Osteoarthritis of the Hip

By: Devin Blizzard LeBlanc & Jonah Blatt

 

Overview of Hip Osteoarthritis

 

Osteoarthritis (OA) is a disease that affects the bone and cartilage of a joint and is most commonly found in the hip and knee (Lane et al., 2011). Cartilage is known as the elastic material that covers and protects the outer surface of the bones that form the joint. OA of the hip is shown to be the failure of the body’s ability to repair any cartilage that has been damaged in the hip joint (Lane et al., 2011).  OA of the hip joint can result in significant symptoms such as pain and stiffness in the hip that become worse with activity. Normally, these symptoms are relieved by rest and resurface again with activity. These symptoms tend to become gradually more apparent over the course of a few years, as the OA progresses. OA also damages the ligaments and muscles surrounding a joint and some cases lead to inflammation (Arden & Nevitt, 2006). OA is commonly diagnosed by the combination of joint symptoms and structural pathology (e.g. on X-ray). (Pisters et al., 2007).If the degeneration is advanced enough, a surgical process of total hip replacement may be needed, however if addressed early enough OA can often be treated conservatively without the need for surgery.

What causes Osteoarthritis?

 

As previously mentioned, lining each of our joints is a substance known as articular cartilage. It has special properties that make it an excellent shock absorber and protective covering for the surfaces of bones in our joints. Specifically, in the hip there is cartilage covering the ball-like head of the femur, as well as lining the cup-like pocket of the hip known as the acetabulum. Surrounding this joint is a capsule containing synovial fluid, allowing the two bones to move past one another with very little resistance.

As we put weight through our joints, damage can occur to the cartilage as it absorbs the impact of our movements. This is completely normal, and we regenerate the damaged cartilage keeping our joints moving properly. The process of OA begins when our cartilage becomes unable repair itself and continue covering the underlying bone properly. When this happens the bone beneath the cartilage thickens in response to the increased pressure or force, which is no longer being softened to the same extent by the cartilage (Shahiraz & Wainright, 2018). This bony growth further increases the damage to the cartilage, and aggravates the surrounding joint capsule causing inflammation and pain.

 

If the disease progresses untreated and unmonitored, the bone can continue to thicken with the cartilage thinning and wearing away until no cartilage remains. This leaves just thickened bone with very little space left in the joint to move, as well as a very irritated synovial joint capsule causing pain with movement.

Am I at Risk of Developing Hip Osteoarthritis?

 

Hip OA is one of the most disabling conditions primarily affecting those as they age. For example, in those aged 85 there is roughly a 25% risk of developing hip OA. (Murphy, Eyles, & Hunter, 2016). OA most often occurs in joints that are exposed to heavier than normal workloads over a long period of time. It can also be triggered by those with joints formed differently or who have experienced joint injuries in the past (Murphy, Eyles, & Hunter, 2016). Risk factors for OA can be separated into those at the level of the joint and the level of the whole person. At the level of the joint the most significant factor is an abnormal hip joint (i.e. Hip dysplasia or femoroacetabular impingement) which leads to increased stress on the hip joint over time. (Murphy, Eyles, & Hunter, 2016).  Your age, sex, weight, and occupation are some of the risk factors that can also influence your risk of developing hip OA.

How do I know if I have Hip Osteoarthritis?

 

OA tends to affect individuals differently, but the most common symptoms of OA in the hip are pain and stiffness, which becomes worse with activity and feels better with rest. The hip will often feel stiff and painful first thing in the morning, improving within an hour. This stiffness and pain will seem to gradually become worse and worse, while being difficult to pinpoint a specific day or moment when the hip started feel stiff and painful.

This is a process that can occur over several years, progressing very slowly. Coming in to see a physiotherapist, or your family doctor about medical imaging of the hip can help diagnose if the pain you’re feeling is related to OA or a different condition. The earlier you know, the more can be done to limit further damage and manage the condition.

 

 

 

I have Hip Osteoarthritis, how can Physiotherapy help?

 

Physiotherapy can help to assess the state of your current hip OA, as well as plan for the future. PT’s can help with giving you proper education on OA and can create an individualized program to help you increase your general mobility, strength, flexibility, and manage your symptoms surrounding the hip joint. The individualized programs consist of exercise prescription to help reduce pain and improve the quality of movement in the hip joint and improve your overall quality of life.The conservative strategies that physio can provide may be enough to help you continue moving and get on with your life without causing further damage (Shahiroz & Wainright, 2018), potentially preventing the need for a hip replacement. If you are a candidate

for hip replacement, physiotherapy prior to treatment can help you to prepare for the upcoming surgery. A large predictor of successful outcomes following surgery is the functional status and preparation before, so early management is a key to ensuring the best recovery possible.

 

 

 

 

Final Thoughts on Osteoarthritis

 

OA is a painful and potentially disabling condition for individuals as they age. However, there are ways to prevent the disease from progressing, and ways to manage it even after pain and stiffness are already present. Physiotherapy can help conservatively manage and treat painful and stiff joints, while planning for the future and what treatments you may need. In the instances where surgery is required, physiotherapy can help prepare you before, and get back to moving after surgery. If you’re experiencing pain and stiffness when you’re moving, come see the physiotherapists at Family Physiotherapy, they’re here help you move and feel your best.

 

Family Physiotherapy, assessing and limitations and injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References

 

  1. Arden, N., & Nevitt, M. (2006). Osteoarthritis: Epidemiology. Best Practice & Research

Clinical Rheumatology,20(1), 3-25. doi:10.1016/j.berh.2005.09.007

 

  1. Department of Physical Therapy. (2017). CP-Hip-OA-2017-18. Toronto: University of Toronto.

 

  1. Lane, N., Brandt, K., Hawker, G., Peeva, E., Schreyer, E., Tsuji, W., & Hochberg, M. (2011).

OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthritis and

Cartilage,19(5), 478-482. doi:10.1016/j.joca.2010.09.013

 

  1. Murphy, N. J., Eyles, J. P., & Hunter, D. J. (2016). Hip Osteoarthritis: Etiopathogenesis and

Implications for Management. Advances in Therapy,33(11), 1921-1946. doi:10.1007/s12325-

016-0409-3

 

  1. Pisters, M. F., Veenhof, C., Meeteren, N. L., Ostelo, R. W., Bakker, D. H., Schellevis, F. G., & Dekker, J. (2007). Long-Term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review. Arthritis & Rheumatism,57(7), 1245-1253. doi:10.1002/art.23009

 

  1. Shahiroz, J., & Wainright, A. (2018, January 23). Osteoarthritis and the Role of the Physiotherapist Across the Continuum of Care. Lecture presented in University of Toronto, Toronto.

 

  1. http://www.arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/osteoarthritis

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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How to Run Injury-Free

By Peter Poon, PT

Running injuries

Now that summer is in full swing, many of us will want to enjoy the sunshine by going for a casual jog or more vigorous run around the neighbourhood. Some may think running is not an exact science: just pick up a pair of (brightly-coloured) running shoes and…go. However, poor running form can lead to injuries down the road, much like how riding a bike with misaligned wheels will eventually wear down the bike and the rider. It has been estimated that between 4 – 18% of individuals have some kind of running injury at any given time.[1] Common injuries such as patellar tendinopathy, tibialis posterior tendinopathy, tibial stress syndrome (shin splints) and achilles tendinopathy are usually due to improper loading during lower body exercises and may not yet be impacting you enough to seek out a physiotherapist.  

 

Can technique be resulting in painful runs?

If you have been experiencing pain either during or after a run, ask yourself the following:

  • Where is my pain? What does it feel like?
  • I am in pain during my run. Does it go away quickly (with rest) or does it linger for days?
  • I am in pain after my run. How long after does the pain start?
Pain with running can be improved with a proper assessment and treatment plan
Pain with running can be improved with a proper assessment and treatment plan

The above are all plausible signs that your body is not agreeing with your running routine. When your body experiences pain, it is generally a sign  that it cannot cope with the stresses from that activity.  You can reduce your risk of ending up with severe injuries if you identify subtle movements or habits that could lead to injuries and develop a proactive long-term injury-prevention strategy.  During an assessment, physiotherapists can identify these factors and prescribe individualized exercises and tips to get you moving efficiently.

 

Could previous injuries be causing me running pain?

Imagine you have just sprained your ankle, instead of walking with a heel-toe pattern, your body compensates by doing a stutter step. Compensations are one of your body’s natural defense mechanism. Short term compensations are necessary to keep you moving with less pain. However not all compensations are ideal; in the previous example, walking with a stutter step will lead to decrease use of your calf and hip muscles to propel you forward. If left unchecked, it will lead to future muscle imbalances which could affect your running form. Even though you may feel no pain from your previous injuries, you could have developed subtle compensations, which could have abolished the pain but only “band-aid” the problem. During a gait assessment, physiotherapists can identify these changes and give you specific advice to keep you running on all cylinders.

 

Am I a heel, midfoot or forefoot striker (am I pounding away at the pavement or landing light as a feather)?

Different landing patterns will create different stresses on your foot and body; some patterns are better at absorbing shock than others and some can lead you susceptible to injury.

 

Am I taking laboured or big strides?

Taking laboured or big strides is an inefficient method to run or to run faster. This is due to a greater energy loss from lifting your leg (versus shorter strides) which decreases forward propulsion. Not surprisingly, big strides will increase impact on your feet when you land. While it may be okay for some sprinters, imagine the impact on your feet if you were to repeat this for 5-10km. Physiotherapists can easily identify this fault and give you specific tips to help improve your efficiency.

 

Did I suddenly change or increase the volume (time, distance or # of runs per week) or intensity of my run?

Sudden increase in volume of training is a catalyst for sprains and strains. Daily to weekly adjustments of the applied mechanical stress (either volume, or intensity) is the best way to avoid injury.

 

Calluses or getting black toes can be a sign of inappropriate shoes

The fit of the shoe is essential to stay injury free. Shoes that are too small or too narrow could lead to unwanted bunions and black toes. 

 

Am I running the same circles in a track or same route every time? Do I run on different types of surfaces?

Not only does cross training on irregular surfaces or trails keep your muscles guessing, but it also helps improve balance and adds variety to your workout. The variation will increase strength and endurance in your foot and ankle muscles, which leads to less repetitive strains in the future.

 

A few final thoughts on Running

These are all valid questions to consider whether you are just picking up running, coming back from an injury or wanting to stay injury-free. A running gait assessment by a physiotherapist can help you with answers to the above questions. Not only do we conduct an interview at the beginning to find out your running routine, we look at your running form from head-to-toe to identify possible areas that need to be addressed. With this information, physiotherapists can assist runners in developing individualized long term solutions to stay running injury free.

As always, contact us if you need any tips or advice.

 

Family Physiotherapy serving the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.

Peter Poon is a registered physiotherapist at Family Physiotherapy.

[1] Lopes A, Hespanhol JLC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012; 42(10): 891-905