Mrs Green, a 69 year old retired post mistress, visited Cheadle Osteopathy because of pain in her right groin, knee and buttock. She had been suffering on and off for three years but it had gradually got worse and more frequent over the last 6 months. There had been no recent falls or injuries that would account for her symptoms. She said the pain was like a “toothache”, a deep, dull, ache. At its most severe the pain was 7 (out of 10) on a pain scale.
The pain was at its most intense in the mornings, when she first got out of bed, and again in the evening after the day’s activity.
She had seen her General Practitioner (GP) two years ago about it and was prescribed a course of Naproxen (a Non-steroidal Anti-inflammatory drug- NSAID). Initially these NSAIDs helped Mrs Green but after 3 weeks she started to develop stomach pains and indigestion. Having read through the accompanying NSAID advice sheet she discovered that her symptoms were most likely attributable to the NSAID. She returned to her GP and he prescribed her Omeprazole, to help protect her stomach, whilst continuing to take the NSAIDs.
When Mrs Green visited us for Osteopathy, she was awaiting an appointment for NHS Physiotherapy, but felt she needed to start treatment sooner, as her symptoms were becoming more debilitating. This lady was a keen dog walker and enjoyed gardening, both of which were becoming increasingly more difficult.
When we examined Mrs Green we found her right hip was restricted in various directions, painful to move and made a “clicking noise”. As Osteopaths we look at how the whole body functions and how one part of the body can have a knock on effect on another. We also examined her pelvic joints, lower back, and knees. It was noted that Mrs Green had a longer right leg, than her left, by about 5mm. This was not something that Mrs Green had previously been aware of. Over time it was felt that, as a result, Mrs Green would have put more load bearing through her right hip joint, accelerating the “wear and tear” in the joint on that side. It had also lead to an imbalance in the way the two sides of her pelvis moved and an unequal stress on the joints of her lower back. Some of the symptoms relating to the buttock pain were thought to be more likely coming from the knock on effects on the lower back and pelvis than being related directly to the hip itself.
In the past Mrs Green had been a keen squash player and a runner, both of which can be quite high impact on the joints.
A number of specific tests helped to confirm that the diagnosis was most likely “wear and tear” or hip osteo-arthritis.
We discussed our findings with Mrs Green and with her consent it was agreed that we would write to her GP to present our findings and request a x-ray of her hip. This would help to confirm the diagnosis and ensure that she was being offered the best management and treatment options available to her.
The x-ray would only help to confirm the severity of her condition, in the meantime we were happy that it was safe to proceed and treat Mrs Green to alleviate her symptoms and improve her mobility.
We provided physical therapy, manual techniques such as soft tissue massage and joint mobilisations, for her hip as well as her pelvis and lower back. She was also given exercises that helped to reinforce the benefits of treatment at home. We discussed ways she could adapt some of her garden postures and jobs to reduce the stress on her hip and back.
After a few sessions Mrs Green was finding that she was more comfortable, required less NSAIDs, was sleeping better and able to walk her dog for longer with minimal discomfort.
Her x ray results confirmed that she had ‘moderate’ Osteo-arthritis of the hip. She was referred to see an Orthopaedic Surgeon and they were in agreement that she should leave surgery for the time being and continue with her overall management program of pain relief, as required, exercises and Osteopathy every couple of months.
What is Osteo-arthritis?
Commonly known as “wear and tear”, it is when the protective lining (cartilage) of a joint, wears down over time, leaving the bone beneath exposed to increased load bearing and rubbing of the joint surfaces. The result is inflammation, pain, swelling, stiffness and reduced movement.
The area where symptoms are felt may not be around the joint which is arthritic. For example some people experience hip osteo-arthritis as knee pain or pins and needles in the arm coming from an arthritic neck. A thorough examination by a professional who understands body mechanics, such as an Osteopath, can help in identify the root cause of the symptoms and therefore advise about the most appropriate approach to treatment.
It commonly occurs as part of the aging process but can be accelerated by injury or trauma to a joint or chronic increased loading or pressure. In theory it can affect any joint in the body but is most frequently seen in the hips, knees, hands and spine (when it is known as spondylosis).
Pain is typically worse when trying to move after prolonged periods of rest and by “over doing things”.
It cannot be reversed and is a progressive condition, meaning it is likely to get worse over time, however it is often well managed with pain killers (such as NSAIDs), physical therapy such as Osteopathy, specific exercises and lifestyle adaptations. Occasionally surgical joint replacements may be required, but they are a last resort.
Management of this condition also involves:
- Weight management – in some cases losing as little as a half a stone in weight can help to reduce symptoms.
- Muscle strengthening – Strengthening around the joint can help to stabilise the joint and improve symptoms.
- Stretching – several times daily to maintain good ROM.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDs) – these drugs can play an important role, helping control pain and reducing inflammation. Long term use should be cautioned as they are strongly associated with gastric ulcers and can cause renal (kidney) impairment.
- Use of pain killers – Can help to alleviate pain.
- Use of a cane – this may help provide support.
- Use of supplements – The range of supplements varies. Some have come in for criticism as they lack adequate research, however some have gained popularity and may be worth trying as an alternative to long term NSAID use.
Surgical Intervention for hip osteo-arthritis
Total Hip Replacement – This surgery replaces the top part of the thigh bone, the damaged “ball” of the ball and socket formation of the hip joint, with a metal ball. The hip socket is resurfaced using a metal shell and a plastic liner.
Hip resurfacing – This is a surgical option that can provide relief while delaying hip replacement surgery. In hip resurfacing, the diseased hip joint surfaces are removed surgically and substituted with metal, rather than removing the ball of the hip socket, the surgeon covers it with a metal cap. Future hip replacement surgeries are still possible.