Pain-Free Living

Exercises for Hip Osteoarthritis

by Maura Daly Iversen, PT, DPT, MPH, ScD, and Anne-Marie Dupre, PT, DPT, MS, NCS

Your hips play an important role in many everyday activities, from sitting down to standing up, from walking to climbing stairs, from tying your shoelaces to cutting your toenails. If you have osteoarthritis (OA) of the hip, you know that pain and stiffness can make these activities difficult to do. You may avoid exercise because you think it will make things worse, but research shows that the right kind of exercise can actually help improve hip mobility and reduce pain. In this article, we’ll show you some easy stretching and strengthening exercises designed to do this. Many of the exercises are suitable for people who’ve had a hip replacement, but others may need modifying because they involve moves that can destabilize the new joint. The exercise instructions explain which ones these are.

Before we move on to Stretches, Static Strengthening, and Dynamic Strengthening, let’s look at how the hip joint works, how OA affects it, and how exercise can help.

How the hip works

To understand why the hip plays such a significant role in function, it is important to understand the design of the joint and how it moves. The hip is a ball-and-socket joint connecting the femur, or thighbone, and the pelvis. The head of the femur is the “ball,” and the part of the pelvis called the acetabulum is the “socket” (see The Hip Joint). Covering the ball and lining the socket is a slippery material called cartilage, which cushions the bone and allows the ball and socket to slide smoothly against each other when they move, instead of grinding. The ball-and-socket design allows the hip to have a great range of motion: You can bend at the hip and straighten up again; you can rotate your hip to the side; and you can rotate your legs, move them from side to side, and move them back and forth. None of this would be possible, of course, without the muscles surrounding the joint, which contract to make it move. The muscles also help keep the joint stable.

The muscles also play another important role. The hip is a weight-bearing joint: It helps support your body weight and absorbs some of the impact of activity. Your hip withstands forces equal to one-third of your body weight when you stand, three times your body weight when you walk up stairs, and more than four times your body weight when you run. When the cartilage is healthy, the muscles are strong, and the joint is stable, those forces are distributed equally across the joint, with the muscles and cartilage absorbing much of the stress.

Effects of OA

In OA, the cartilage in the hip gradually wears away. As the cartilage wears, the space between the ball and socket narrows, and eventually bone rubs on bone. The joint begins to feel stiff and painful. The muscles around the joint are weak, mostly because people with OA tend to use their painful joint less (although a 1997 study suggested that muscle weakness might possibly be a risk factor for knee OA, rather than a result of it). Whatever the case, when muscles are weak, they can’t support the joint as well, and the added stress on the joint can accelerate cartilage degeneration. With weak muscles, your ability to move the joint decreases, too. Sometimes, when the joint isn’t moved much, muscles develop contractures, that is, they shrink, or shorten. Contractures alter the alignment of the joint and limit movement. They can also affect how the muscles work, so that more energy is required to carry out activities, resulting in fatigue.

Why exercise is important

As we noted earlier, hip OA can interfere with everyday activities such as walking. Limited hip mobility may impair personal hygiene and sexual function, too. It can also affect how you move your spine, knees, and ankles, putting abnormal stresses on these joints. For all of these reasons, it is important to maintain or improve your joint mobility with exercise.

A comprehensive exercise program contains three elements: flexibility, strengthening, and aerobic exercises. Flexibility exercises stretch the muscles around the joint and help to improve mobility. Strengthening exercises strengthen the muscles so that they better support and protect the joint. And aerobic exercise increases endurance and makes the muscles work more efficiently, improving function. Because the different types of exercise help you in different ways, you need all three in your program.

Aerobic exercise

Walking, biking, tai chi, swimming, and pool exercise programs are all aerobic activities. Some of them have other benefits, too. For example, in one study of women with arthritis who did a pool exercise program, researchers noted significant increases in hip range of motion and strength. Tai chi has been shown to improve balance, important in preventing falls.
Before beginning an aerobic exercise program, talk to your doctor, particularly if you have ever had heart problems. What kind of exercise and how much you should do will depend on the severity of your pain. Generally, if you have mild hip pain, you should do 15–30 minutes of aerobic activity at least three days a week. If you have moderate pain, you can engage in aerobic exercise but should limit your time to 10–20 minutes a day, three days a week. If you have severe hip pain, you should avoid biking and focus on swimming or light weight-bearing exercise, such as water aerobics, for 10 minutes a day, three days a week.

Stretching and strengthening

Click the links above for stretches and strengthening exercises that can help you maintain or improve your hip mobility and function. If you experience any increase in pain when you do these exercises, stop and talk to your doctor or physical therapist. You may need to modify your form or technique. It may help to perform fewer repetitions. Try taking a warm shower before exercising, or postpone exercising until a few hours after you get up, so that your joints and tendons have had a chance to loosen. Many of these exercises can be adapted for the pool. Water makes movement easier by reducing the weight on your joints, and warm water (84–86 degrees Fahrenheit) relaxes tight and stiff muscles.

Tips for stretching. The stretches we describe are designed to increase your hip’s range of motion. They can also loosen up the muscles, helping to reduce pain and stiffness. Every person, regardless of pain level, should perform stretching exercises at least once a day. To get the most out of your stretches, follow these tips:

• Do each stretch three times, holding the stretch for 15 seconds each time.
• Make sure your technique is correct as you stretch — use the illustrations in this article as a guide, or ask your physical therapist for instruction. Keep the joint you are exercising aligned properly; for example, if you are stretching your hamstring, keep your leg straight, not rotated (that is, not turned in or out).
• Do not bounce. That means, don’t do repeated, brief stretches. If you do, your muscle will go back to its original position instead of lengthening, which is what you want. Bouncing can strain muscles, too.

Tips for strengthening. There are two main types of strengthening exercises: static, or isometric, and dynamic, or isotonic. In static exercises, you contract the muscles around a joint without moving the joint itself. Holding a fist is one example. In dynamic exercises, you move the joint as far through its full range of motion as you can. How many repetitions of these exercises you should do and how often you should do them depend on your level of pain. If you have mild pain, you can perform 10 repetitions of each static and dynamic exercise 1–2 times a day. If you have moderate pain, you should perform 6–10 repetitions of each static exercise and only 3–5 repetitions of each dynamic exercise once a day. If your pain is severe, you should perform only static strengthening exercises; do 1 repetition of each exercise 4–6 times a day. These are general guidelines; before you start exercising, talk to your doctor or physical therapist about what’s right for you.

Last Reviewed October 10, 2012

Dr. Maura Daly Iversen is Professor and Chair in the Department of Physical Therapy at Northeastern University and Senior Lecturer in Medicine in the Division of Rheumatology, Immunology, and Allergy at Harvard Medical School in Boston.

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