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How to avoid a Hip Replacement.

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By Michael Hall,

Here’s the latest research on how to avoid a hip replacement.

If you want to avoid or at least delay a hip replacement, recent research published in November 2013, indicates that you can.

In this study conducted in Norway, 71 patients with hip osteoarthritis (as verified by X-rays and scans) were divided into exercise / information group and an information only group. The exercise group underwent 12 weeks of a physiotherapy supervised exercise therapy program, performed 2-3 times each week.

It was found that those people who participated in the exercise therapy program had a “significantly higher 6 year cumulative survival of their native hip to total hip replacement” and therefore “has the potential to reduce the need for or postpone surgery in patients with hip OA (osteoarthritis). This finding supports that recommendation that exercise therapy should be considered a first-line therapy and offered to patients with OA.”1

Living well with arthritis is one thing, but preventing it is even better. To help me explain how you may be able to do this, let’s delve a little deeper.

So what is arthritis?

Arthritis is often referred to as a single disease. In fact, it is an umbrella term for more than 100 medical conditions that affect the musculoskeletal system, specifically joints where two or more bones meet.

Arthritis-related problems cause inflammation and damage to joint cartilage (the tissue that covers the ends of bones, enabling them to move against each another) and surrounding structures. This can result in joint weakness, instability and deformities that can interfere with the most basic daily tasks such as walking, driving a car and preparing food.

While there are about 100 forms of arthritis, osteoarthritis is the most prevalent accounting for 51% of cases in Australia, and it is this form of arthritis that we will refer to in this article.

What causes osteoarthritis?

There are many causes of osteoarthritis. These include:

1.Incorrect biomechanics (excessive or abnormal forces on the joint surfaces) due to faulty postures and / or movement habits;
2.Joint trauma (e.g. car accident) associated with injury or surgery and incomplete or inadequate rehabilitation;
3.Congenital or genetic causes (e.g. Hip dysplasia, Chronic Juvenile Arthritis, Ante-verted / Retro-verted hips);
4.Diseases (e.g. Perthes disease, Slipped Epiphysis etc.);
5.Lifestyle, occupational and sporting factors (e.g. squash);
6.Excessive weight (e.g. obesity);
7.Poor diet, leading to nutritional deficiencies (e.g. Rickets)

What does hip osteoarthritis “feel” like?

Hip osteoarthritis is characterised by a gradual onset of deep hip or groin ache that can be referred down the inside or front of the thigh. The hip is also stiff on getting out of bed in the morning or standing after a period of sitting. As the hip degenerates, the pain often becomes worse at the end of the day and also becomes more constant at rest and at night.

How is hip osteoarthritis diagnosed?

Hip osteoarthritis can generally be easily diagnosed. On an x-ray, there is reduced joint space (leading to a “short” leg) as well as bony protuberances, called osteophytes, at the joint edges. Clinically, all movements of the hip are markedly limited (The normal hip movement ranges are 1200’s flexion (bending forwards), 100’s extension (moving leg backwards) and 450’s internal/external rotation (turning the hip inwards and outwards), with the most common faults being limited hip rotation as well as hip flexion contractures (shortening of the muscles at the front of the hip which bend the leg up) reflecting the overuse of these muscles and perhaps the underuse (and therefore weakness) of the hip and leg push-off muscles (e.g. gluteus medius/maximus, quadriceps and calf muscles).

As the hip becomes stiff (especially in extension or moving the leg backwards with walking), the lower back compensates by moving more, leading to exaggerated pelvic rotation and excessive lower back extension and potentially irritation and pain. As the gluteal muscles further weaken, the body begins to sway from side to side with walking to help lift the leg through. This is called a Trendalemberg gait pattern.

How do every day postures and movements contribute to osteoarthritis?

There are a number of faulty postures, movement patterns and abnormal or excessive forces (e.g. obesity) which may lead to hip osteoarthritis. These include walking with your feet turned in, excessive sitting and standing with your hips in a flexed position. All these postures and movements patterns lead to tightening of the muscles and structures at the front of the hip (as well as weakness of the muscles at the back and sides of the hip), forward tilting of the pelvis, hip joint compression and stiffness.

Can the effects of hip osteoarthritis be prevented or at least minimised?

There are a number of effective techniques and exercises which may reduce hip pain and increase hip movement, strength and have you walking and moving better. Whilst there is no cure for arthritis, if the joint structures stop being irritated (and inflamed), they will become less painful, less stiff and more flexible, allowing for improved movement and function.

If the primary characteristics of hip arthritis are tight hip flexors, reduced hip mobility in all directions (especially hip extension and rotation), weak hip gluteal muscles, then the primary aim of any treatment and training program is to lengthen the hip flexors, restore hip mobility (especially hip extension and rotation) and strengthen gluteus medius and maximus.

The best results are achieved with a combination of “hands on” techniques, corrective exercise and postural / functional movement optimisation.

To lengthen the hip flexor muscles (ilopsoas and tensor fascia latae), soft tissue massage release, dry needling and PNF stretching techniques are all effective. To mobilise or free up the hip joint is best achieved with a combination of traction and rotation mobilisation “hands on techniques.

To maximise mobility, exercises such as hanging your leg over a step with a 2-3 kg weight around the ankle and then rotate the leg inwards and outwards within pain limits, can be used to reinforce “hands on” traction techniques. Stretching the hip flexors is also important and can be achieved through lunging stretches or sliding your affected leg out along the floor whilst holding the other knee to your chest as you lie on your back.

To correct your standing posture and enhance your ability to walk, you must strengthen your gluteal muscles as well as your “lower” abdominals, quadriceps and calf muscles. Best outcomes are achieved with a precise strategy of meticulous isolated strengthening each muscle group and then integrated muscle strengthening with other associated muscles before progressing into correct function such as standing balance, squatting, step stepping and perhaps even hopping.

It is not often appreciated, but optimal strengthening and conditioning of muscles involves careful attention to detail of exercise positioning, “patterning”, activation, timing, loading, repetition, sets, holds, recovery periods, nutrition, sleep/rest quality, psychological stress/tension levels etc. And when there is pathology involved such as with hip osteoarthritis or in fact any physical problem, these factors become even more important.

As with all injuries and or physical problems, if the original cause(s) is not corrected, the signs and symptoms will always return no matter what “hands on” techniques or exercises have been performed.

Do you sit for prolonged periods of time and stand bent forward or walk with your feet turned in or wide apart? Do you cycle with your knees turned in close to the bar on your bike? Do you walk or run or stand from sitting with an inadequate push-off or squat with your knees together?

All of these faulty postures and movement patterns, lead to muscle imbalances, relative joint stiffness, faulty joint alignment and potentially osteoarthritis or many other pain syndromes such as osteoarthritis of the knee (especially kneecap or patellofemoral joint), ankle (e.g. anterolateral impingement syndrome), foot joints (e.g. sub talar and mid tarsal joints) and even toe joints (e.g. hammer toes).As this research shows, the most important point is that hip osteoarthritis along with many other degenerative muscle / joint syndromes are potentially preventable or at least able to be minimised.

However, to do this requires optimal posture and movement patterns and then a physical capacity building exercise program that resists the degenerative forces of ageing, gravity, ergonomics and everyday occupational and functional routine movement patterns.

If you want to prevent or minimise the effects of osteoarthritis, this is where you need to start!

To prevent and / or solve any physical problems starts with awareness that comes from an assessment. If you want to optimise your physical health status or are concerned that you may be at risk of developing hip osteoarthritis or any other physical pain syndrome, please feel welcome to contact us here at Bodywise Health for a FREE assessment. We would be delighted to perform a detailed and thorough examination and set you on the right path to optimising your physical potential so that you can get the most out of your life.

For a FREE hip assessment or walking evaluation and advice, please call 1 300 BODYWISE (263 994).

References

1. Svege I, Nordsletten L, Fernandes L & Risberg MA; Annals of Rheumatic Disease. Published online first: November 20, 2013. Doi:10.1136/annrheumadis-2013-203628

2. Ganz MD, Leunig MD at al. The Etiology of Osteoarthritis of the Hip; Clinical Orthopaedics and Related Research. 2008; 466 (2): 264-272.

3. Tepper S, Hochberg M; Factors Associated with Hip Osteoarthritis: Data from the First National Health and Nutritional Examination Survey. American Journal of Epidemiology 1993

4. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

5. Sahrmann SA. Diagnosis and Treatment of Movement Impairment Syndromes, 2002

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

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How strength training can build muscle in oldr adults

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By Michael Hall,

50 or over? Want to stay independent? Here’s how

If you are 50 or older, research indicates that you will lose an average of 0.18kg of muscle per year. It is widely acknowledged that this loss of muscle leads to physical deterioration, functional decline, loss of independence and reduced quality of life. There is evidence however, that resistance exercise can prevent or slow muscle loss in older people. Despite this, the research up until now has been vague and confusing as to how much exercise and what type of exercise works best for older adults. A recent study published in Medicine & Science in Sports & Exercise 2011, is one of the first to analyze the effect of different training programs on lean body mass and across different age groups.

In the study, 49 different training programs were analysed from 1990 to 2009. To be part of the study, people had to be at least 50 years of age and untrained. A total of 1357 people participated with an average age of 65.5 years and the programs ranging in length from 10-52 weeks (average 20.5 weeks).

The exercise programs consisted of exercising two to three times per week, at an average intensity of 74.6% of 1RM (the maximum amount that can be lifted in 1 repetition). Each exercise session consisted of an average of 8 different exercises, being performed 10 times (repetitions) followed by a 110 second rest period and with a total of 20 sets per session. Most of these studies corresponded with the guidelines of resistance exercise for older adults as recommended by the American College of Sports Medicine.

Overall, there was an increase of 1.1kg per person. The study showed that the greater the amount of training, the greater the increase in muscle. The study also showed that the younger the person, the more muscle that was gained. Therefore, for optimal results, older adults should begin resistance exercise as early as possible. A higher training volume appears to be better for adaptive purposes.

The study found that most of the resistance exercise programs simply increased the amount of load lifted over the trial period (i.e. the intensity increased); however, studies involving younger age people followed a periodization model of progression in intensity, volume and more. This indicates that single set/fixed volume exercise programs may not be as effective in increasing muscle in older adults and that these should include a systematic progression of training volume.

This study gives a valuable insight as to the factors that are most effective in helping healthy older adults maintain or increase their muscle mass. It shows that the current exercise guidelines for older adults might be too cautious and that adjusting them in the light of this review is likely to improve the health and lifestyle benefits achieved.

Bodywise Health Comment

1. Your program must be safe.

First, it is recommended that you get a medical clearance from your doctor and then to begin a program under the supervision and instruction of a health professional. This is especially important if you are a beginner or have a physical impairment (e.g. arthritis, osteoporosis etc.).

When beginning, start slowly and progress slowly. It is wise to begin at lower intensity (e.g. 60-80% of the load that can be lifted once) with more repetitions (8-20) and fewer sets (e.g. 2) for the first 4-6 weeks of training.

2. Your program must be effective.

For best results, it must focus on resolving the physical deficits that have been identified in your initial examination. Generally, your body will adapt to the postures and movements that you do most in life. As one physiotherapist once said, “People, who sit in a chair for prolonged amounts of time, eventually become a chair”. The initial examination must therefore be precise and comprehensive enough to determine not just the source of biomechanical problems (stiff/short muscles, restricted joints etc.) but the cause of the problems (e.g. faulty posture and incorrect movement patterns because of weakness, tiredness or lack of awareness etc.). Resolving physical deficits involves optimising the parts (increasing the control and strength of muscles, freeing stiff joints etc.) as well as addressing the whole (improving posture, correcting movement habits and fixing work settings etc.). Essentially, it involves bringing the body back into ideal biomechanical alignment by increasing the control of stabilising muscles, the strength of prime mover muscles, and the length of muscles that are tight, short or stiff.

It is important to begin with activities that test your balance and muscle stabiliser control, as this forms the foundation upon which strengthening can take place. For this reason, clinical pilates and exercises involving balance, free weights or cables are recommended. By improving joint control, they make every day activities easier and help to protect against physically challenging or unexpected activities.

Your body is extremely efficient with adapting to exercise. Consequently, conditioning exercise programs can lose their effectiveness quite quickly depending on the type of exercise and the condition of the exerciser. To ensure exercise programs remain optimally effective, these programs need to be modified every four weeks for beginners, every three weeks for regular exercisers and every two weeks for elite athletes. The instructing health professional must have an understanding of correct loading (i.e. how much load is effective to produce results without being too much to cause injury or too little to have no effect). Knowing the physiology of muscle is also important. Fast twitch fibres respond best to short amounts of higher intensity exercise (and are primarily responsible for the increase in muscle size), and slow twitch which respond better to lower intensity, higher volume/increasing time exercise. Consequently, better results will be achieved if the intensity, amount and duration of the exercises is in sync with the type of muscles being exercised.

3. Your program must be fun.

Let’s face it; if you don’t enjoy an exercise program, the chances are that you won’t continue with it. It is important that whatever you enjoy doing that your program fits in with this. If you like to walk or run at home alone, then doing some balance, stabilisation, strengthening and stretching exercises on a swiss ball or foam roller at the end of your walk or run would be ideal. If a gym is what you prefer, then go for it. Or if enjoy something a little more personal, then clinical pilates might be the way to go. The key is to give an exercise program a trial for four to six weeks. If you don’t like it then or haven’t got the results that you want then try something else. Eventually you will find something that you enjoy and which works for you.

4. Your program must be convenient.

Life is so busy these days that fitting something else in might be difficult. If doing your program is easy and convenient however, you are more likely to stick at it. And if you stick at it, you are more likely to see results which then become self reinforcing.

At Bodywise Health, we specialize in providing conditioning exercise programs that are designed to prevent injury as well as to correct or rehabilitate physical problems. So if you are concerned about becoming weaker or if you suffer from arthritis, osteoporosis, back or neck pain, Bodywise Health can provide you with a program to help you get your strength and life back.

References:
1. Peterson MD, Sen A & Gordon PM. Medicine & Science in Sports & Exercise 2011; 43(2): 249-258

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Knee surgery Vs Physio

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By Michael Hall,

Got knee pain? Think surgery is the answer? New research shows you might need to think again.

You have knee pain and you just want to get it better in the best, fastest way possible, right? Surgery would have to be the logical answer, given that it repairs the faulty structures and “fixes” the problem. Besides, it what all the AFL teams resort to when one of their players have got a knee “problem”. New research and multiple studies indicate that this may not always be the best course of action.

Knee surgery no better than sham?

The latest study was conducted in Finland on 146 patients with degenerative (wear and tear) menisci (cartilage) tears. The menisci are crescent shaped fibro cartilage disc structures that sit between the femur (thigh bone) and tibia (shin bone). They have two purposes, one to act as a cushion between the bones and two, to increase the surface contact of the bones and thereby provide increased stability to the knee joint. The classic way that they get torn is if you twist when your knee is bent. However, over time your menisci can also develop tears, especially if you have arthritis. Arthroscopies involve surgeons trimming these torn menisci and sucking out the “debris”. It is assumed that the tear is the cause of pain and that by smoothing out the jagged edges, the pain will go away.

In this study, patients were divided into two groups, one who received standard surgery and the other sham surgery, or surgery where surgeons made an incision under epidural anaesthetic, but didn’t do anything to the cartilage.

The result? One year later, both groups had the same outcomes, that of reduced knee pain. The researchers had to conclude that knee arthroscopies were no better than sham surgery.

Proven! – Physiotherapy may be just as good as knee arthroscopic surgery

This result has been confirmed by four previous studies, two proving that physiotherapy provides just as good outcomes as arthroscopies for knee pain:

1. In 2013, a study comparing the functional outcomes of physiotherapy against surgery and physiotherapy, found that physiotherapy alone provided just as good results as surgery and post operative physiotherapy.

2. In 2008, Kirkley and colleagues found the same result. That is, after comparing medical and physiotherapy with arthroscopic surgery for osteoarthritis (OA) of the knee, researchers concluded that medical and physiotherapy outcomes in terms of pain and stiffness were equal to those provided with surgery.

3. In 2002, in a landmark study in Texas, Moseley and colleagues compared arthroscopic surgery with sham surgery (i.e. the surgeons just made cuts in the patients’ knees) on 180 patients. They found no difference in self reported pain and function in a 24 month follow up.

4. In 2012, Bohensky and colleagues examined the results of all elective knee arthroscopies for patients 20 years or older with osteoarthritis of the knee from 2000 to 2009 in Victoria. They concluded that “despite the evidence questioning its effectiveness, there has been no sustained reduction in arthroscopy use for people with a diagnosis of OA.”

Given that arthroscopic surgery for knee OA cost Victorian taxpayers 180 million dollars last year, it would seem that this 180 million dollars could have been reduced.6 And this is not to mention the possible complications of superbug infections, medical mistakes, the risks involved with a general anaesthetic and the fact, the you are likely to need ongoing physiotherapy treatment for at least another six weeks.

Arthroscopic surgery an option, but perhaps NOT the first option

The evidence is clear. The management of meniscal tears depends upon the severity of the injury as well as the physical demands of the person. The reason for this is that the outer part of the meniscus has a blood supply and therefore can heal if it is damaged. In contrast, the inner, central part of the meniscus doesn’t have a blood supply and consequently cannot heal.

Hence, for small meniscal tears or osteoarthritic knees, physiotherapy has been shown to provide as good if not better results for much lower cost and much reduced risks. For optimal results to be achieved however, physiotherapy techniques and modalities must be combined specifically to optimise each stage of the healing process. Specifically, techniques must be directed towards protecting against re-injury (e.g. taping, bracing, crutches), reducing inflammation (e.g. Rest, Ice, Compression, Elevation), minimising swelling (e.g. Bodyflow), and then promoting healing and enhancing the tissue repair (e.g. Lipus Ultrasound). At the same time, function must be optimised with graduated movement (e.g. knee straightening and bending), strength (especially gluteal and quadriceps muscles), hip/knee control (with standing balance, squatting, walking, step-ups etc.) and functional/sporting activities (e.g. hydrotherapy, hopping, running etc.).

So when should you seek surgery?

Surgery is more likely to be indicated if you have sustained your injury with a severe twisting movement and are unable to continue with your activity. Other factors that may indicate whether surgery is required is if you knee is locked or has severely limited movement, has a palpable clunk or pain on minimal bending and / or there has been minimal improvement after three weeks of physiotherapy.

The final word

Please don’t misunderstand, surgery is a treatment option, but whether it should be the first or last treatment option depends upon the severity of the injury, the physical demands of the person and the outcome of physiotherapy management. Whether you have osteoarthritis or a less severe torn meniscus, physiotherapy and exercise has been shown to be just as effective as arthroscopic surgery and perhaps even more so in some cases. And with risks of anaesthetic reactions, superbug infections, drug reactions and medical complications, surgery costing about $2,000 compared to less than $1,000 for a typical course of physiotherapy, both the costs and the benefits line up heavily in favour of physiotherapy as being the treatment of choice for knee osteoarthritis and less severe meniscal tears.

For a FREE knee assessment or walking evaluation and advice, please call 1 300 BODYWISE (263 994).

References

1. Sihvonen, R, Paavol M, Malmivaara A, Itälä A, et al. for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group N Engl J Med 2013; 369:2515-2524
2. Katz JN1, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675-84.
3. Kirkley A, Birmiingham TB, Litchfield, RB, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
4. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscope surgery for osteoarthritis of the knee. N Engl J Med 2008; 359: 1097-1107.
5. Bohensky MA, Sundararajan V, Andrianopoulos, N, de Steiger, R, et al. Trend in elective knee arthroscopes in a population-based cohort, 2000-2009. MJA. 2012; 197 (7) 399-403.
6. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.

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Introducing the Bodywise Health Team

MICHAEL J. HALL
Practice Principal, Physiotherapist
Ba.App.Sci. (Physio) Mem.A.P.A.

 michal

Michael graduated in 1988 from Lincoln Institute/Latrobe University, completing his Physiotherapy Degree in Canada. MichAel’s extensive experience in the treatment of spinal and sports injuries includes being in charge of physiotherapy for the Cedar Court Back Rehabilitation Program and Ormond Football Club.

He has travelled extensively throughout the USA and Canada visiting and working in some of some of the finest spinal and sports rehabilitation centres in the world. Michael, has also completed many sports, spinal and musculo-skeletal post-graduate courses including Geoff Maitland, Muscle Energy, Vladimir Yanda, Robin McKenzie, Mulligan, Shirley Sahmann, Clinical Pilates, Paul Chek just to name a few. Michael was project manager, author and trainer for the Focus On You Health Management Software Program- a program designed to empower people through education and training to improve their own health.

Michael above all is a people’s person who enjoys the outdoors and is passionate about empowering people to live fulfilled and healthy lives.

FELICIA WONG

Physiotherapist BHSc (Physiotherapy)

 Felicia Portrait

George graduated from LaTrobe University with a Bachelor of Health Sciences/Master of Physiotherapy Practice. Throughout his training, he has gained a broad range of experience across Melbourne’s major metropolitan hospitals in areas including ICU, multi-trauma, orthopaedics, neurological rehabilitation and cardiothoracics. 

  • Felicia Wong graduated from Curtin University with a Bachelor of Science in Physiotherapy. Since then, she expanded her skills in the areas of Private Practice, Aged Care, and Occupational Health and Safety.

  • Throughout her career, Felicia has acquired further qualifications in advance Dry Needling, Occupational Health Physiotherapy (Level 1), APPI Pilates Matwork (Level 1) and Therapeutic Yoga (Level 1). She is currently undergoing further training with Polestar® Pilates, a world-renowned rehabilitation-based Pilates curriculum. 

    Felicia is particularly passionate about injury prevention, hence her involvement in corporate ergonomic assessments, where she has the opportunity to influence both pre- and post-injury work postures. Her other passion lies in the art of movement, which she integrates within her Pilates and Yoga teachings. Outside work, Felicia enjoys challenging her strength and flexibility at Pole Fitness and Aerial Silks classes! 

 

Also, providing Remedial Massage services at Bodywise Health is:

SUSAN LY - remedial massage therapist

NAOMI CONWELL -  relaxation, remedial, sports, deep tissue massage therapist

Our friendly receptionists and practice managers are:

Denise O’Toole, Margaret Norden, Kerri McGeorge and Naomi Dall

 

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Victoria. Australia 3188

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