Hip Pain (Osteoarthritis)
The hip joint is where the pelvis and the femur (thigh bone) meet. It is classified as a ball and socket joint. The ball (the head of the femur) sits in the socket (acetabulum) and this joint is further stabilised by a thick capsule and strong ligaments which hold everything in place. The femur is the longest and heaviest bone in the human body, and there are several large muscle groups that act around the hip joint, resulting in the generation of very large forces.
The femoral head and the acetabulum are both lined with cartilage. The cartilage allows for a degree of shock absorption and smooth movements of the joint surfaces against one another. The joint is also lubricated by the presence of synovial fluid. Overall, the hip joint favours stability more so than mobility. Its range is not the same as that of a shoulder, but it makes up for that in its ability to support significant loads.
Osteoarthritis is a term used to describe the age related changes that occur in any joint over time, either secondary to an injury/deformity, or often without an obvious identifiable cause. The first apparent change is usually cartilage damage, which increases over time, eventually causing the underlying bony surface to become exposed with growth on the edges of the joint, visible on X-ray as bony spurs.
Symptoms are often worse on waking up in the morning, after over-activity, as well as sitting or standing for a prolonged period of time. As the tissues around the joints become inflamed and painful, the simplest of actions like climbing stairs or bending to tie a shoe-lace can suddenly seem very difficult, which naturally has a detrimental effect on a person’s quality of life.
Various elements can predispose people to developing the condition and increase the rate of degeneration. These include obesity, genetics, gender (women being more likely to develop OA than men), the onset of old age, overuse of the joint in physically demanding occupations, or in professional athletes and previous joint trauma.
A diagnosis can be made using various methods including clinical criteria and radiographic findings (X-rays and scans). The American College of Rheumatology recommends a combination of history, physical examination and laboratory tests to help diagnose osteoarthritis.
The symptoms emerge as a result of a number of processes occurring in the hip. These processes include aggravation of joint surfaces, bone thickening and spurs, tightening muscles that are trying to protect the joint, as well as inflammation of the joint capsule and the surrounding structures.
Movement and Muscle Dysfunction
The body’s response to this damage is to attempt to protect the joint and to avoid painful positions. Research has shown that those suffering from hip OA decrease their speed of walking along with reducing their step lengths. Patients with hip OA will often alter their gait pattern to avoid pain, which often results in inefficiencies or a limp.
The inefficiencies of limping can increase the energy cost of walking by up to 50%. The range of movement of the joint is affected, and as a result of altered patterns of muscle activity, both muscle strength and stability around the affected hip reduces. This impairs the body’s ability to effectively support the joint and to control loads placed on it.
Compensations for these changes have been shown to have detrimental effects on joints other than the hip itself. Certain muscles that act around the knee become weaker, and hip OA sufferers have been shown to be more likely to require subsequent knee replacement surgery on the opposite limb. There have even been demonstrable changes in forces at the ankle.
Experts agree that symptom relief can be achieved if muscular imbalances can be addressed and the muscles are trained to work more efficiently. At the initial onset of OA, doctors often advise regular light exercise along with painkillers and/or anti-inflammatory drugs to manage symptoms.
The majority of conservative treatment for hip osteoarthritis is based on the management of the condition and improving muscle strength around the joint. Once therapeutic exercise has been introduced and adjustments in lifestyle made, if the OA continues to limit normal functioning in daily life, then a surgical intervention is often considered. This can involve resurfacing of the hip joint. If this fails, the last resort is to replace the joint with an artificial hip, in a procedure known as hip arthroplasty or Total Hip Replacement (THR).
The National Institute for Health and Clinical Excellence UK (NICE), advises physiotherapy and therapeutic exercises as the most effective and highly-proven treatment for reducing symptoms and slowing down the degenerative process.
AposTherapy® Treatment for Hip Osteoarthritis
Based on the latest evidence regarding the central role biomechanics plays in osteoarthritis treatment, AposTherapy® offers a novel approach for the treatment and management of the disease. The AposTherapy® device allows us to alter the forces acting upon the hip joint with the aim of reducing joint loads that occur when we are walking. This therefore reduces the pain and compensations that have been occurring as a result (limping), and facilitates a more normal walking pattern. Simultaneously, the convex pods provide a low level of instability to the wearer on every step whilst they carry-out their normal daily activities. This requires the muscles to activate and “stabilise” the hip joint, thus acting more efficiently as the shock absorber. Over time, after wearing the devices for a short period every day, the body “learns” to walk with this more co-ordinated pattern for lasting benefits. The aim is to provide the joints optimal control and stability both in or out of the AposTherapy® devices.
AposTherapy® is clinically proven to reduce pain, improve patients’ walking patterns and contribute to a better quality of life in hip osteoarthritis.