Posts tagged hip pain
Optimizing Glut Activation During The Crab Walk
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Strengthening the muscles of the hip, gluts, is a key component of rehabilitation for patients with low back pain, hip pain, and knee pain. These muscles help to optimize movement in the lower quarter improving joint mechanics and force distribution during life and recreational activities. In our Facebook posts, we have shown videos on optimizing the firing in the muscles on the back and side of the hips. These videos detail beginning, intermediate, and advanced exercises for each muscle group. One commonly utilized exercise is the crab walk which incorporates a lateral side stepping movement against a resistance band. A new research article highlights how placement of the band can optimize recruitment of the glut muscles.

Lewis and colleagues analyzed the activation of the glut muscles during a crab walk exercise using different elastic band positions (J Athletic Training. 2019). 22 healthy adults were asked to side step with the elastic band around the knees, ankles, and feet. During each 3 of the conditions, researchers analyzed EMG activity from the hip muscles including the TFL, gluteus medius, and gluteius maximus. As expected, increased glut work was found when the band was moved from the knees to the ankles lengthening the lever. Interestingly, placing the band around the feet increased the glut work without increasing the contribution from the TFL (often a muscle we try to utilize less during exercise). Thus, placing the band around the feet may be an optimal position to recruit the hip with less contributing from compensatory muscles.

Physical Therapy Reduces Healthcare Costs and Opioid Utilization After Hip Surgery
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Arthroscopic hip surgery rates have dramatically increased in the last decade due in part to increased MRI imaging.  MRIs are very sensitive, but lack specificity in many musculoskeletal disorders with high rates of false positives among asymptomatic populations.  Hip pathologies such as impingement (cam or pincer) and labral tears can be found in up to 68% of patients without hip pain.  As we described in our previous blog posts, many patients with these pathologies are able to improve pain and function with Physical Therapy alone.  Further, authors report no differences in long term outcomes between surgery and Physical Therapy.  A new study highlights the importance of post operative Physical Therapy in patients who do not respond to conservative treatments.  

Rhon and colleagues followed patients who underwent hip arthroscopic surgery between 2004 and 2013 to determine their outcomes and healthcare utilization (Physical Therapy. 2018).  The authors reported on 1870 patients of which 83% received Physical Therapy alone, 72% received opioid medication, and 56% received both Physical Therapy and opioid medication.  Authors reported a $5000 savings on healthcare expenditure, a reduction in subsequent hip surgeries, and opiod utilization among patients receiving Physical Therapy first.  Not surprisingly, patients receiving opioids first utilization more medication, over a longer period of time compared to patients receiving Physical Therapy.

Click Here to learn more on how MEND can help accelerate your recovery after hip surgery

Low Rates of Arthritis Found Among Marathon Runners
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Similar to Sasquatch and the Loch Ness Monster science may also be putting another myth to rest.  In our previous posts, we have written on the lack of data supporting the idea running leads to wear and tear or arthritis.  In fact, some research has shown running may have a protective effect on joints with runners having significantly less arthritis than their sedentary peers.  Until now there has not been a study which examined the link between running and arthritis among marathon runners.

Ponzio and colleagues examined 675 marathon runners (at least 5 marathon races) subjectively for complaints of pain, lost training or race time, and arthritic diagnoses (Journal of Bone and Joint Surgery, 2018).  The runners in the trial ran an average of 36 miles per week with an average running experience of 19 years.  About 1 in 2 marathoners reported hip or knee pain, but the overall prevalence of arthritis was 9% well below the national average of 18% even when controlled for age, sex, body mass index and activity level.  The authors concluded "there was no significant risk associated with running duration, intensity, mileage, or the number of marathons completed."  The authors did note age, family history, and surgical history independently predicted an increased risk for arthritis among the 9% with arthritis.  

This study adds to the literature refuting the link between running and arthritis.  

Physical Therapy Improves Outcomes After Hip Impingement Surgery
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Hip impingement, femoracetabular impingement, is a common source of pain for patients.  Much research is needed on this more recent diagnosis secondary to the high rates of impingement found in pain free athletes.  In addition, more research is needed on the comparison of conservative versus surgical management of the condition.  Patient's undergoing arthroscopic surgery to resurface the joint and remove the bony impingement often are prescribed a formal post operative Physical Therapy program.  A recent randomized, controlled trial compared the effectiveness of this program to a general, unsupervised exercise program.

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Bennell and colleagues in the British Medical Journal compared these two programs in 30 patients who underwent surgery for hip impingement (2017).  The Physical Therapy group included 1 pre operative and 6 post operative sessions focused on manual therapy and progressive exercise.  The control group did not receive post operative rehabilitation.  The authors reported a superior recovery for the patients in the PT group at 14 weeks post operatively, but these changes were insignificant at 6 months.  Similar to other post operative Physical Therapy trials, PT has been shown to accelerate the recovery of patients undergoing surgery by allowing them to return to activities sooner than patients not receiving the same care. 

Dry Needling versus Steroid Injection for Hip Pain
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Dry needling is an effective Physical Therapy intervention for the treatment of muscle pain and injury.  Our previous post described a recent review article supporting its' use for the reduction of short term pain and disability in multiple body parts including the spine and hip.  Painful trigger points and muscle pain can also be treated with corticosteroid injections performed by physicians with similar intentions of short term pain relief.  A recent study compared the effects of dry needling and steroid injections for the treatment of lateral hip pain (greater trochanter pain syndrome).  

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Greater trochanter pain syndrome is a diagnostic term used to include many injuries to the outer hip including glut muscle and tendon pain, bursitis, and hip muscle tears.  Steroid injections are commonly performed in this area to reduce pain and allow an easier transition into Physical Therapy.  Brennan and colleagues in the Journal of Orthopedic and Sports Physical Therapy compared the effects of steroid injections to dry needling for patients with lateral hip pain (2017).  50 hips were randomized to one of the two treatments including either dry needling or steroid injection for up to 6 weeks based on provider choice.  The study showed similar results between groups for either dry needling or steroid injection at short and long term follow up.  The authors report dry needling is a viable treatment alternative for hip pain.

Contact your local Physical Therapist to learn more about dry needling for hip pain

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.