Hip osteoarthritis (OA) is a common degenerative joint condition that leads to pain, reduced mobility, and functional limitations. The 2025 Clinical Practice Guidelines published in the Journal of Orthopaedic & Sports Physical Therapy provide clear, evidence-based recommendations for conservative management.
Manual Therapy
Strong evidence supports the use of manual therapy, including soft tissue techniques and joint mobilization. Both high- and low-force long-axis hip distraction and mobilization with movement have been shown to:
- Improve joint range of motion
- Reduce pain
- Enhance physical function
Treatment should be modified based on individual hip morphology and tissue irritability.
Exercise Therapy
Exercise is a cornerstone of hip OA management. Individualised programs focusing on flexibility, strengthening, and endurance are recommended. Programs may include aquatic therapy and should be performed 1–5 times per week over 5–16 weeks. Exercise consistently demonstrates improvements in pain, strength, and daily function.
Dry Needling
For patients with Grade II–III hip OA, dry needling targeting muscles such as the iliopsoas, rectus femoris, TFL, and gluteal muscles can provide short-term (up to 3 weeks) improvements in pain, range of motion, and muscle performance.
Patient Education and Weight Management
Education on activity modification, joint unloading strategies, and pain coping skills is essential. For individuals who are overweight or obese, collaboration with medical and nutrition professionals to support weight reduction is recommended.
Functional, Gait, and Balance Training
Impairment-based functional training, gait retraining, balance exercises, and appropriate use of assistive devices should be provided when deficits are identified during assessment.
Modalities and Bracing
Therapeutic ultrasound may be used cautiously, with patients informed about conflicting evidence. Bracing is not recommended as a first-line intervention and should only be considered if other conservative treatments fail.
Overall
Current evidence strongly supports physiotherapy-led, individualised conservative management for hip osteoarthritis. Exercise, manual therapy, and education remain the foundation of effective care.
References
Hip Pain and Mobility Deficits – Hip Osteoarthritis: Revision 2025 Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(11):CPG1–CPG31. doi:10.2519/jospt.2025.0301