Hip Osteoarthritis

OSTEOARTHRITIS (OA)

IS THE MOST COMMON LIFE STYLE DISEASE AND EVEN MORE COMMON THAN HIGH BLOOD PRESSURE AND DIABETES. IT CAN OCCUR IN ANY JOINT OF THE BODY, BUT MOST OFTEN DEVELOPS IN THE WEIGHT BEARING JOINTS SUCH AS THE HIP AND KNEES.

Signs and symptoms

• Pain with the following features: Usually develops slowly and worsens over time; present in your groin or thigh that radiates to your buttocks, lower back, or knee; flares up with activity such as walking, stair climbing, rising from a chair; night pain – prevents you getting to sleep or wakes you during the night
• Stiffness – that makes it difficult to walk or bend ( e.g. when putting on socks or getting in and out of the car), often worse in the morning or following long periods of sitting
• Locking of the joints and a grinding noise (crepitus) during movement
• Limp with walking due to decreased range of motion and/or pain

What is happening in the body?

• All joints in the body are lined with articular cartilage designed to minimize friction during movement.
• Around the joint is an articular capsule that helps to stabilize the joint as well as producing synovial fluid. The fluid provides nutrition for the cartilage and helps the joint move smoothly.
• We used to describe osteoarthritis as “wear and tear” of the joint cartilage.
• We now understand that it is a more complicated process.
• With osteoarthritis the articular cartilage begins to diminish in size and changes to the surface of the joint occurs (e.g. osteophytes, irregular surfaces of joints).
• This process can cause an inflammatory reaction, leading to swelling, pain and reduced strength of the surrounding muscles (e.g. gluteal muscles).
• Predisposing factors -certain factors that may make you more likely to develop the disease, including:
  –  Increasing age
  –  Family history of OA
  –  Previous injury to the hip joint
  –  Overweight
  –  Inactivity
  –  Overload for a long time e.g., heavy labour or excessive exercise
  –  Gender (hip OA seems to be more common in males)
  –  Improper formation of the Hip joint at birth (hip dysplasia)

What can you try at home to help? 

• Evidence largely supports weight loss and exercise as the most effective long term treatment for pain relief and control of hip osteoarthritis
• Using heat or ice for pain relief, topical creams/ointments, gentle range of motion exercises throughout the day, pacing your activities and using pain medication/non-steroidal anti-inflammatories as prescribed by your doctor or pharmacist are some other options to consider.

How can physiotherapy help? 

• Accurate diagnosis – not all hip pain is due to OA. Physio can diagnose the cause of your pain
• Activity modification – your physio is an expert at helping you still stay engaged in the activities that are most important to you while not aggravating your symptoms
• Pain relief- this includes manual therapy (massage/joint mobilisations), taping, stretching, dry needling/acupuncture
• Exercises – current research shows that specific, guided exercise programs targeted at building muscle strength and joint stability is the main stay treatment for hip OA, one such program is the GLA:D program which is run here in the clinic
• Optimise biomechanics – biomechanics refer to how your posture, range of movement and muscle strength to help you move in a pain-free and efficient manner. If pain has led to compensation of the way you move, your physio can guide you in returning to moving well. Occasionally this may include use of orthotics or referral to a podiatrist.

REMEMBER:

A diagnosis of OA is not a slippery slope to worsening pain and ultimate surgery. It is only 10% of patients that require surgery. Your physio will guide you safely through the progressions towards your functional goals, whatever they may be.