An excellent article by Simms entitled "The Development of Hip Osteoarthritis: Implications for Conservative Management" featured in Manual Therapy (1999) highlights the imbalance of the neuromusculoskeletal system, which may be a key player in the development of hip osteoarthritis. This article calls for an intense evaluation of range of motion and strength testing of the muscles around the hip, and the importance of searching for asymmetries as we treat our patients.

The article discusses three different presentations of osteoarthritis. The first is the classic "upward and outward" where the head of the femur migrates upwards and out; two, "medial and downward" where the head of the femur migrates down towards the acetabulum;  or the final category, a more "congruous" hip osteoarthritis.

With all of these cases, if the muscles of the hip are explored thoroughly, a direct link can be seen to the types of osteoarthritis. It behooves the therapist to evaluate the range and strength of the hip muscles, particularly the range of the hip abductors, tensor fascia latae, and the strength of all the various gluteal muscles.

Another article, also by Simms in the same issue, looked at the assessment and treatment of hip osteoarthritis. Simms discusses ways of assessing these areas using range of motion and strength tests. He provides very specific treatment techniques for mobilizing the hip joint and all the various translations to ensure different motions.                                                                                                

*External rotation--anterior/superior glide 
*Internal rotation--posterior/inferior glide
*Abduction--inferior/anterior glide
*Adduction--superior/posterior glide

In addition, Simms provides an excellent review of how to begin early rehabilitation of the gluteal muscles. In the early stages the following exercise would be done:
1. Static gluteal squeezes in supine
2. Small range hip extension with leg over the side of the bed in a closed chain position to provide strength

As the patient progresses, they can do contraction of the stance limb with abductors while stepping on the other leg. This can be accomplished through:
1. Raising and lowering the contralateral pelvis off a step.
2. Stance activities and balance boards weight shifts in later phases as closed chain activity increases.

The author does not discourage weight lifting, but does encourage that the therapist be sure that the muscles doing the activity are the correct muscles prior to strength training with weights.