Not All Hip Rehab Is The Same!

When we talk about hip rehabilitation, we tend to lump everything together — improve range of motion, manage pain on extension, strengthen the muscles, do more exercise. It sounds reasonable, and in some ways it is, but when you actually look at patients, it quickly becomes clear that not all “hip problems” are the same.

A young dog with hip dysplasia, an older dog with severe osteoarthritis, and a post-operative case — whether it’s an FHO or a total hip replacement — may all present with hip-related issues, but the underlying problem is completely different in each case.

And because of that, applying the same rehabilitation approach across all of them doesn’t really work. In fact, the same exercise can lead to very different, sometimes opposite, outcomes.

• Hip dysplasia

  
  

In hip dysplasia, the main issue is instability.

The femoral head doesn’t stay well-centered within the acetabulum, and the joint is constantly exposed to small amounts of uncontrolled motion. So rather than asking how to make the dog stronger, I find it more useful to ask whether the dog can actually control those small movements within the joint, especially under load.

If we rush into more walking, more activity, or larger movements, we often end up reinforcing poor control — more translation, more compensation, and ultimately more irritation of the joint.

If there is active inflammation or pain, that needs to be addressed first, even before exercise is introduced. From there, I tend to use small, slow movements like weight shifting to start activating deep stabilizing muscles around the hip. At this stage, the goal is not to build strength, but to build control, because in these patients, moving more is not the same as moving better.

• Hip osteoarthritis

  
  

Osteoarthritis is a very different situation. Here, the joint is not primarily unstable — it is painful, stiff, and often has reduced arthrokinematics. These dogs already have decreased muscle function and muscle mass, and if we push too hard, the joint will flare up.

So again, pain management becomes the first step, but the type of pain matters.

Is it more inflammatory, or more chronic and adaptive?

That distinction often guides decisions around medication, joint injections, or other modalities such as shockwave therapy.

Manual therapy can sometimes help restore joint motion, but its effectiveness depends on what we are dealing with. If the end feel is more capsular, we may be able to make some difference. If it is clearly bony due to advanced arthritic change, the impact will be limited — but even then, we still try to optimize what we can. These dogs have often been loading the joint in a suboptimal way for a long time, so flexibility issues around the hip are also common and need to be considered.

What becomes more important here is load management. Rather than asking how to progress the exercises, I find it more helpful to understand the dog’s current tolerance. What level of activity keeps the dog comfortable without triggering a flare?

Sometimes that even means allowing activities like ball play if that is an important part of the dog’s life, but guiding the owner to observe how the dog moves during those activities and to avoid positions that increase abnormal joint loading.

At this stage, the joint is already significantly affected, so the goal is not rapid improvement, but sustainability — low-load, consistent activity, carefully dosed exercise, and avoiding fatigue.

• Post-operative cases: FHO / THR

  
  

Post-operative cases introduce yet another layer. The issue here is not just weakness or pain. With procedures like FHO or total hip replacement, the biomechanics of the hip region may be fundamentally altered, and the dog essentially has to relearn how to use the limb. Rehabilitation, in this context, becomes a process of reintroduction.

Early on, I’m not focused on strengthening at all. I’m simply looking for whether the dog is willing to load the limb, and whether it can place it consistently. Even small improvements in weight bearing are meaningful at this stage, and effective pain control is essential to allow the dog to start using the limb. As we progress, the focus shifts toward control — not just whether the limb is used, but how it is used.

Can the dog manage weight shifting appropriately? Can it maintain a stable three-leg stance without collapsing? Later, we begin to work on more functional movements, such as sit-to-stand transitions and other everyday activities.

Timing is critical throughout this process. If we push too early, we risk overloading healing tissues. If we wait too long, compensatory patterns can become ingrained. So progression is not about following a fixed protocol, but about continuously reading and responding to the patient in front of you.

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In the end, hip rehabilitation is not defined by the joint itself, but by the problem we are trying to solve. Instability requires control, pain requires careful load management, reduced joint motion needs to be addressed where possible, and post-operative cases require re-education.

The same exercise can be helpful, neutral, or even harmful depending on when and why it is used.

So it’s not about the exercise, or the timeline.

It’s about the patient — and what they need, right now.

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