip ², alongside walking, swimming or cycling ¹. A few people in trials found exercise increased their pain ³, so we adjust the load if it stirs the hip up. We move you on when the hip does what your daily tasks ask of it.
• Return: back to whatever the hip was stopping: stairs, the car, a long walk, sport. We test those tasks themselves. You leave with a program to keep doing and a plan for flares.

How long it usually takes. There is no healing date to give. In the largest review, gains from exercise lasted three to six months after supervised sessions ended ³, so the program carries on at home. After a hip replacement your surgeon sets the timeline. Surgeons' patient guidance, not a trial, puts most light daily activities at 3 to 6 weeks after the operation ⁷.

Hip flare-ups have been studied directly. Researchers followed people with hip osteoarthritis online for 90 days and compared the days before each flare with their ordinary days ⁵. That shows what tends to come first. Whether changing it prevents flares hasn't been trialled.

• Jolts and near-falls. An injury to the hip in the previous week went with almost three times the odds of a flare. The hip giving way in the previous two days went with double, and the more often it gave way, the higher the risk ⁵. On stairs, hold the rail until the muscles around your hip are stronger ².
• Poor sleep and fatigue. Both were linked with flares. Short sleep by itself wasn't ⁶. Spreading activity through the day, not doing it all at once, is the standard pacing advice ².
• Low seats. They tend to aggravate the hip. Cushions or seat raisers can lift a chair, sofa, toilet or bed ².
• Extra body weight. It increases the stress on your hips, and if you're above a healthy weight, losing some can help reduce pain ¹.