Hip Arthritis: How Physiotherapy Can Delay or Avoid Surgery
Hip osteoarthritis causes pain, stiffness, and reduced mobility that can significantly impact quality of life. While hip replacement surgery is highly effective, it is not the first option — NICE guidelines recommend physiotherapy, exercise, and weight management as first-line treatments, with surgery reserved for cases where conservative management has failed.
The evidence supporting exercise for hip OA is substantial. Research shows that structured exercise programmes reduce hip pain, improve function, and can delay the need for surgery by months or years. Some patients are able to avoid surgery altogether, while others find that their pre-operative physiotherapy significantly improves their surgical outcome.
The most effective exercises target the muscles around the hip — particularly the gluteals (buttock muscles, which stabilise the hip during walking), the hip abductors (side hip muscles, important for side-to-side stability), the quadriceps, and the core muscles. When these muscles are strong, they absorb more of the load that would otherwise fall on the arthritic joint.
Specific exercises include: clam shells (lying on the side, lifting the top knee — strengthens hip abductors), bridges (lying on the back, lifting the hips — strengthens glutes and core), standing hip abduction (lifting the leg to the side against resistance), sit-to-stand practice (functional leg and hip strengthening), and resistance band exercises.
Flexibility exercises address the stiffness that accompanies hip OA. Gentle stretching of the hip flexors (front of the hip), hip rotators, and hamstrings maintains range of motion. Manual therapy, including joint mobilisation by a physiotherapist, can provide additional relief from stiffness.
Weight management is crucial — every kilogram of body weight adds approximately three to four kilograms of load to the hip during walking. Even modest weight loss can significantly reduce hip pain.
Low-impact aerobic exercise — swimming, cycling, and walking on flat surfaces — maintains fitness without excessive joint loading. Avoid high-impact activities such as running.
Our home visit physiotherapy service provides comprehensive hip OA management at home. For patients who do need surgery, our hip replacement physiotherapy service provides specialist pre- and post-operative rehabilitation. Our elderly physiotherapy service supports older adults with multiple conditions affecting the hip.