Who is prone to hip arthritis?

Femero Acetabular Impingement Syndrome

For unknown reasons - it could be genetic, or trauma, anatomists aren't sure - extra bone is laid down in and around the hip in the young person. The key sign is stiffness, without pain in the hip, starting in the young person, and of course continuing progressively and relentlessly as we age, if nothing is done.

Routinely now I examine every hip, as much can be done to treat this not uncommon condition, and prevent hip arthritis. An ounce of prevention ...

It is imperative - for many reasons - that we do not allow the growing child to also become obese. The prevalence of painful degenerative osteoarthritis in the hip then becomes much, much higher.

Read more about FEMERO ACETABULAR IMPINGEMENT SYNDROME >> …



Read more more FEMERO ACETABULAR IMPINGEMENT SYNDROME Case File >> …



Hip Dysplasia

Whereas Femero Acetabular Impingement Syndrome refers to too much coverage of the ball of the hip, in Hip Dysplasia you have too little coverage.

The end result is much the same. Both lead to Hip Arthritis if the conditions are not detected early and carefully managed. Inter alia this means that the sports of choice are cycling and swimming, and long distance running and hiking, ballet and heavy athletics will just give way to injury, pain and ultimately a Hip Replacement.

The child with hip dysplasia is also has the yen to run is a problem. A patient and good friend of mine, at 54 is in a wheelchair much of the time, or walks with two crutches, and is on daily morphine. He's had his third hip operation now, and the surgeons say they can do no more. He was very sporty as a child ... why didn't somebody warn him!

Slipped Capital Femoral Epiphysis.

Another important condition which occurs predominantly in young girls (5:1) is the Slipped Capital Femoral Epiphysis (SCFE) syndrome. Unless carefully managed it leads inevitably to debilitating early osteoarthritis. Catching it early is essential, which is what chiropractors are trained to do.

SCFE usually presents with pain in the thigh and knee, typically in a young obese teenager. Delay in the diagnosis leads to an ever increasing slip of the growing end-plate of the hipbone, and high risk of morbidity. It occurs in roughly 1/ 1000 children, but eight times higher in obese adolescents.

Your child has groin, thigh, knee pain? Don't buy into the 'growing pains' myth. Get him/ her to a skilled musculo-skeletal therapist. Early diagnosis is essential, as the results of surgery for severe slips are not good:

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Long-term follow-up study of one hundred and twenty-one patients with SCFE.

Boyer DW; Mickelson MR; Ponseti IV

J Bone Joint Surg Am 1981 Jan;63(1):85-95.

We evaluated 121 patients who had had slipped capital femoral epiphysis twenty-one to forty-seven years after the diagnosis was made.

The results were very good in most of the eighty-three hips with the slip left unreduced.

Fifty-four hips that were treated by procedures designed to improve the alignment of the slipped femoral head had more complications and less favorable results, but in general, these were the more severe slips.

However, there were enough slips of comparable severity that were treated unreduced to suggest that the long-term results, even in moderate and severe slips, were better after in situ fixation than after operative and manipulative treatment (as performed between 1915 and 1952). Twelve of the thirteen hips with acute slips were reduced (the thirteenth was one of the eighty-three unreduced hips) and aseptic necrosis developed in three, while nine had good results.

Read more about surgery …



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A Short Leg

Research has now proved that a short leg is one of the causes of hip and knee arthritis. Scientists speculate that mechanical factors, including joint instability and malalignment from a short leg, contribute to the progressive degeneration of the hip and knee cartilage.

TipWhilst a simple heel lift to correct a leg length inequality is important, depending on the scoliosis caused by the short leg, this has to fitted by an expert. We of course recommend your chiropractor!

Read more: LEG LENGTH INEQUALITY …



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Glucosamine Sulphate

Effect of glucosamine sulfate on hip osteoarthritis:a randomized trial. The effectiveness of glucosamine sulfateas a symptom and disease modifier for osteoarthritis is still under debate.

OBJECTIVE: To assess whether glucosamine sulfate has an effect on the symptoms and structural progression of hip osteoarthritisduring 2 years of treatment.

INTERVENTION: 2 years of treatment with 1500 mg oforal glucosamine sulfate or placebo once daily.

CONCLUSION: Glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis. International Standard Randomised Controlled Trial Number: ISRCTN54513166.

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Perthe's Disease

Never neglect the limping child, mostly in the 5-12 age bracket. The first sign of Perthe's disease is pain in the hip, and a marked limp. Remember, Growing Pains is a non-existent mythical disease. Never dismiss your child’s hip or groin pain as ‘growing pains’ – prompt and correct management of Perthe’s is absolutely essential to prevent devastating early hip arthritis. Ignore your limping child and you may be condemning him or her to a nightmare of early hip arthritis. Early as in thirty odd.

I have two patients who had undiagnosed Perthes disease in the hip as children. Both have had multiple hip replacements, the first before thirty. Both are now fifty odd, the one permanently on crutches, the other in a wheel chair.

The limping child. Take note!

Read more: PERTHES DISEASE …



Trauma

Other factors that can contribute to developing hip arthritis include traumatic injuries to the hip and pelvis, as in serious falls and motor vehicle accidents.

It's dangerous getting out of bed in the morning! However, even more people die in bed! Seriously though, most falls in the home occur in the bathroom and on the stairs.

What are the common symptoms of hip arthritis?

• Pain and stiffness, particularly in the groin, with activities such as walking. A limp is common.

• Flexion of the hip (pulling the knee to the chest, and particularly towards the opposite shoulder becomes stiff.) Try pulling first one knee to the chest, and then the other. Are they equal? Now rotate the hip. Still the same? Another movement that is lost, but one which is difficult for the patient to detect, is internal rotation.

• Disabling pain in the sacroiliac joint ANATOMY >> is often a major feature of the condition. Even more than the pain in the groin, it is the fixation in the SI joint that may lead to disabling pain hip and thigh pain.

• Vague ache referring down the front of the leg towards the knee. Often misdiagnosed as a knee problem, but in fact is actually a referred pain from the hip.

FROM THE COAL FACE

'Tell me about your problem, Mr S.' Mr S was a 75 year old man. He walked with a slight limp, but it was not that obvious. He used no stick.

'I can't walk. I get pain spreading down the front of my thigh towards the knee. It started about 20 years ago, but is now getting much worse.'

'Have you seen your doctor?'

'Yes. He sent me to a neurologist who says that I have lumbar stenosis which is causing the pain in the leg. He wants me to have an operation. He says nothing else will help.'

'Well, let's examine you, and see what we can find.'

'Is there any point? How can you open up the canal when it's too small and tight for the nerves.'

'First an examination, Mr S. Then the diagnosis and thoughts about treatment.'

Mr S did indeed have lumbar stenosis - but that wasn't the cause of the pain in his leg. A two minute examination revealed very limited flexion, adduction and internal rotation of the hip. Both he and I were astonished just how much chiropractic could help his condition. Within a few months he could sleep through the night without pain and walk for half an hour. It gave him a new lease of life. The neurologist hadn't examined his hip, and made assumptions and presumptions.

X-ray

* Flattening of the head of the hip bone.

* Loss of the joint space.

* Sclerosis - white bone being laid down.

* Cysts forming in both the head and the acetabulum.

Cysts within the ball of the hip? Nope, one of the most beautiful photos taken from the Hubble telescope of the halo of light around a star in the Milky Way. It's been called Starry Night, so named because it reminded astronomers of the Van Gogh painting.

What is the treatment for hip arthritis?

• Weight Loss is the most important first step in the treatment of hip arthritis. Significant weight loss will save many patients from the knife. While weight loss is never easy, the inevitable deterioration and pain, loss of independence, and threat of surgery should motivate you to get the kilograms of butter off. It can be done. Weight loss in the obese helps reduce not only the pain of this degenerative condition, but it reduces the progressive nature of the condition too. Consider our free Weight Loss Programs. It works! FREE WEIGHT LOSS PROGRAMS >>
  

• Accept that activities that cause pain should be limited. This is perhaps easy for the older person, but in young people, not being to dance, or jog is difficult. The alternative sadly is an early hip replacement. It's all about Right Choices.
• Cycling and aquacise are good options for hip arthritis.

• Walking is always good, but obviously the distance and terrein will be limited by how advanced your hip arthritis is. For a simple three minute test of fitness, click here: KASCH PULSE RECOVERY TEST >>
  
• Use of a stick in the hand opposite to the affected hip reduces the demand placed on the hip arthritis joint.

• Chiropractic treatment of the sacro-iliac joints, best done using a ‘Thompson Drop technique’ can make a very significant difference. The usual side-posture chiropractic techniques have to be modified. Report immediately if your chiropractor's treatment gives sharp stabs of pain in the groin. Read more: SACROILIAC JOINT TREATMENT …
  
  
• Mobilisation of the hip by you the patient on a daily basis is extremely important. It reduces the stiffness, and helps the flow of nutrients into the joint, and removes toxic waste products that build up in the joint.

• Your chiropractor should do cross friction of the joint capsule and surrounding muscles, in particular the Adductor magnus. It will be painful.

• Mobilising using a Mulligan Mobilisation belt is also very beneficial for hip arthritis.
  
  
• Specific stretches and strengthening exercises are vital in the management of hip arthritis.

• Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly prescribed for hip arthritis. They have a place but used on a long term basis have serious side effects for the stomach, heart, kidneys and liver. For more information on NSAIDs click here ANTI INFLAMMATORY DRUGS >> Never, ever take two anti-inflammatories simultaneously. Like aspirin and Ibuprofen. NEVER! Read more: DUAL ANTIINFLAMMATORY DRUGS ...
  
  
  
• Surgery for hip arthritis sometimes simply cannot be avoided. Done by an expert surgeon many people’s life styles have been dramatically improved. Just look at the fabulous Tom Watson! It is of course major surgery, and the risk of blood clots to the heart, lungs and brain as well as the risk of dementia should the anaesthetic not go well, all must be weighed.

• For more medical information about hip replacements.

• For more about the danger of developing Alzheimers disease after surgery click here: ANAESTHETIC ALZHEIMERS

PREVENTION

IMPORTANT CONSIDERATIONS

Obesity

Find me an obese seventy year-old not suffering from disabling hip, knee or ankle arthritis. Not too mention high blood pressure, diabetes ... Weight loss can be achieved, it much be achieved - or face the consequences. It can be done!

For more about our free weight loss program, click here …

Smoking

I was yesterday consulted with a new patient with severe low back and leg pain. He is now having difficulty urinating, and can't lift his heel from the ground. The first surgery was a botch, the second much better and for a month he had much less pain. But nobody warned him to stop smoking (so he says anyway), and now it's a real mess. With inadequate oxygen those tissues never had the chance to heal properly. He's looking to chiropractic for a miracle. Those we do at once, the impossible takes a little longer!I've spelt it out to him: Stop smoking or I won't accept you as a patient, because we won't win. We may not anyway.

Why smoking is so addictive - video

Monthly Newsletter

Chiropractic Help, Issue #10 – Friday Fun: Stones in my Clog

Chiropractic Help, Issue #09 – Friday Fun: Headache/ Cucumber

Chiropractic Help, Issue #08- Spinal Stenosis/ Celery

Chiropractic Help, Issue #07- Root-of-all-Healing/ Garbanzo beans /Chickpeas

Chiropractic Help, Issue #06 - Safety-on-the-Stairs/ Ginger

Chiropractic Help, Issue #05 - Safety-in-the-home/ Red foods

Chiropractic Help, Issue #04 - Whiplash-and-the-Joints-of-Luschka/ Parsley

Chiropractic Help, Issue #03 - How to stop falling/ Danger of a low fat diet

Chiropractic Help, Issue #01 - Tingling the arms and hands/ Apples

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