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Hip · Hip Osteoarthritis

Hip Arthritis

Wear-and-load changes in the hip joint — the surfaces and surrounding tissues have become more sensitive. It's common with age and it does NOT mean the joint is 'bone on bone' or beyond help.

The hip has gradually become deconditioned and sensitised. The single best-evidenced treatment is exercise and education — stronger muscles offload and support the joint — which guidelines mandate ahead of injections or surgery.

How it typically shows up

Deep groin or front-of-hip pain in someone around 50 or older, with brief (under an hour) morning stiffness, restricted or painful turning the hip inward, and pain on walking/weight-bearing — diagnosed clinically. Core treatment is exercise + education.

How long recovery takes

Exercise reliably reduces pain and helps you move better over weeks; a typical program is about two sessions a week for six weeks, then you keep going on your own.

Flares are expected and are not joint damage — ease the exercises back a little, you don't stop. If pain keeps climbing week on week despite easing off, get it assessed.

The phased recovery approach

  1. Phase 1 · 1–3 weeks

    Calm

    Start gentle neuromuscular control, active hip range, and low-load aerobic work; learn that some pain and the odd flare are safe.

    What you get back: everyday moves with less ache.

    • Standing Hip Flexion (marching) — 2–3 sets × 8–12 reps · Hold a support, lift one knee toward your chest and lower with control
    • Standing Hip Extension — 2–3 sets × 8–12 reps · Hold a support, push one leg straight back from the hip
    • Supported Mini-Squat — 2–3 sets × 8–12 reps · Hold a counter, sit back a little way
    • Sit-to-Stand — 2–3 sets × 8–12 reps · Stand up from a chair without using your hands

  2. Phase 2 · 3–6 weeks

    Rebuild

    Progress hip and lower-limb strengthening to offload and support the joint.

    What you get back: longer walks and easier stairs.

    • Low Step-Up — 2–3 sets × 8–12 reps · Step up onto a low step, drive through the heel
    • Hip Hinge — 2–3 sets × 8–12 reps · Push the hips back, keep a long flat back
    • Double-Leg Squat — 2–3 sets × 8–12 reps · Feet hip-width, sit back and down only as far as comfortable
    • Standing Hip Extension — 2–3 sets × 8–12 reps · Hold a support, push one leg straight back from the hip

  3. Phase 3 · 2–6 weeks

    Back to walking

    Maintain strength and aerobic fitness for walking and daily life.

    What you get back: walking and daily life, comfortably.

    • Graded Walking — 1 sets × 1200–1800s hold · Build up walking time gradually
    • Sit-to-Stand — 2–3 sets × 10–15 reps · Stand up from a chair without using your hands
    • Low Step-Up — 2–3 sets × 10–15 reps · Step up onto a low step, drive through the heel
    • Hip Hinge — 2–3 sets × 10–12 reps · Push the hips back, keep a long flat back

  4. Phase 4 · 3–8 weeks

    Back to the gym

    Progress hip-friendly loaded lower-body strength work while respecting the hip OA flare rule.

    What you get back: lower-body training without a next-day flare.

    • Leg Press — 3–4 sets × 8–12 reps · Use a comfortable hip range; do not chase deep flexion
    • Loaded Box Squat — 3–4 sets × 8–12 reps · Hold a backpack or household load close to the chest
    • Sit-to-Stand — 3–4 sets × 8–12 reps · Stand up from a chair without using your hands
    • Loaded Romanian Deadlift (barbell / dumbbell) — 3–4 sets × 8–12 reps · Hold a barbell or dumbbells: push the hips back keeping a long flat back, stand tall by squeezing the glutes

  5. Phase 5 · 2–6 weeks

    Back to sleep

    Restore enough hip tolerance and nighttime positioning comfort that the hip no longer drives sleep pain — keep the gluteals and the strength base strong while you settle the side-lying provocation with positioning.

    What you get back: sleeping on that side without the ache.

    • Graded Walking — 1 sets × 900–1800s hold · Build up walking time gradually
    • Standing Hip Abduction — 2–3 sets × 10–15 reps · Stand tall, take one leg out to the side without leaning
    • Standing Band Abduction — 2–3 sets × 10–15 reps · Band at the ankles, take one leg out to the side
    • Standing Hip Extension — 2–3 sets × 10–15 reps · Hold a support, push one leg straight back from the hip

Exact exercises, sets and progression depend on your severity, equipment and goal — this is the shape of the program, not a one-size prescription.

What matters while you recover

  • Exercise is the treatment — and it's safe

    Hip arthritis is common and very treatable. Exercise is the single best-evidenced treatment — guidelines put it ahead of injections and surgery — and it does not 'wear the joint out'. Stronger muscles protect the joint. Hurt isn't the same as harm.

  • Motion is lotion — keep moving

    Staying active is part of the treatment, not a risk to the joint. Keep walking and moving within comfort, break up long periods of sitting, and pace bigger activities across the day rather than avoiding them. The joint does better used than rested.

  • Flares are okay — and not damage

    Some pain while you exercise (up to about 5/10) is fine, and an occasional flare that settles back to baseline within a day is expected — it is NOT a sign of harm. If pain goes beyond that, reduce the load a little; don't stop moving.

Common questions

Will exercise wear the joint out faster?
No — the opposite. Strengthening offloads and protects the joint; guidelines make exercise the core treatment for almost everyone with hip OA.
Is it okay if it hurts a bit while I exercise?
Yes — up to about 5/10 is acceptable, and a flare that settles back to baseline within a day is fine. Flares aren't damage; if pain exceeds that, reduce the load rather than stopping.
Do I need an X-ray or a hip replacement?
Usually not first — hip OA is diagnosed clinically, and exercise + education is the first-line treatment. Surgery is considered only if a good exercise course hasn't helped enough.

Go deeper

Related hip conditions

Sources