Physical Therapy for Hip Osteoarthritis: What the Latest Guidelines Mean for You
Cibulka MT, Clewley D, DeRosa C, et al. Physical therapist management of hip osteoarthritis. J Orthop Sports Phys Ther. 2023;53(6):1-40. doi:10.2519/jospt.2023.0604
Background
Hip osteoarthritis (OA) is a major cause of pain, stiffness, and functional decline in adults—especially those over 50. As physical therapy becomes a first-line intervention for joint degeneration, understanding what strategies work best is critical. This Clinical Practice Guideline (CPG), developed by a panel of physical therapists, researchers, and orthopedic experts, presents the strongest current evidence on how to manage hip OA conservatively.
What question is the study trying to answer?
What is the most effective way for physical therapists to help people with hip osteoarthritis reduce pain, improve function, and maintain independence without surgery?
What are the experimental groups and differences in the trial?
This wasn’t a clinical trial but a systematic review of studies published between 1995 and 2021. The expert panel graded dozens of common PT interventions by their strength of evidence and clinical effectiveness. The recommendations are intended to guide care from diagnosis to discharge.
What did the study find?
Here are the key takeaways that affect you as a patient:
Education & Self-Management: Patients who understand their condition and remain active tend to do better. Education should include pacing strategies, load management, and realistic expectations for exercise.
Therapeutic Exercise: Individualized strengthening and stretching programs significantly reduce pain and improve function. Aquatic exercise is also a good option for people with high pain levels or reduced mobility.
Manual Therapy: Mobilization techniques, when combined with exercise, offer short-term relief and help restore hip mobility.
Gait & Balance Training: Targeted interventions for gait mechanics and fall prevention are valuable, especially in older adults.
Modalities: There is limited support for modalities like ultrasound. TENS may help reduce pain in the short term but is not recommended as a standalone treatment.
Outcome Measures: Physical therapists should track your progress using tools like the HOOS, WOMAC, NPRS, and LEFS to monitor improvements in pain, mobility, and daily function.
Potential limitations to the study
Some recommendations had moderate or limited evidence, and further research is needed to refine specific protocols (e.g., optimal exercise dosage or long-term manual therapy effects). Additionally, most included studies involved relatively healthy adults with isolated hip OA.
What does this mean for you as a patient?
Hip OA doesn’t always require surgery. With a focused physical therapy program, many people can maintain or even improve their function and reduce their pain significantly. Staying active, showing up consistently to PT, and sticking with your home program are key predictors of success.
If you haven’t discussed exercise therapy, manual treatment, or education about hip OA with your provider, it’s worth bringing up. This guideline emphasizes that patients who are engaged in their care do better in the long run.
Final thoughts
This new guideline reinforces a proactive approach to hip OA. Rather than relying on medications or delaying care, taking early, structured action with a physical therapist can delay disease progression and improve quality of life.
Cibulka MT, Clewley D, DeRosa C, et al. Physical therapist management of hip osteoarthritis. J Orthop Sports Phys Ther. 2023;53(6):1-40. doi:10.2519/jospt.2023.0604
⚡Want to know what recovery looks like after knee replacement? Read our full article on the first month after total knee replacement.
Written by Christian Hill, PT, DPT, CDNT – Licensed Physical Therapist with over 10 years in orthopedic rehab.
