Hip Osteoarthritis: who to see and what helps

Hip Osteoarthritis · Kitchener, Waterloo & Cambridge

Hip osteoarthritis is the gradual breakdown of the hip joint. It is usually felt in the groin or the outside of the hip and shows up in small things, like reaching your feet to put on socks. Exercise is the main treatment, and the guideline written for physiotherapists says hands-on treatment of the hip should be used as well. A CARESPACE physiotherapist or chiropractor is the first visit, and both treat the hip that day.

What hip osteoarthritis is

Our Osteoarthritis page covers how the condition develops and who is at risk. This one is about what sets the hip apart: where the pain shows up, what a fall means, and how the joint is treated.

Symptoms of hip osteoarthritis

• Pain in the groin or on the outside of the hip
• Pain that is often worse when you move the hip, though it can also be there when you rest or sleep
• Difficulty putting on shoes and socks
• Difficulty getting in and out of a car
• Stiffness after rest that eases within about 30 minutes, and less movement in the joint

Pain that may spread to the upper thigh and feels worse when you move or lie on that side points to bursitis instead: see Hip Bursitis & Gluteal Tendinopathy. If you are not sure which it is, start with Hip Pain.

What causes hip osteoarthritis

The general risks apply: age, family history, a previous injury to the joint, excess body weight and heavy physical work. Ontario’s quality standard adds that osteoarthritis can be diagnosed before the age of 40 in people with a factor such as an earlier joint injury or hip dysplasia.

How hip osteoarthritis is diagnosed

Mostly by examining how the hip moves and hearing how the pain behaves. The UK guideline says to diagnose osteoarthritis without imaging in people aged 45 or over who have activity-related joint pain and morning stiffness lasting no longer than 30 minutes.

When it is an emergency

A fall changes things. Call 911 or go to an emergency department if you have severe hip pain after a fall or injury, cannot walk or put weight on the leg, or have tingling or loss of feeling in the hip or leg after an injury. Do not drive yourself. This is the advice of the NHS, the UK’s health service, for hip pain, put in Ontario terms.

A joint infection comes on quickly, usually over a few days; osteoarthritis does not. The NHS, the UK’s health service, gives these signs of one: severe pain in a joint, usually just one, that started suddenly; swelling around a joint; a change in the colour of the skin around a joint; difficulty moving a joint; or joint pain along with feeling generally unwell and a high temperature, or feeling hot, cold or shivery. Ontario’s quality standard adds chills and sweats, and names a hot, swollen joint as a feature that needs investigating. If you develop any of these, go to an urgent care clinic or an emergency department the same day. A joint infection is serious and should be treated as soon as possible, usually in hospital, so it is not something to bring to an appointment with us.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if hip stiffness lasts more than 30 minutes after you wake up, or if the pain is getting worse quickly or keeps coming back. Prolonged morning stiffness and quick worsening do not fit the usual pattern of osteoarthritis and may call for blood work, imaging or another diagnosis, such as rheumatoid arthritis or gout. The same goes for hip pain that began with a fall or injury but meets none of the emergency signs in the first paragraph: have a physician or nurse practitioner look at it before you book with us.

What the evidence says about treating hip osteoarthritis

• The sources. The UK’s NICE guideline (2022), Ontario Health’s quality standard (2024), the American College of Rheumatology’s 2026 update (so far a summary) and the 2025 hip guideline from the American physiotherapy association’s orthopaedic academy, which grades its advice by letter: A for exercise, hands-on treatment and dry needling, B for working with dietitians on weight, and C for balance and gait training. When the rheumatologists say “strongly”, their panel was confident that benefits outweigh downsides for nearly all people; “conditionally” means a majority of informed people would choose it and a minority would not.
• Exercise first. No guideline here disputes it: each recommends exercise in its firmest terms. The programme should be individualized and may include exercise in water; in the hip studies, progressive strength training was superior to aerobic exercise, and both were better than unsupervised home exercise.
• Hands-on treatment, with exercise. The physiotherapy guideline says clinicians should use soft-tissue and joint mobilization for mild to moderate hip osteoarthritis where the joint is stiff or painful. The UK guideline goes no further than “only consider”, and only alongside exercise. In 2019 the rheumatologists conditionally recommended against adding it to exercise, and their 2026 summary is silent on it.
• Dry needling and acupuncture: opposite answers. NICE says do not offer either for osteoarthritis. The physiotherapy guideline says clinicians should use dry needling of trigger points in the muscles around the hip, in people with moderate (grade II or III) hip osteoarthritis, for short-term (three-week) gains in pain, movement and function. Acupuncture, separately, is conditionally recommended by the rheumatologists.
• Weight loss for people who are overweight. Strongly recommended by the rheumatologists for people with hip osteoarthritis who meet the criteria for overweight or obesity. NICE says any amount is likely to be beneficial.
• Balance, walking and canes. Clinicians should provide balance, gait and functional training, including the proper use of a cane, where those are limited, says the physiotherapy guideline; NICE says to consider walking aids. The same physiotherapy guideline says bracing should not be a first line of treatment.
• TENS and ultrasound. NICE says do not offer either, and the rheumatologists conditionally recommend against TENS. The physiotherapy guideline says only that ultrasound may be added as a shared decision, with the person told that the evidence conflicts.

What a doctor may offer

The following come from a physician or nurse practitioner, not from CARESPACE. NICE says to consider an anti-inflammatory gel for joints other than the knee, with tablets if the gel is ineffective or unsuitable. The rheumatologists strongly recommend corticosteroid injections for the hip, given under ultrasound guidance; NICE describes the relief as short-term, 2 to 10 weeks. NICE says do not offer hyaluronic acid injections, and the rheumatologists conditionally recommend against them. A hip replacement becomes a question for your physician once symptoms are substantially affecting your quality of life and non-surgical treatment is ineffective or unsuitable; age, smoking, other health conditions and body weight should not exclude anyone from referral. Hip Replacement Rehab covers the recovery.

How each CARESPACE service treats hip osteoarthritis

Physiotherapy

A physiotherapist can measure how far the hip bends and rotates, test the muscles around it and watch how you walk, then prescribe progressive strengthening. Joint and soft-tissue mobilization can be added where the hip is stiff, along with balance and gait work and advice on using a cane. Some CARESPACE physiotherapists offer dry needling; the two guidelines that address it for the hip disagree (see the evidence list), so talk the choice through.

See our physiotherapy team →

Chiropractic

A chiropractor can mobilize the hip joint and treat the soft tissue around it, which is the kind of hands-on treatment the physiotherapy guideline supports, and can prescribe exercise. The UK guideline supports hands-on treatment for the hip only alongside exercise, so the plan should include strengthening as well.

See our chiropractic team →

Kinesiology

A kinesiologist can supervise progressive strength training, the form of exercise that did best in the hip trials, and keep adding load as the hip and leg muscles get stronger. Those trials ran exercise one to five times a week for 5 to 16 weeks.

See our kinesiology team →

Personal Training

A personal trainer can keep you exercising once a supervised programme ends, using options that go easier on a sore hip, such as exercise in water, and working toward the 150 minutes of aerobic activity a week that Ontario’s standard sets as a target.

See our personal training team →

Massage Therapy

A Registered Massage Therapist can work on the buttock, groin and thigh muscles around the hip. Soft-tissue treatment is part of the manual therapy the physiotherapy guideline supports, and the rheumatologists conditionally recommend massage for hip osteoarthritis on low-certainty evidence, having conditionally recommended against it in 2019. Arthritis Society Canada’s view is that there is not enough research evidence to say massage should be recommended.

See our massage therapy team →

Nutrition & Dietitian

A Registered Dietitian is the CARESPACE practitioner for weight management, where that is one of your goals, and you leave the first visit with a plan. The physiotherapy guideline says clinicians should work with physicians and dietitians to support weight reduction in people with hip osteoarthritis who are overweight. On glucosamine, NICE says do not offer it, and the rheumatologists strongly recommend against it and chondroitin.

See our nutrition team →

Acupuncture

Acupuncture for an arthritic hip is aimed at easing pain. The rheumatologists conditionally recommend it for the hip; NICE says not to offer it, on evidence that was mostly about the knee; and Arthritis Society Canada calls the research on arthritis symptoms limited. If you choose it, keep the exercise programme going alongside.

See our acupuncture team →

Where most people start

Start with a physiotherapist or a chiropractor. If walking is limited, say so when you book.

How your team works together

Strengthening and hands-on treatment can run together at the start, under a physiotherapist or chiropractor. As the programme moves toward exercise alone, a kinesiologist or personal trainer can carry it on, and a Registered Dietitian is involved where weight is one of your goals. Medicines, injections and a surgical opinion come from your physician or nurse practitioner.

Browse by service: physiotherapists, chiropractors, kinesiologists, personal trainers, registered massage therapists, registered dietitians and acupuncture practitioners.

What to expect at your first visit

1. Where it hurts. Groin, outer hip or thigh, what socks, shoes and the car are like, and whether the pain wakes you.
2. The hip itself. How far it bends and turns in and out compared with the other side, and the strength of the muscles around it.
3. Walking and balance, and whether a cane would help for now.
4. A first treatment, and exercises matched to what the examination found.

What you can do at home

• Keep moving, without overdoing it: the aim is to avoid putting too much strain on the hip, not to stop using it.
• Wear comfortable, shock-absorbing shoes with a soft sole.
• Avoid low chairs, which put extra pressure on the hips, and avoid carrying anything heavy.
• Tai chi has a conditional recommendation for the hip.
• Use an ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours when the hip is sore.

In a Waterloo Region winter, take icy sidewalks and driveways seriously: severe hip pain after a fall is an emergency, as the warning signs above say.

Outlook

Change in an arthritic hip is usually slow, over months or years. The exercise programmes in the trials lasted 5 to 16 weeks; the sources give no figure for how long the gains last. If symptoms keep limiting your life despite treatment, raise a surgical referral with your physician or nurse practitioner.

Hip osteoarthritis treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractor in Kitchener, Kinesiology in Kitchener, Personal Trainer in Kitchener, Massage Therapy in Kitchener, Nutritionist & Dietitian in Kitchener and Acupuncture in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractor in Waterloo, Kinesiology in Waterloo, Personal Trainer in Waterloo, Massage Therapy in Waterloo, Nutritionist & Dietitian in Waterloo and Acupuncture in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge, Nutritionist & Dietitian in Cambridge and Acupuncture in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is it arthritis or bursitis?

Bursitis pain may spread to the upper thigh and feel worse when you move or lie on that side. Osteoarthritis brings pain in the groin or outside of the hip with stiffness and trouble reaching your feet. Have it examined if you are unsure.

Is walking good for hip osteoarthritis?

Yes, within what the hip tolerates. Staying active is strongly encouraged, pain when you are active does not mean you are damaging the joint, and a cane is worth considering if walking is limited.

Do I need an X-ray for hip osteoarthritis?

Not for the diagnosis, if you are 45 or over and the pattern is typical. Imaging is for symptoms that do not fit.

Does dry needling help hip osteoarthritis?

The evidence list above has the detail: one guideline supports it for short-term relief and another says not to offer it. Exercise is the part of treatment they agree on.

Where can I get treatment for hip osteoarthritis in Cambridge?

Physiotherapy in Cambridge is where most people begin. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. Full text on the NCBI Bookshelf.
• Koc TA Jr, Cibulka M, Enseki KR, et al. Hip Pain and Mobility Deficits: Hip Osteoarthritis, Revision 2025. Journal of Orthopaedic & Sports Physical Therapy, 2025.
• American College of Rheumatology. 2026 Update of the American College of Rheumatology Recommendations for the Management of Osteoarthritis of the Knee, Hip, and Hand. Guideline summary, approved September 8, 2026; the full paper has not yet been published.
• Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology, 2020. Used for how the recommendation strengths are defined and for its positions on manual therapy and massage.
• Ontario Health. Osteoarthritis: Care for Adults With Osteoarthritis of the Knee, Hip, Hand, or Shoulder. Quality standard, 2024.
• NHS. Hip pain in adults. Reviewed November 2025.
• NHS. Osteoarthritis: symptoms. Reviewed March 2023; its next review was due in March 2026.
• NHS. Septic arthritis. Reviewed September 2026.
• Arthritis Society Canada. Osteoarthritis. Reviewed February 2021.

Related conditions

Osteoarthritis
Hip Pain
Hip Bursitis & Gluteal Tendinopathy
Hip Replacement Rehab
Knee Osteoarthritis

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