How to Manage Hip Arthritis


Osteoarthritis (OA) is the most common cause of hip pain in adults over 50. Simply put, OA is a degeneration of the hip joint. The cartilage that lines the joint degenerates over time until the femur (ball) and the acetabulum (socket) no longer have the lubrication and protection required for normal, smooth joint motion.  This can become quite painful and ultimately lead to decreased activity levels and increased difficulty with daily tasks such as walking and standing up, especially first thing in the morning.

Treatment for hip OA can include stretching and strengthening of the muscles surrounding the hip. Ultrasound and hot packs can be used in the short-term management of pain and activity limitations in order to return to exercise and begin therapy quicker. Manual therapy including joint mobilization, soft tissue release and massage all have significant evidence supporting their use to improve function and reduce activity limitations in people with OA.

2017 updated risk factors for osteoarthritis of the hip include, but are not limited to:

  • Decreased hip internal rotation and flexion range of motion
  • Morning stiffness
  • Male sex
  • Higher BMI
  • Hip pain
  • Age over 50

Hip Internal Rotation : range of motion becomes limited


Hip Flexion also becomes restricted and painful


We’re here to help. In many cases, a prescription of manual therapy to improve hip range of motion, as well as an individualized exercise program can help to prolong or prevent joint replacement surgery.

Treatment recommendations include:

  • Ultrasound for short-term pain reduction
  • Flexibility, strengthening and endurance exercises
  • Manual therapy for joint mobility, flexibility and pain
  • Education on activity modification, exercise, supporting weight reduction when overweight, and methods of unloading arthritic joints.

Recent evidence suggests that NSAIDs (such as Aspirin and ibuprofen), COX-2 inhibitors, and steroid injections are effective at relieving pain and symptoms in hip OA. However, there is some evidence that suggests NSAIDs may increase the progression of hip OA my decreasing glycosaminoglycan synthesis. In addition, there can be serious gastrointestinal side effects associated with NSAID use. Consult your physician before use.

What can you do at home?

Below is a video with a few stretches recommended to improve hip mobility. This is not an exhaustive list but rather a starting point and something to try. It is always recommended that you see a physical therapist to individualize your treatment approach.

The information provided is not medical advice. If you would like more information please visit us at or call to schedule an appointment. 


Running in Minimalist Footwear

by Dylan Bartley, MSPT

You may have heard of the class action lawsuit against the Vibram FiveFingers that resulted in a settlement. If you’re a runner who tried the iconic FiveFingers shoes and developed an injury such as plantar fasciitis or achilles tendonitis, this may be sweet validation for you. If you’re one of the many people who used them and loved them either casually or as a running shoe, then maybe you’re left wondering, is it just a matter of time before I develop an injury? Should I go back to those cushy, supportive Brooks shoes my Podiatrist said I should use? Are all minimalist shoes such as the Nike Free and the New Balance Minimus risky to run in? In 2013 we saw sales of minimialist footwear stop their climb and begin to decline, replaced, of course, by sales of motion control shoes and stability shoes.

Well, let me shed a little light on some of those questions. Let’s start with anatomy: there is a variability in the morphology of our ankle bones that predisposes one towards having a low or a high arch. Structurally some of us have the type of arch that wants to collapse and pronate while others are just blessed with a normal or high arch that supinates well. And there is a fourth category: those that have a structurally normal or supinated foot but when they stand and move, they pronate and collapse too much. Let’s call them functional pronators. A knowledgeable physical therapist should be able to assess what kind of foot you have exactly and guide you through the process of choosing footwear.

If you are in the first category of structural pronators, then you may not fare well in your attempt to run in minimalist shoes. There are just too many biomechanical forces to overcome when your foot hits the ground and eventually your tendons and ligaments get strained. Using a stability shoe or motion control shoe or orthotic placed in a minimalist shoe will reduce your risk of injury. Your level of strength and conditioning (or simply personal preference) determines which of those shoes will work best for you. If you are genetically blessed enough to have a neutral, supinated, or functionally pronating foot, then you may be able to slip some minimalist shoes on and get your foot in shape. You can rely on your foot’s ability to naturally pronate and absorb the shock of landing without over-taxing your soft tissues.

By the way, I say “get your foot in shape” because the wean-in process with this kind of thing is real. That is, of course, why even people with perfect arches often get injured when wearing Vibram FiveFingers. Those of us with sedentary jobs or feet that have been living the life of luxury supported by rigid orthotics and supportive running shoes will have an even greater challenge. Functional pronators may need extra time to strengthen their foot muscles. It can take anywhere from 6 months to a year to really build up enough strength to wear a minimalist shoe for an entire 10k or just walking around town all day. There are so many fine motor intrinsic muscles in your foot like the flexor digiti minimi brevis that you probably have never been asked to use unless you were a modern dancer or you grew up walking barefoot in Africa. So be patient as you gradually increase the distance of your runs in minimalist shoes. Wear them half the day at work, and bring a cushy old pair of shoes to switch into at lunchtime. Alternate wearing your minimalist shoe on short runs while wearing supportive shoes on long runs. And listen to pain. See a physical therapist to help diagnose and treat even minor injuries before they become chronic, severe ones. Stretch after your runs and employ a little self-massage and strength training to help your body through any strains. Your new and improved feet will thank you.

Active Marin has moved!


Active Marin Physical Therapy is excited to announce that we have moved to a beautiful, spacious, new location in Mill Valley at 319 Miller Ave., Suite 2. Our ground floor office is easily accessible from both downtown Mill Valley and the freeway and has ample parking.

We are happy to now offer Pilates based rehabilitation, TRX training, Active Release Technique, advanced manual therapy and, as always, and individualized approach to your specific needs.

Visit us at our new location: