Living with joint pain can feel like a constant battle. Every step, bend, or turn reminds you of how important healthy joints are for a full and active life. If you’ve been noticing stiffness, discomfort, or pain in your hip, you’re not alone.

Hip osteoarthritis (OA) is one of the most common causes of pain and limited movement in adults, especially as we age. This condition can slowly creep up, often starting with mild discomfort before becoming a major disruption in your daily life.

Did you know that up to 27% of adults may show signs of hip OA on X-rays, but not all experience symptoms? That means this condition can be more widespread than it seems, impacting millions around the world¹.

The Short Version

Hip osteoarthritis is gradual wear of the hip joint’s cartilage — a common cause of groin and hip pain, especially with age, higher load, or previous injury.
It usually develops slowly from a mix of factors, not one single cause, and X-ray changes don’t always match how much pain someone feels.
The most strongly evidence-supported treatment is a progressive exercise programme to build strength and keep the joint moving. Manual therapy, taping, laser and dry needling are optional adjuncts that may help with comfort, not stand-alone solutions.
Scans and surgery aren’t usually needed. If hip pain follows an injury, you can’t weight-bear, or it isn’t settling, it’s worth being assessed in person.

Dealing with hip pain in Sandton? Book an assessment and we’ll work out what’s driving it.

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What is Hip Osteoarthritis?

Hip osteoarthritis (OA) is a condition where the cartilage in the hip joint wears down. Cartilage is a soft tissue that cushions the bones and helps the joint move smoothly. When it breaks down, the bones rub together, causing pain, stiffness, and difficulty moving. It is a long-term condition that usually gets worse over time.

How Common is Hip Osteoarthritis?

Hip OA is very common. About 8% of adults over the age of 45 experience symptoms such as pain and stiffness in the hip¹. Many others have changes visible on X-rays without feeling any symptoms².

Who Does Hip Osteoarthritis Affect Most?

Older adults are the most affected since cartilage naturally wears down with age. Women after menopause are more likely to develop OA, possibly due to hormonal changes. Being overweight increases stress on the hips, making the cartilage wear out faster⁴. Jobs or activities that involve heavy lifting or standing for long periods also increase the risk³.

Common Signs and Symptoms of Hip Osteoarthritis

Hip Pain: A dull or sharp pain felt in the groin, thigh, or buttocks, especially after walking, climbing stairs, or sitting for long periods.
Morning Stiffness: The hip feels stiff when you first wake up but tends to ease within 30 minutes after moving around.
Reduced Range of Motion: Difficulty bending or rotating your hip, making tasks like tying shoes or getting in and out of a car harder.
Clicking or Popping Sounds: You might hear or feel a grinding or popping sensation in the hip during movement.
Pain with Weight-Bearing Activities: Discomfort that worsens when standing, walking, or carrying something heavy.
Limping: You might unconsciously favor one side, causing a noticeable limp as you try to avoid pain.
Muscle Weakness: The muscles around the hip feel weaker, leading to instability or difficulty with balance.
Swelling or Tenderness: Although less common, some people notice swelling or feel tenderness when touching the hip joint.
Pain at Rest: In more advanced cases, you may feel pain even when lying down or resting.

Why Does Hip Osteoarthritis Happen?

How the Hip Joint Works

The hip is a ball-and-socket joint, where the “ball” (the head of your thigh bone) fits into the “socket” (part of your pelvis). This joint is lined with cartilage, a smooth tissue that cushions the bones and helps them move easily.

Surrounding the joint are muscles, ligaments, and a fluid-filled capsule that work together to support and lubricate the hip. When everything is healthy, the hip moves smoothly and painlessly.

What Happens in Hip Osteoarthritis

In hip OA, the cartilage that protects the joint begins to wear down. This can happen gradually over many years. Without enough cartilage, the bones in the hip start to rub against each other. This rubbing causes pain, swelling, and stiffness. Over time, the joint may develop bony growths called osteophytes, which make movement even harder.

As the joint becomes more damaged, the body tries to repair itself, but this often leads to more problems. The lining of the joint can become inflamed, and the joint space (the gap between the bones) gets smaller, limiting movement.

How the Joint Is Affected

There isn’t one single cause of hip OA, but several factors work together:

Wear and Tear Over Time: Everyday activities like walking and bending put stress on the hip joint. Over the years, this can slowly break down the cartilage, especially in people who are very active or perform repetitive movements.
Extra Pressure on the Joint: Carrying extra weight increases the load on your hips. For every pound you gain, your hips feel three extra pounds of pressure when you walk⁴.
Injuries or Trauma: Previous injuries to the hip, like a fracture or dislocation, can damage the cartilage and lead to OA years later.
Changes in Joint Shape: Some people are born with hips that don’t fit perfectly, a condition called hip dysplasia. This uneven shape puts extra stress on certain parts of the joint and increases the risk of OA.

The Role of Inflammation

As cartilage wears down, the body releases chemicals that trigger inflammation in the joint. This inflammation can worsen the damage, leading to a cycle of pain, swelling, and further breakdown. This is why managing inflammation is a big part of treating OA.

Genetics and Hormones

Some people are more likely to get OA because of their family history. If your parents had OA, you may have inherited genes that make your cartilage weaker. For women, hormonal changes after menopause may also play a role by affecting bone and cartilage health.

What Other Conditions Could It Be?

Trochanteric Bursitis

This condition causes pain on the outside of the hip, unlike hip OA, which typically affects the groin. Pain worsens when lying on the side or pressing on the outer hip, but joint movement isn’t as limited.

Hip Labral Tear

A tear in the cartilage rim of the hip socket causes sharp pain in the groin, especially during twisting movements. It’s more common in younger, active people and doesn’t involve cartilage wear like OA.

Sciatica

Pain from a compressed nerve in the lower back can radiate to the hip or thigh. Unlike OA, sciatica often includes tingling or numbness and doesn’t cause joint stiffness.

Hip Fracture

A hip fracture causes sudden, severe pain, often after a fall. Unlike OA, the pain is immediate and makes weight-bearing impossible⁵.

Rheumatoid Arthritis

This autoimmune condition affects multiple joints and often causes swelling, fatigue, and fever, which aren’t typical in OA.

Common Mistakes When Treating Hip Osteoarthritis

Ignoring Pain

Many people ignore early signs of hip OA, thinking the pain will go away. This allows the joint to deteriorate, leading to worse pain, stiffness, and limited movement. Early action can slow the damage and help preserve your mobility.

Avoiding Movement

Fear of pain often leads people to stop exercising, but this weakens the muscles supporting your hip. Gentle activities like walking or swimming help reduce stiffness and maintain strength. Avoiding movement can make the condition worse⁵.

Over-Relying on Medication

Using only painkillers might ease symptoms but doesn’t address the cause. Without physical therapy or exercise, the joint continues to wear down. Overusing medication can also lead to side effects like stomach issues or dependency.

Neglecting Weight Management

Extra weight puts more pressure on your hips, speeding up joint damage. Losing even a small amount of weight can ease pain and improve mobility. Ignoring this can worsen symptoms and limit your treatment options.

Delaying Treatment

Waiting too long to address symptoms can lead to severe damage, making treatments less helpful. Early care gives the best chance for long-term relief and mobility.

Types of Scans For Hip Osteoarthritis

X-Ray

An X-ray is often the first scan used to check for hip OA. It shows the bones in your hip and can reveal if the space between the bones is narrowing, which happens when cartilage wears down. X-rays also help detect bony growths called osteophytes.

MRI (Magnetic Resonance Imaging)

An MRI provides a detailed view of the soft tissues in your hip, including cartilage, muscles, and ligaments. It’s used to assess how much cartilage is left, check for inflammation, or identify tears in the surrounding tissues. MRI is particularly useful if your symptoms don’t match X-ray findings.

CT Scan (Computed Tomography)

A CT scan creates a detailed 3D image of your bones. This can be helpful when planning surgery or when other scans aren’t conclusive. CT scans can reveal hidden joint damage that may not show up on an X-ray.

Is Surgery Needed?

Surgery is typically considered when other treatments haven’t worked and pain or stiffness severely limits your daily life. The most common surgery is a total hip replacement, where the damaged joint is replaced with an artificial one. This can reduce pain, improve movement, and help you get back to normal activities.

Surgery is usually recommended if:

Pain is constant and doesn’t improve with medication or rest.
Daily tasks like walking or dressing are difficult.
The hip joint is severely damaged, as seen on scans.
Other treatments, like exercise or injections, haven’t helped.

The Role of Physiotherapy After Surgery

Physiotherapy is critical after surgery to ensure you recover and get the most out of your new hip. A personalized program helps you:⁸

Regain Strength: Build up the muscles around your hip to support movement.
Improve Mobility: Stretch and move the joint safely without pain.
Return to Activities: Gradually resume daily tasks and hobbies.

With the right physiotherapy plan, most people recover well and return to an active lifestyle within a few months⁸.

When to Have Hip Pain Assessed in Person

Most hip OA is managed well without scans or surgery, and steady, sensible loading is the cornerstone. Occasionally, though, hip pain points to something that deserves an in-person look. It’s worth being assessed by a physiotherapist or doctor if you notice any of the following:

Hip pain after a fall or injury, or a sudden inability to put weight on the leg
Severe pain with the leg appearing shortened or turned outward (possible fracture)
Fever, redness, warmth or marked swelling around the joint (possible infection)
Night pain that isn’t related to how you’ve moved or loaded the hip, or unexplained weight loss
Pins and needles, numbness or weakness travelling down the leg
Pain that keeps worsening despite several weeks of sensible load management

None of these necessarily mean something serious, but they’re worth getting assessed in person so you can be guided properly.

Treatment Options for Hip Osteoarthritis

As a physiotherapist, I offer several evidence-based treatments to manage hip osteoarthritis. These aim to reduce pain, improve mobility, and strengthen the joint.

Exercise Therapy for Hip Osteoarthritis

Strengthening exercises support the hip joint by reducing stress, while stretching improves flexibility and reduces stiffness. Low-impact activities like swimming or cycling are ideal for maintaining activity without overloading the joint⁵.

Myofascial Release

Hands-on techniques release tension in the muscles and connective tissue around the hip, improving mobility and reducing discomfort. This is especially useful for relieving tightness and stiffness.

Orthopedic Manual Therapy

Gentle mobilizations of the hip joint restore movement, decrease stiffness, and ease everyday tasks like walking or bending⁶.

Laser Therapy

Hip OA often sits alongside other local sources of pain around the hip, such as greater trochanteric pain syndrome or adductor tendinopathy. Low-level laser is sometimes used as an adjunct for those soft-tissue and tendon-related complaints, aiming to ease pain in the shorter term rather than treating the joint itself. The better-quality laser evidence is in knee OA, so it is used cautiously and as a supporting measure alongside your main programme, not as a stand-alone solution⁷.

Dry Needling

This technique targets tight muscles or trigger points, improving circulation and releasing tension, which eases pain.

Strapping and Taping

Taping supports the hip joint and reduces strain during activity, making movement less painful.

Conclusion

A hip osteoarthritis diagnosis doesn’t have to define your life. With the right approach, you can ease your pain, rebuild your strength, and get back to doing what you enjoy most.

Recovery is all about steady, consistent effort—whether it’s sticking to your exercises, attending therapy sessions, or giving your body the rest it needs. It may take time, but each small step brings you closer to feeling better and moving freely again.

You’re not facing this alone. I’m here to guide you every step of the way. Let’s take the first step toward your recovery together.

Struggling with ongoing hip pain or stiffness? A proper assessment can pinpoint what’s driving it and get you on a clear, progressive plan.