Posts tagged hip arthritis
Dry Needling Improves Pain, Mobility, and Function In Patients With Hip Arthritis

Hip arthritis is a painful condition causing pain, loss of range of motion, and lost function in many middle to older aged adults. The pain from hip arthritis is multifactorial in nature arising from the cartilage and joint surfaces as well as the surrounding soft tissues. Physical Therapy consisting of manual therapy and strength training remains the first line treatment for patients with hip arthritis. High level exercise has previously been shown to preserve the patient’s native hip delaying the need for a total joint replacement. Previous research has documented the benefits of joint mobilization and manipulation in patients with hip arthritis, but recent research has highlighted the benefits of dry needling by Physical Therapists in this condition.

Ceballos-Laita and colleagues conducted a double blind, randomized controlled trial on the effectiveness of dry needling in patients with hip arthritis (Musculoskelet Sci Pract. 2019). 30 patients were randomized to either dry needling or a sham needling group for 3 treatment sessions. Patients’ pain, function (gait and strength), and range of motion was assessed at baseline at at the conclusion of the treatment sessions. Authors found significant improvements in pain, range of motion, and function after the dry needling treatment compared to the sham group. Interestingly, the sham group reported increased pain and decreased hip range of motion at the conclusion of the trial. This study indicates dry needling may be included in a Physical Therapy treatment plan for patients with hip arthritis to reduce pain and facilitate a rapid transition to an exercise program.

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Physical Therapy Exercises Are Cost and Clinically Effective Compared To Primary Care Alone For Knee Arthritis

Physical Therapy interventions including manual therapy and exercise remain the primary intervention for patients with knee arthritis. These treatments have been shown to delay or prevent the need for costly, more invasive treatments including total knee replacement. Prescribed Physical Therapy exercises are designed to reduce pain, improve mobility, and increase a patient’s leg strength. Stronger muscles attenuate forces across the painful knee joint allowing a patient to achieve a higher level of physical function and participation their prior levels of activity. Additional treatment options available to patients include primary care or orthopedic management involving diagnostic imaging, medication, injections, and education. A recent study compared the cost and clinical effectiveness of usual care versus Physical Therapy management for patients with knee arthritis.

A randomized controlled trial in the journal Osteoarthritis and Cartilage was conducted to compare the effectiveness of different conservative interventions among patients with hip or knee arthritis (Abbott et al. 2019). Authors randomized 206 patients with either hip or knee arthritis to one of four groups: usual medical care, supervised Physical Therapy Exercises, manual Physical Therapy, or combined manual and exercise Physical Therapy. Physical Therapy participants were provided with 10, 50 minute sessions including follow up “booster” sessions at 4 and 13 months. Authors found the greatest cost and clinical effectiveness in the patients who received supervised Physical Therapy exercises in addition to usual care.

Is Acetaminophen Effective For Hip Or Knee Arthritis?

Paracetamol, or acetaminophen, was initially introduced in the late 1800s and has become the most commonly prescribed medication for fever and pain in the United States. It is one class of medications recommended by the American College of Rheumatology for patients with arthritis who have not responded favorably to weight loss and Physical Therapy. Although a relatively inexpensive and commonly prescribed medication recent research has demonstrated the harmful effects of acetaminophen when combined with other pain medications which may also contain the same drug. A recent Cochrane Review of the evidence analyzed acetaminophen’s effects on patients with hip or knee arthritis.

Leopoldino and colleagues reviewed 10 randomized placebo controlled trials of 3541 patients with either hip or knee arthritis (Cochrane Review. 2019). Patients within these trials were followed for up to 24 weeks to determine the impact of the medication on pain, activity, and adverse events. Authors reported at 3 and 12 week follow there was high quality evidence that acetaminophen provided no clinically important improvements in pain and physical function. No increased risk of adverse events was found among the medication vs. placebo patients. Patients with knee or hip arthritis should follow up with their physician before making any medication decisions.

The Lesser Known Benefits of Exercise for Patients with Arthritis

Osteoarthritis is estimated to affect 250 million people worldwide leading to high rates of global pain and disability.  These rates are expected to raise as our population of baby boomers continues to age into their golden years.  Unfortunately, many with osteoarthritis will become less active or sedentary because of their symptoms and in turn are at risk for many chronic diseases including diabetes and heart disease.  Physical inactivity has also been shown to be one of the risk factors for mental health diagnoses including dementia.  Exercise remains one of the most powerful conservative treatments for over 20 chronic conditions including arthritis

A new clinical commentary highlights the importance of exercise in the treatment of patients with hip and knee arthritis (Skou et al. JOSPT. 2018).  Authors report on the evidence from over 50 and 10 randomized controlled trials on the effects of exercise for knee and hip arthritis, respectively.  Articles report exercise therapy in this patient population is as effective as anti inflammatory medications for these conditions.  Interestingly, the effects of exercise, aerobic or strengthening, are not dependent on a patient's severity of arthritis or clinical presentation.  Thus all patients can benefit from a Physical Therapy exercise program tailored to their specific needs and clinical condition.

Authors recommend beginning with supervised exercise sessions prescribed by a Physical Therapist.  This allows the Physical Therapist to design these programs based on the patient's clinical presentation and make adjustments as needed for an optimal therapeutic response.  In general, experts recommend 30-60 minute exercise sessions, twice per week, focused on both aerobic and strength training of major muscle groups.  This dosage is thought to reduce the chronic low grade inflammation associated with arthritis as well as many chronic diseases including diabetes and heart disease.  Conversely, physical inactivity creates a cycle of chronic inflammation and contributes to chronic disease progression.  In addition to its' anti inflammatory effects, exercise also impacts many of the associated risk factors for chronic diseases including high blood pressure, cholesterol, insulin resistance, body mass index, and body composition changes.  

Contact your local expert Physical Therapist to learn more on the beneficial effects of exercise