1. Introduction / Plain Theory

Hip osteoarthritis is a degenerative joint condition involving the gradual breakdown of articular cartilage, remodeling of subchondral bone, and low-grade inflammation within the hip joint capsule.
It leads to pain, stiffness, and reduced mobility, most commonly affecting adults over 50 years of age.

The hip joint — a deep ball-and-socket articulation between the femoral head and acetabulum — is designed for strength and stability.
Over time, mechanical overload, poor joint alignment, or previous injury can disturb its balance, causing cartilage wear and bony changes such as osteophytes and joint-space narrowing.

Hip osteoarthritis affects approximately 10–15% of adults over 60, and is one of the leading causes of pain and disability worldwide.
While structural degeneration cannot be fully reversed, pain and function can be significantly improved through manual therapy, exercise, and lifestyle management.

2. Typical Symptoms and Functional Impact

• Deep, aching pain in the groin, buttock, or front of the thigh.

• Stiffness, especially in the morning or after sitting.

• Reduced range of motion — difficulty crossing legs, putting on socks, or getting in/out of a car.

• Pain aggravated by walking, climbing stairs, or prolonged standing.

• Occasional clicking or grinding sensations within the joint.

Functional impact:
Hip OA can progressively limit mobility, independence, and participation in exercise or social activities.
Compensatory strain in the lower back, opposite hip, or knees is common as movement patterns change.

Red flags:
Rapid deterioration, fever, night pain, or unintentional weight loss require medical evaluation for inflammatory or systemic causes.

3. Contributing Factors / Underlying Causes

Hip osteoarthritis develops when joint loading exceeds the tissue’s ability to repair and adapt over time.
Contributing factors include:

• Previous hip injury (labral tear, dislocation, or fracture).

• Genetic predisposition to cartilage degeneration.

• Repetitive mechanical stress from sport or heavy work.

• Pelvic or spinal asymmetry altering joint load.

• Weak gluteal and core muscles reducing stability.

• Obesity increasing compressive forces on the joint.

• Systemic metabolic or inflammatory conditions (e.g. diabetes, metabolic syndrome).

From an osteopathic perspective, hip degeneration often represents a regional adaptation problem — the result of altered motion and load transfer through the pelvis, lumbar spine, and lower limb rather than a purely local “wear and tear” process.

4. Osteopathic Approach

Osteopathic care for hip osteoarthritis aims to improve mobility, reduce pain, and optimise load distribution across the joint and surrounding structures.

An osteopathic assessment may include:

• Evaluation of hip range of motion, pelvic symmetry, and gait.

• Palpation for joint stiffness, fascial tension, and muscular imbalance.

• Gentle mobilisation of the hip, pelvis, and lumbar spine to restore movement.

• Myofascial release for the gluteals, adductors, iliopsoas, and quadriceps.

• Functional and indirect techniques to reduce discomfort and improve fluid dynamics.

• Breathing and posture retraining to support whole-body balance.

• Guidance on graded movement, strength training, weight management, and pacing.

Osteopathic treatment complements medical care by supporting joint function and comfort, often improving mobility and delaying progression or need for surgery.

5. Scientific Evidence & References

Evidence supports manual therapy and targeted exercise as effective first-line conservative management for hip osteoarthritis.
Research shows that joint mobilisation, soft-tissue work, and education significantly improve pain, mobility, and quality of life.

Osteopathic approaches align closely with modern multidisciplinary guidelines — integrating mobility, circulation, and mechanical balance to promote joint health.

References

1. Zhang W, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137–162. Link

2. Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee and hip: evidence-based approach to therapy. BMJ. 2012;345:e4934. Link

3. French HP, et al. Manual therapy and exercise for hip osteoarthritis: a systematic review and meta-analysis. Clin Rehabil. 2013;27(10):935–948. Link

4. Abbott JH, et al. Manual therapy, exercise therapy, or both in osteoarthritis of the hip or knee: a randomized controlled trial. Osteoarthritis Cartilage. 2013;21(4):525–534. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for hip and pelvic pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Hinman RS, et al. Optimising conservative management of hip osteoarthritis: integrating manual therapy and exercise. J Orthop Sports Phys Ther. 2019;49(2):88–94. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for hip osteoarthritis: network meta-analysis. Front Pain Res. 2024;15:1507485. Link