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1st Feb

2013

Tendinosis and Muscle Tears Common in Hip Osteoarthritis

Several recent research studies have shown that a large percentage of people with hip osteoarthritis (OA) – or wear and tear of the cartilage in our hip joint – also have degenerative changes and sometimes tears, in muscle tendons in our buttock. Such wear and tear tendon changes are referred to as tendinosis, but the more commonly used term by the lay population is “tendinitis”.

Common muscle tendons involved are the short outward rotators in our buttock such as the piriformis and obturator muscles, and the gluteus medius and minimus. It is not known today if the hip joint OA causes the tendon wear, or if the tendon abnormalities contribute to the development of the joint arthritis.

However, it is recommended that treatment for hip pain should start early on, to more successfully treat the tendinosis, which may also slow the progression of the OA. Physical therapy is typically recommended as the first line of treatment, possibly in combination with appropriate medications, as needed.

For rehabilitation exercises to be effective, they need to be designed in a way that they both help to rebuild, or regenerate, the weakened and worn muscle tendon, and help the arthritic hip joint, in the case of hip OA.

Both the arthritic joint and the degenerated tendon require initially low intensity and high repetition exercises, performed multiple times a day in short bouts of exercise. This may e.g. include a side lying “clam exercise” where the bent knee is moved up and out, and an exercise to rotate the leg outwards, performed either lying or sitting.

The muscle tendon will over time also require light resisted exercise, initially performed to mild fatigue, without putting weight on the leg in order to avoid excessive muscle contraction and joint compression. Gradually, the resistance can be progressed, and some weight can be put on the leg during the exercise, provided that there is no pain in the hip and the exercise form is good. With such exercise, the body has the capacity to rebuild fiber, or collagen, in the involved muscle tendon, and both decrease the pain from the tissues, and increase the muscle strength.

High intensity strength training is not recommended for people with hip muscle tendinosis together with OA, as this can accelerate the wear and tear process of the hip joint cartilage. Daily stationary bicycle exercise with low tension can be of benefit for the arthritic joint as well as for the soft tissues surrounding the joint. Manual therapy techniques can also reduce the pain and guarding of the involved hip muscles, and reduce the joint pain.

Best wishes,

Gunnar

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