Hip OA: Anatomy and Biomechanics
Hip OA: Anatomy and Biomechanics
Hip OA: Anatomy and Biomechanics
Regardless of the nature and severity of the osteoarthritis in your hip, your physician will work with you
to determine what the best course of treatment will be. When degenerative changes are not severe the
associated pain and dysfunction may successfully be treated with rest, anti-inflammatory measures,
activity modification and physical therapy. After a thorough evaluation your physician and their staff
will recommend the most appropriate course of action to take. When joint degeneration is severe and
conservative measures are unsuccessful in restoring function your physician may recommend a total hip
replacement procedure.
Rehabilitation Philosophy
Physical therapy is often recommended for treatment of pain and dysfunction associated with
osteoarthritis. The physical therapist will evaluate your mobility, flexibility and strength with the
purpose of determining any underlying deficits that contribute to increased stress on the painful joint.
You will be counseled on which activities you can safely continue and which should be avoided. The
physical therapist will teach you exercises that will help to reduce joint stress. In most cases this will
include strengthening and stretching the muscles around the hip and knee, as well as strengthening your
core. Your treatment may also include manual techniques that are designed to improve the mobility of
the hip joint and reduce pain.
Recommended Exercises
Range of motion and flexibility
Heel Slides
Supine Hip Internal/External Rotation
Gentle Bridging
Gentle Lower Extremity Stretching (based on individual assessment)
Gluteus maximus
IT Band/ Tensor Fascia Latae (TFL)
Hamstring
Hip Rotators
Iliopsoas /Rectus Femoris
Piriformis
Gentle Cycle if Tolerated
Guidelines
Perform range of motion exercises daily. Do 2-3 sets of 15-20 Reps. Perform stretching program daily.
Hold stretches for 30 seconds and perform 2-3 repetitions of each.
Goals
Continued protection of injured joint
Continue to improve flexibility
Begin to strengthen areas of weakness/instability
Recommended Exercises
Range of Motion and Flexibility
Cycle (slow progression of resistance)
Continue ROM and Flexibility from Phase 1 as needed
Strength
Begin open chain strengthening (based on strength assessment)
Bridging exercises
Straight Leg Raise (SLR)
Hip Abduction
Hip Extension
Hip External Rotation
Quadraped positional exercises
SLS (single leg stance)
Guidelines
Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.
Cardio program should be performed no more that 3-5 times a week for 20-35 minutes.
Perform strengthening exercises daily. Do 2-3 sets of 15-20 Reps.
Goals
Continue to avoid exacerbation of symptoms
Continue to maximize return of strength and flexibility
Establish closed chain strength and stability
Recommended Exercises
Range of Motion and Flexibility
Continue cycle, may add walking
Continue lower extremity stretching from Phase 1 and 2
Strengthening
Continue progression of open chain program with ankle weights
Can add gym equipment (Leg Press, Multi-Hip, Cable Column Posterior Depression)
Pain free closed chain hip strengthening
Continued progression with SLS activities
Continued progression with bridging exercises (Physioball, Foam Roll)
Step Up Progressions (forward and Lateral)
Guidelines
Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.
Cardio program should be performed no more that 3-5 times a week for 20-45 minutes.
Perform strengthening exercises 3 times a week. Do 2-3 sets of 15-20 Reps.
Goals
Continue to avoid hip overload
Progress with single leg strengthening
Achieve adequate strength and flexibility to return to activity
Recommended Exercises
Flexibility
Continue daily stretching
Cardio
Continue cycle, walking
Return to running/sport progression (outlined by physician or physical therapist)
Strengthening
Continue SLR/Open Chain program and gym equipment progression
Static lunge with progression to dynamic
Lateral lunge progressions
Progressive single leg strengthening (single leg squat, single leg dead lift, single leg ER)
Return to Sport
Work with physician or physical therapist to outline progressive return to sport
Guidelines
Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.
Cardio program should be progressed in preparation for return to sport.
Perform strengthening exercises 3 times a week. Do 2-3 sets of 15-20 Reps
Phase 1 *Control Pain and ROM and Flexibility *ROM Daily 2-3 sets of 15-20
Acute Phase Inflammation Cycle (if pain free motion) Reps
*Re-establish Normal Heel Slides (in pain free arc) *Stretching Program Daily 2-3
ROM Supine Hip Rotation Repetitions of 30 Seconds
*Begin Pain Free Supine Bridge
Flexibility Program Lower Extremity Stretching
*Manual Therapy • Rectus Femoris/Iliopsoas
• IT Band/TFL
• Hamstring
• Hip Rotators
• Piriformis
• Gluteus Maximus
*based on individual assessment
Phase 2 * Continued Protection ROM and Flexibility * Stretching Program Daily 2-3
Sub-acute of Injured Joint Cycle (slow progression of resistance) Repetitions of 30 Seconds
Phase A *Continue to Improve Continue ROM and Flexibility From Phase 1 *Cardio program should be
Flexibility Strength performed no more that 3-5
*Begin to Strengthen Begin Open Chain Strengthening times a week for 20-35 minutes.
Areas of • Bridging exercises *Perform strengthening exercises
Weakness/Instability • Quadraped positional exercises daily 2-3 sets of 15-20 Reps
• Straight Leg Raise
• Hip Abduction
• Hip Extensors
• Hip Rotators
• SLS (single leg stance)
*based on individual assessment
Phase 3 * Continue to Avoid ROM and Flexibilty * Stretching Program Daily 2-3
Sub-acute Exacerbation of Continue Lower Extremity Stretching from Phase 1 Repetitions of 30 Seconds
Phase B Symptoms and 2 *Continue to Stress Proper Gait
*Continue to Maximize Continue cycle, may add walking * Cardio program should be
Return of Strength and Strengthening performed no more that 3-5
Flexibility Progress OKC Program with Ankle Weights times a week for 20-45 minutes.
*Establish Closed Chain Can Add Gym Equipment *Perform strengthening exercises
Strength and Stability Step Up Progressions (Forward Step Ups, Lateral Step 3 times a week 2-3 sets of 15-20
Ups) Reps.
Pain Free Closed Chain Hip Strengthening
Continue progression with SLS activities
Continue progression with bridging exercises
Phase 4 * Continue to avoid hip Flexibility * Stretching Program Daily 2-3
Sport Specific overload Continue daily stretching Repetitions of 30 Seconds
Phase *Progress with single leg Cardio *Cardio program should be
strengthening Cycle, walking, elliptical machine progressed in preparation for
*Achieve adequate Begin return to running progression per MD return to sport.
strength and flexibility to Strengthening *Perform strengthening exercises
return to activity Continue OKC program 3 times a week. Do 2-3 sets of
Continue gym equipment progression 15-20 Reps
Continue step-up progressions (lateral step-ups,
cross over step-ups)
Static lunge with progression to dynamic
Lateral lunge progressions
Progressive Single Leg Strengthening (single leg
squat, single leg ER, single leg dead lift)
Return to Sport
Outlined by PT or MD