Let’s get this important misconception out of the way: Done correctly, working out is not going to exacerbate your hip pain or make your arthritis worse. But not exercising can make your arthritis worse, which is why doctors recommend exercises as an important part of your arthritis treatment plan, whether you have osteoarthritis or an autoimmune, inflammatory form such as rheumatoid or psoriatic arthritis.
Here’s what’s happening in your hip when you have arthritis, and why exercising and moving more helps relieve pain and stiffness.
How Arthritis Affects Your Hips
The hip is a ball-and-socket joint — the “ball” is the top of your thigh bone, and it sits in a “socket” that’s formed by part of your pelvic bone. Slippery tissue called cartilage covers the bone surface and helps cushion the joint. “Cartilage creates a low-friction environment so you can move easily and without pain,” explains Wayne Johnson, MD, orthopedic surgeon and assistant clinical professor at the University of Oklahoma.
In osteoarthritis (OA), the cartilage in the hip joint gradually wears down, which over time leads to pain, stiffness, swelling, and lack of mobility, says Dr. Johnson, who is a fellow of the American Academy of Orthopaedic Surgeons. Everyday tasks — like bending over to tie a shoe, getting up from a chair, or going for a walk — become more challenging and painful. The lifetime risk of developing osteoarthritis of the hip is 25 percent.
With rheumatoid and other forms of inflammatory arthritis, the immune system mistakenly attacks a protective lining in your joint called the synovium, and destroys cartilage. Though RA tends to affect smaller joints first (such as those in your hands and feet), symptoms can spread to both your hips as the disease progresses.
How Exercise Helps Hip Arthritis
Think of your hip joint like a bicycle, says Dr. Johnson. The muscles around the hip are the strong, supporting frame of the bike. The joint — especially one with arthritis — is like the weaker, flimsier chain. A strong frame takes some of the stress off a weaker chain.
The same is true in your hip. “We lose muscle strength as we age,” explains Dr. Johnson. “And any excess weight puts even more stress on a joint that’s becoming weaker due to arthritis.”
Exercise, then, helps strengthen the muscles that support your hip, which takes some of the load off on the worn-out, weaker joint. “That shift can translate to a decrease in pain and stiffness, easier motion and improved flexibility,” he says.
Exercise also help enhance balance, boost energy, improve sleep, and control weight. And in people with mild to moderate hip OA, a study published in Annals of the Rheumatic Diseases found those who exercised for one hour at least twice a week for 12 weeks were 44 percent less likely to need hip replacement surgery six years later, compared with those who did not exercise.
The types of exercise that can help ease arthritis pain may include:
- Range-of-motion and stretching exercises (to help maintain and improve flexibility)
- Strengthening exercises (to work your muscles a little harder)
- Aerobic exercise, like swimming or biking (to improve cardiovascular health and control your weight)
- Other activities like yoga and tai chi or even gardening and walking the dog.
Precautions to Keep in Mind Before Exercising with Hip Arthritis
If you’re new to exercise, it’s always smart to first talk to your doctor. “It’s important to consider the current limits of your joints, and work within those limits,” explains Lauren Shroyer, MS, director of product development at the American Council on Exercise. Your doctor or physical therapist can make sure the exercises are safe for you and help you gain strength, without exacerbating inflammation or aggravating joint pain, she says. Likewise, if you’ve had surgery on your hip, get guidance from your doctor or physical therapist on what hip exercises are safe for you.
More tips to help protect your joints:
Start slowly. Ease your joints into exercise if you haven’t been active for a while, say experts. Push too hard too fast, and you can overwork your muscles and worsen joint pain. Go easy at first, then increase the length and intensity of your work out as you progress.
Move gently. Warm up your muscles with five to 10 minutes of stretching at the start of every exercise activity, says Dr. Johnson; and do it again at the end. Don’t force any stretches; keep your movements slow and easy. With strength training, begin with fewer reps or lower weight, and build up gradually.
Stop if your hip (or anything else) hurts. “Listen to the pain,” says Shroyer. Take a break when your joints start to ache; or you feel any new joint pain, it’s time to stop. Talk to your doctor about what pain is normal and when it’s a sign of something more serious.
Stretch every day. If you have a flare of RA or an increase in OA pain, you should still stay active, says Dr. Johnson. Some simple stretching may diminish some of the pain.
Exercises to Help Relieve Hip Arthritis Pain
The following hip exercises were recommended by Shroyer at ACE and Dr. Johnson from the AAOS:
Hip Exercise: Clock Tap
Improves balance and stability, and strengthens muscles in your hips and legs
- Stand next to a wall or door frame for support.
- Balance on right foot; hold on to wall or door frame to stay steady, if needed. Keep your knee straight over your ankle, with a slight bend.
- Tap your left foot around your right foot, as if your right foot is the centerpiece on a clock, and your left is touching numbers on a clockface. Start at 12 o’clock, then tap at 11, 10, and 9.
- Retrace the numbers back to 12; then tap 1 and 2, and retrace back to 12.
- Repeat the sequence four times; then complete with the opposite foot.
Tip: Stay within a comfortable and stable range of motion when tapping “around the clock,” says Shroyer. If your knee starts to shift over as you tap for the 9 spot, you may be past your range. As you get stronger, you may be able to reach further on each side.
Hip Exercise: Standing Iliotibial Band Stretch
Stretches the outside of your hip
- Stand next to a wall for support.
- Cross the leg that is closest to the wall behind your other leg.
- Lean your hip toward the wall until you feel a stretch at the outside of your hip. Hold the stretch for 30 seconds.
- Cross the leg that is further from the wall behind your other leg.
- Repeat on the opposite side; then repeat the entire sequence four times.
Tip: Don’t lean forward or twist at the waist.
Hip Exercise: Knee to Chest
Stretches your buttocks
- Lie on your back on the floor with your legs extended straight out.
- Bend one knee and grasp your shinbone with your hands.
- Gently pull your knee toward your chest as far as you’re comfortable.
- Hold the stretch for 30 seconds and then relax for 30 seconds.
- Repeat on the other side, then pull both legs in together. Repeat the entire sequence four times.
Tip: Keep your lower back pressed into the floor.
Hip Exercise: Hamstring Stretch
Stretches the back of your thigh and behind your knee
- Lie on the floor with both knees bent.
- Lift one leg off of the floor and bring the knee toward your chest. Clasp your hands behind your thigh below your knee.
- Straighten your leg and then pull it gently toward your head until you feel a stretch. (If you can’t clasp your hands behind your leg, loop a towel around your thigh. Grasp the ends of the towel and pull your leg toward you.)
- Hold for 30 seconds and then relax for 30 seconds.
- Repeat on the other side; then repeat the entire sequence four times.
Tip: Don’t pull at your knee joint.
Hip Exercise: Hip Extension
Strengthens your buttocks
- Lie on your stomach on a firm, flat surface with a pillow under your hips. Keep your head, neck, and upper body relaxed.
- Bend one knee 90°.
- Lift your leg straight up.
- Slowly lower your leg down to the floor, counting to 5.
- Do 8 reps; then complete the exercise on the other side.
Tip: Begin with 8 reps, using only your body weight; and progress to 12, recommends Dr. Johnson. When that becomes easier, add ankle weights in one-pound increments. Each time you increase the weight, start again at 8 reps, working back up to 12.
Hip Exercise: Sit-and-Stand
Increases mobility and strengthens leg, core, and back muscles
- Stand in front of sturdy chair that won’t move, feet planted on the floor about hip-distance apart.
- Press your hips back and bend your knees a little to lower yourself into a seated position.
- Then tip forward from the hips, push through your feet and up with your legs to a standing position.
- Repeat the sequence 3 times.
Tip: Gradually build up to 5 or 10 reps, says Shroyer: “Sitting and standing is essential movement pattern you want to stay strong in.”
Hip Exercise: Bodyweight Squat
Progression from the sit-and stand to help strengthen thighs and buttocks
- Stand with your feet shoulder-distance apart, or a little wider. If needed, hold on to something stable, like the back of sturdy chair or kitchen sink.
- Keep your chest lifted and shift your weight back into your heels while slowly pushing your hips back, as is you were sitting down into a chair.
- Keep your feet flat and lower yourself as far as you’re comfortable (such as a quarter or halfway down to where a chair would be).
- Push through your heels and bring your body back up to standing.
- Repeat the sequence 3 times; gradually build up to more reps.
Tip: Keeping your feet a little wider than shoulder-distance apart is better for balance when you are struggling with hip pain, says Shroyer.
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