Hip Disorders: Osteoarthritis & Bursitis

Hip Disorders: Osteoarthritis & Bursitis

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.

Sun City Physiotherapy Locations

Downtown

1468 St. Paul Street, Kelowna, BC
Phone: 250-861-8056
downtown@suncityphysiotherapy.com
more info

Glenmore

103-437 Glenmore Road, Kelowna, BC
Phone: 250-762-6313
glenmore@suncityphysiotherapy.com
more info

Lake Country

40-9522 Main St., Lake Country, BC
Phone: 250-766-2544
winfield@suncityphysiotherapy.com
more info

Lower Mission

3970 Lakeshore Road, Kelowna, BC
Phone: 778-699-2006
lowermission@suncityphysiotherapy.com
more info
Skiing and Snowboarding

Skiing and Snowboarding

Physiotherapy » Posts Tagged "treatment"

Skiing and Snowboarding

Ski and snowboard season is here!

I’m sure many of you skiers out there have already started to dust off your equipment, check the daily snow report and maybe even head to the mountain for some early season skiing.

We are fortunate in Kelowna to have so many great ski resorts nearby. Skiing and snowboarding are great ways to get some fresh air and exercise when it can be a challenge to stay active in Kelowna through the fall and winter. This is especially true lately when it has been so wet, cold and dark outside. Since most outdoor activities have wrapped up for the summer, I think that this is the perfect time of year to start conditioning your body in preparation for the upcoming ski season, if you are not already doing so. A good exercise program which addresses core and hip stability, balance, flexibility, muscle endurance and aerobic conditioning will go a long way to help improve your endurance and technique on the mountain to help you get the most out of your season.

If you are currently recovering from an injury or if you have just been sedentary for some time and are noticing a lack of strength, balance, range of motion or overall conditioning, it can be very useful to engage in a progressive rehabilitation exercise program prior to doing something more demanding on your body, like hitting the slopes for the day.

In the clinic, it is not uncommon to see overuse or traumatic injuries pop up as a result of unresolved muscle weakness, due to injury or sedentary behaviour, followed by more demanding or intense exercise. This excessive demand could come from lifting very heavy weights, running too fast or too far, attending an advanced exercise class or participating in a full day of winter activities. While the above examples may very well be a realistic long term goal, you may be putting your body at an increased risk of injury if you engage in an activity that your body is not adequately prepared for.

Exercise needs to be consistent and frequent, rather than all or none. Set a goal to exercise small amounts each day. An exercise program should include a combination of core stability, strengthening, stretching, balance training and aerobic conditioning.

If you are currently recovering from an injury or if you have been inactive for some time and are not sure where to begin, a physiotherapist can help get you on the right track, by developing a safe and effective individualized home exercise program based on your specific goals and current ability.

Sun City Physiotherapy Locations

Downtown

1468 St. Paul Street, Kelowna, BC
Phone: 250-861-8056
downtown@suncityphysiotherapy.com
more info

Glenmore

103-437 Glenmore Road, Kelowna, BC
Phone: 250-762-6313
glenmore@suncityphysiotherapy.com
more info

Lake Country

40-9522 Main St., Lake Country, BC
Phone: 250-766-2544
winfield@suncityphysiotherapy.com
more info

Lower Mission

3970 Lakeshore Road, Kelowna, BC
Phone: 778-699-2006
lowermission@suncityphysiotherapy.com
more info
Hockey Injuries

Hockey Injuries

Hockey Injuries

Every Fall, thousands of Okanagan hockey players return to the local rinks. Although most will have a great year of pain free hockey, many will suffer an injury during the season.
The most common types of lower body hockey injuries suffered are to the groin and hip flexor muscles. These muscles cross the hip joint from the pelvis and either pull the thigh across the midline of the body (adduction) or upward into flexion. A certain amount of hip rotation also occurs during this. These actions are key movements during skating. They occur when pulling the leg back under your body, prior to push off or when turning and performing crossovers. These same muscles are also under stress when used to control end-range extension and abduction (hip movement away from midline of the body) during the push phase of the stride. In fact, it is during this controlled muscle lengthening (eccentric contraction) that the muscle most commonly fails and a strain occurs. These important muscles are also used to stabilize the body during shooting, brace during body contact, and when a player slips or catches an edge.
Hip strength imbalances, decreased hip mobility, poor core/trunk stability, and lack of a good dynamic warm up have all been associated with increased risk for these injuries. The age of the athlete and a previous hip injury are also predictive factors. An athlete can’t change their age or go back in time and erase a previous injury, but they can be proactive about the other factors.
Research suggests that hip adductor (groin) strength should be no less than 80 percent of abduction strength (outer hip muscles). This can be worked on by including hip exercises such as lunges that step into 45 degree quadrants and lateral directions as well as forward and back (lunge matrix). I also like the use of the lunge matrix because it works on hip mobility and hip stability in positions your hip often gets into during hockey. You can also focus on your core stability during these movements. Training your trunk to stabilize during the skating and shooting motion is paramount.
A dynamic warm up is a series of sport specific movements that are designed to prepare the muscles for use and are performed in a safe controlled fashion. In hockey these can include movements such as squatting, lunging and high knees to name a few. With the hockey teams I work with, I will often go through a series of 10 to 15 movements off ice before getting equipment on. As a Physiotherapist, my personal routine is to usually target a few specific movements by performing air squats and lunges with rotation in the dressing room prior to lacing up my skates.
Even with the best prevention, an injury can still occur. Hockey is an explosive game with quick changes of direction and plenty of incidental contact. If you do suffer an injury to the groin region that you think is a strain, I suggest you ice the injured area for the first couple days and abstain from pain provoking activities. You should not return to skating until you can walk and lunge without pain. Optimally, you should make your first session back a skating only session and not put yourself into a game until you know you can tolerate skating. If you do have pain that does not settle in a couple days, or you experience other symptoms such as pain with coughing, or numbness into your groin, you should have it assessed by your doctor or Physiotherapist. There are other conditions that can occur in the region that are more serious than a muscular strain and these should be ruled out. Recovery from injuries to the groin can take anywhere from 3 to 5 weeks and they have the potential to become chronic if not treated properly.
If you suffer from this type of injury, talk to your Physiotherapist about the best course of treatment so you can get back on the ice sooner.

Sun City Physiotherapy Locations

Downtown

1468 St. Paul Street, Kelowna, BC
Phone: 250-861-8056
downtown@suncityphysiotherapy.com
more info

Glenmore

103-437 Glenmore Road, Kelowna, BC
Phone: 250-762-6313
glenmore@suncityphysiotherapy.com
more info

Lake Country

40-9522 Main St., Lake Country, BC
Phone: 250-766-2544
winfield@suncityphysiotherapy.com
more info

Lower Mission

3970 Lakeshore Road, Kelowna, BC
Phone: 778-699-2006
lowermission@suncityphysiotherapy.com
more info

Snowmobiling aches and pains

On February 2, the groundhog told us that spring will arrive soon. But don’t fear – the sledding days are not yet over. If you are looking to maximize your snowmobiling adventures or to try the activity for the first time before the snow disappears, then this is for you.

Like any other activity, it is important to understand the risks and how to prevent injury. In this case I’m not talking about injuries from accidents, although that is still very important to take precautions to avoid. My focus is instead on the aches and pains you may experience throughout your body.

Snowmobiles have come a long way from the original 20 ton machine that was first designed for log hauling, with most modern machines weighing over 500 lbs and able to reach speeds of 110 mph (Heisler 2010). With prolonged time on the machine you are exposed to awkward positions for your upper body, long periods of sitting with a forward bent posture, and vibration stresses. Not to mention the heavy lifting, pulling, and pushing when you need to get out of a jam. Common aches and pains from riding are the low back, neck, shoulder and the occurrence of white-finger syndrome (Heisler 2010).

I’m not suggesting you quit your sport! There are certain factors that can be modified to prevent you from injury, and to keep you more comfortable.

A factor to the aches and strains is the ergonomics of a snowmobile. One of the most important parts to adjust is the steering bar (Rehn et al. 2005). Ideally it should be close enough to your body and have the grips oriented in a way so that your wrists aren’t bent, your shoulders aren’t hiked up and you do not have to reach so far forward. This will put you in a more comfortable posture for your upper limbs and your lower back, as well as lowering the grip force you need to use. Specific positions are to have your wrists neutral, elbows bent 60-70 degrees and if you have a seat back, for it to be tilted back 45 degrees (Heisler 2010). Grips should ideally be about 1.5” in diameter to lessen the grip strength required to steer (Heisler 2010). When looking at buying a snowmobile, also consider its seat suspension. Whole-body vibration, which will occur even on groomed trails, puts the discs in your back at risk for injury (Bovenzi and Hulshof 1999).

There are other factors to consider beyond just the ergonomics of your sled. Here are things you can do to prevent injuries:
Avoid sitting too long in poor posture: When you sit, you lose the normal curve in your low back. This is made worse by bending forward. The posture in combination with the machine’s vibration puts the discs at risk of injury. When possible, alter how you sit so that you back isn’t arched so much.
Wear appropriately warm mitts: Vibration of the upper limb, along with cold exposure, can contribute to the occurrence of “white-finger syndrome” which increases the chances of frostbite. It will also affect your ability to grip properly (Heisler 2010). To minimize this risk, stay warm!
Keep strong: Think of sledding as you would another sport – one that requires strength and endurance. Keep your body fit, and flexible, during the week to prepare you for the weekend adventures.
Listen to your body: If you’re getting fatigued, it’s time for a break. That is when you have a greater chance of adopting poor postures, or hurting yourself with the sudden jolts and turns.

And of course, listen to your body if you’re experiencing pain. Delayed onset of muscle soreness, DOMS, has been reported to last about 1-3 days after snowmobiling (Heisler 2010), but if it extends beyond that, or if you’re finding you’re getting weak (a loss of grip strength is commonly reported) – seek out care from a health professional.

Enjoy the rest of the sledding season, have fun, and stay injury-free!

Thoracic Outlet Syndrome: another source of neck and arm pain.

It’s well known that pain in your neck, radiating down the arm can be a result of an irritated nerve root in your neck. What’s often overlooked, is that compression can occur further down the nerve continuum as they bundle together and exit the neck. These nerve bundles are partnered with major blood vessels as they travel through the shoulder and further into the upper arm. As they exit the neck, these neurovascular structures become susceptible to compression. Knowing this, we now consider the possibility of compression of not just the nerves, but the blood vessels too.

Thoracic Outlet Syndrome (TOS) is a complex presentation of signs and symptoms that result from compression of the neurovascular bundle as it emerges from the thorax and enters the upper limb. The thoracic outlet is the space bordered by the scalene muscles, first rib, and clavicle. The neurovascular structures pass from the neck and thorax into the axilla (arm pit region), and continue to branch further into the upper arm, to forearm, and hand. TOS is more common in women, particularly those with poor muscular development, poor posture, or both.

In the office, we assess and diagnose injuries related to repetitive upper extremity use or trauma. Swimming, baseball, tennis, and volleyball, are common sports that may bring on symptoms of TOS. Functional and biomechanical assessment of these patients who engage in repetitive and extreme abduction (out to side) and external rotation (outward rotation) of the shoulder, often demonstrate TOS signs and symptoms. Other patient populations who may develop TOS include those who are in sustained poor postures in their activities of daily living and work, and tend to develop shortened chest and shoulder structures, and weak/lengthened neck and upper back structures.

Anatomically, TOS can be a result of bony and soft tissue factors. Bony causes often involve rudimentary or “extra” ribs which increases the risk of compression, e.g. cervical rib. Soft tissue factors can include muscular tightness or hypertrophy related to sport. Trauma or mechanical stress to the neck, shoulders, upper back, or upper extremities can bring on signs and symptoms.

The common presentation of TOS includes a high degree of variability. Most people describe a vague and often confusing source. Pain can originate from the root of the neck and radiate to the entire arm. Strength loss can occur. Depending on the structures being compressed, people can also experience numbness, swelling, tingling in the arm and hand, heaviness in the arm, loss of movement, rapid fatigue, dull aching, cold and discolouration.

Our challenge as physical therapists is to distinguish by specific testing, whether or not you present with a true TOS. From the comprehensive list of signs and symptoms above, we can easily see how TOS can mimic neck injury (disc, nerve root pain), and even shoulder and elbow injury.

Physical therapy treatment addresses postural abnormalities and muscle imbalance, in order to assist in alleviating symptoms by relieving pressure on the thoracic outlet. We work to minimize tension directly around the nerve entrapment points. Manual therapy and exercise strategies would assist in correcting muscles that have shortened or lengthened because of poor posture. It is also important to take into consideration a patient’s activities of daily living, work environment, sleep positions, etc. Surgical intervention is often considered in severe cases of blood vessel compression and compromise.

Symptoms often resolve with conservative physical therapy in 90% of individuals, with good ability to return to previous lifestyle with little difficulty.

Vince Cunanan is a registered physiotherapist and associate at Sun City Physiotherapy. He can be contacted at our Downtown St. Paul Street location or email downtown@suncityphysiotherapy.com