Osteoarthritis Hip Treatment

A New Perspective On Lateral Hip Pain

Osteoarthritis and bursitis are two musculoskeletal conditions that can afflict the hips. Hip osteoarthritis is a degenerative condition affecting the joints of the hips, while hip bursitis is an inflammation of the bursa at the lateral point of the greater trochanter (the bony point on the side of the body that we normally associate with the hip). Treatment for osteoarthritis of the hip and treatment for bursitis of hip should be undertaken with the assistance of a trained health professional.

Anatomy of the Hip

The hip is a ball-and-socket joint, a joint in which the rounded surface of one bone is inserted into the hole of another. This structure is what gives the pelvis so much of its stability, because the femoral head (the uppermost part of the femur, or thigh bone) is held in place by the pelvic acetabulum, a large rounded depression. However, the hip also maintains a surprising amount of flexibility in the frontal (abduction / adduction), sagittal (flexion), and transverse (rotation) planes of motion.

The acetabulum is a convergence of the ilium, ischium, and pubis bones of the pelvis. Where the acetabulum meets the head of the femur, the joint of the hip emerges. Collectively, these bones comprise what is commonly known as “the hip bone.” The articular surface of the cartilage in the acetabulum possesses a thick rim along its edges that deepens the depression and lends support without sacrificing flexibility. This cartilage also allows the tissues to rub against one another without causing injury.

Also assisting in the lessening of friction are small sacs called bursae that are found throughout the body wherever joints are located. The bursae of the shoulders, hips, knees, and elbows contain a special lubricating fluid that moisturizes the joint area and cushions bones and soft tissues. In the hips there are two prominent bursae: the trochanteric bursa on the bony point of the hip, and the iliopsoas bursa on the inside (groin side) of the hip. (If the iliopsoas bursa becomes inflamed, the patient will experience pain in the groin area). Other bursae include the gluteus medius bursa, a smaller bursa lying in between the gluteus medius muscle and the greater trochanter, and the ischial bursa that lies between the base of the pelvis and the hamstring tendons.

Hip Osteoarthritis

The most common cause of musculoskeletal pain, osteoarthritis is a progressive disease that affects over 15 percent of the world’s population. Characterized by pain in the joints, hip osteoarthritis results from degeneration of the articular cartilage in the hips. This, in turn, causes a thickening of the bone beneath the cartilage, the formation of bony outgrowths known as osteophytes, and synovial inflammation.

The primary initiating causes of osteoarthritis are not well understood, but what is clear is that some people are at greater risk for developing hip osteoarthritis than others. Risk factors for osteoarthritis of the hip include joint misalignment, trauma, old age, obesity, continual lifting or moving of heavy objects, and sports that place tremendous pressure on the lower half of the body (for example, professional running).

Hip Bursitis

Bursitis is a condition in which the bursae become swollen and inflamed. Hip bursitis commonly afflicts the ischial, iliopsoas, and greater trochanteric bursae. Generally these bursae are injured either as a result of inflammation due to excessive friction or post-traumatic injury. Direct blows can cause bleeding into the bursae, resulting in the formation of hematoma.

The iliopsoas bursa is the largest bursa in the body. Athletes engaged in sports that require constant and repetitive use of the hip flexors, such as soccer and ballet, are especially prone to iliopsoas bursitis.

Athletes may experience severe groin pain that radiates to the front of the hip or thigh, necessitating groin pain treatment. The pain may become so great that it disrupts the patient’s gait, rendering walking difficult and causing a limp. Motion is sometimes accompanied by a loud snapping sound.

For those suffering from greater trochanteric bursitis, pain is usually felt posterior to the greater trochanter. Additionally, it will often radiate into the lateral buttock. Risk factors for developing greater trochanteric bursitis include a broad pelvis, leg-length discrepancy, and excessive pronation (inward turning) of the foot. Symptoms may include pain when running, climbing stairs, or standing for long periods. Pain may be exacerbated by rotation, adduction, and abduction of the hip.

Ischial bursitis may occur as a result of a direct blow to the ischial tuberosity or as a complication from an adjacent hamstring injury. Athletes with ischial bursitis will feel pain while sitting and tenderness during physical examination.

Osteoarthritis Hip Treatment

Physicians rely on both clinical and radiographic findings to diagnose osteoarthritis accurately. Imaging techniques that reveal evidence of joint degeneration are more effective in diagnosis than clinical criteria by itself. Historically, osteoarthritis has been diagnosed using radiographic evidence of cysts and osteophytes, although more recently the primary determining factor has been joint space width, which is a reliable predictor of the thickness of cartilage. Studies have found that joint space width that is less than or equal to two millimeters was closely associated with hip pain in over 3,000 elderly patients. Another recent study has indicated that cartilage space narrowing is the most reliable indicator of hip osteoarthritis.

Prior to prescribing hip osteoarthritis treatment, a physician will inquire about the patient’s physical symptoms. Generalized hip pain and pain in the thigh or groin may indicate osteoarthritis. So also may impaired gait, decreased range of motion, and pain during leg rotation. In the earliest stages of the condition patients may experience pain only intermittently and when the joints are in use; however, as it progresses they will feel pain and stiffness even when at rest. In the most advanced stages some victims will develop crepitus, a continual creaking that may require snapping hip treatment.

The main goal of hip and groin pain treatment is to reduce pain and impairment, improving mobility and preventing the need for surgical treatment. The best treatment for osteoarthritis of the hip combines both pharmocologic and non-pharmocologic modalities.

Non-pharmocologic treatments include exercise, physical therapy, and weight reduction for the overweight or obese. A consistent regimen of strengthening and aerobic exercises has been shown to reduce pain and improve function in patients suffering from hip osteoarthritis. Recent studies have indicated that the improvement in muscle strength gained from an exercise program may slow the progression of osteoarthritis. In particular, hydrotherapy (water-based physical therapy) and strength training have all proven demonstrably effective in treating patients with hip problems. Both high-intensity and low-intensity aerobic exercise are equally beneficial to gait and functional status. For best results, patients should begin with a low-intensity exercise program and gradually progress to one with a higher intensity.

Assistive devices are also recommended for patients for patients with osteoarthritis of the hip. These may include canes to improve balance when walking and insoles that limit the advance of disease by reducing the pressures exerted on the hip joint.

Pharmologic hip and groin pain treatments include acetaminophen, non-steroidal anti-inflammatory medications (NSAIDs), and analgesics. When tested against placebos, acetaminophen has been shown to significantly reduce pain and improve function in patients. NSAIDs may be substituted in the lowest possible doses for patients who don’t respond well to acetaminophen. Several trials have shown that NSAIDs effectively relieve pain in the knees and hips. However, they are sometimes accompanied by unfortunate gastrointestinal side effects.


In the majority of cases, bursitis of the hip can be treated with conventional, non-surgical treatments. NSAIDs will help to control local inflammation in patients with greater trochanteric and ischial bursitis. Ice massages, heat, physical therapy, and steroid injections have also proven effective.

Hip Joint Pain Treatment at the New York DNR

The New York DNR provides some of the best treatment for hip bursitis and hip osteoarthritis in New York City. We use biofeedback motor control training to treat injuries and conditions of the knees, legs, and hips. Making use of real-time force-plate analysis, motor control training has proven effective in treating injuries incurred in high-intensity recreational activities like uphill running, figure skating, and ballet. We also employ extracorporeal shockwave therapy (ESWT), a low-intensity shockwave treatment that uses pressure waves to get blood circulating and trigger the body’s own self-healing mechanisms. Finally, Computer-Assisted Rehabilitative Environment is a fully immersive environment that uses both virtual reality and feedback training to correct abnormalities in the gait cycle and restore walking and weight-bearing.



A clinical exam and diagnostic ultrasound imaging can help your therapist pinpoint the exact location and cause of your hip and groin pain.

Ultrasound enables you and your therapist to view the hip and groin region in real time, while in motion. In addition to ultrasound, video gait analysis can help us identify faulty movement mechanics that contribute to hip and groin pain. Once the exact cause is determined, an effective treatment plan can be initiated.


Please explore more advanced diagnostic option unavailable anywhere else:


Hip dysfunction and pain can be a complex issue due to interactions of the trunk, pelvis, low back, groin and hip joint. Physical therapy and rehabilitation that is based only on subjective clinical analysis often addresses the symptoms without resolving the underlying cause.


At NYDNRehab, our groundbreaking motion analysis technology and high resolution diagnostic ultrasonography have enabled us to develop a battery of tests that perfectly reveal the dynamic functional pathology of the hip joint and pelvis. Our tests are evidence-based protocols that are considered to be the gold standard in the world of research.

Our testing protocol includes:


Combined lumbopelvic hip stability test using DLEST methodology with C.A.R.E.N., our computer assisted rehab environment


Hip joint stability test using DLEST methodology with C.A.R.E.N.


3D star excursion banner test (SEBT) for assessing the involvement of the hip joint and muscles in postural stability


3D gait or running analysis


3D kinematic joint angle analysis during a squat, lunge, drop jump and pelvis on hip rotation


Rehabilitative ultrasonography for viewing intrinsic hip stabilizing muscle activation patterns

We also perform neuromotor testing with DD Robotech for:

  • Proprioception
  • Tracking ability
  • Force sense
  • Critical power
  • Reactive power
  • Flexibility


Surface electromyography (SEMG) may be added to any of the above tests when needed.

Based on our experience and evidence-based information, we believe that physical therapy and rehabilitation should be based on objective quantifiable data.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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