Glenn Wellmann DPT

A hip arthritis diagnosis usually arrives with a mental image: a joint wearing out, on a countdown clock you cannot stop. Most people leave the appointment quietly editing their life. They stop hiking. They stop the gym. They start treating the hip like something fragile.

Hip osteoarthritis feels like a deep ache in the groin or the front of the thigh, sometimes wrapping into the buttock. It stiffens after sitting and first thing in the morning, usually loosening within 30 minutes of moving. Turning in bed, putting on socks, and getting out of a low car seat are the classic complaints. If that is your hip, here is the part that gets buried: activity is the treatment, and the goal is to modify what irritates it, not to quit what you love.

Why it happens, in plain words

Cartilage is the smooth surface lining the ball and socket of your hip. In osteoarthritis it thins unevenly, the bone underneath remodels, and the joint lining gets periodically irritated. Two things follow. The joint has a smaller comfortable range, so end-range positions like deep flexion or hard twisting get provocative. And the muscles around the hip, especially the glutes and quads, tend to weaken, partly from pain and partly from months of doing less.

That second part is the piece you control. Cartilage change is slow and largely out of your hands, but muscle strength, joint tolerance, and how much you can do before your hip complains are all trainable, at any age and any stage of arthritis. Rest is what erodes them.

What the evidence actually says

Exercise is not the consolation prize while you wait for a hip replacement. It is first-line treatment in every major guideline. The 2019 American College of Rheumatology and Arthritis Foundation guideline gives exercise a strong recommendation for hip osteoarthritis, alongside weight loss for people who are overweight, self-management programs, and tai chi (Kolasinski et al., Arthritis Care and Research, 2020). The 2019 OARSI guideline, built on 407 randomized trials, puts structured land-based exercise at the core of care for everyone with hip osteoarthritis (Bannuru et al., Osteoarthritis and Cartilage, 2019).

How much does it help? A Cochrane review pooled 10 randomized trials of land-based exercise for hip osteoarthritis and found high-quality evidence for a pain reduction of 8 points on a 100-point scale (95 percent confidence interval 4 to 11) and a similar function improvement right after treatment, with a number needed to treat of 6 (Fransen et al., Cochrane Database of Systematic Reviews, 2014). That is a modest average with a very good safety profile, and averages hide the responders. Clinically, the biggest wins go to the people who were doing the least before they started.

The style of exercise matters less than most people assume. A 2024 multicenter trial randomized 160 adults with hip osteoarthritis to 12 weeks of either high-intensity progressive resistance training or a neuromuscular control program, two supervised hour-long sessions a week in both arms. Both groups gained 1.5 extra chair stands in 30 seconds, and pain improved about 9 points on the HOOS scale in each, with no meaningful difference between them (Kjeldsen et al., Annals of Internal Medicine, 2024). I broke that trial down in more detail in my Research Bites post on strength training versus control work for hip arthritis. The practical read: pick the version you will actually keep doing twice a week.

What to keep doing

Start from the assumption that an activity stays unless it proves otherwise. The test I use with patients is simple: pain of 4 out of 10 or less during the activity, and back to your normal baseline within 24 hours. If it clears that bar, it is not damaging your hip, even if it aches a little.

• Walking and hiking. Keep them. Frequency and terrain are the dials, not the activity itself. My post on hiking and joint health covers how to build back up.
• Strength training. Squats, deadlifts, split squats, leg press, and step-ups all stay in, adjusted for range and load. Strong hips tolerate more.
• Cycling and swimming. Great for keeping volume up on cranky weeks.
• Golf, skiing, pickleball, doubles tennis. Keep them with a real warm-up and honest recovery days.
• Stairs. Slower with a hand on the rail is fine. Avoiding stairs entirely teaches your hip that stairs are dangerous.

One caveat: walking alone is not enough. It is great circulation and mood work, but it will not build the hip and thigh strength that carries you through the next decade, which I covered in is walking enough to build strength.

What to modify

Modification is not restriction. It is changing one variable so the activity survives.

1. Trade depth for load. Deep hip flexion is often the irritating position. Squat to a box at the depth that stays under 4 out of 10, then add weight in that shorter range. Cue: sit back toward the box, shins fairly vertical, knees tracking over mid-foot.
2. Split long efforts up. Two 25-minute walks usually beat one 50-minute walk on a stiff hip. Same volume, less continuous compression.
3. Change grade before distance. Steep downhill is the most common hiking trigger. Flatten the route first, keep the mileage, add grade back later, and use poles on descents.
4. Adjust seat height and posture. On the bike, raise the saddle slightly so the hip folds less at the top of the pedal stroke. In the car and at a desk, get your hips at or slightly above knee height.
5. Warm up on purpose. Five to ten minutes of easy cycling or brisk flat walking before anything demanding. Arthritic hips are startlingly better once warm, which is exactly why the morning stiffness fools people.
6. Aim for gentle end-range, not aggressive stretching. Easy hip rotation work and lunge-position mobility are fine. Yanking into painful end range does not remodel a joint, it just flares the lining.

A simple weekly template

This is close to what I write for most patients with hip osteoarthritis. Every set stays at 4 out of 10 or less, back to baseline the next day.

• Two strength sessions a week, 30 to 40 minutes: a squat or leg press (3 sets of 8 to 10), a hip hinge such as a Romanian deadlift or hip thrust (3 sets of 8 to 10), a step-up or split squat (2 to 3 sets of 8 each leg), banded hip abduction (3 sets of 12 each side), and calf raises (3 sets of 12). Add weight or a rep when the last set feels easy.
• Two to four easy aerobic sessions a week, 20 to 40 minutes: walk, bike, or pool. This is the volume that keeps the joint comfortable.
• Five to ten minutes of daily mobility: hip rotation in sitting, a supported half-kneel, and bridges to start the day moving.
• One thing you actually enjoy, weekly. In the trials above the benefit came from consistent sessions over 12 weeks, not from any magic exercise.

Give it 12 weeks before you judge it. That is the window the research uses, and roughly what I see clinically.

Red flags: when to get it looked at in person

• Night pain that wakes you consistently and worsens week over week, unrelated to how much you did
• Groin pain after a fall, or a sudden inability to bear weight, which can signal a fracture
• Fever, warmth, or feeling generally unwell alongside hip pain
• Unexplained weight loss, or a history of cancer with new deep bone pain
• Sudden locking, catching, or giving way of the hip
• Numbness, tingling, or progressive leg weakness, which points at the back rather than the hip
• Pain and function getting steadily worse over 12 weeks of consistent exercise

Where to go from here

Most people with hip arthritis do not need a longer list of exercises. They need to know which activities to defend and which variable to change on each one. That sorting is what a comprehensive evaluation is built for: a full hour to test the hip, watch you move, and leave with your own list of keeps and modifications. If you already know the diagnosis and want the program written and progressed around your ski season, that is my home exercise program service. If you would rather use insurance-based care, CACC Physical Therapy is the option I point people to.

References

• Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care and Research. 2020;72(2):149-162. doi:10.1002/acr.24131. https://pubmed.ncbi.nlm.nih.gov/31908149/
• Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019;27(11):1578-1589. https://www.oarsijournal.com/article/S1063-4584(19)31116-1/fulltext
• Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews. 2014;(4):CD007912. doi:10.1002/14651858.CD007912.pub2. https://pubmed.ncbi.nlm.nih.gov/24756895/
• Kjeldsen T, Skou ST, Dalgas U, et al. Progressive resistance training or neuromuscular exercise for hip osteoarthritis: a multicenter cluster randomized controlled trial. Annals of Internal Medicine. 2024;177(5):573-582. doi:10.7326/M23-3225. https://pubmed.ncbi.nlm.nih.gov/38588540/