Hip & GroinArthritis / DegenerativeStrong evidence
Hip Osteoarthritis
Hip OA commonly causes groin/anterior thigh pain, mobility loss and reduced walking function; rehabilitation emphasizes exercise, education and selected manual therapy.
THE MSK CLINICAL STORY
The sock test: when a morning routine tells you about the hip
A fictional teaching case. Follow the clues, enjoy the conversation, and make the decisions a thoughtful clinician would make—not an instant diagnosis from a single symptom.
Scene 01 · The patient walks in
A 66-year-old man stops halfway through putting on a sock. 'My groin aches, turning my foot inward feels stuck, and my shoes are winning this argument.' His back has been blamed for months.
A little clinic conversation
Patient: 'Isn't groin pain always from a muscle pull?' Therapist: 'The hip joint would like a chance to explain itself.'
Scene 02 · Follow the clues
Groin or anterior thigh pain with restricted hip internal rotation and functional limits can suggest hip OA, though hip, spine and other conditions can overlap.
Plot twist · What could fool us?
Hip discomfort can be felt at the knee, and the back can mimic hip symptoms. Serious causes such as fracture, septic joint or avascular necrosis need screening.
Choose your learning lens
Same clinical case, two ways to understand it. The complete examination and treatment guide is still available below.
In everyday words
Joint changes in the hip may make bending, turning and walking harder. We can often improve function through tailored exercises and practical changes, even when stiffness does not disappear completely.
Scene 03 · The rehabilitation journey
Make daily movement comfortable → build hip strength and walking tolerance → restore confidence with shoes, stairs and community activities.
Groin pain, reduced hip internal rotation and difficulty putting on socks most strongly support which next step?
Choose one answer to reveal the explanation. No score, no pressure—just better clinical reasoning.
These cases teach reasoning; they do not provide a diagnosis for an individual patient. Always consider red flags, contraindications, comorbidities and local referral pathways.
Periarticular muscles and functional kinetic chain
Mechanism / Why It Happens
Multifactorial age, morphology, previous injury, load and metabolic factors
Classification / Grades
Clinical OA
Radiographic OA when imaging is indicated
Symptoms
Groin pain
Stiffness
Reduced walking tolerance
Difficulty shoes/socks, stairs or rising from low chair
Clinical Signs
Reduced internal rotation/flexion
Antalgic gait
Hip abductor weakness
Pain at end range/loading
Red Flags & Referral Clues
Fracture/stress fracture
Avascular necrosis risk
Septic hip
Rapid deterioration
Inflammatory/systemic features
Diagnostic Examination
How to perform the tests — step by step
Each test includes patient setup, therapist position, hand placement, exact performance, positive finding and clinical interpretation.
Hip ROM Pattern
Identify mobility deficits typical of hip OA.
Patient position
Supine.
Therapist position
Beside tested hip.
Hand placement
Support thigh/leg while controlling pelvis.
How to perform
1Assess hip flexion.
2Assess internal and external rotation with pelvis stabilized.
3Compare sides and note pain/end-feel.
Positive sign
Painful restriction, often particularly internal rotation and flexion.
Interpretation
Supports hip OA in the appropriate clinical context; not diagnostic alone.
FABER
Assess hip mobility and symptom provocation.
Patient position
Supine in figure-four position.
Therapist position
Beside tested hip.
Hand placement
Stabilize opposite pelvis; gently guide tested knee.
How to perform
1Flex, abduct and externally rotate tested hip.
2Stabilize contralateral pelvis.
3Gently lower knee within tolerance.
4Note groin vs posterior pain and range.
Positive sign
Groin pain or marked restriction supports hip involvement.
Interpretation
Useful supportive finding with history and ROM pattern.
Differential Diagnosis
FAIS
Greater trochanteric pain syndrome
Lumbar referral
Stress fracture
Inflammatory arthritis
Investigations / Imaging
Typical OA may be diagnosed clinically; imaging is used for atypical features or when it changes management.
Radiographs are common when surgical planning or diagnostic clarification is needed.
Complete Rehabilitation Plan
From protection to full function
Phase 1 — Education, Mobility & Baseline Strength
Reduce disability and build confidence in movement.
What to do
Education
Activity pacing
Hip mobility within tolerance
Hip/trunk strengthening
Walking/aerobic activity
Exercise dosage
Hip abduction/extension: 3 x 8–15
Sit-to-stand: 3 x 8–15
Walking/cycling: frequent tolerable bouts
Progress when
Walking and transfers improve
Exercise recovery predictable
Phase 2 — Progressive Lower-Limb Capacity
Improve strength, balance and walking/stair function.
What to do
Progress resistance
Step/lunge patterns as tolerated
Balance
Aerobic conditioning
Exercise dosage
Strength 2–3 days/week, 3–4 x 6–15
Balance 3 x 30–60 s
Aerobic work several days/week
Progress when
Meaningful improvement in functional goals
Phase 3 — Long-Term Management / Escalation
Maintain independence; identify when joint-replacement opinion is appropriate.
What to do
Sustainable exercise
Weight management if relevant
Walking aid if needed
Medical/orthopaedic review for persistent major quality-of-life limitation
Exercise dosage
Maintain strength and aerobic program long term
Progress when
Independent self-management or escalation when appropriate
Manual Therapy — Role & Application
Hip joint mobilization and soft-tissue techniques may be used for selected pain/mobility deficits alongside exercise.
Manual therapy should not be the sole treatment.
Modalities — Use / Avoid
Do not build OA care around electrotherapy.
Exercise, education and self-management remain central.
Return / Discharge Criteria
Focus on patient-specific walking, stair, work and recreation goals.
Referral for arthroplasty opinion when quality of life is substantially affected despite appropriate nonsurgical management.
Common Clinical Mistakes
Avoiding strengthening because the joint is arthritic
Treating only stiffness with passive techniques
Delaying appropriate referral when disability remains severe
Clinical Pearls
Groin pain plus loss of hip internal rotation is a common clinical pattern.
2025 hip OA CPG supports exercise and manual therapy as components of rehabilitation.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
