by Andrew Provost, PT
A brief discussion on the current findings of hip Osteoarthritis and treatment techniques. (Part #1 in discussion of common hip pathologies)
Have you been experiencing pain your hip or pelvic region? Do you have pain in your groin area? Then you may have an underlying hip pathology. Although there are many types of injuries and changes that can occur at the hip, osteoarthritis is common and can be a very debilitating condition.
- The most common form of arthritis in the human body
- Degeneration of the articular cartilage
Pathology of Hip Osteoarthritis:
- Loss of hyaline cartilage
- Sub-chondral bone sclerosis
- Joint space loss
- Osteophyte formation
Changes in Hip OA over time:
By 2030, the proportion of the population with OA will rise from 20% to 30% in people >60 years old.
Contributing factors are:
- Increased life expectancy
- Increased body weight
- Decreased physical activity
(French et al. EMPART Trial. BMC Musculoskeletal Disorders, 2009)
Increased Risk for Hip OA:
- Strong hereditary component
- High BMI, physical activity at work (risk for progression to THA)
- Previous hip injury, sports activity, presence of Heberden’s nodes (risk for development of hip OA)
- Labral lesions – 73% of patients with a fraying or torn labrum have chondral changes suggestive of OA
Role of Physical Therapy:
- PT is the most common non-pharm. Intervention prescribed for OA
- Aim of PT is to reduce pain and restore function
- Techniques include, but are not limited to: joint mobilizations, strengthening exercises, stretching exercises, and manual techniques to improve soft tissue mobility.
Manual Therapy goals:
- To modulate pain
- To increase ROM
- Reduce soft tissue inflammation
- Improve extensibility and stability of contractile and non-contractile tissue
- Facilitate movement
- Improve function
Many of the manual therapy techniques performed by the physical therapist are done in an effort to restore restricted ROM (range of motion) in a pain free and/or pain reduced fashion. Often times, those inflicted with hip osteoarthritis have difficulty walking and standing for prolonged periods of time, experience pain and weakness when attempting to negotiate stairs, and have difficulty maintaining static positions of sitting. The ultimate goal of the manual techniques / joint mobilizations is to increase the space between the articular surfaces, thus decreasing the compression (bone on bone) of the underlying arthritis. In conjunction with many of the manual techniques to improve the patients ROM, it is also important for the therapist to address the strength and flexibility deficits that may also be contributing to his or her symptoms. Aquatic therapy can be an excellent adjunct to weight bearing exercises if the patient has difficulty performing such exercises fully weight bearing. The buoyancy of the water has been shown to be extremely beneficial with degenerative conditions at the knee and hip.
From a physical therapist’s perspective, the hip and its surrounding complex can be extremely fun and challenging region to work with. With regard to hip osteoarthritis, patients are frequently surprised at the things they are able to accomplish and return to without having to undergo surgical intervention. With a wide range of special tests and evaluation techniques, the therapist will be able to determine whether or not you are good candidate for non-evasive treatments that were touched upon above.
I look forward to getting the opportunity to work with you and your hip.
Andrew Provost is a Physical Therapist at Boston Sports Medicine