Evidence-based physiotherapy for hip OA typically includes a combination of the following:

• Patient Education:
  • Understanding OA: Explaining the nature of the condition and what to expect.
  • Pain management strategies: Teaching about pacing activities, using heat/ice, and coping mechanisms.
  • Importance of exercise: Emphasizing the benefits of regular physical activity.
  • Weight management: Discussing the role of weight reduction in reducing joint load.
• Exercise Therapy
  • Range of Motion (ROM) Exercises: Gentle movements to maintain and improve hip flexibility. Examples include:
    • Heel slides
    • Knee-to-chest stretches
    • Internal and external hip rotations
  • Strengthening Exercises: Targeting muscles around the hip, pelvis, and core, which are crucial for stability and shock absorption. These may include:
    • Gluteal muscles (gluteus medius, maximus) – e.g., clam shells, side-lying leg raises, bridging.
    • Hip abductors and adductors.
    • Quadriceps and hamstrings – e.g., mini-squats, chair stands.
    • Core stability exercises.
  • Low-Impact Aerobic Exercises: To improve cardiovascular fitness and manage weight without excessive joint stress. Examples include:
    • Walking (on a treadmill or outdoors)
    • Stationary cycling
    • Swimming or water exercises (hydrotherapy) – particularly beneficial as water buoyancy reduces joint load.
  • Balance and Proprioception Exercises: To improve stability and reduce fall risk, especially important as OA can affect proprioception. Examples include:
    • Single-leg stance
    • Tandem walking
    • Progressive balance exercises.
• Manual Therapy:
  • Hands-on techniques performed by the physiotherapist to improve joint mobility, reduce pain, and release muscle tension. This can include:
    • Joint Mobilization: Gentle, rhythmic movements to improve the glide and slide of the joint surfaces.
    • Soft Tissue Massage: To address muscle tightness and spasms in the surrounding hip and thigh muscles.
    • Stretching: Passive or active-assisted stretching to improve muscle length and flexibility.
• Functional Training:
  • Training focused on improving daily activities that are challenging due to hip OA. This might involve:
    • Gait training (walking re-education).
    • Stair climbing techniques.
    • Getting up from a chair or bed.
    • Picking up objects from the floor.
• Modalities:
  • While not core treatments, certain modalities may be used as adjuncts for pain and inflammation management:
    • Heat or Ice: For localized pain relief.
    • Transcutaneous Electrical Nerve Stimulation (TENS): For pain modulation.
    • Ultrasound: Its effectiveness in OA is debated, but some therapists may use it.