“I have arthritis in my hip, and I am going to need a replacement within the year.” I have heard this many times during my years as a physical therapist. But in a society where hip replacement surgeries are getting less invasive and more common, they are not always the best – or right option.
I have also heard stories like this:
Patient “I injured my right hip back in my 20’s in a skiing accident. Now it limits me all the time and the x-rays showed pretty significant arthritis. I am planning surgery in a few weeks. Surprisingly, the left hip images actually showed more ‘bone-on-bone’ arthritis, so the surgeon said I could have that hip replaced about 6 months after the right.”
Me: “Does the left hip hurt or bother you?”
Patient: “No, but it will need it anyway someday, so I might as well get it over with now.”
While pain from arthritis is more common in the 50’s and 60’s, arthritis is always progressive, but pain is not. For example, my grandmother lived to be 95 years old and never had a joint replacement. While I’m sure x-ray images would have shown significant degenerative change/arthritis, she was active, climbed stairs, went to the YMCA for exercise, and never used a cane or walker.
One explanation for the scenario above is that after the hip injury from skiing, that individual learned ways to compensate for early pain by using the right leg less and relying more on the left. Over the years, the right hip lost some of its mobility and strength, while the left leg gained more strength; and the cycle continued.
What is Hip Osteoarthritis?
Arthritis occurs when the cartilage in the hip joint deteriorates. It can lead to pain, stiffness, and reduced mobility. While surgery, such as hip replacement, has been a standard treatment option, it involves risks, increased pain and decreased mobility during initial recovery, and potential complications following.
Physical Therapy for Hip Pain
Physical therapy focuses on improving the joint mobility and function and increasing strength in the hips, core, knees, ankles. At RecoverRx Performance Physical Therapy, we also focus on manual techniques to reduce compression on the joint and relieve tension/tightness in the muscles around the joint.
The British Journal of Sports Medicine published a paper just last year showing that exercise was as effective as NSAIDS at improving pain and function after 4 weeks or 6 months. Imagine, a treatment that offers all the benefits as medication but with the side effect of increased fitness vs risk of myocardial infarction, gastrointestinal bleeding, and stroke (https://bjsm.bmj.com/content/early/2023/01/02/bjsports-2022-105898)
Furthermore, the goal of physical therapy is long term joint preservation (to delay or avoid the need for invasive procedures), improved overall fitness levels, and an increased participation in the activities that bring meaning and purpose to our lives. While surgery removes the old bones and replaces them with new materials, the surrounding tissue is still going to need to regain range of motion (which is often restricted temporarily or permanently by post-op precautions to avoid dislocating the implant), regain strength (especially in the muscles effected by the procedure), and relearn proper walking patterns to avoid the long term complications from compensation that we saw in the skiing example above.
And let’s be honest – we are creatures of habit. So if we are not very active before surgery, there is a strong correlation to not being active after surgery (https://www.jospt.org/doi/10.2519/jospt.2018.7877) Instead, physical therapy will empower you with self-management techniques, home exercises, and lifestyle modifications to promote long-term benefits. By making exercise and activity your first line of treatment and defense, you may be surprised at how much better you feel and how much your energy and motivation improves as well!
If you are ready to get on the path to recovery, give us a call today to learn how we can help you!
Dr. Sarah
