Background
Hip pain associated with osteoarthritis is the most common cause of hip pain in older adults. Hip OA occurs when the smooth cartilage that covers the ends of our bones becomes worn. This wear can cause pain, swelling, inflammation and when more extreme deformity of the joint. The cartilage is designed to reduce friction within our joints and act as a shock absorber. When this cartilage is damaged our joint space narrows, which can cause a grinding, rubbing or crunching sensation in the hip, typically, the pain develops slowly and worsens over time. Still, in some cases, pain can have a sudden onset.
Hip OA affects each person differently, and symptoms will vary from mild to severe; therefore, it is important not to compare your symptoms to others. Importantly – the amount of pain or dysfunction that a person with hip OA experiences doesn’t correlate with how much wear shows on X-Ray or MRI. Some people have what looks like advanced wear and tear yet they have no pain at all. Others display very minimal wear on imaging yet have significant pain. What does tend to correlate with pain-levels is leg strength and positive beliefs about function.
While hip OA can be quite painful at times, it is important to maintain your regular exercise and physical activity routines as much as your hip symptoms allow. It is best to avoid activities or positions that bring on pain or make your hip pain worse. There is no cure of hip OA, but research shows it can be managed effectively using exercise, weight loss, and medications, with no need for surgery in many cases. Your physiotherapist will work with you to help manage your condition and keep you healthy and active!
Essential Anatomy
To better understand hip OA, it is important to understand some basic human anatomy.
The hip joint is made up of the head of the femur (thigh bone) and the acetabulum (socket) of the pelvis. Both the acetabulum and head of the femur are covered with articular cartilage, with its role to prevent friction and act as a shock absorber. The joint capsule attaches around the rim of the acetabulum to assist with stability. This joint capsule is then reinforced with three strong ligaments, the iliofemoral and pubofemoral ligaments anteriorly (on the front) and the ischiofemoral ligament posteriorly (on the back). The hip is a robust joint and designed for stability and weight-bearing.
What causes Hip Osteoarthritis?
The exact cause of hip OA is unclear, but some risk factors have been identified. These include, but not limited too:
- Being overweight or obese
- Sedentary lifestyle
- Occupation causing excessive strain on hips (i.e. manual labour causing repeated loading)
- Family history of osteoarthritis
- Older age - people over the age of 50 years are more at risk.
- Previous hip joint injury or significant trauma to the joint (i.e. bone break, high impact sport at a young age, car accident)
- Other congenital and developmental hip diseases
Physiotherapy treatment
In all cases of hip OA, causative factors need to be identified and addressed. These include:
- Environmental factors
- Behavioural factors (e.g. Prolonged sitting during the day, lack of general exercise and movement)
- Being overweight
To address these issues, get up and regularly move throughout the day, have assistance with heavy lifting activities, eat a balanced diet (we can recommend a good dietician for you), and most importantly, exercise!
Also, problems with flexibility, control and strength of the hip and thigh can contribute to the worsening of your hip OA.
Mobility:
Common flexibility issues include:
- Stiff and restricted hip joint
- A stiff hip joint capsule
- Tight hip posterior muscles (i.e. gluteals)
- Tight posterior thigh muscles (i.e. hamstrings)
- Tight anterior thigh muscles (i.e. quadriceps, psoas, adductors, TFL)
To address these, we use manual therapy and soft tissue massage, as well as teaching our clients to stretch and perform self-treatment with tools, such as foam rollers.
Control:
Control refers to the ability for an individual to monitor and adjust their body position and posture through a variety of different settings. When it comes to hip OA, control of the hip and pelvis is very important. Your physiotherapist will assess your control to determine if this a contributing factor to the problem.
In many cases, control exercises have a beneficial therapeutic effect as they introduce the body to a safe and pain-free range of motion that the person may not have been aware of.
Strength:
Strength is fundamental when it comes to the rehabilitation of hip OA. Strong and resilient tissues promote optimal function and are less likely to become tight or weak. Therefore, it less likely these structures will send the brain pain signals when under pressure from poor postures or stress-related tension. A targeted strengthening program, whether that be land-based or water-based, is the gold standard treatment for hip OA!
Summary
In summary, if you are suffering from Hip Osteoarthritis remember:
- Hip OA is ubiquitous and effectively managed with physiotherapy treatment.
- Changes to your sedentary behaviours and weight status are very effective at reducing your hip pain.
- Flexibility, control and strength deficits need to be identified and addressed.
- General exercise is an easy way to help manage and prevent the worsening of your hip OA!
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If you are suffering from Hip OA, book in with your Physio for a thorough assessment using this link – [FREE initial assessment]. Once the cause has been identified, a plan can be designed specifically for you and get you back to doing what it is you love.