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.
Optimal bone health is a serious consideration in people approaching mid-life. It is common knowledge that bones become more brittle as we age. What may be less recognized are the factors we can control through exercise and nutrition in the first half of adult life that have a direct effect on prevention of osteoporosis.
Osteoporosis is a disease characterized with a loss in bone mass and deterioration in the sturdiness of bone structure. This is associated with the increased risk of fractures, particularly in the hip, wrist and spine. It is prevalent in the older population. If you are a woman, you have a 50% lifetime risk of a fracture from osteoporosis.
Bone loss is an insidious process. In the early stages it is called “osteopenia” It can occur when an arm or leg is casted after a frracture. A loss in bone mineral density (BMD) can accelerated after taking steroid medications or with certain autoimmune disorders or diabetes.
Reduced levels of estrogen after menopause accelerate bone loss. However, it is well- established that if a woman in her 40’s and 50’s exercises regularly and has good nutritional habits, she can diminish her post-menopausal bone density loss substantially. Osteoporosis is optional!
How does exercise affect bone health?
Bone is a living tissue. Bone cells, called osteophytes, have the ability to act like strain gauges and adapt to the amount of stress placed on them. Regular weight bearing exercise or strength training is essential to maintaining healthy bone. Resistance training improves muscle mass and strength and can increase spine and hip bone density. It is essential that the exercises chosen are safe and appropriate for the individual. Physiotherapists assess posture, understand risk factors and can advise which exercises are best for those with osteoporosis.
As a preventative measure and for those with mild osteopenia, high and medium impact exercise such as soccer, tennis, activities such as skipping and step-ups can stimulate healthy bone cells to produce a stronger bony matrix and increase BMD.
For individuals with moderate osteoporosis, weight bearing exercise and moderate impact exercises are appropriate, high impact exercise is not. Strength training exercises should target the specific areas affected. Balance exercises and fall prevention awareness are important, as falls can result in fractures, which are painful and can take much longer to heal than with normal bone. Working with a physiotherapist with specific knowledge about osteoporosis to set up an exercise program is highly recommended. Check with your physician before beginning a strenuous exercise program.
Attention to postural alignment during strength training is important. Certain exercises place too much strain on the midback area and can increase the rounding, or kyphosis in this area. For example, repeated curl-ups for abdominal strengthening, or swinging kettle balls with arms extended should be avoided.
Why does nutrition play such an important role in prevention of bone mineral density loss?
Bones are important warehouses for calcium and other important minerals needed for cellular function. If our diet is low in calcium, the body borrows it from our bones. If it’s not restored, a net deficit in minerals can result in reduced BMD.
In order to maintain optimal bone health, sufficient amounts of Calcium, Magnesium, Vitamin D are recommended.
As a physiotherapist, I assess and treat injuries that occur in the workplace. These can be sudden (acute), or gradually over time (overuse). Overuse injuries come from repeated stresses that cause micro-damage of muscles, ligaments, or joints. Over time the micro-damage turns larger, and pain and weaknesses become apparent. Overuse injuries are quite common, difficult to diagnose, but relatively easy to prevent.
Any job comes with some degree of risk of injury. Knowing what your risks are, and working together with your employer or organization to minimize these risks is important for keeping your body happy and work-ready.
When possible, look at your work environment to see if anything is within your control to be changed. I will use physiotherapy as an example: There are times when I can modify my environment in order to make a task easier on my body. I can raise and lower the treatment table, or my stool on which I’m sitting, or in some cases I can use equipment that is ergonomically friendly.
Other times, the environment is not ideal, but also not in our power to modify. This is when you need to think of your body mechanics – the way you use your body to perform a task. Here are some general tips, from head to toe, of ways you can keep good body mechanics. This list is not exhaustive so it is important to consider each task you have to do individually, and what risks may be involved.
Head and neck: a common posture that is a big no-no is the forward head posture where the chin juts forward and hinging occurs about one vertebra in the lower neck. Any time you are in an upright position, keep a nice gentle chin tuck, with the back of your neck long.
Upper body: the other common poor posture is the rounded shoulder posture. When in this position too long, the muscles in the front of the chest get tight, and muscles in the back get long and weak. Also avoid hunching your upper back, which can also contribute to a forward head posture. Keep your shoulders pulled back, with your chest open and proud.
Arms: working repetitively above shoulder height can put you at risk of an injury called ‘impingement’ in the shoulder. When it is possible, avoid having your hands overhead, or above shoulder height, especially if lifting. This can mean using a step if you’re trying to reach high, or finding ways to better position yourself around your task. Avoid repetitive reaching away from the body; if it is possible, put your body closer to where you’re working.
Hands and fingers: if your job involves a lot of bending of your wrist or fingers, gripping or grasping, it is important to stretch those tired muscles, and to strengthen the opposing muscle groups to balance it out. If you work at a computer, look to see what your wrist position is at the keyboard or the mouse. Ideally, they shouldn’t be bent up toward you too far, and the bottom of your wrist shouldn’t sit on a hard surface for a prolonged time.
Low back: Lifting techniques and proper sitting posture can make a big difference in low back pain! If you sit a lot, try to support the normal curve of your spine either through a ‘lumbar support’ or a rolled towel. For those who lift during the work day, remember the following important points. Keep the load you’re lifting close to your body. If what you are lifting is below waist height get into a lunge, or a squat position and stick your bottom out like you’re going to sit in a chair. This helps to preserve a ‘neutral spine’ – which is slightly arched. Lastly with regards to lifts, or picking anything up / putting anything down of any weight, avoid twisting and bending simultaneously.
Legs and feet: avoid twisting your body when you have a foot, or both, planted. Wear footwear that is supportive, and appropriate for your job. If you have been prescribed orthotics, ensure you wear them while working, to help support your feet and legs. If sitting, change up your position: try not to sit all your time with legs crossed, and if you do cross your legs, try to balance how long each is the leg on top.
If you do notice new pain or weakness, attend to it as soon as possible. While many injuries require 4-8 weeks to heal at the level of the tissue (although you may return to some functions during that period), this time frame can be made longer if the injury doesn’t have a chance to heal, or if it gets re-aggravated. Be conscious of what you feel, what your job demands are, what may have caused it, and how that risk can be minimized. Seek help when help is needed, be it through your work’s first aid service, or a health professional.
Across Canada, during the month of May there will be promotion of the profession of physiotherapy. Meanwhile, across Canada during the month of May, many people will be asking the question of “What is physiotherapy, anyway?” With National Physiotherapy Month nearing, I felt this would be a great time to answer that very question, and others that I have been asked from friends, family, and clients.
Questions such as:
- What is physiotherapy?
- What do you do?
- Who gets physiotherapy?
- Where can you work?
- How long did you have to go to school?
My dad, while I was undergoing my studies, once asked, “So, you’ll be cracking backs then?”
In short, physiotherapy is the assessment, diagnosis, and treatment of pain, injuries, and a broad range of chronic conditions. It is delivered in a number of ways including soft-tissue techniques (i.e. massage), hands-on manual therapy, modalities, and the most fun (for us) – exercises. Physiotherapy is often a complement with other health professions to help decrease pain, and optimize strength, function and overall well-being.
To become a physiotherapist in Canada now, an undergraduate degree must be completed, followed by a two-year Master of Science degree. The latter involves extensive hands-on practice both in class and in placement settings. The schooling doesn’t end there! Physiotherapists are committed to life-long learning, taking further education to improve current, or gain new, skills. (So to answer my dad’s question: yes, after courses and a specified number of hours of training, physiotherapists can ‘crack’ backs. Although we prefer to use the term ‘manipulate’.)
Physiotherapy isn’t limited to people with acute injuries – the service is also provided for people with heart disease, stroke, amputations, chronic pain, and lung disease, to name a few conditions. All ages and abilities can be treated: from pediatrics to geriatrics and everything in between. Physiotherapy can also be proactive, by promoting healthy living and avoidance of injuries and illness.
There are many settings in which physiotherapists work. The most commonly thought-of environments are the clinic or hospital. Physiotherapy is also provided in retirement residences, long term care facilities, hospices, community health centres, in home, in the work place, on the sports field, and in schools.
When looking at how many systems of the body can be treated with physiotherapy, and all the different environments in which it can be delivered, it is understandable for there to be some mystery around the subject. I hope this was helpful in understanding what the profession is. For further information, you can visit the website for the Canadian Physiotherapy Association (www.physiotherapy.ca), and the BC division (www.bcphysio.org). To learn more about National Physiotherapy Month check out www.npmcanada.ca, where you can find information, take a survey, or thank a physiotherapist. Although, seeing people feeling and functioning better is the best ‘thanks’ of all!
It’s that beautiful, sunny time of year again. It’s time to hit the tennis court, walk the golf course, hop onto the bike, or participate in other active ways of enjoying the Okanagan spring weather. As you increase your strength and endurance through these activities, be sure to also keep flexible. Make stretching a part of your routine.
Stretching describes a maneuver used to increase flexibility of soft tissue, lengthening the structures that have become shortened or stiff. Shortening can occur from situations such as immobilization (i.e. being in a cast), prolonged postures, weakness or imbalances of muscle groups, injury, or developmental conditions. Vigorous activity can also lead to shortening and tightening of muscles.
Benefits of stretching
Stretching improves flexibility by increasing the range of motion of a joint and decreasing stiffness in a muscle. This improved flexibility can improve performance in some sports, such as gymnastics, dancing, martial arts, or goalies in hockey. In other situations, improved flexibility can help obtain better posturing or help with pain. Other goals of stretching are to reduce the risk of muscle strain, reduce muscle soreness, and enhance mental and physical relaxation.
The risk of injury from stretching exercises is low when done correctly (described below), and when held for a short duration pre-exercise (less than 8-10 minutes of stretching per area), won’t compromise muscle strength.
When to stretch
It is important to ensure that you are warmed up prior to stretching. It is best to do so actively, such as by doing a light jog, bike, or quick walk for 5-10 minutes. If you are stretching pre-activity, do so after your warm-up regime. If stretching post-exercise, it follows the active cool-down.
The American College of Sports Medicine (ACSM) recommends stretching to be a part of overall fitness program, performed for the major muscle groups at least 2-3 times a week. In some cases, stretching should be performed daily.
How to stretch
Two of the more common kinds of self-stretching are static and dynamic. Dynamic stretches are usually performed pre- rather than post-exercise. These take the joint through the range of motion rather than being sustained at an end position. These exercises should be performed as instructed by a physiotherapist or your coach.
For static stretching, go into the position slowly, just to the point of feeling tension, not pain. Hold the position for 15-30 seconds if pre-activity, and the full 30 seconds if post. It is a low intensity stretch—it should not feel strong. If you feel like you are unable to hold the full duration, back out of the position slightly. Don’t bounce while here—just hold the position. When the 15-30 seconds is up (I recommend using a stop watch, or sing the ABCs—you’d be surprised at how long it actually is!) slowly release the tension, not allowing the muscle to recoil. The ACSM recommends 3-5 repetitions per stretch.
In order to avoid injury, it’s important not to overstretch, by taking the posture too far. The position should not cause discomfort or pain, and should be within a normal range of motion for the joint being exercised (don’t hyperextend).
Overstretching can do harm by causing strain, hypermobility, or even instability. Make sure that proper alignment is used—if you are unfamiliar with a stretch, seek assistance. Otherwise the exercise may not target the proper muscle, and can even cause stress to other structures
In some cases, extra help is needed. A trained individual, such as a physiotherapist, can use manual (hands-on) techniques to help you through the maneuver. Sometimes special techniques, such as ‘contract-relax’, will be used.
What to stretch
Post-activity, you’ll want to focus on the muscles that were just exercised.
Typically the muscles most frequently shortened are the hamstrings, calves, hip flexors and pectorals (front of the chest).
If unsure of how or what to exercise, or if you have an injury, be sure to seek advice from a trained individual to ensure you’re getting the maximum benefit from your stretching program, safely.
One of the most common reasons people require physiotherapy is for low back pain. Treating low back pain usually centers on the common goals of decreasing pain, increasing range of motion and improving function. For the majority of low back injuries a core stability exercise program is beneficial for improving function and returning to activities of daily living, work and sports. Core stability exercises are a common and often successful treatment in physiotherapy for recovering from an injury, preventing a further injury, improving general health and optimizing athletic performance.
So what exactly is core stability?
We have three different systems that aid in the stabilization of our spine. One is the passive system which includes non-contractile tissues such as bones and ligaments. The second is the active system which includes contractile tissues such as muscles and tendons. This active system of muscles that attach to the spine and pelvis is necessary for stabilizing the spine and producing motion. The third is the motor control system. This can be thought of as our ability to turn on and off the required muscles to the correct degree at the appropriate time.
What causes someone to have poor core stability?
A lack of stability is often seen when one of the above three systems is affected. This could include factors such as: an injury to the tissue itself, insufficient muscle endurance, muscle imbalance or poor motor control. In fact, in many people with low back pain it is common to see atrophy of the spine stabilization muscles, poor muscle endurance, a muscle imbalance or delayed activation of the stabilization muscles. Physiotherapy focuses primarily on motor re-learning, or learning to activate the correct muscles at the appropriate time, and improving the endurance of these muscles.
What exercises should I be doing to improve core stability?
It is important to begin by understanding what exercises to avoid, exercises that may be doing you more harm than good. We determine the quality of a core stability exercise not only by how well it turns on the correct muscles but also by the amount of stress it puts through the spine, known as compression and shear forces. For example, while a sit up may be a great exercise to strengthen the core, specifically the rectus abdominis muscle, it requires excessive bending (or flexion) of the low back and results in a high compression force on the spine. Repeated bending of the back and high compression forces on the spine is a common mechanism of injury for tissue damage to the vertebral disc. This would make it a poor choice when designing a core stability program. It would also be unwise to do this exercise alone, as it will most likely result in a muscle imbalance which could potentially lead to injury. It is advisable to start a core stability program with exercises that keep the spine in a neutral position and avoiding excessive bending and twisting. Common exercises that I often teach to improve core stability include a front plank, a side plank and a squat. Along with other exercises, these three challenge different muscle groups and have lower compression and shear forces through the spine which minimizes the risk of injury.
When designing a core stability exercise program it is important to focus on improving motor control and muscle endurance rather than trying to improve muscle strength at higher loads. It would also be beneficial to include a cardiovascular exercise, such as walking, to your program. The exercises you include should be comfortable and should not cause any low back pain. One exercise program is not appropriate for everyone. Exercises should consider your training goals (injury rehabilitation, injury prevention, general health or improving athletic performance) and your past medical history (including general health and specific history of low back injury).