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).
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
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