Osteoarthritis (OA), also known as degenerative joint disease (DJD), is a disorder of the joints caused by progressive loss of cartilage alongside other changes in the joint. OA of the hip occurs between and around the ball and socket of the hip joint and is the most common diagnosis for pain in the hip.
The pain individuals experience is varied and depends on many factor. That said as the degeneration progresses many individuals will eventually have intolerable pain, lose their overall functional ability, independence and quality of life. At this point surgical intervention is usually required with total hip replacement (THR) the most likely option.
THR has been shown to be very effective in reducing pain and improving function but some individual’s still report hip pain following THR after the arthritic joint has been replaced.
What is not commonly understood is that much of the pain from hip arthritis is due to the secondary changes associated with the arthritis. Changes such as restriction in the joint capsule, increased pressure in the joint, weakness and tightness of all the muscles that work around the hip, loss of balance and overall increase in stress on surrounding joints including the knee, pelvis and lower back.
In fact why do people without hip arthritis get hip pain? There are many potential reasons such as bursitis and/or tendinitis from muscle imbalances, weakness and tightness patterns that throws off human biomechanics. Pain could be coming from their back, pelvis or somewhere else. When biomechanics are off, there is often stress to hip, knee, foot and ankle, which can result in pain. People that show no degenerative changes do not have arthritis so we know there are lots of reasons for hip pain outside of arthritis. People that have arthritis have a lot of these imbalances. Not changing the mechanics of how the back, pelvis, hip, knee and ankle all work together reduces possibility of reducing or managing your hip pain. It would not be sensible to put new tyres on a car and not realign and balance the wheels. The point is the reason the car is not moving well is more than just old tyres.
If you are trying to manage hip OA conservatively (pre-surgical intervention) then it is essential to improve biomechanical imbalances. Studies that have investigated the combination of manual therapy techniques, focusing on increasing capsular mobility of the hip, and therapeutic exercise have shown excellent results in reducing pain associated with hip arthritis.
Manual therapy techniques are defined as those in which a medical provider, such as a physiotherapist, osteopath, or chiropractor, perform skilled hand movements intended to improve tissue extensibility, increase range of motion, induce relaxation, mobilise or manipulate soft tissues and joints, modulate pain, and reduce soft tissue swelling, inflammation, or restriction. There are a variety of manual therapy techniques that target the hip joint capsule with the goal of increasing its extensibility.
The first and most widely used manual therapy technique to improve general hip joint capsular mobility and decrease pain immediately is termed Long Axis Hip Traction
Combining manual therapy with specific therapeutic exercises shows the greatest promise for conservative treatment of hip osteoarthritis. By increasing the patient’s mobility and decreasing their pain, they are better able to perform their long-term exercise routine for decreasing weight, increasing flexibility, and increasing biomechanical strength. These conservative measures can decrease the need for pain relieving medication, improve patient morale, improve functionality, and most of all, improve quality of life.
Although conservative treatment does not cure arthritis nor prevent surgery at some point, if you can gain strength and mobility, and improve activity level, you have a greater chance of more comfortably delaying surgery until it is absolutely necessary.