Published on April 27, 2026

Evidence-Based Care for Hip Osteoarthritis

Image of a provider pointing to an x-ray of a foot.

For many adults as they age, hip pain isn't just an inconvenience, it’s a barrier to daily life. With a global prevalence of over 8 percent, hip osteoarthritis (OA) is a leading cause of disability. However, a diagnosis doesn't mean you have to stop moving or that you can’t do something about it.

Based on the latest Clinical Practice Guidelines (CPG), here is how we identify and treat hip OA to get patients moving again.

How do we diagnose hip OA?

Beyond just an X-ray, we also look at primary clinical signs, called the “Big Five.” If a patient meets these criteria, hip OA is highly likely:

  1. Pain in the hip/groin region
  2. Internal rotation of the hip is less than 15 degrees
  3. Morning stiffness that lasts less than 60 minutes
  4. Age over 50 years
  5. Pain specifically during internal rotation

On occasion, pain from your back can also mimic hip pain, so it’s important to correctly identify the primary problem.

What treatments are available?

Now, once we have identified the problem, how do we treat it? The Clinical Practice Guidelines rank treatment-based interventions by effectiveness. Braces should not be the main form of treatment.

Manual Therapy
This includes hands-on treatment to gently move joints and soft tissues. It helps improve movement, spreads weight more evenly across the joint, and may reduce wear and tear.

  • Usually done 1–3 times per week for 6–12 weeks

Personalized Exercise
Exercise programs should be made just for you. They should focus on your specific weaknesses and limits in movement.

  • Functional Training: Balance and walking exercises are especially important if you are at risk of falling.
  • Weight Management: If you are overweight, losing weight can help reduce stress on your joints.

Modalities
Treatments like ultrasound may give short-term relief, but they should be used along with an exercise program—not by themselves.

What Should You Avoid?
Braces should not be the main form of treatment.

In summary, the most effective non-surgical treatment for hip OA is a combination of manual therapy and specific strengthening exercises to help keep the joint open. Maintaining your mobility is key.

References:

  • Cibulka, M. T., et al. (2017). Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017. JOSPT.
  • Fan, Z., et al. (2023). The prevalence of hip osteoarthritis: A systematic review.

Dave Bearss, P.T., D.P.T., C.S.C.S., T.P.I., is a physical therapist who specializes in sports medicine and is a Certified Strength and Conditioning Specialist. He sees patients at the Campus Ridge Building, located on the campus of MyMichigan Medical Center Midland. To schedule an appointment, call the office at (989) 837-9100.