Posts in hip pain
Does Physical Activity Improve after a Total Knee or Hip Replacement?

Total knee and hip replacements are among the fastest growing surgeries in our country.  Physical Therapy remains the first line treatment for patients with knee and hip arthritis, but in patients with severe osteoarthritic pain and loss of function joint replacement remains a good surgical option.  In prior research among patients undergoing these procedures there is often a disconnect between subjective reporting of pain and function and the objective testing of a patient's function.  For example, a patient may report great outcomes and an ability to walk long distances without fatigue or pain, but objective testing in Physical Therapy often reveals residual endurance, strength, and balance impairments.  

In addition to severe pain, one of the most important indications for a total joint procedure is loss of function.   After the surgery patients are expected to increase their activity levels due to reduced pain, but new research is questioning this assumption.  A recent review article in the Journal of Orthopedic and Sports Physical Therapy examined if physical activity levels increased after these procedures (Arnold et al. 2016).  Authors reviewed the available data and found 8 studies of 373 patients who underwent a total joint replacement.  

These studies objectively tracked a patients physical activity levels up to 1 year after the procedure to see if levels had increased compared to pre operative levels.  The authors reported negligible improvements at 6 months and limited evidence to support increases in activity levels at 1 year.  At one year, patients with total joint replacements were significantly less active than their peers.  This study indicates the importance of post operative Physical Therapy to effectively improve strength, endurance, and balance allowing patients to resume an active lifestyle.  

Physical Therapy Reduces Need for Total Hip Replacement

Over 200,000 Americans undergo a total hip replacement often as a result of severe hip osteoarthritis.  Patients who enter the surgery in a weakened, less functional state have worse outcomes up to 2 years post operatively compared to their higher functioning peers (Fortin et al. 1999, 2002).  This is concerning because the most rapid recovery after surgery occurs in the first 3 months with slower recovery up to 1 year.  A patient with more difficulty entering surgery would have limited success in this crucial window in their recovery.  Conversely, pre operative Physical Therapy for patients with limited flexibility, strength, balance, and endurance can improve surgical outcomes, but similar to research in knee osteoarthritis may delay or prevent the need for the surgery.  

A recent study was conducted to determine the long term impact of PT interventions on patients with hip osteoarthritis (Svege et al. Ann Rheum Dis. 2015).  Patients were randomized to either an education or PT group and followed up to 6 years after the treatment.  The authors reported the average time to a total hip replacement was 5 and a half years in the Physical Therapy group compared to 3 and a half years in the education group.  In addition, twice as many patients in the Physical Therapy group did not require surgery reducing the need for surgery by 44%.  

This evidence adds to our knowledge on the beneficial effects of Physical Therapy on patients with hip osteoarthritis.  Patients with hip pain are advised to see a Physical Therapist to postpone or prevent the need for a total hip replacement. 

Hip Osteoarthritis and the Impact of Exercise

Currently, in the state of Colorado patients can access their Physical Therapist without a referral from another healthcare provider such as primary care physician.  This model of care has been utilized since the 1950's throughout the country and is most notable in our military where our soldiers have direct access to their Physical Therapists.  In both the civilian and military worlds seeing a Physical Therapist first is both clinically and cost effective for patients, saving an average of $1000 per plan of care.  For the majority of musculoskeletal conditions exercise is the key intervention to reduce pain and improve function.  There is no better healthcare profession than Physical Therapy for the design and implementation of an exercise program for patient's in pain.  A new research paper was released demonstrating the importance of exercise in the management of hip osteoarthritis.

Hip osteoarthritis is a common condition leading to pain, loss of motion, weakness and loss of function in many middle to older aged adults.  Prior research has shown exercise therapy's ability to reduce pain and improve function in patients with hip osteoarthritis.  A recent study compared the cost of exercise therapy and primary care to primary care interventions alone (Tan et al. Osteoarthritis Cartilage. 2015).  Over 200 patients were followed over the course of a year and their medical expenses were collected.  The authors reported exercise therapy was a less costly treatment option compared to primary care alone.  

To learn more on how Physical Therapy and exercise can save you money and improve your quality of life contact your local Physical Therapist.    

Lateral Hip Pain and Bursitis

Patients with outer hip, lateral, pain have previously been diagnosed with trochanteric bursitis indicating the fluid filled sack between our hip muscle tendons and our thigh bone is to blame for their symptoms.  In addition the -itis ending in the diagnosis leads us to believe there is an inflammatory process taking place in the hip.   Interventions designed to combat inflammation where previously utilized in an attempt to reduce pain and improve function.  Based on the recent research experts have moved toward a more accurate diagnoses for symptoms in the lateral hip which is changing our understanding of the pathology and treatment interventions for this common condition.  

boulder physical therapy lateral hip pain bursitis

Experts are currently moving away from the diagnosis bursitis due to the lack of confirming findings on diagnostic imaging.  Bird et al. reported only 8% of patients with lateral hip pain had bursitis on ultrasound imaging (Arthritis and Rheum. 2001).  A recent study by Long et al. found 80% of close to 800 patients with lateral hip pain did not show any signs of bursitis.  Conversely these imaging studies, including MRI, are finding more chronic, degenerative (scar tissue) changes in the tendons on the gluteus medius and minimus tendons as well as the IT band.  These changes explain the limitations of interventions designed to treat inflammation in these patients.  

The diagnosis Greater Trochanteric Pain Syndrome (GTPS) is now being utilized to more accurately describe these chronic changes among patients with lateral hip pain.  GTPS accounts for a small amount of sports injuries but has its' highest incidence among individuals aged 40-60 years old (Mulligan et al. 2014).  In our Physical Therapy practice we commonly see this condition among individuals with a prior history of low back pain and IT band pain.  These patients often demonstrate weakness in their hip musculature leading to muscle imbalances across the lower quarter.  The degenerative changes in the tendon represent a decrease in the tendon's ability to tolerate loading in movement and athletic events.  Interventions should focus on correcting hip muscle imbalances and poor movement patterns which perpetuate this condition.   When appropriate, progressive resistance exercises should be implemented to improve these tissues' ability to tolerate stress and help remodel the tendon.

To learn more about how to accurately diagnose and treat your lateral hip pain contact your local Boulder Physical Therapists at Mend.