(Keywords: Developmental Hip Dysplasia, hip arthritis, femoro acetabular impingement syndrome, chiropractic help, hip pain questionaire)
At the Chiropractic Coalface one comes regularly
into contact with patients who have had less-than-satisfactory hip
replacement surgery. In addition, I personally have several patients
every single day who are experiencing hip (not sacro-iliac joint) and
groin pain. Hence the beginning of a long journey of self-discovery
about the hip joint.
"If left untreated, and the condition does not resolve on its own, the long-term consequences are very serious, including a shorter leg and a pronounces limp, with premature onset of arthritis and hip pain."
Prevention of hip arthritis is vital and DDH was not, in my day, something we learned about in Chiropractic School. Nor was Femero Acetabular Impingement Syndrome, DDH's first cousin. Both if poorly managed have a high predeliction for hip arthritis.
In the normal healthy hip the upper part of the femur ends in a round, smooth ball...
which fits neatly and snugly right in a cup (called the acetabulum) in the large ilium bone...
Both the ball and the cup are lined with super-slippery, hard hyaline cartilage so that one doesn't have bone-on-bone contact. The hip joints after all bear the full weight of the body.
The joint is filled
with a nutrient-rich fluid that sloshes about supplying the cartilage
with oxygen and all it's needs for metabolism - it's living tissue, just
as muscle, bone and nerves are. Cartilage has no blood supply of its
own (as muscle, bone... do). This hyaline fluid also removes the waste
products of cartilage metabolism.
HYALINE CARTILAGE ...
Notice the position of the thighs in this normal vertex presentation... the "taylor's position" with flexed and ABducted hips. The ball is kept firmly in the socket.
The space in the belly may be, due to various factors very limited (tight) and some babies show a range of abnormalities from a moulded head to abnormal feet, a congenital torticollis or stiff neck... Likewise Developmental Hip Dysplasia may occur if the knees are forced together, with a tendency to subluxate the hips.
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Thus it's vital
the pregnant woman does not in the last trimester spend long hours
sitting in a cramped position. Stretching out whilst lying, walking,
swimming ... is essential, simply to make space for the developing
infant. Whilst DDH almost certainly has an underlying genetic
predisposition, scientists reason that the position of your babe in
utero is profoundly important. Read further...
DEVELOPMENTAL HIP DYSPLASIA ... what happens in utero?
Thus the chiropractor who treats Infantile Colic and finds a baby with a strong disinclination to turn the head one way or another (a common finding in "huilbabies" - the crying infant - as we call them in Holland), would be on the look out for other abnormalities such as DDH. More about Colic Chiropractic and the Pavlik harness used for babies with DDH ...
How DISABLING is your Hip Pain?
This hip pain questionaire has been designed to give your Chiropractor (and you) a more objective measure of how bad your hip pain is...
HIP PAIN QUESTIONAIRE ...
So, what is DDH?
Notice, in the X-ray above, the deep socket and especially the very definite lower margin of the acetabulum.
In the X-ray below of DDH, there is a shallow socket, with a sloping upper margin instead of a proper roof. In addition the lower margin of the acetabulum is barely seen.
Ancillary findings ...
Notice, in comparison with the normal hip above, how a much larger portion of the ball protrudes beyond the socket; it is un-roofed, and cannot contribute to bearing the weight of the body. The nett result is that the weight of the body is concentrated on a much smaller area of cartilage between the ball and socket, with far greater stress on the hyaline cartilage and underlying bone.
Notice too, instead of a nice round ball, the flattened, 'mushroom-shaped' medial margin of the ball; this is a finding common to several hip abnormalities.
Notice again in the X-ray below the various features of Developmental Hip dysplasia. The sloping socket, the large unroofed part of the ball, the flattened femoral head, the wide margin in the lower part of the hip, and now, in this slightly older patient, the beginning of 'sclerosis' on both the roof of the socket and the ball. This is hip arthritis in the making.
This patient already has pain in the groin radiating down the inner thigh muscles, pain on the side of the hip, and sacro-iliac joint pain. She also has short leg causing a tilted pelvis and a curvature of the spine. Undiagnosed Development Hip Dysplasia causes a leg length inequality.
Take no positive action and there's a hip replacement waiting in the wings. It won't be long before hiking will become painfully impossible.
Examination of the infant
If you take your colicky baby to a Chiropractor s/he will during the routine examination gently flex the hips, moving this way and that, listening for a deep-sounding 'thunk' as the hip subluxates. In fact whilst caring for your child, you too should listen out for odd sounds coming from the hip joints.
Whilst only 1 / 1 000 babies (about 80% girls) have Developmental Hip Dysplasia, it's probably a much higher percentage of unhappy, colicky babies.
In the clicking hip of the small infant, the diagnosis of DDH is confirmed with a ultrasound scanner which allows the radiologist to view the hip whilst it's in motion. S/he'll actually will see the hip subluxate as it clicks.
In serious cases the hip actually dislocates. That's a disaster. In mild cases it simply subluxates and clicks and becomes arthritic in later life.
Your chiropractor, if s/he is experienced in the examination of the infant will be doing these tests, Hip Dysplasia Ortolani Galeazzi Barlow, noted orthopaedists to whom the world is indebted for their enormous contribution to the understanding of Developmental Hip Dysplasia.
There is a strong genetic predeliction for Developmental Hip Dysplasia. If Granny or Gramps had an arthritic hip, then every one of their children and grandchildren should be routinely examined for abnormalities like Developmental Hip Dysplasia (DDH) and Femoro Acetabular Impingement Syndrome (FAIS).
Breech births increase the likelihood of DDH too, by a very large margin of ten. Now it's 1/ 100 babies.
Add to that the effect of a constrained, tight intrauterine last-trimester, and a poor diet, and smoking, and we may be looking at 1/20 - 1/50 births.
The treatment of the infant with DDH cannot be successfully achieved only with chiropractic. Your chiropractor would reduce the subluxation, but modern care involves an orthopaedic device called the Pavlik harness which keeps the head of the femur firmly in the socket.
Why? Because in the newborn, the socket hasn't yet properly formed. It's the presence of the ball in the socket that builds a proper socket and to date that can only be done by successfully keeping the femoral head firmly in the acetabulum - that's what moulds the socket to the correct shape.
However, in the child, young adult and adult, I believe that chiropractic has a major role to play. Currently I have one adult woman of 45, two young women in their early twenties and one girl of nine under care. All four have far less pain, and are more than satisfied with chiropractic care. All four had been less than satisfactorily managed medically. Developmental Hip dysplasia CaseFile ...
You cannot alter the shape of the socket, but what you can do is to strengthen the muscles of the hip, buttock and pelvis. Hip exercises ...
I've been developing these exercises for several years, and am now ready to share them with you. They are tricky, be warned. Do them every morning before arising from your bed, and again before going to sleep. Obviously again during the day would be helpful. They take about two minutes only.
So, I've split the exercises into three parts. Do part I for perhaps a week until you can do it confidently, and only then proceed to part 2.
You've practised part 1 and can do it confidently? Right, you're ready for part 2.
And now on to Developmental hip dysplasia exercises, part 3. Make this exercise routine part of your life and by reducing the tendency for your hip to subluxate, pop out, click, it will add years to the hip joint and save you a lot of pain; and perhaps a total hip replacement.
It's widely acknowledged medically that Developmental Hip Dysplasia leads unerringly to hip arthritis and surgery. "Total hip surgeries may be inevitable later in adulthood."
There is no research currently
to prove my assertion, but my experience of this condition is that
correct management from an early age, and a sensible expercise regime
will be able to prevent many total hip replacements. But there is I
regret no chiropractic research following the child with DDH for fifty
years! Not yet.
HIP ARTHRITIS ...
Femoro acetabular impingement syndrome Case File
FAIS is an allied condition in which there is TOO MUCH
coverage of the ball. Conversely it makes for an inordinately stiff hip
in the young person, mimicking an arthritic capsular pattern, but with
no arthritis. It too leads to hip arthritis. Chiropractic manages this
condition exceptionally well too.
Femoro acetabular impingement syndrome CASE FILE ...
HEALTHY LIVING TIPS for the pregnant woman
The rapidly growing infant places great demands for nutrients and oxygen on the mother. A diet rich in the healthy fats, protein, carbohydrate, vitamins and minerals, HEALTHY LIVING TIPS ... and of course ample oxygen. I know of no direct link like a lack of Folate, or the smoking mother to Developmental Hip Dysplasia but that's probably simply because researchers haven't yet discovered the link.
Of course, because of the prevalence of backache in pregnancy, WALKING BENEFITS ... are even more important.
OMEGA-3 fat is essential for healthy blood vessels, and for the growing brain. Sixty percent of the brain is built of omega-3 fatty acids. Think fish oil and/or flax seed nutrition information ...
Mixed hip dysplasia AND impingement syndrome
Occasionally, both hip dysplasia and either a CAM or Pincer deformity can coexist in the same hip, confusing the clinician. Hypermobile hip dysplasia CAM FAIS ...
Are you enjoying this site? Finding it useful? Then you'll love Stones in my Clog by chiropractor Dr Bernard Preston. Chiropractic stories from the Holland, light, interesting and fun.
True tales from the Chiropractic clinic. Only $2.99 on your Kindle, tablet or smartphone.
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Interesting challenges of the day
1. Mr B came initially for a painful and stiff neck and then asked whether chiropractic could help the cold numb feeling running down the side of his thigh for six months. Meralgia paresthetica is a double crush syndrome with the nerve affected in the back and groin. He's 80% improved after five treatments.
2. Mrs C has a long history of severe, disabling migraine headaches since having her wisdom teeth removed. She clenches her teeth at night. After six treatments she has no migraines but some jaw joint discomfort remains; a bite plate is in the offing.
3. Mrs U has the trophy for the worst back this year. After major surgery with plates and screws two years later she still had paresis in the lower leg and severe disabling back pain. She's doing far better than expected, in no little part due to a lift in her shoe for a very short leg.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of her foot. It started after a long drive in the car. After six treatments she is 60 percent better, but it's slow and is going to take the full 6 weeks to heal.
And now a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. This lady is a 70 year old woman, is on maintenance care for a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection after a total shoulder replacement. After four operations he is incapacitated.
8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.
9. This man is a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. I reassured him it's not hip arthritis.
10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.
11. Mr C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
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