When Your Hips Don’t Lie (But They Do Ache): Understanding Osteoarthritis of the Hip Joint

When your hips don’t lie (but they do ache). In my clinical experience, a lot of people I have met over the years do not fully understand osteoarthritis of the hip joint. Well, many don’t understand osteoarthritis itself, often confusing it with rheumatoid arthritis. In this blog post, my aim is to provide you with a comprehensive understanding of osteoarthritis of the hip joint, how it impacts people, what can be achieved using manual therapies and exercises to help manage it. We will end the blog with strategies and tips to help those patients who are awaiting a hip replacement, or have already had one, but need help getting back on their feet without pain.

It has been found that x-rays obtained in chiropractic clinical practice revealed 19% of patients over the age of 40 showed osteoarthritis of the hip¹. This is why here at Spriggs Chiropractic, we utilise x-rays of our patients to assess for and stage anyone suspected to have arthritis, so we can get you the right treatment, at the right time. If you suspect or have been told by a healthcare professional that you have osteoarthritis, but you haven’t been x-rayed, give us a call on 01645 43238 to book your consultation so we can help you get the right treatment.

What is Osteoarthritis?

Osteoarthritis is the most common form of arthritis and a major cause of pain and disability worldwide^2,3. Hip osteoarthritis affects up to 10% of people over 45 years in developed countries, with prevalence increasing with age⁴. Globally, hip arthritis has its highest prevalence in Europe affecting 12.6% of the population, whereas in Africa, affecting only 1.2% of the population¹. Interestingly, Fan and colleagues in their paper discovered there is no statistical difference in the prevalence of hip arthritis between men and women⁴.

Osteoarthritis is described as a degenerative disease, meaning it is the result of gradual, progressive changes within the joint that damage the structure of the hip, leading to pain, stiffness, and loss of mobility. In my clinical experience, I have noticed that patients are unaware of the differences between osteoarthritis and rheumatoid arthritis. The difference between osteoarthritis and rheumatoid arthritis is rheumatoid arthritis is a specific type of inflammatory arthritis. Osteoarthritis has an inflammatory phase, but is not driven by inflammation, whereas rheumatoid arthritis is an inflammatory arthropathy, meaning it directly causes inflammatory changes within the joint that leads to significant destruction and deformity of the joint. Osteoarthritis, as stated earlier, is the result of gradual changes over time, however, it can be accelerated by trauma or injury to the joint. There are several stages to osteoarthritis of the hip joint including:

1. Cartilage Softening and Thinning
   • Cartilage and water loss, reducing elasticity and shock absorption.
   • Early structural weakness makes it prone to microdamage that gradually damages the joint surfaces.
2. Cartilage Breakdown
   • Fissures and ulcerations form.
   • Progressive thinning exposes underlying bone.
3. Bone Changes
   • Known in medicine as subchondral bone, this is the layer of bone beneath the cartilage surface. As the cartilage thins, the bone becomes exposed and becomes damaged.
   • The exposed bone hardens (sclerosis) getting thicker as it responds to the increasing pressure placed on it by the lack of cartilage.
   • Subchondral cysts (fluid-filled sacs) develop within the bone due to the micro-fractures that form in the exposed bone.
4. Bone Spur (Osteophyte) Formation
   • Bony outgrowths form at the joint margins in response to increased pressure and progressive joint instability.
   • These restrict movement and irritate surrounding tissues.
5. Joint (Synovial) Inflammation
   • Cartilage debris triggers low-grade inflammation within the joint capsule known as synovitis. This inflammatory reaction fuels pain and stiffness.

If a patients suspected of having osteoarthritis attends Spriggs Chiropractic, x-rays of the joint will be obtained to assess the amount of joint damage. There comes of point where osteoarthritis will progress to the point where a surgical intervention or even a joint replacement might be needed. Our Chiropractors will use x-rays to assess the stage of the joint disease and use them to structure your plan of management to get you the best results.

On an x-ray, osteoarthritis is characterized by a narrowed joint space, bone spurs, and sclerosis as you can see from the image below!

Symptoms of Hip Osteoarthritis

Symptoms of hip arthritis vary greatly from person to person. Some patients experience severe pain when only small amounts of damage can be seen on an x-ray, whereas other patients with more severe damage is seen on x-ray experience only mild pain. In the early stages, manual therapies such as joint mobilisations, massage, stretches and strengthening exercises can be very effective for pain management. Symptoms of osteoarthritis include:

• Deep groin or buttock pain, sometimes radiating to the thigh or knee.
• Stiffness, especially after rest (“start-up stiffness”).
• Decreased range of motion, particularly trying to turn the hip inwards, called internal rotation.
• Limping, difficulty walking or altered gait.
• Pain worsening with weight-bearing activities.

Complications of Advanced Hip Osteoarthritis

The complications of osteoarthritis of the hip are the crux of this blog post really. There are complications of hip arthritis that are significant, that a lot of people are completely unaware of. If untreated, hip osteoarthritis can progress to disabling stages:

• Severe Loss of Mobility: Limited joint motion interferes with walking, climbing stairs, or even sitting.
• Chronic Pain: Ongoing pain may impair sleep and mood.
• Muscle Weakness and Atrophy: Reduced activity causes wasting of gluteal and thigh muscles.
• Joint Deformity: Femoral head migration and leg-length discrepancy can occur in late disease.
• Secondary Pain Syndromes: Altered gait increases strain on the lumbar spine, knees, and ankles.
• Loss of Independence: Patients may need walking aids or surgery.

The more significant and worrying end stage of osteoarthritis of the hip is, if the joint destruction and bone spur growth gets too severe, these changes can disrupt the blood supply to the ball of the ball and socket joint. If this happens, the bone will die, leading to a condition called osteonecrosis⁵. Osteonecrosis is a severe complication of osteoarthritis due to the poor bloody supply to the hip joint and can result from repeated joint injections into the hip⁵. Things like smoking and alcohol abuse increase the risk of developing osteonecrosis of the hip joint⁵, so smoking cessation and reducing alcohol intake will reduce these risks.

Hip-Spine Syndrome

Hip-Spine syndrome is a complex and interesting disorder that deserves its own blog post so we can delve into its intricacies and nuances. For the sake of this blog post, we will briefly touch upon it. Hip-spine syndrome is a pain syndrome that is often reserved for those patients who have hip surgery, the subsequently develop back pain, or vice versa. Typically, the patient will have osteoarthritis in both the spine and hip, and the resulting change in hip/spine alignment and function leads to increased stress on the other body part, leading to pain and disability^6–8.

Stronger Hips, Healthier Life: Exercise Matters in Osteoarthritis

Muscle weakness and muscle loss is strongly associated with physical pain, functional limitations and risk of falling in patients with hip arthritis⁹. Strengthening exercises are therefore recommended to improve function and reduce pain. The most important thing for  patients is to keep as much muscle mass as possible around the joint. This is what I tell my patients all the time. Whether you are looking at surgery as being your next step, strengthening the muscles that support the joint and keeping as much muscle mass as possible will help you before and after the surgery¹⁰.

However, there is an inherent problem here isn’t there? How is someone supposed to exercise when they are struggling with hip pain and lack of mobility? This is where a combination therapy might be helpful.

Joint injections have been shown to provide short-term pain relief for arthritis patients¹¹. Much of the discussion of hip arthritis management surrounds the combination of an injection to help manage the patients’ pain, whilst the patient when commences an exercise rehabilitation plan. It is therefore suggested that a combination of different conventional medical treatment, along with alternative therapies, including exercises is recommended in the management of symptoms associated with hip arthritis¹²

If you having hip arthritis and are need of additional support in managing your symptoms, call us to book your consultation on 01635 34238 or book online via our website. One of our chiropractors will be excited to see you.

At the end of the day,  it comes down to finding a strategy that works for you and helps you achieve your goals. If a walking aid is required to help manage your pain, that is what they are for. The important thing is staying active and doing a much exercise as you can to stay fit and healthy. Sedentary lifestyles are not a good thing when it comes to being healthy. An arthritic joint needs to be moved regularly and is doing resistance training to increase or maintain as much muscle mass as you can.

I hope you found this blog post interesting and informative. I always enjoy writing them and finding up-to-date research to help educate and inform you of the role chiropractic can have on improving your quality of life.

By Mark Spriggs DC, MChiro, MSc, PGCert, FRCC

References

1. Poulsen E, Christensen HW, Overgaard S, Hartvigsen J. Prevalence of hip osteoarthritis in chiropractic practice in Denmark: a descriptive cross-sectional and prospective study. J Manipulative Physiol Ther. 2012;35(4):263-271. doi:10.1016/j.jmpt.2012.01.010
2. Long H, Liu Q, Yin H, et al. Prevalence Trends of Site-Specific Osteoarthritis From 1990 to 2019: Findings From the Global Burden of Disease Study 2019. Arthritis Rheumatol. 2022;74(7):1172-1183. doi:10.1002/art.42089
3. Aresti N, Kassam J, Nicholas N, Achan P. Hip osteoarthritis. BMJ. 2016;354. doi:10.1136/BMJ.I3405
4. Fan Z, Yan L, Liu H, et al. The prevalence of hip osteoarthritis: a systematic review and meta-analysis. Arthritis Res Ther. 2023;25(1):1-11. doi:10.1186/s13075-023-03033-7
5. George G, Lane JM. Osteonecrosis of the Femoral Head. J Am Acad Orthop Surg Glob Res Rev. 2022;6(5):1-10. doi:10.5435/JAAOSGlobal-D-21-00176
6. Devin CJ, McCullough KA, Morris BJ, Yates AJ, Kang JD. Hip-spine syndrome. J Am Acad Orthop Surg. 2012;20(7):434-442. doi:10.5435/JAAOS-20-07-434
7. Chavarria JC, Douleh DG, York PJ. The Hip-Spine Challenge. J Bone Joint Surg Am. 2021;103(19):1852-1860. doi:10.2106/JBJS.20.01728
8. Yoshimoto H, Sato S, Masuda T, et al. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005;30(14):1650-1657. Accessed June 12, 2019. http://www.ncbi.nlm.nih.gov/pubmed/16025036
9. Liu W, Yin M, Li H. Optimizing resistance training for pain management in knee and hip osteoarthritis: a pairwise and dose–response meta-analysis. Front Public Heal. 2025;13. doi:10.3389/FPUBH.2025.1623679/PDF
10. Juhlin J, Sernert N, Åhlund K. Pre-operative gluteus medius tendon degeneration and its impact on strength and functional ability one year after total hip replacement. Ann Med. 2024;56(1). doi:10.1080/07853890.2024.2388701
11. Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthr Cartil. 2023;31(4):458-466. doi:10.1016/j.joca.2022.11.005
12. 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 Rheumatol (Hoboken, NJ). 2020;72(2):220-233. doi:10.1002/ART.41142