A diagnosis of coxarthrosis – osteoarthritis of the hip joint – changes the entire life of many patients. Initially, only mild symptoms are often present, but over the years, the pain and limitations in mobility increase noticeably. Especially in the advanced stages of coxarthrosis, the question arises: Can physiotherapy still help, or might it do more harm than good?

This article discusses the connections in detail, explains the specific changes in coxarthrosis, highlights the opportunities and risks of physiotherapy, and shows when it is better to take the next step towards surgical therapy and individual consultation with an experienced hip specialist – such as Prof. Kutzner at the Endoprotheticum Rhein-Main in Mainz .

What is coxarthrosis?

Osteoarthritis of the hip is a degenerative disease of the hip joint . It involves a progressive breakdown of the articular cartilage, changes in the bone, and, in later stages, misalignment of the entire joint. While the hip joint functions smoothly as a ball-and-socket mechanism in youth, it becomes increasingly irregular in osteoarthritis.

Patients initially notice this as decreased stamina and stiffness in the morning or after prolonged sitting. Later, pain in the groin, thigh, or buttocks .

Restricted mobility as the main symptom of coxarthrosis

One of the most noticeable and burdensome symptoms of coxarthrosis for patients is the restricted mobility .

Typical is:

• Problems putting on shoes or socks
• Difficulties getting in and out of the car
• Pain during longer walks
• Limitations when climbing stairs
• Blockages when rotating the hips (e.g. when crossing legs)

These movement restrictions are not just a secondary symptom, but are directly caused by the structural changes in the joint .

Why does advanced coxarthrosis lead to restricted movement?

The reasons for the reduced mobility in advanced coxarthrosis lie in the profound changes of the joint itself:

Cartilage degeneration:

The smooth articular cartilage, which normally acts like a "shock absorber", wears down. This leads to friction between the bones.

Bone extractions (osteophytes):

The body attempts to enlarge the joint surface by forming bony outgrowths. However, these osteophytes restrict movement.

Joint space narrowing:

The space between the joint surfaces becomes increasingly smaller, leading to pain and mechanical blockage.

Stiffening of the joint capsule:

Inflammation and scarring in the joint capsule cause additional limitations in movement.

The result: The hip is "stuck". Even with the greatest effort, it is almost impossible to regain full mobility.

What role can physiotherapy play in coxarthrosis?

Especially in the early stages of coxarthrosis, physiotherapy a crucial role. It can:

• the muscles to relieve pressure on the hip,
• improve coordination ,
• Maintain everyday functions through targeted exercises ,
• Relieve pain by correcting incorrect posture.

However, the situation is different the advanced stages

Limits of physiotherapy in advanced coxarthrosis

Many sufferers hope that physiotherapy can restore lost hip mobility . But this is precisely where the problem lies:

• The bony changes (osteophytes, malpositions) cannot be reversed by training .
• Attempts to make the joint capsule and muscles "more mobile" encounter a mechanical barrier in the joint.
• This often leads to increased pain after the exercises.
• The result: Patients often feel worse after physiotherapy than before .

This creates a vicious cycle: more exercise training means more pain, more inflammation and less quality of life.

When can physiotherapy still help with coxarthrosis?

Despite all the limitations, there are situations even in advanced stages where physiotherapy remains beneficial:

• Strengthening the muscles : Strong thigh and gluteal muscles stabilize the joint and make everyday life easier.
• Pain-relieving measures : Manual techniques, heat or electrotherapy can relieve tension.
• Gait training : Physiotherapeutic training can help to avoid incorrect loading while walking.
• Preparing for surgery : “Prehabilitation” before hip surgery improves recovery after the procedure.

However, it is clear that improving mobility through physiotherapy is hardly possible in advanced cases of coxarthrosis.

Why physiotherapy can activate symptoms in coxarthrosis

Attempting to "free up" the hip through stretching and mobilization significant increase in symptoms for patients with advanced coxarthrosis .

The reasons:

Mechanical blockage:

Osteophytes restrict the range of motion. Attempting to "train over them" only further irritates the joint.

Joint inflammation:

Any overload leads to inflammatory reactions, swelling, and pain.

Muscular protective tension:

The body reacts with tension, which in turn restricts mobility.

Instead of making progress, many affected individuals experience setbacks.

Physiotherapy for coxarthrosis – helpful or harmful?

An honest answer is: Both are possible.

• Helpful: if the physiotherapy is specifically aimed at pain relief, muscle strength and preparation for surgery.
• Harmful: when she tries to restore lost hip mobility .

Especially in the advanced stages of coxarthrosis, the disadvantages of overly aggressive exercise training often outweigh the advantages.

The right time to see a hip specialist for coxarthrosis

If the pain increases, mobility is severely restricted, and physiotherapy does more harm than good, a hip specialist be consulted.

At the Endoprostheticum Rhein-Main in Mainz, under the direction of Prof. Dr. Karl Philipp Kutzner , patients receive individual consultations. Together, they decide whether conservative measures are still appropriate or whether the time has come for joint replacement.

The advantage: A specialized clinic can not only assess the current situation, but also offer the best possible treatment – ​​up to and including the most modern form of artificial hip joint .

Conclusion: Physiotherapy does not always help with hip osteoarthritis

Physiotherapy is a valuable tool for treating osteoarthritis of the hip – but not at every stage of the disease. While it can improve mobility and quality of life in the early stages, it reaches its limits in advanced stages .

• The limited mobility is a direct consequence of bony changes.
• Attempting to resolve this limitation through physiotherapy often leads to increased pain .
• Physiotherapy can still be useful when it comes to muscle strength, pain relief, and preparation for surgery .
• Anyone suffering from increasing discomfort should definitely consult a hip specialist such as Prof. Kutzner at the Endoprotheticum Rhein-Main in Mainz .

Because one thing is clear: In advanced cases of coxarthrosis, the only way back to true mobility and quality of life is often through a surgical solution in the form of a total hip replacement.