The hip is one of the largest joints in the body and its anatomy is well designed to resist the compression of weight bearing. However, it is prone to the development of osteo-arthritis (OA), with it occurring more frequently and also progressing more quickly in women than men.
OA of the hip is characterised by degeneration and thinning of the articular cartilage, inflammation and sclerosis (erosion) of the bone, and spur formation around the joint margins. It can ultimately lead to severe pain, loss of mobility and strength, and a progressive reduction in their quality of life.
Unfortunately, OA of the hip is all too often considered ‘inevitable’ by some health professionals, and little intervention other than pain relieving medication is provided. Recent research into the treatment of the condition is challenging this perception, with short courses of manual Physiotherapy and specifically tailored exercise programs gaining huge improvements in function for some patients. It is likely that a focused program of Physiotherapy can be of enough benefit to patients to significantly delay their need for surgical replacement.
The Role of Physiotherapy
- Hydrotherapy and exercise have been employed by Physiotherapists as the first line of treatment for hip OA for many years.
- Manual treatment has also been used, and as more research has been done into the problem, the techniques used by Physiotherapists have become more specific and more effective.
- Through identifying muscular imbalances and addressing hip joint tightness, manual therapy may provide long term pain relief.
- Followed up with a targeted exercise program to address each individual’s problems, the success of a focused program of Physiotherapy treatment can be profound. It is also interesting to see that these positive results can be achieved in just a few sessions (an average of just 5), suggesting that lengthy and expensive periods of treatment are not necessarily required.
Muscular Stability in managing Hip OA
Some of the major causes of degeneration are avoidable, and it is important to realise that there are simple, active steps that you can take to preserve your hip.
Maintaining muscular strength plays a huge role. Weakness of the muscles surrounding the hip makes us adopt compensatory movement patterns that place abnormal force on the mechanics of the joint itself. Osteoarthritis is frequently the result of these patterns and the shearing force they place through cartilage, leading to areas of focal destruction.
The gluteal muscles of the buttock are particularly important in providing support for the hip. Perhaps the most important is the gluteus medius; it braces the hip during weight bearing, distributing the forces involved with walking and running. Walking alone imparts a force of 3-4 times your body weight (and 5 times your weight when running!), so you can understand just how vitally important strong gluteals really are. They are your shock absorber for the underlying joint, so training these will be an important focus of you Physio treatment program.
We all lose strength as we get older but that doesn’t mean we should stop being active. Disuse of the hip muscles leads to a downward spiral in our functional capability, causing further stress, pain, weakness and deconditioning. It is a scenario often encountered in the elderly where lifestyle, decreasing strength, genetics and previous medical history may all combine to hasten osteoarthritis. You can avoid this cycle of deconditioning with the right advice, treatment and exercise regime from us!