Hip Osteoarthritis: When Everyday Movement Starts to Hurt

Stairs. That is where a lot of people first realise something has changed. You reach the bottom step, put your hand on the banister to steady yourself, and there is a deep, dull ache in the groin or the front of the hip that was not there a year ago.

Putting on socks in the morning has become a small negotiation. Getting out of the car after a long drive takes an extra second. Rolling over in bed can wake you up. None of it feels dramatic on any given day. It is the accumulation over months that makes you realise this is not just getting older. This is something.

That something is often hip osteoarthritis. It is one of the most common causes of chronic hip pain in adults, and it is also one of the most treatable. Most of what you are dealing with is well-studied. Most of the treatments that actually work are well-known. And the honest answer to "what should I do" is clearer than for a lot of other conditions.

This article walks through what hip osteoarthritis actually is, what the research honestly shows works, and how we approach it at Unpain Clinic in Edmonton. Plus what you can safely do at home while you figure out your next step.

KEY TAKEAWAYS

• Hip osteoarthritis is a slow breakdown of the cartilage in the ball-and-socket joint of the hip. It is not a disease that has to end in surgery for most people.
• Exercise therapy and weight management (where it applies) are the two treatments with the strongest evidence. The systematic review of exercise therapy for hip osteoarthritis in Osteoarthritis and Cartilage Open and the large study of weight loss and hip osteoarthritis in the International Journal of Obesity are the current strongest references.
• The OARSI Guidelines for the non-surgical management of hip and knee osteoarthritis sequence the care: core treatments first (exercise, education, weight management), adjuncts second, surgery when it is genuinely the right next step.
• Shockwave therapy for hip osteoarthritis has one published pilot RCT (Şah in the Journal of Personalized Medicine) showing positive short-term results. It is a promising signal but not yet an established evidence base. It fits as an adjunct in the right presentation, not as a stand-alone first-line treatment.
• Hip osteoarthritis is a slow-adapting condition. Meaningful improvement usually shows up over 8 to 12 weeks of consistent care, with continued gains over the months that follow. The plan needs time.

HIP OSTEOARTHRITIS, IN PLAIN TERMS

The hip is a ball-and-socket joint. The head of the femur (thigh bone) sits in the acetabulum (socket in the pelvis). Both surfaces are covered in cartilage, a smooth, slightly spongy tissue that lets the joint glide through a wide range of motion.

Osteoarthritis is the slow wear of that cartilage. Some areas of the joint take more load than others, and those areas thin first. As the cartilage becomes less able to distribute load evenly, the bone underneath starts to change. Bone spurs (osteophytes) grow around the edges. The joint capsule can become inflamed. And the muscles around the hip start to adapt to the pain, usually by getting tighter and shorter on some sides and weaker on others.

The pain usually has one or more of these qualities:

• Deep ache in the groin (the most common location for true hip joint pain)
• Pain in the front of the thigh or the buttock
• Stiffness first thing in the morning that eases over ten to thirty minutes
• Pain that gets worse with prolonged standing, walking, or a day of higher activity
• Difficulty putting on socks, cutting toenails, or getting in and out of a low chair

One myth worth putting to rest early. Hip osteoarthritis is often described as "wear-and-tear" arthritis, which sounds like the joint is grinding itself away and there is nothing to do about it. That framing is not helpful. Cartilage does wear down over time, but the pain and disability of hip osteoarthritis are shaped by many factors: cartilage state, inflammation, muscle strength around the joint, load patterns, and body weight. Several of those are things you can influence. Which is why the evidence shows treatment works even when the picture on X-ray does not change much.

WHAT MAKES IT WORSE, AND WHAT MAKES IT BETTER

The setup for hip osteoarthritis is usually a combination of factors over years. Age is the biggest risk factor and the one you cannot change. Prior hip injury or a specific structural anatomy (a shallow socket, an impingement-shaped femur, an old childhood hip condition) can bring it on earlier. Extra body weight loads the joint with every step and contributes to systemic inflammation. Weak glutes and tight hip flexors change how load is distributed through the joint over years.

What makes it better falls into a few honest categories. Regular moderate movement is protective, not harmful. Strengthening the muscles around the hip changes the loading pattern in a way that eases pain. Losing weight, where it applies, has one of the biggest effects available. And a proper plan that starts where you are, progresses as you can tolerate, and is done consistently outperforms almost any single passive treatment.

This is where the "what should I do" question gets answered.

THE TWO TREATMENTS WITH THE STRONGEST EVIDENCE

Exercise therapy is the treatment with the largest and most consistent evidence base for hip osteoarthritis. The systematic review and cumulative meta-analysis by Teirlinck and colleagues in Osteoarthritis and Cartilage Open pooled the available randomised trials and concluded that exercise reduces pain and improves physical function. The effect sizes are described as small to moderate in the statistical sense, which in plain terms means most people notice meaningful improvement in what they can do. Not a miraculous cure. A real, durable improvement in the things that matter day to day.

The types of exercise that have been studied include lower-limb strengthening (particularly for the glutes and quadriceps), general aerobic activity (walking, cycling, aquatic exercise), and range-of-motion work. No single "best" protocol has emerged. What matters is that the program is individualised, progresses over time, and is done consistently over months.

Weight management, for patients who are carrying extra weight, has strong evidence with a clear dose-response. The large study by Salis and colleagues in the International Journal of Obesity followed over 1,400 adults with hip osteoarthritis through a structured weight loss program. The finding was clear: the greater the weight loss, the greater the improvement across pain, function, stiffness, sport and recreation, and quality of life. Participants who lost more than 10% of their body weight had the largest improvements.

This is not the only study to reach this conclusion, and it is consistent with the parallel evidence in knee osteoarthritis. Weight management is not relevant for everyone with hip osteoarthritis. For patients who are carrying extra weight, it is one of the most effective interventions available.

The OARSI Guidelines for the non-surgical management of hip and knee osteoarthritis are the current international reference for how to sequence care, and they build the plan around these two treatments as core, with everything else supporting them.

WHERE SHOCKWAVE, MANUAL THERAPY, AND THE REST FIT

Everything else in hip osteoarthritis treatment is an adjunct. The right ones for you depend on your specific presentation, and the honest goal of the adjuncts is to make the core plan work better, not to replace it.

Manual therapy (hands-on physiotherapy for stiff joints and loaded-up muscles) is a supportive adjunct. The evidence for it as a stand-alone intervention is mixed, but in practice it earns its place when the hip capsule is stiff, the calf and thigh are loaded up, or the lower back is compensating in a way that makes exercise harder to do. Loosening those things up lets the exercise program actually progress. That is the useful use of manual therapy.

Shockwave therapy for hip osteoarthritis specifically has a promising early signal and a limited evidence base. To be honest about what the literature shows: one published randomised controlled trial (Şah in the Journal of Personalized Medicine) tested focused and radial shockwave against sham in 148 patients with hip osteoarthritis. Both shockwave groups outperformed sham for short-term pain and function on the WOMAC index, and the focused shockwave group had the largest effect. That is a real, positive, placebo-controlled trial and it is meaningful. It is also, by the authors' own description, a pilot trial and the first of its kind. A single pilot trial is not the same as an established evidence base.

The general mechanism of shockwave (improving local blood flow, effects on pain-signalling nerves, tissue-level effects) is described in the mechanism review in the Journal of Clinical Orthopaedics and Trauma and it makes the intervention biologically plausible for hip osteoarthritis. In practice, shockwave can be a reasonable adjunct to the core plan when other conservative measures have plateaued, when the patient wants to try a non-invasive option before considering injection therapy, or when related conditions (trochanteric bursitis, gluteal tendinopathy) are contributing to the picture, where shockwave has stronger direct evidence.

What shockwave is not, at this stage, is a stand-alone first-line treatment for hip osteoarthritis.

Medications and injections have a defined role. Acetaminophen and topical or oral non-steroidal anti-inflammatory drugs can help manage flares. Intra-articular corticosteroid injections can produce short-term pain relief. These decisions are made by a physician, not by a physiotherapist.

Total hip replacement is one of the most successful operations in orthopaedic surgery for appropriately selected patients. It is not the failure of conservative care. It is the appropriate next step when conservative care has been given a genuine try and is not enough.

HOW TREATMENT WORKS AT UNPAIN CLINIC EDMONTON

The first appointment is a 60-minute physiotherapy assessment. The goal on that first visit is not to start treatment. It is to figure out where you sit on the spectrum of hip osteoarthritis, what specifically is driving your pain right now, and what the plan should look like.

The assessment includes a full history, a targeted physical exam (hip range of motion, strength, gait analysis, functional tests such as the sit-to-stand and 30-second walk), a review of any imaging you have had, and screening for anything that would need a physician referral first.

At the end of the assessment, you get a clear explanation of what is driving your pain, a personalised plan, and a straight answer on realistic timelines. A realistic timeline for meaningful improvement is typically 8 to 12 weeks of consistent care, with continued gains over the months that follow. Some patients feel meaningfully better in the first month. Some need the full timeline.

Treatment is built around a small set of tools working together, with the ones that have the strongest evidence at the centre.

The core is a progressive exercise program tailored to your presentation. Not a generic handout. A program that starts where you can safely start, progresses as you tolerate it, and rebuilds strength and mobility around the hip.

Around that, we add manual therapy where the assessment identifies stiffness or muscle tightness that is making the exercise harder to do. Weight-management coordination sits alongside the physical work when it is relevant. We do not deliver weight loss programs, but we help patients coordinate with dietitians, physicians, or structured programs when it fits the case.

Where shockwave therapy is indicated by the assessment, we use it as an adjunct. Focused shockwave therapy can be applied to the hip region for patients whose presentation fits. Radial shockwave therapy can be used for surrounding muscle work. We are honest with patients that shockwave for hip osteoarthritis specifically has one pilot trial's worth of positive evidence to support its use, not a fully established evidence base. It is an option we offer thoughtfully, not the centre of the plan.

Most treatment plans run over 8 to 12 weeks with re-assessment every few sessions. Some patients then transition to a self-managed program with occasional check-ins. Some continue with periodic sessions. What fits you depends on the case.

The dedicated hip osteoarthritis service page has more detail on the condition-specific pathway.

WHAT YOU CAN DO AT HOME THIS WEEK

This is general education, not individual medical advice, and results vary.

Move often, and keep moving. The biggest mistake most people with early hip osteoarthritis make is reducing activity because it hurts. In the short term this reduces pain. In the medium term it reduces the strength around the hip, which makes the pain worse the next time you try to be active. The pattern that works is the opposite: gentle, consistent, daily movement.

Strengthen the glutes and thighs. Bridges (lying on your back, knees bent, lifting the hips off the floor by squeezing the glutes), sit-to-stands from a firm chair (using your legs, not your arms), side-lying hip abductions, and clamshells are all safe places to start. Two or three sets of 10 to 15 repetitions, most days of the week, over weeks.

Work on hip and calf flexibility. A tight hip flexor and a tight calf can both change how load moves through the hip joint. Kneeling hip flexor stretches and standing calf stretches held for 30 seconds each, done daily, are useful. Sharp joint pain during a stretch is a signal to back off.

Lose weight if it applies. If you are carrying extra weight, this is one of the highest-impact things you can do. The evidence shows a clear dose-response: more loss, more improvement in symptoms. Gradual, sustainable loss over months is what changes outcomes. Coordinate with your physician or a dietitian.

Use heat before activity, ice after a flare. Heat helps the hip loosen up. Ice helps a flared joint settle. Neither changes the condition, but both are useful tools.

Support aids are not a failure. If a cane on the opposite side of the sore hip helps you walk further without pain, use it. If a small heel lift or cushioned shoes help, use those. Reducing pain during activity keeps you moving, and moving is what improves the condition.

Sleep positions. Side-sleepers with hip pain often do better with a pillow between the knees, which keeps the pelvis level and takes rotational strain off the hip. Back-sleepers can try a pillow under the knees.

Some symptoms are not "wait and see." Sudden severe hip pain after a fall or specific event, especially if you cannot bear weight, needs urgent medical assessment. Pain that wakes you constantly at night and is not settling with position changes, fevers with hip pain, or a rapid decline in what you can do warrant a physician review.

FREQUENTLY ASKED QUESTIONS

What does hip osteoarthritis pain feel like?

Most commonly, a deep ache in the groin, often with associated pain in the front of the thigh or the buttock. Stiffness first thing in the morning that eases over 10 to 30 minutes of movement is characteristic. Pain typically gets worse with prolonged standing, walking, or a day of higher activity, and it can flare at night. Pain on the outside of the hip is sometimes hip osteoarthritis but is more often coming from the tissues around the greater trochanter, which is a related but distinct condition.

Is walking good or bad for hip osteoarthritis?

Walking is generally good, particularly at a moderate pace on flat surfaces. Reasonable daily walking maintains strength around the hip, keeps the joint moving through its range, and does not accelerate cartilage wear at typical loads. What is not helpful is either sitting all day (which lets the surrounding muscles waste) or high-impact activity that repeatedly aggravates the hip (which can drive flares). A gradual, consistent walking habit is one of the safest ways to keep the hip in good shape.

Do exercises really help hip osteoarthritis?

Yes. The systematic review evidence is clear that exercise therapy reduces pain and improves function in hip osteoarthritis. The effect is not dramatic in any individual study, but the direction is consistent and it translates into being able to do more of what you want to do with less pain. The best exercise is the one you can do consistently over months. Individualised programs delivered by a physiotherapist have better adherence and outcomes than generic handouts.

Is shockwave therapy effective for hip osteoarthritis?

The evidence is limited. One published pilot randomised controlled trial has directly tested shockwave for hip osteoarthritis. It showed positive short-term results for focused shockwave compared to sham. This is a promising signal but a single pilot trial is not the same as an established evidence base. Shockwave can be a reasonable adjunct to the core plan (exercise and weight management) in the right presentation. It is not a stand-alone first-line treatment for hip osteoarthritis at this stage.

When should I consider a hip replacement?

Hip replacement is appropriate to consider when a genuine trial of conservative care (typically several months of consistent physiotherapy, appropriate medications, weight management if relevant, and lifestyle adjustment) has not produced acceptable pain control and function. Timing is a personal decision made in consultation with an orthopaedic surgeon, and it depends on how much the hip is limiting your life, not just what the X-ray looks like. Modern hip replacements are highly successful for appropriately selected patients.

Can hip osteoarthritis be cured?

Osteoarthritis cannot currently be reversed in the sense of restoring cartilage to its original state. It can be managed effectively. For most patients, well-delivered conservative care substantially reduces pain, improves function, and allows a return to activities that seemed lost. Some patients eventually proceed to hip replacement, and for them, surgery is a successful and durable solution. "Not curable" is not the same as "not treatable." Hip osteoarthritis is one of the more treatable chronic musculoskeletal conditions.

When should I book a physiotherapy assessment?

If hip pain has been ongoing for more than a few weeks, if it is affecting what you can do in a way that matters to you, or if it keeps returning every time you try to increase activity, a proper assessment is likely to save you time. Hip osteoarthritis is a condition where the treatment plan improves substantially with a proper assessment, because the specifics of your presentation (which muscles are weak, which are tight, how your gait has adapted, what other joints are contributing) shape what will actually help.

PATIENT TESTIMONIAL

“Recently Dr Lacina Barsalou treated me with shockwave for two separate injuries. Last season she successfully treated my Achilles tendinitis. After treatment the pain was significantly reduced and it healed well. More recently she has been treating me for a fall on stairs where I injured both knees and hip. Dr B can readily pinpoint the source of pain, administer shockwave therapy and offer home exercise to support the treatment. Her treatment and advice for both injuries has helped me tremendously. I highly recommend shockwave, the Unpain Clinic and Dr Lacina Barsalou. I’ve found it to be a miracle like therapy for pain and injury.”- Barbara Burton

ABOUT THE AUTHOR

Written by Uran Berisha, Founder of Unpain Clinic and Medical Shockwave Institute. Uran has Bachelor of Science in Physiotherapy and is an International Educator in Shockwave Therapy. Medically reviewed by Uran Berisha.

BOOK YOUR INITIAL ASSESSMENT

If hip pain has been slowing you down and the standard three-sentence summary has not been enough, the next step is a 60-minute physiotherapy assessment at Unpain Clinic Edmonton. The assessment identifies what is driving your pain right now, screens for anything that would need a physician referral first, and lets you leave with a clear, specific plan built around the evidence. Book your initial assessment with Unpain Clinic.

WHAT WE DO NOT OFFER

We do not perform corticosteroid injections, hyaluronic acid injections, PRP injections, or surgery. We do not prescribe medications. We do not deliver structured weight loss programs (we coordinate with dietitians and physicians who do). If your presentation suggests a hip that has progressed beyond what conservative care can address, an inflammatory arthritis, an avascular necrosis, a hip fracture, or anything requiring urgent medical evaluation, we will tell you plainly and help you find the right next step.

REFERENCES

1. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. doi:10.1016/j.joca.2019.06.011. PMID: 31278997. https://pubmed.ncbi.nlm.nih.gov/31278997/
2. Salis Z, Gallagher R, Lawler L, Sainsbury A. Loss of body weight is dose-dependently associated with reductions in symptoms of hip osteoarthritis. International Journal of Obesity. 2025;49(1):147-153. doi:10.1038/s41366-024-01653-w. PMID: 39420084. https://pubmed.ncbi.nlm.nih.gov/39420084/
3. Simplicio CL, Purita J, Murrell W, Santos GS, Dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. Journal of Clinical Orthopaedics and Trauma. 2020;11(Suppl 3):S309-S318. doi:10.1016/j.jcot.2020.02.004. PMID: 32523286. https://pubmed.ncbi.nlm.nih.gov/32523286/
4. Şah V. The Short-Term Efficacy of Large-Focused and Controlled-Unfocused (Radial) Extracorporeal Shock Wave Therapies in the Treatment of Hip Osteoarthritis. Journal of Personalized Medicine. 2023;13(1):48. doi:10.3390/jpm13010048. PMID: 36675709. https://pubmed.ncbi.nlm.nih.gov/36675709/
5. Teirlinck CH, Verhagen AP, van Ravesteyn LM, Reijneveld-van de Vendel EAE, Runhaar J, van Middelkoop M, Ferreira ML, Bierma-Zeinstra SM. Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis. Osteoarthritis and Cartilage Open. 2023;5(1):100338. doi:10.1016/j.ocarto.2023.100338. PMID: 36817089. https://pubmed.ncbi.nlm.nih.gov/36817089/