PAVLIK HARNESS

Developmental Hip Dysplasia (DDH)

The HARNESS is used constantly in the first six weeks of your baby's life after which s/he will be weaned off the device for the next couple months.

Developmental Hip Dysplasia is a condition more frequent in a breech or transverse presentation in utero resulting in a shallow hip socket for the femoral head. This allows the hip to subluxate or dislocate in the newborn.

The key tests performed by your chiropractor are the Ortholani, Galeazzi and Barlow manoevres. You may yourself notice abnormal skin folds in the groin and a resounding "thunk" in the hip when you change your baby's diaper.

DDH in its severe form will be immediately detected by the paediatrician, but mild conditions can slip through undetected. If present, it is essential that your child wears a Pavlik Harness which keeps your baby's hips firmly set in the socket. This allows the developing socket to grow deep enough to support the hip.

In our chiropractic clinics we see a significant number of patients, young and old, with DDH that was not detected at birth. Pain develops in the groin, and often radiates either down towards the knee, or upwards to the upper lumbar spine. The leg may actually "collapse" under your weight, and I've recently be treating a lad of 10 who had pain so severe that he was in a wheelchair for a week. Luckily he's back playing football, though that is being carefully assessed. Sometimes your sporting routine may have to be changed to accomodate the changes in the hip.

It is a condition that can, in the adult, be well managed with chiropractic but really the solution is early diagnosis, and use of the Pavlik harness for your baby. It's a simple device that will causes your baby no discomfort - far better than a lifetime of misery.

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HIP ARTHRITIS

The reduced movement limits the flow of capsular fluid in the joint resulting in poor nutrition of the hyaline cartilage - untreated it will rapidly degenerate. Chiropractic aims to increase the movement in the joint... HYALINE CARTILAGE ...

PRESENTATION

If there is doubt, and ultrasound 'echo' scan is used. This has the advantage of no ionising radiation such as X-rays and the examiner can see precisely what happens when the "thunk" occurs. Does the hip subluxate or dislocate?

Missed, the young toddler will walk with an unusual waddling gait if the dysplasia is in both hips, with a greatly increased lordosis in the lumbar spine. This sets your baby up for not only hip and groin pain, but back pain in the future. A technically difficult operation is on the cards, when the hip has to be completely dislocated. The trick is not to be neurotic but, if you notice something unusual, the sooner you do something the better. Treated early the Pavlik harness means that the hip, kept firmly in the socket, carves a normal deep socket. Missed and neglected, your baby will likely have a shallow socket, an "unroofed" hip, and the prospect of much pain and one or more total hip relacements in his or her future. Prevention... a Pavlik harness.

The young adult presents with groin pain, and often pain in upper lumbar spine and sacroiliac pain. The hip may 'give'. It may be one or both hips. Running a finger up the inner thigh causes SEVERE PAIN. Big time, the muscles of the groin, and the capsule are extremely tender on palpation. Ranges of motion of the hip are clearly increased...

As the years progress gradually the range of motion decreases as the labrum wears and subtle signs of hip arthritis develop. Ultimately severe arthritis develops with the first, possibly of several, total hip replacements.

The Chiropractic contribution

I now routinely treat young adults, middle aged folk and the older person with DDH. They present invariably with groin and often low back pain. This back pain may be at the thoraco-lumbar junction, mediated via the Femoral nerve and Psoas muscle, and/or in the sacro-iliac joint. Obviously the sooner one detects the disease and starts treatment the better.

The response to chiropractic? Generally excellent in the young and middle aged patient. Once the stiffness and arthritis starts it becomes increasingly difficult.

CHIROPRACTIC HELP

It's the young and middle aged adult where chiropractic comes into it's own. Treatment can be summarised as:

1. Direction. The patient with DDH has to accept that long distance walking and running is not for them. A 5-10 kilometre hike? No problem. The "Four day 200km hike in Nijmegen" that the Dutch are currently feverishly preparing for is sheer madness for the patient with DDH.

2. A simple set of daily exercises to maintain the range of motion and strengthen the muscles associated with the hip.

3. Correction of any sacroiliac and lumbar subluxations.

4. Active release technique for the muscles and capsule in the groin. This can be extremely painful. The pain is short-lived, perhaps thirty seconds, a hot feeling in the leg for a day, and then astonishing progress.

5. Gentle mobilisation of the hip, if there is limited range of motion.

6. If present, management of a short leg using a heel lift.

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