Hip Disorders: Osteoarthritis & Bursitis

Our hip joints allow us to do an amazing number of things – walk on two legs, pivot, squat, even kick a ball. It is an engineering marvel to combine the stability required to balance the weight of the torso over a structure the size of a golf ball, with the substantial degree of mobility available. The high demands on the hip joints can, however, take their toll over a lifetime.

Osteoarthritis is the most common hip disorder affecting adults. Primary osteoarthritis (OA) has no recognizable cause, while secondary OA is thought to occur due to altered joint mechanics or following joint trauma. Obesity, excessive loading due to occupational or sport demands can contribute to breakdown of articular cartilage. There is likely a genetic component as well. Muscle imbalances around the hip are also predisposing factors, as shearing forces or high compression load will cause abnormal wear and tear. Alignment issues of the low back, pelvis and leg can also contribute to abnormal forces around the joint.

Muscle imbalances occur as a result of weak, tight, or inappropriately recruited muscles. Our neuro-muscular system can develop certain abnormal pathways of firing, creating suboptimal movement, and potential damage to joint structures. If these are retrained before the cartilage damage is severe, it can halt the progression and reduce the symptoms of arthritis.

One of the most important groups of muscles for maintaining optimal compression and centering the ball, (or head) of the femur in its socket are the Gluteal muscles on the lateral side of the hip. Core strength and balance are also very important components of optimal hip health.

A second common diagnosis of hip pain is trochanteric bursitis. The most prominent lateral point on the hip bone is called the greater trochanter. It was commonly thought that the bursa overlying this point was the most common local cause of lateral hip pain. However, in a recent study, using real-time ultrasound, 80% of patients with lateral hip pain did NOT have bursitis. 50% of the 877 patients studied had tendinosus of their gluteal muscles, ie. a degeneration of the deep hip rotators tendon’s collagen in response to overuse, occuring when other stabilizer muscles weaken. It is part of what has been labeled Greater Trochanteric Pain Syndrome (GTPS).

Symptoms of both OA and GTPS can be similar. Pain from OA is usually felt in one or more of the following areas: the groin (most common), over the greater trochanter, or down the front of the thigh and knee. Usually, arthritis pain is reported with or after activity, progressing to pain at night or at rest.

With GTPS, point tenderness is noted at or behind the greater trochanter, typically worse at night, especially when lying on the affected side. Lateral hip pain with repeated stair climbing and squatting is more likely due to GTPS.

Maintaining adequate strength and flexibility of the hip muscles is an important component of treatment and prevention of both hip osteoarthritis and trochanteric pain syndrome. Physiotherapists are trained to assess these disorders. They can prescribe individual exercise where deficits in strength, mobility and balance are noted.

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Treatment Options for Hip Osteoarthritis

Hips and Knees, Physio Articles

Hip osteoarthritis is a common condition that involves the degeneration of the articular cartilage of the hip joint. If you have this condition and are noticing an increase in pain and a decrease in physical function you may be wondering what treatment options are available to you.

With osteoarthritis of the hip you may feel a constant ache localized to the groin and side of your hip and sometimes extending into the front of your thigh and knee. The hip often feels stiff, especially first thing in the morning when you get out of bed and it can make activities of daily living much more painful including standing, walking and stairs. It can also make it difficult to put your socks on, get into and out of your car and even get on and off of the toilet.

Stiffness, pain and having difficulty with many previously easy daily activities may lead you to want to do less physical activity. The trouble is, not moving will often lead to weakness, further stiffness and general deconditioning.

A physiotherapist can help design a treatment program with a focus on decreasing pain, increasing range of motion and flexibility, improving core stability, gaining muscle strength and endurance and improving general conditioning. Other functional goals often include improving walking pattern, speed and distance, ability to go up and down stairs without pain and better control going from sit to stand.

This is often accomplished through a combination of education, manual therapy and exercise. An exercise program is often extremely beneficial to help improve physical function and decrease pain. A physiotherapist is an excellent resource to put together a safe and effective home exercise program for you to perform daily at home or at your local gym. Also, if you enjoy swimming, bring this up with your physiotherapist as aquatic exercise is a great form of treatment for hip osteoarthritis.

Other possible physiotherapy treatments that may be effective for some individuals with arthritis of the hip include: acupuncture, massage, heat on the muscles around the hip, ice, TENS, supportive footwear and/or a gait aid such as a cane or walking poles. It is important to talk with your doctor about your arthritis to discuss other treatments that may be beneficial to help manage your symptoms. Certain medications may be helpful, but it is important to bring this up with your doctor to be sure they are appropriate for you. Also, if you are overweight, a weight management program can be extremely beneficial to decrease the stress on your joints. Since nutrition plays a crucial role in weight management, it is important to have this discussion with your doctor.

A small portion of individuals with hip osteoarthritis will eventually opt to have a total hip replacement. This is often the case when symptoms are progressively getting worse and significantly limiting activities of daily living. If you have had a total hip replacement a physiotherapist guided post-operative hip strengthening program is ideal in order to decrease pain, improve your hip function and return to your active lifestyle.