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1st Sep

2011

Manual Therapy with Exercise Therapy for Hip Osteoarthritis

Hip pain is common in the general population, and can have many causes. One frequently seen cause is osteoarthritis, or degenerative wearing of the cartilage in joints, which in particular can affect weight-bearing joints, such as the hip. The discomfort may start as a mild ache and progress over time, often felt in the groin or deep inside the hip, and at times in the buttocks. Pain from osteoarthritis most commonly starts in our 50s and beyond, but can occur sooner in life, in particular if a person has had traumas to the hip, or has engaged in heavy labor long-term, or participated in sports that expose the hip to extreme forces.

The pain may over time extend down the thigh, or may be felt mostly in the knee and progress to be present even at rest. It may become painful to walk for long distances, which often increases if walking up and down hills and stairs, and a limp may gradually develop. Hip movements start to become painful, in particular if putting the hip on full stretch in different directions, and the range of motion of the hip gradually decreases. There is often pain if twisting the hip with full weight on the leg, or if sitting with the foot placed on top of the opposite thigh. Although often negative early on, x-ray films and an MRI scan later reveal the degenerative changes.

Physical therapy is typically recommended as an early treatment choice, as research and clinical data have shown improvement in pain, mobility, muscle function and ambulation. Both exercise therapy and manual hip joint mobilization treatment can be effective, with the best results typically produced by combining the two, as is often done with orthopedic manual therapy. Even in more advanced arthritis, such treatment may postpone the need for joint replacement surgery. One of the most commonly used manual therapy techniques is long axis distraction to the hip, which has been shown to increase hip joint capsule extensibility, increase lubrication to the joint cartilage, decrease pain and improve hip mobility. The physical therapist can also design specific exercises, which produce hip joint distraction and mobilization, and which can be performed daily.

Exercise therapy for osteoarthritis of the hip usually at first entails a large number of movement repetitions with low or minimal loading of the joint, such as active or lightly resisted motions without weight-bearing, in severe cases requiring the leg to be supported by slings to eliminate gravity, or gentle water therapy, and stationary bicycle exercise with minimal or no tension. As the muscle guarding and pain decrease, and the mobility and tolerance to activities increases, weight-bearing exercises and activities are gradually added and progressed, as the hip joint cartilage requires a considerable amount of intermittent weight-bearing every day for optimal health. Therefore, broken up sessions of walking throughout the day is now recommended, gradually progressed without causing pain over the next 24 hours. An effective program also aims at restoring mobility and muscle function in the ankle, knee and back, if lacking.

Best wishes,

Gunnar

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