Hip osteoarthritis And Physiotherapy
We see a lot of Hip osteoarthritis (OA) at Movement Centre in Randwick. Hip arthritis can present with a variety of different symptoms. It is often unilateral, but can affect both hips. The pain can be felt through the low back, pelvis, lateral hip or down into the thigh. Importantly, it can be quite hard to identify hip OA from pain sites and symptoms alone. Because of this, a thorough assessment is important for an accurate diagnosis. Often the most significant symptom is stiffness in the hip that can make bending forward, rising from sitting, and tying shoes difficult. Despite this, hip osteoarthritis is a condition that can be effectively managed with physiotherapy, education and exercise.
What is osteoarthritis?
OA is a condition that affects a joint or joints in our body. It is characterised by several signs and symptoms:
- Stiffness in the hip
- Particularly with rotating movements
- Joint pain and stiffness that may gradually improve with movement, but becomes more sore with too much loading
Within the joint, hip osteoarthritis is characterised by:
- Bony changes around the joint
- These may be around the acetabulum (the socket), or the femoral head and neck (the ball)
- Subchondral sclerosis – bony thickening;
- Thinning of the articular cartilage
It is important to remember that OA is present in many hips that experience no pain. Often we see the changes in both hips of our patients, but only pain and stiffness on one side. This is a great way to understand that the changes on x-ray are not the only determinant of whether you will have pain. The results we see on X-ray and imaging are also not a great indicator of the severity of the problem.
Who develops hip osteoarthritis?
The prevalence of hip arthritis increases after the age of 50. Aside from age, sex and gentic factors, the main risk factors for development of OA include:
- Joint injury
- Joint overload
- Being overweight
- Periods of physical inactivity
- Muscle weakness
Experiencing stiffness and soreness in the hips?
Hip OA patients that present to us often have a history of several years of joint stiffness, aches and hip pain. This may follow on from an injury, or follow a sharp increase in their exercise load.
The initial sign is often stiffness in the morning, and a general ache with commencement of movement. The pain and stiffness settles with gentle movement, but can worsen if pushed too hard or too far. Stairs and prolonged walking can be quite irritating, especially if pushed beyond usual loads. The hip pain can be hard to define. It can be located around the anterior thigh, lateral hip, low back or pelvis. It can sometimes even radiate further down the leg. Identifying the hip joint as a true source and cause of the pain can be important so we can rule out other involved structures such as the low back and nerve irritation.
By the time patients are seeking help for their pain and stiffness, they often have a long history of intermittent, and at times gradually progressing symptoms. It is never too early or too late to seek help and get on top of your symptoms to restore function.
To scan or not to scan when suspected hip osteoarthritis?
By the time many patients present to us for physio, they often have seen a GP and had scans taken. Scans can be a confronting problem for many of our patients with hip pain. Scans – usually x-rays – are often a first step taken by GPs to identify the nature of the problem. The issue with scanning hips with pain is that the scan will often show up a whole host of things related to very
normal processes in the joint. It is hard to delineate which of these normal processes is related to the clinical signs and symptoms the patient is experiencing. And more importantly, if this isn’t properly explained to a patient, the scan and the results can create fear, movement inhibition, and very genuine worry in patients.
Scans can be useful if we are unsure about what is happening in the hip. But often the scan doesn’t add information over and above the clinical signs and symptoms.
Best physio management of hip arthritis
The RACGP guidelines for hip osteoarthritis management involves a tiered system for management. The first and best line of treatment recommended by the RACGP is for:
- Exercise
- Education
- Weight loss – where applicable
These three interventions present the most effective, affordable, and easy to implement strategies. Thankfully, these are all interventions we can help with at Movement Centre.
The second tier of management involves medication for pain and inflammation, heat, soft-tissue work, and walking aids. The third and final tier of intervention – for when conservative management hasn’t succeeded – is referral for x-ray, and orthopaedic specialist input.
Unfortunately we often see a complete inversion of these guidelines. Patients we see have often undertaken nearly every-step of the system before they undergo significant education or specific exercise therapy.
At Movement Centre, our
physio Andrew is qualified with the GLA:D program, which is a program based on managing hip and hip arthritis with the best evidence.
What is the GLA:D program?
GLA:D stands for “
Good living with Arthritis: Denmark“, and is a program developed by researchers in Denmark for the best management of hip and hip osteoarthritis. The program involves education and exercise classes that have been formulated to best improve symptoms and function of hip and hip arthritis. The program is suitable for hip or
hip OA, and is appropriate across any age range, and most functional capacities. It is a prescribed exercise program, with exercises that are tailored in their difficulty for each individual. The program lasts for 12 exercise sessions, delivered over 6 weeks. Outcomes from the program show that ¾ people maintain meaningful improvement even 12 months after the program. Further, ¾ people who have previously desired surgery no longer wish to have surgery at the 12 month follow-up post-program.
At Movement Centre in Randwick, we will be commencing GLA:D classes for both individual and group exercises in the second half of 2022. Email us at info@movementcentre.co, or come and speak with us if you wish to have more information on the course.
For those not interested in the program, but still experiencing hip arthritis symptoms, we are happy to help with individualised care. Our approach involves addressing the functional and physiological limitations – primarily strength, range of motion and pain barriers.
Our patients have access to our rehab gym to utilise outside of their appointment times. This ensures that our patients have access to exercise equipment that they need to keep active.
Come and visit our team in Randwick at Movement Centre if you are experiencing hip pain or stiffness. hip osteoarthritis is a very manageable condition if treated with the best care. We pride ourselves on providing that best care, and helping our patients get back to the activities they love.
