Hip Osteoarthritis: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- Jun 30
- 6 min read
All information in this blog is supported by NICE guidance and a major 2025 clinical practice guideline, alongside peer-reviewed research. Reference numbers appear throughout, with the full list at the bottom of the page.
What Is Hip Osteoarthritis?
Hip osteoarthritis is a degenerative joint condition affecting the hip, and is genuinely one of the most common sources of lower limb pain and functional decline seen in musculoskeletal practice. ¹ It involves a combination of genetic, developmental, mechanical, and environmental factors working together. ²
NICE Guideline NG226, Osteoarthritis in over 16s: diagnosis and management, sets out the general framework for osteoarthritis care across the UK, directly applying to the hip as one of the primary joints it addresses. ³ Alongside this, a major new clinical practice guideline published in November 2025 specifically for hip osteoarthritis provides the most current, detailed, evidence-based recommendations for assessment and physical therapy management of the condition. ¹
What Is Actually Happening Inside the Joint?
Arthritic changes occur both inside and outside the hip joint itself, resulting in loss of joint space, the development of bone spurs (osteophytes), and changes in the bone just beneath the joint surface, including thickening (sclerosis) and the formation of cysts. ⁴ As the condition progresses, joint range of motion reduces and weakness develops in the muscles surrounding the hip. ⁴
Interestingly, hip osteoarthritis doesn't develop the same way in everyone. Degenerative changes occur more frequently and rapidly in people with developmental hip dysplasia compared with those who have structurally normal hips, and people with a specific bony shape variation called a cam deformity also tend to develop hip osteoarthritis more quickly. ⁴ This genuinely reinforces why a thorough individual assessment matters, the underlying joint shape and history can meaningfully influence how the condition progresses.
Risk Factors
The 2025 clinical practice guideline identifies a comprehensive, evidence-based list of risk factors for developing hip osteoarthritis: ⁵
Age, the most consistently identified risk factor
Female sex
Genetics
Obesity
Local joint risk factors, including hip dysplasia
History of hip developmental disorders
Previous hip joint injury
Reduced hip range of motion, particularly internal rotation
Presence of osteophytes (bone spurs)
Lower socioeconomic status
Higher bone mass
Higher body mass index (BMI)
This is a genuinely broad and well-evidenced list, reflecting how hip osteoarthritis develops through a combination of factors rather than any single cause.
Common Signs and Symptoms
Groin pain, often the primary location, though pain can also be felt in the buttock, thigh, or referred toward the knee
Stiffness, particularly after rest or first thing in the morning
Reduced range of movement, particularly with internal rotation
Pain that gradually worsens with activity over time
A feeling of grinding or catching within the joint in some cases
The 2025 clinical practice guideline recommends the FABER test, a specific hands-on assessment combining flexion, abduction, and external rotation, as a useful indicator of how irritable the hip joint currently is. ⁶
What to Look Out For
Please seek prompt medical assessment if you experience:
Sudden, severe hip pain following a fall or trauma, particularly in older adults (possible fracture)
Inability to weight-bear on the affected leg
Fever, redness, or warmth around the hip (possible infection)
Significant, unexplained weight loss alongside hip pain
Rapidly progressive symptoms not following the usual gradual pattern of osteoarthritis
How Is It Diagnosed?
Diagnosis combines clinical assessment with appropriate outcome measures. The 2025 clinical practice guideline recommends using at least one self-reported outcome measure and one physical performance measure, alongside relevant physical impairment measures, for both diagnosis and ongoing reassessment of hip osteoarthritis. ⁶ This structured, evidence-based approach helps track how someone is genuinely progressing, rather than relying on a single snapshot assessment.
How We Can Help
There is strong evidence supporting both exercise and manual therapy for the management of hip osteoarthritis. ⁶ UK guidance similarly emphasises non-drug approaches, including education and staying physically active, as the foundation of management, prioritised ahead of medication wherever possible. ³
Osteopathic manual techniques and manual therapy: the 2025 clinical practice guideline strengthens its emphasis on manual therapy techniques to improve mobility and reduce pain, used alongside, rather than instead of, an active exercise programme. ⁷ Manual therapy is consistently recommended as an adjunct to enable other active management approaches such as exercise. ⁸
Medical acupuncture: this is a genuinely interesting and useful update. The 2025 guideline references dry needling, a closely related technique to acupuncture, targeting trigger points in the iliopsoas, rectus femoris, and tensor fasciae latae muscles, as part of an evidence-based comparison study, supporting its use for short-term symptom relief alongside other treatment. ⁹ ¹⁰
Deep tissue and sports massage: targeted soft tissue work for the muscles surrounding the hip, supporting overall function and complementing manual therapy and exercise.
Cupping and gua sha: used as complementary tools within a broader treatment plan to support soft tissue release around the hip and surrounding muscles.
Weight management advice: where relevant, multiple clinical guidelines recommend a target weight loss of around 5 to 7.5% for people with a BMI over 25, supported by evidence for improving symptoms. ¹¹ We can discuss this sensitively as part of a broader, supportive approach to your overall management.
Exercise and Rehabilitation
Programmes incorporating strengthening, flexibility, and cardiorespiratory exercise, typically delivered over an average of 10 weeks, showed genuine, meaningful benefit. ¹³
Flexibility and range of motion work: addressing the joint capsule, surrounding muscle tightness, and overall flexibility helps increase range of motion, decrease pain, and improve function, particularly relevant for mild to moderate hip osteoarthritis with movement-related impairments. ¹⁴
Muscle strengthening and endurance exercises: restoring strength, endurance, and power in the muscles surrounding the hip joint is a core, well-evidenced component of treatment. ¹⁴
Functional, gait, and balance training: recommended specifically where these particular impairments are present, representing one of the most powerful tools available in non-surgical hip osteoarthritis management. ⁶
Stretching specific muscle groups: targeted stretching of the iliopsoas, rectus femoris, and tensor fasciae latae, performed for around 45 seconds at a time, has shown meaningful benefit in research directly comparing it with dry needling techniques. ⁹
Your practitioner will guide a structured, individualised programme tailored to your specific impairments and stage of hip osteoarthritis.
What to Expect at Your First Appointment
We will take a thorough history and carry out a hands-on assessment in line with current clinical practice guideline recommendations, including relevant outcome measures and specific tests such as FABER, to assess both your symptoms and the overall irritability of your hip joint. We will explain clearly what we find and build an evidence-based treatment plan combining manual therapy with a structured, progressive exercise programme.
Frequently Asked Questions
Do I need a scan? Not always for initial assessment and treatment. Clinical evaluation, alongside structured outcome measures, generally guides the treatment approach without imaging being essential for non-surgical management.
Will I need surgery? Not necessarily, particularly in the earlier stages. Physical therapy can be considered as a genuine treatment option for people with mild to moderate symptomatic hip osteoarthritis, to improve function and reduce pain. ¹⁵ Surgery remains an option for more advanced cases that have not responded sufficiently to conservative management.
Will losing weight help? For people who are overweight or obese, research supports a meaningful symptom benefit from a weight loss target of around 5 to 7.5% of body weight, alongside the other elements of your treatment plan. ¹¹
Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Hip Osteoarthritis Clinical Practice Guideline 2025. Physiotutors, summarising Koc et al. Available at: https://www.physiotutors.com/hip-osteoarthritis-the-new-2025-clinical-practice-guideline-for-physiotherapists/
Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(11):CPG1-CPG31. Available at: https://www.jospt.org/doi/10.2519/jospt.2025.0301
National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. NICE Guideline [NG226]. 2022. Available at: https://www.nice.org.uk/guidance/ng226
Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy. Available at: https://www.jospt.org/doi/pdf/10.2519/jospt.2025.0301
Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(11):CPG1-CPG31. Available at: https://www.jospt.org/doi/10.2519/jospt.2025.0301
12 of 12 Top Hip Papers of 2025, APTA Clinical Practice Guidelines for Assessment and Management of Hip Osteoarthritis: 2025 update. Dr Alison Grimaldi. Available at: https://dralisongrimaldi.com/blog/clinical-practice-guidelines-for-hip-osteoarthritis/
Hip Osteoarthritis Clinical Practice Guideline 2025. Physiotutors. Available at: https://www.physiotutors.com/hip-osteoarthritis-the-new-2025-clinical-practice-guideline-for-physiotherapists/
Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. ScienceDirect. 2023. Available at: https://www.sciencedirect.com/science/article/pii/S1063458423008324
Hip Pain and Mobility Deficits, Hip Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. 2025. Available at: https://www.orthopt.org/uploads/content_files/files/Hip_pain_and_mobility_deficits_hip_osteoarthritis_2025.pdf
New 2025 Hip OA Clinical Practice Guideline Now Available. APTA Orthopedics. Available at: https://www.orthopt.org/news/new-2025-hip-oa-clinical-practice-guideline-now-available
Hip Pain and Mobility Deficits, Hip Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. Available at: https://www.orthopt.org/uploads/content_files/files/Hip_pain_and_mobility_deficits_hip_osteoarthritis_2025.pdf
Hip Pain and Mobility Deficits, Hip Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. Available at: https://www.orthopt.org/uploads/content_files/files/Hip_pain_and_mobility_deficits_hip_osteoarthritis_2025.pdf
Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. ResearchGate. Available at: https://www.researchgate.net/publication/395463747_Hip_Pain_and_Mobility_Deficits_-_Hip_Osteoarthritis_Revision_2025
Hip Pain and Mobility Deficits, Hip Osteoarthritis: Revision 2025. Journal of Orthopaedic & Sports Physical Therapy. Available at: https://www.jospt.org/doi/pdf/10.2519/jospt.2025.0301
AAOS Updates Clinical Practice Guideline for the Management of Osteoarthritis of the Hip. American Academy of Orthopaedic Surgeons. Available at: https://www.aaos.org/aaos-home/newsroom/press-releases/aaos-updates-management-of-hip-osteoarthritis-guideline/
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