Hip pain and hip osteoarthritis

What it is

Hip osteoarthritis is a whole-joint condition: cartilage thins, the capsule stiffens, the bone underneath changes and the muscles around it weaken. The classic pattern is groin pain that refers into the front of the thigh and sometimes to the knee - which is why a proportion of people present convinced their knee is the problem.

As with the knee, the joint change on an x-ray and the pain a person experiences correlate poorly. What correlates well is muscle strength, particularly the hip abductors that stop the pelvis dropping with every step, and the extensors that drive it forward.

What it feels like

• Deep pain in the groin, often described as inside the joint rather than on it
• Referred pain down the front of the thigh, occasionally as far as the knee
• Stiff for the first minutes after sitting or first thing in the morning
• Difficulty putting on socks and shoes, or getting into a car
• A limp late in a walk, and worse the day after a long one

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Hip abductor weakness

Glute medius stops the pelvis dropping on the opposite side with every step. Weak, it lets the pelvis drop and shifts the load and the joint reaction force. It is the strongest modifiable factor here.

Hip extensor weakness

Glute max drives the hip through the second half of every stride. When it is weak the hip flexors and lumbar spine take over, and the joint is loaded through a shorter, less efficient range.

Loss of internal rotation and capsular stiffness

This is often the earliest sign, before pain. A stiff capsule reduces the joint's ability to share load across its surface, concentrating it in a smaller area.

Femoroacetabular impingement

Extra bone at the ball or socket produces repeated abnormal contact through the joint. It is a well-established precursor to hip osteoarthritis, particularly in people who were athletic when young.

Hip dysplasia

A shallow socket concentrates load on a smaller area of cartilage. Mild dysplasia is common, frequently undiagnosed, and a major cause of hip arthritis presenting earlier than expected.

A previous hip injury or fracture

Any significant injury to the joint surface substantially raises the risk of arthritis decades later.

Body weight

Joint reaction forces at the hip are several times body weight in ordinary walking. Weight is a mechanical factor and it also contributes inflammatory signalling.

Occupational loading

Farming, construction and other heavy-lifting occupations show consistently higher rates. Total lifetime load matters.

Age and genetics

Both raise risk and neither is modifiable, but both operate on top of the factors that are. Family history is a reason to start strengthening earlier, not a reason to consider it decided.

Avoidance and deconditioning

A painful hip is used less, the abductors and extensors weaken, and the joint loads worse - which produces more pain. This loop is often a bigger contributor to disability than the joint change is.

Who tends to get it

• Adults over fifty, with prevalence rising steeply thereafter
• Anyone with a history of hip dysplasia or femoroacetabular impingement
• People with a family history of hip osteoarthritis
• Those in heavy manual occupations
• Anyone with a previous significant hip injury

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineHip Relief & Rotation

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Groin pain after a fall in an older adult - assume fracture; night pain with fever; inability to weight-bear

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise therapy reduces hip pain and improves function reliably, and it is first-line in every guideline. It takes eight to twelve weeks to show clearly and needs continuing. It does not reverse joint change and it is not a substitute for hip replacement when the joint has failed - but it delays that point for many people, and the people who go into a replacement stronger come out of it faster. Sudden severe hip pain, an inability to weight bear, or pain after a fall in an older adult is a fracture question and needs urgent assessment.

Prevalence basis: Primary-care and cohort estimates

Others the same routine covers

These share the Hip Relief & Rotation routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.