Osteoarthritis (OA) of the hip results from the gradual breakdown of the protective cartilage cushioning the joint. This wear-and-tear leads to increased friction, pain, and stiffness, making everyday movements difficult. Exercise is the primary non-surgical strategy for managing symptoms and slowing functional decline. Movement maintains the joint’s capacity and strengthens supporting muscles, directly reducing the load placed on the hip. Incorporating specific, joint-friendly activities can significantly reduce pain and improve mobility.
Foundational Principles for Safe Movement
Starting an exercise program when experiencing hip discomfort requires a cautious approach focused on minimizing irritation while maximizing benefit. The guiding principle for anyone with hip OA is to “start low, go slow,” meaning you should begin with minimal duration and intensity and increase activity levels very gradually as your tolerance improves. This method respects the sensitivity of the joint and helps prevent painful flare-ups that could derail consistency.
Consistency is far more impactful than intensity, making shorter, more frequent sessions preferable for long-term success. Listen to your body: mild muscle soreness after an activity is normal, but sharp joint pain signals that you must immediately stop and adjust your routine. The “two-hour rule” helps monitor intensity. If joint pain is significantly worse and persists for more than two hours after exercise, you have overdone it, and the next session should be scaled back.
Targeted Strengthening Exercises
Strengthening the muscles surrounding the hip joint is highly effective for hip OA. Stronger muscles provide dynamic stability and reduce mechanical stress on the damaged cartilage. The primary focus should be on the gluteal muscles. The gluteus medius stabilizes the pelvis during walking, and the gluteus maximus powers hip extension. Strengthening the quadriceps also contributes to overall leg and hip stability.
Glute Bridge
The Glute Bridge targets the gluteus maximus and hamstrings without requiring weight-bearing on the hip joint. Lie on your back with knees bent and feet flat, about hip-width apart. Engage your core and squeeze your buttocks, slowly lifting your hips until your body forms a straight line from shoulders to knees. Hold this position briefly for 3 to 5 seconds before gently lowering back down. Aim for 10 to 15 repetitions per set.
Clamshell
The Clamshell exercise is particularly effective for isolating and strengthening the gluteus medius, which is often weak in hip OA patients. Lie on your side with knees bent and stacked, ensuring your hips are aligned and not rolled back. Keeping your feet touching, slowly lift your top knee upward, opening your legs like a clamshell.
Control the movement as you lower the knee back down. It is important to keep the movement small and controlled, avoiding any rocking of the pelvis. Work toward 10 to 15 repetitions on each side.
Seated Straight Leg Raise
This exercise works the hip flexors and quadriceps in a non-weight-bearing position, which is ideal for painful joints. Sit upright in a firm chair with feet flat on the floor. Slowly straighten one leg in front of you until the knee is fully extended, engaging the thigh muscles.
Hold the leg up for 3 to 5 seconds before slowly lowering it down with control. Repeat the movement 10 to 15 times on each leg. Once this becomes easy, a small ankle weight can be added for increased resistance.
Low-Impact Aerobic Activities
Low-impact aerobic exercise helps manage body weight, which directly reduces the load on the hip joint, and improves cardiovascular health. These activities are defined by their smooth, rhythmic motion that minimizes harsh impact forces on the joints. Regular movement also helps circulate the synovial fluid within the joint capsule. This natural fluid provides lubrication and nourishment to the remaining cartilage.
Water-based exercise, such as swimming or water aerobics, is highly recommended because water buoyancy supports the body, significantly reducing gravity’s effect on the hip joint. This allows for a greater range of motion and longer duration of activity with less pain. Stationary cycling is also an excellent choice, as the smooth, circular pedaling motion allows the hip to move safely without jarring impact.
Walking is accessible but should be done on flat, even surfaces using proper, supportive footwear to absorb shock. Start with short durations, such as 10 to 15 minutes, to build tolerance. The goal for aerobic activity is typically 20 to 30 minutes, three to five times per week, maintaining a pace that elevates the heart rate without causing a noticeable increase in joint pain.
Range of Motion and Flexibility Work
Hip OA frequently causes stiffness, which can limit the joint’s ability to move through its full range. This stiffness may lead to compensatory movements that strain other areas like the lower back. Flexibility exercises gently maintain the joint’s current capacity and reduce tightness in surrounding muscle groups. Stretching tight muscles, particularly the hip flexors and external rotators, helps keep the joint in better alignment and reduces resting discomfort.
Supine Figure-Four Stretch
The Figure-Four stretch gently targets the small, deep muscles in the buttocks, such as the piriformis, which can contribute to hip pain. Lie on your back with both knees bent and feet flat on the floor. Cross one ankle over the opposite thigh, creating a “figure four” shape with your legs.
Gently pull the bottom knee toward your chest until a comfortable stretch is felt in the buttock of the crossed leg. Never stretch into sharp pain.
Gentle Hip Flexor Lunge
Prolonged sitting shortens the hip flexor muscles, placing increased pressure on the joint. A gentle lunge stretch counteracts this tightness. Kneel on the floor with one knee down (use a pillow underneath) and the other foot flat in front of you in a half-kneeling position.
Keeping your back upright and core engaged, gently shift your hips forward until you feel a stretch at the front of the hip of the kneeling leg. Hold the stretch for 30 seconds and repeat two to three times on each side, ensuring the stretch is static and not bouncing.