• gluteus medius
• stepping
• hip
• osteoarthritis
• exercise
• muscle

Earnest: determined, assiduous, sincere, heartfelt, well meant, diligent, hard working, conscientious, committed. Of persons: Serious in purpose, feeling, convictions or action—for example, she made an earnest promise to do her best. Of words or actions: proceeding from intense convictions—for example, he said he would help, but I doubt whether he was in earnest.

“The way we currently manage elderly patients is inappropriate, inefficient and wasteful”

Osteoarthritis (OA) can affect all intra-articular and periarticular tissues comprising synovial joints (bone, cartilage, muscle, nerves, etc). The aetiology of OA is complex and multifactorial but, recently, muscle sensorimotor dysfunction (muscle weakness, increased fatigability, proprioceptive deficits) has been implicated in the pathogenesis of OA, by impairing neuromuscular protective mechanisms that prevent harmful abnormal joint movement, damage, and pain.¹ These arguments have largely been based on studies investigating the knee and vertebral column musculature, the hip muscles have received less research attention, probably because of difficulties in isolating, examining, and interpreting the results. In this issue of the Annals of the Rheumatic Diseases, however, Sims et al extend our knowledge in this area, reporting a study investigating muscle motor function in patients with unilateral hip OA.²

Investigating muscle involvement in OA is a pointless, academic exercise if it has no clinical application, but of all the synovial joint tissues affected by OA, muscle is the tissue we can most easily manipulate. In patients with established OA simple exercise regimens requiring inexpensive, unsophisticated equipment improve muscle function, joint pain and stability, function and disability.^1,3,4 More speculatively, maintaining well conditioned muscle might provide us with a strategy to prevent primary or secondary joint damage.

So exercise affords us an efficacious, safe, low tech, low cost treatment, available to the large population of patients who need …