Taking A Hip Pain Patient Through A Full Rehab Plan

Posted By: Andy Barker

You see a hip osteoarthritis (OA) patient that has all but been written off by several different doctors and consultants.

She has been told that she will never get back running (she loves endurance running and has completed multiple marathons and ultra-marathons in the past) and that a joint replacement is her only solution for the pain.

She has a family history of hip OA; her mum had bilateral hip replacements in her early 40’s.

As this patient is the same age she is worried that the same thing is happening to her.

Her story does sound similar for sure, even more so as her mum was also a keen runner in her 20’s and 30’s.

She has a pretty stressful job and uses exercise as a ‘release’ so the thought of not being able to ever run again has left this patient feeling very worried and anxious about what the future holds.

How do you manage this sort of patient?

Where would you even start?

OA is not great, let’s be honest.

But it is also common, and you will see many patients with all types of arthritic conditions like this throughout your career.

It might be the hip, knee lower back or ankle, or another degenerative joint problem.

This patient has Grade IV OA in her right hip (this is not good).

I know because I have seen her recent MRI and CT scans as I am currently treating her in my clinic.

It’s a big injury and she doesn’t present great.

On the bed she has painful and greatly reduced hip range of movement, poor muscle strength in all directions and significant pain with even low intensity tasks like walking, sit to stand and going up and down the stairs…

Even sitting or driving for longer than 10 mins brings on her symptoms…

Which will then last into the next day.

If we are being honest, the long term outcomes for this patient is not great.

Can we change the OA and the damage caused to the joint surfaces?


Can we get the patient back to running?


Can we help the patient reduce their pain and improve their function?


I’d never make promises to patients that I did not believe to be true, but the fact is, 99% of patients do get better…

Even patients with severe injuries like grade IV OA.

This patient will likely have a hip replacement in the future.

I told her that in the initial assessment.

But I also told her there was a lot we could do to help her and that conservative management could be effective in helping her with her current symptoms and helping her improve her activity levels.

The goal is to get back running and we set out a plan to do that in the first session.

The best thing for you as a therapist is that you can help with 99% of issues, even the most severe OA hips, knees and ankles, and other big injuries, if you have the right plan.

Always remember you don’t treat a diagnosis, you treat the patients problems.

To a certain degree it does not really matter how ‘bad’ the diagnosis or prognosis is, in nearly all cases you will be able to improve your patients symptoms and function.

With this patient, she had zero hip internal rotation and greatly reduced hip flexion on her affected side, which were both very painful.

This is where I started (ROM is where you should always start with any injury).

Real important to this case was finding out why her right hip had become a problem in the first place.

She had no incident of injury, having just woken up one day with a sore hip, which had got significantly worse over the last 12 months.

The problem was that her right hip was overworking.

This linked to some previous injuries to her opposite leg, namely her left ankle (fibula fracture 20 years ago).

In short, for the last 20 years she had been overusing her right side, so no surprise her right hip had taken a bashing, especially with all the long distance running, and had started to become a problem.

Grade IV OA does not happen overnight and in this case, like so many others, pain is just one symptom and can happen later on, after damage has already started.

Her rehab plan was two-fold.

Firstly, we need to manage her right hip pain and restore the problems she has on that side, namely a loss in hip ROM and loss of hip muscle output.

But we also need to fix up the problem on the left side, to get this leg doing more work and to stop her overusing her right leg and further aggravating her right hip.

If you only fix the painful side (in this case the right hip) and leave alone the cause of the problem (in this case the left lower leg), you might be able to make some changes to pain and function on the right…

But these changes will almost certainly be short lived as the thing that has caused this problem, and is still driving her right hip issue, is still there (her left lower leg problem).

If you fix up both the site and source of symptoms with any injury then you have a real chance of making a success of any patient or athletes rehab…

Even with complex cases like this patient with severe hip OA that wants to get back to ultra-marathon running. 

This is a complex case and one that might worry you if this same patient walked in your clinic, but the management of cases like this need not be complex.

If you can understand how to tackle cases like this, no hip pain problem (or any other problem for that matter) should faze you.

This case study is a lady that I am currently treating in my clinic and is central to my upcoming webinar…

Hip Pain – Making Sense of Your Hip Assessments, Treatments & Rehab

I’ll cover everything from the subjective and objective assessment…

Early treatment and rehab prescription…

Progressive rehab exercises and how to be confident your patient is ready to push on, without fear of flaring them up and causing their pain to return.

I’ll reason every test, treatment technique and exercise I show you so you understand 100% why I am doing what I am doing…

And if you understand this, you will be able to take these tests, techniques and exercises and use them with your own patients with hip pain (or any other injury for that matter).

Secure my free webinar place right now. [https://us02web.zoom.us/webinar/register/WN_vnjwFYFjSji-KeXiOTojHA]

The webinar will last less than 1 hour, but will cover all this…

– How To Easily Differentiate Between Different Hip Injuries So You Can Confidently Make The Right Diagnosis

– Why Hip Injuries Are Often Caused By Another Problem & Why Missing This Will Lead To Poor Patient Outcomes (99% of Therapists Are Doing This)

– How To Make Quick Changes In Hip Pain With Your Hands-On Treatments, That Actually Work, Even For Complex Problems Like Hip OA

– Specific Early, Mid & End Stage Rehab Options To Help You Progress A Hip Pain Patient Through A Full Rehab Plan From Start To Finish

– Plus I’ll Be Holding A LIVE Q & A Session To Answer Any Questions

Don’t miss and book your place right now…

Secure my place before they all go. [https://us02web.zoom.us/webinar/register/WN_vnjwFYFjSji-KeXiOTojHA

Looking forward to this event and helping you out.


PS. Any questions or specific things you want me to cover on the webinar, just hit reply to this email and let me know and I’ll be sure to cover them on the webinar.

Here’s the link to register [https://us02web.zoom.us/webinar/register/WN_vnjwFYFjSji-KeXiOTojHA] just in case you missed it.

PPS. If they links are not working you might be reading this blog post after the event. If you want to learn how to get access just send me an email to andy@newgradphysio.com with the word ‘hip-pain’ and I’ll let you know how.