312 | Does Exercising Make My Hip Arthritis Worse?

[00:00:06] Welcome to the Optimal Body Podcast. I'm Dr. Jen. And I'm Dr. Dom and we are Doctors of Physical Therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in. So now that we're deep in summer, and a lot of people are going to be getting

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[00:01:24] So we're going to go into hip arthritis today or hip osteoarthritis. This is something that's very common. And so understanding the nuances, what the research is saying, what you can really do about it, when is surgery necessary? You know, all the little things that go into it.

[00:01:41] We have, if you're watching on YouTube, we actually have our computers out in front of us now and we are just going to dive into the research right in front of us because it's so much easier than reading off notes in front of you.

[00:01:51] Yeah. And I think that osteoarthritis, I mean, the word itself, osteo meaning bone, arthro or arth meaning joint, itis meaning some sort of inflammatory condition. And so when people think arthritis a lot, they think degeneration.

[00:02:06] Yeah. They think, oh, we're going to see some massive degeneration on a radiograph, on an MRI, on an X-ray. And that's what's causing the pain. But I think one of the most significant things when we were looking through the research was this quote here.

[00:02:20] And this is why it's great to have the computers in front of us was this is a whole person condition where biopsychosocial factors modulate inflammatory processes as well as behavioral responses, trigger pain and disability to affect a

[00:02:34] person's joint health, not solely structural damage, which is a little narrative that needs to be fixed. And this is a thread that if you listen to a lot of our podcasts, I think it's going to be a common thread that continues to be spilled throughout, right?

[00:02:49] Like pain can't just mean there's structural damage in an area. There is your whole person. There is a lot more to the picture. So especially that's what biopsychosocial means. Bio being meaning your body. So, yes, let's look at like structurally what's happening. But psychologically, what are you in?

[00:03:08] Are you in a lot of stress in your life? Are you going through a lot? Are there emotional things that are happening socially? What is happening? Do you have support? Are you economically challenged in ways like all of those added stressors add to the

[00:03:22] pain that we're perceiving within our body? Yeah. And so, I mean, just again, initially talking about arthritis, what is it and what kind of symptoms is somebody feeling? Anytime we're having arthritic symptoms and we're going to talk about this a little

[00:03:37] bit later, too, when we talk about personal stories. I think when we're the clinician working with somebody in a clinic, you hear almost this creaking or crepitus is what we would call it clinically. But this like ratcheting sound in the joint as they move through certain ranges.

[00:03:54] And both of us have experienced this. So you might feel different grinding, locking, clicking in the joint. There's likely going to be a reduced range of motion, reduced hip strength in some instances and a deep feeling pain kind of right in the front of the hip is what's

[00:04:13] most common. And people often give you what they call a C sign. C sign where they grab and point with their front two fingers and say right here in the front of the hip, kind of with this C.

[00:04:23] Those are some of the symptoms people are going to be presenting with. Totally. But that's where it's like we can't just say, oh, here are the common symptoms and you're going to automatically jump and think that you have this.

[00:04:32] Right. Because we can also see a lot of those symptoms play a role in impingement, labral issues, tears. So, FAI, you know, a lot of these symptoms are going to be common with clicking or having that C-shine shape and filling it deep into the joint.

[00:04:51] You know, so we can't know exactly unless you're going to do some more findings. But let's look at the research. Do we need to do, you know, more of the MRI finding? Are there other things that we can start taking charge of if you're having hip pain

[00:05:06] right now? And I think the first thing and what we're going to talk about for a little while here is one of the biggest findings when we're talking about arthritis or arthritic conditions is that conservative treatment, specifically different forms of exercise,

[00:05:21] can be very, very effective in helping reduce pain, increase function, make you feel like you have a better quality of life and even reduce the chances that you'll go into surgery or prolong when you end up having surgery like a joint replacement or something.

[00:05:39] And based on the research as well, we can see that there's not necessarily and this is what you're going to be coming to the podcast for is what exercise should I do? What is the one exercise? Specific exercise.

[00:05:51] Yeah. Or at least the exercise type, right, that I should be doing that's going to be best for my body. And you might even think, you know, it would make sense to do more water based things that take pressure off of your hip and de-load.

[00:06:06] But what we're seeing from the research is that there's no one standard exercise protocol that's going to be better than another. It really is. I mean, patient specific, really like what do you enjoy more that you're going to

[00:06:21] actually keep doing and moving that's going to help promote more movement within your body. So different forms of exercise that we looked at based on the research was like strength, progressive, progressive resistance training.

[00:06:34] So making sure that you're kind of following a program or are being guided by someone that progressively is kind of allowing you to increase your strength, water based exercises, aerobic exercises, performance or functional based exercises, meaning going

[00:06:50] just walking programs, hiking stairs, stuff like that, or neuromuscular type training. So all of these have been studied and research and we can see improvements with continuation on any one of them. Yeah. And this study here showed that if the exercise programs for knee OA, so this

[00:07:09] one they were specifically talking knee OA, but again, in these arthritic conditions, we can kind of draw some inferences based on different joints. We're grouped into three subgroups, aerobic resistance training and performance exercises. Performance meaning more like functional things like walking programs, stairs, sit to stands.

[00:07:28] And there were similar effects for each of these groups and patient preference was a huge driver in the patient being able to choose something that they likely would enjoy more. If you're not somebody who loves strength training, but you'd like going out for walks, great.

[00:07:44] You know, let's start there. And that I think points out a huge point in that the specific type of exercise wasn't as important, but the things that did seem to be very important are that they were directed

[00:07:58] programs, that you were working with somebody who could direct your progress, progress you based on how you were feeling, talk to you about symptoms that might come up during the exercises and that it was something that the patient enjoyed or that it was a patient preferentially selected exercise.

[00:08:15] So all these different types of exercise programs saw benefit. But the things that were consistent were that they had a professional kind of guiding them and helping progress their program and that it was something that they enjoyed relatively more than other types of exercise.

[00:08:32] And I think what's important, too, is that we're not here to say, you know, exercise is everything. You're not going to need a joint replacement and you're fine. Right. Like, of course not. There's different severity for every person, and it depends if it's severely limiting

[00:08:46] your ability to go through your everyday life. We're probably going to say and you've tried exercise, you've tried some conservative treatment. We're going to say it's probably best for you to get a replacement. And at this point in time, we've progressed in hip replacements so well that we're

[00:09:00] you're walking out really good without barely having any restrictions in range of motion now based on what we're doing. And what but what they are seeing from research is that if a patient ultimately decides to request having a replacement done, having participated in a preceding exercise

[00:09:18] program will lead to a faster post postoperative recovery. So if even if you think this is where I'm ultimately going to end up, do exercise first still. Yeah. Preferably guided from physical therapist and then go in and have the surgery

[00:09:35] and then come out and still see, OK, where can I help to continue on? Yeah. That preceding functional level is huge. And I remember going through clinicals, you know, often, especially with knee replacements that seem more common, that different surgeons would give their patients

[00:09:52] requirements to say, yeah, I need you to be able to walk this far prior to going into surgery. Like if it's somebody who was having pretty severe knee pain, they would get them with to the point where they couldn't walk around the block.

[00:10:05] The surgeon was worried about doing the exercise because they're like, OK, you have a very low base level of strength and functional ability in your body. So once you have the replacement, it's going to be very hard to do the exercises necessary for a good postoperative prognosis.

[00:10:22] Same with the hip. If you have a very low functional level, if you feel like you have very low strength levels, diving into a surgery right then might not be the best option where going to get a conservative approach, seeing someone in person,

[00:10:35] building some strength, building that functional ability. One, you might see your pain level slightly come down prior to surgery, but also growing that strength and functional level will just set you up leagues ahead of where you otherwise would have been post-op.

[00:10:50] And I think you even just listening to this podcast and getting the education around your body and what it means, what you can start to do about it, that has also been shown in research that if you're going to combine that exercise with

[00:11:04] patient education, like that is what's going to be best. Yeah. Right. And this research article, is it Svedge? Svedge and his colleagues in 2015 did a research study on exercise and how it impacted people's surgical decisions. And it said, exercise plus other non-surgical treatments is effective and can postpone

[00:11:30] surgery for a large number of OA patients, osteoarthritis patients. A study performed in hip osteoarthritis patients found that the combination of exercise therapy and patient education could reduce hip total hip replacement by 44 percent as compared to those people who receive patient education alone.

[00:11:49] So, patient education could be great, but having someone giving you that guided exercise program along with the patient education by the sounds of this quote says it could reduce total hip replacement. So, 44 percent of people who ended up doing the exercise and patient education ended

[00:12:07] up not getting the replacement altogether. I mean, that's one of the things that I wanted to bring up, too, is like before I even graduated physical therapy school, I was working as a Pilates instructor.

[00:12:18] And one of my little cute old women who came in, she was like in her 80s and she was a beast. My goodness. And she came religiously to Pilates and her

[00:12:32] hips, I mean, I could feel it if I put my hands on her body as she was squatting. I could feel the creaking door kind of feeling, you know, in her hips as she would bend and move. But she continued to come.

[00:12:46] She continued to work on her balance and her strength. And I don't know if she ended up having surgery, to be honest, because then I went on and graduated PT school and went on.

[00:12:56] But, you know, it's just it continues to point out even at her age, you know, the ability to keep moving, to keep doing her activities, to keep exercising with having that. It was probably pretty severe because of the level of. You know, symptoms that we both experienced.

[00:13:15] Yeah. So, again, a lot of what we're pointing out here is that exercise, good education, good. Right. And I think that one of the things that a lot of the studies talked about, too, is like you go into these exercise programs.

[00:13:31] It doesn't mean that your pain level is going to drop to zero. No. A lot of the studies said they consulted with patients saying that after exercise there may be some level of pain, maybe even some level of increased

[00:13:44] pain. Again, anytime we're talking about an inflammatory type disorder or a disorder where when you put more pressure on the area, it can irritate it more. They were consulted with saying, hey, you might see some base level of increased pain after these exercise protocols.

[00:14:02] The important thing is, does that come down to the level you were at before or even slightly better? If it does, then we go on with a second session. And the goal in some of these studies was to get people to the point where they were doing three

[00:14:14] sessions a week. You know, that seemed like if you were able to get to the point where you're doing three sessions a week of training, it would increase the outcomes. It would increase your probability of having better strength gains, functional gains

[00:14:28] versus maybe just going in for one or two sessions a week. Two interesting studies that we looked at were the Freeman-Hann study and the Osteoarthritis Institute study. So they both showed that people with frequent hip or hip pain or common with consistent OA kind of

[00:14:45] symptoms, they showed that only one in seven with the Freeman-Hanns or one in 10 people with the Osteoarthritis Institute really actually showed that they had osteoarthritis on the radiograph. One in seven and one in ten.

[00:15:02] Yeah. And then the second part of that study was looking at people who had radiographic evidence of osteoarthritis. So you look at the image and say, yep, this person has hip degeneration that would be consistent with hip osteoarthritis. And for the Freeman-Hanns study, only 20.7% of people who had

[00:15:21] radiographic osteoarthritis were presenting with consistent pain. For the Osteoarthritis Initiative, 23.8% of people with hip radiographic osteoarthritis had frequent pain. So this kind of just illustrates more of that point that we mentioned at the beginning, that

[00:15:41] what the image says, if you are showing arthritis on your image, it doesn't necessarily mean you have frequent pain. Are we saying that people who have pain and have osteoarthritis on their image, that's not related? Not exactly. No, that definitely can be a contributing factor.

[00:16:02] But the very first thing we said is that there's a lot more things at play. There's that whole biopsychosocial model that we need to take into account. Because on the other hand, there's almost 80, 75 to 80% of people that show osteoarthritis on their image that don't have frequent pain.

[00:16:18] So what are those people doing different when their images look the same or worse, but they aren't having pain? Right. And that's like consistent with a lot of other studies we've looked at, whether it's back pain, whether it's, you know, different kinds of things.

[00:16:34] You know, we can't always relate what we see on an image to what we're feeling. And that's the hardest part, I think, because it is our natural instinct to say, oh, my gosh, I'm having this pain and it's happening very often or it's happening all the time.

[00:16:50] I need to see that image. I need to see how damaged something looks, you know, or how degenerative something more like we look at these big words and we're trying to make it make sense in our head.

[00:17:03] We want that validation of what I'm feeling is what I'm going to see. And the reality is that doesn't always go hand in hand. And that's OK. It doesn't invalidate what you're feeling. No. You're still feeling something very significant.

[00:17:15] Absolutely. But even what you were saying right there and the words that are used, how damaged the joint is, how degenerated it is, how messed up my hip is, that right there adds into that biopsychosocial model.

[00:17:28] When you see an image, you have hip pain, you see an image, you see the degeneration and have a doctor walk in in his lab coats and says, oh, you've got hip OA, look at how degenerated your hip is.

[00:17:40] That starts to play into that psychological portion of the biopsychosocial model to say, this is why my hip is so damaged. I can't move without grinding my bones against each other. All these things that we start to tell ourselves once we see damage in the hip.

[00:17:56] Right. Rather than saying, OK, there's damage there. What can I do in the rest of my life? Instead of saying there's damage, there's changes that are happening. There's fairly natural age related changes. Yes. Happening in my hip.

[00:18:10] And that I think a lot of surgeons, a lot of doctors are starting to move in that direction because we're realizing how common this type of degeneration is. And that many people can be very functional, relatively pain free and live

[00:18:22] happy lives with high quality of life, even with degeneration on their images. Yes. So I think it's really important to take all these factors into play. Another thing that we saw come up in some of the studies was looking at, you know,

[00:18:36] the weight that we carry on our body and how that does play a role in possibly having leading to a hip replacement a little bit sooner. More weight, more pressure on the joints. Yeah. Which is just fact. And sometimes we can't control that.

[00:18:50] Right. But what they did see is that for every 1% of weight loss was associated with a 3% reduction of the risk of hip replacement. So it is just something interesting to look at and say, OK, you know, we're not

[00:19:08] proponents of like saying you need to go on some diet or you need to lose weight. But how can we start to maybe move and eat in a way that helps to support our body so that we naturally maybe start putting off some weight.

[00:19:21] And maybe naturally reduce the inflammation that the foods we eat cause in our body. And I mean, again, the weight, regardless of what type of weight, like when I look at my BMI, I usually land in the overweight category because I have a higher amount of

[00:19:37] muscle mass and that puts more pressure through my joints. I'm already somebody who has had injuries in both of my joint knees and surgery on one of them. So if I get later in life and I'm having knee pain and see radiographs

[00:19:52] saying like, hey, we're seeing degeneration, like weight loss is definitely going to be a thought in my mind to say, hey, how can I take 1% of weight off or, you know, 10 pounds off to maybe lessen the load?

[00:20:05] Because every pound we lose that also magnifies through our joints, depending on if we're walking upstairs or if we're going for a walk or a run or walking up or down a hill. So very important. That's also why water based exercises can be really important, especially if you're

[00:20:22] somebody who, you know, feels like you want to maybe want to drop some weight. But moving in general is really tough because of the pain. The water based exercises can be very important. And when I mentioned that there are surgeons who will give plans to people, I remember

[00:20:39] a lot of people who are coming in for prehab who, you know, were overweight and their surgeon had said, oh, I need to lose 30 pounds before they'll consider doing my surgery. And again, it's not meant to be a discriminatory thing.

[00:20:52] It's meant to be a thing that's going to set you up for the best prognosis post surgery. Right. Yeah. So it's very common, you know, and I think it's just another example of

[00:21:01] continue to keep moving and continue to focus on the things that are just going to help our body rather than worrying about the weight loss and all that other stuff. Right. Because that could add another stressor to it, you know, and just honing in this

[00:21:13] point even more we see from research too, like we can compare two studies that just do exercise or are just looking at taking anti-inflammatories like NSAIDs and, you know, ibuprofen. And we see a similar effect in both of them.

[00:21:27] So as far as pain reduction, as far as pain reduction and function, you know, and especially, you know, in short term and long term follow up. So. We don't always want to rely on the NSAIDs because that can do other stuff to our

[00:21:41] gut and everything. We don't want to just rely on this forever. Right. So another long term benefit then is just going to be that exercise and finding something that you find works best for your body in order to keep moving.

[00:21:54] And we do have a couple exercise recommendations that we think can really help. Yeah. And so, again, based on research, based on the research. I think the first thing is finding something that you enjoy. Yes. And understanding what you enjoy to do.

[00:22:12] I mean, my ultimate recommendation would be like, what is this hip pain or hip osteoarthritis keeping you from doing that would bring you joy in life? Is it being able to walk and go to a picnic with your family, walk and see your grandkids play a sporting event?

[00:22:29] Is it just getting up and down from chairs that's really difficult or getting up and down from the toilet that can become increasingly difficult as we have joint pain? Like, how can we slot that into the exercise or training that we're doing?

[00:22:43] A lot of these things do require strength gains or do require us to have strong joints that support strong muscles that support those joints. So strength training can be a very important component of it, but it doesn't need to look

[00:22:55] like lifting weights. It can look like just sitting and standing from a high chair and then progressing to slightly lower surfaces. That's a great way to start to really build strength in those joints. And again, we've talked about following something directed, following something

[00:23:11] especially in person that you're doing with someone. You know, we do have a HIIT plan on GenHealth. If you are severely limited in range of motion, it's probably not going to be the plan for you. I'm going to say that up front.

[00:23:25] But there are going to be some things where you just are checking in for 8 to 15 minutes and starting to move your body, starting to improve your connection to your inner core, to your glutes, to these muscles that you maybe

[00:23:41] feel that you don't have as good a connection with and strength through movement. You know, a lot of these exercises that we're not just doing mobility, we're doing stability, we're doing that reconnection, that neuromuscular retraining as well

[00:23:54] throughout GenHealth. And, you know, something that I saw super powerful, I remember I saw a patient who she was going to go and get a hip replacement, but she was taking it upon herself to go and get some exercise recommendations prior to the

[00:24:11] prior to the replacement because she knew she was having such severe pain just getting out of a car, standing up straight when walking. Like all of these little things that she had to keep doing before she even got the replacement were so difficult.

[00:24:24] And some of the things that really helped was just starting to reprogram how she's getting that intra-abdominal pressure from her rib cage to her pelvis and and reconnect back into her hamstrings and glutes and connect to that pelvic floor in a

[00:24:40] different way. And all of a sudden, she was walking upright. She didn't have that pain. She was getting out of her car without pain, you know. And again, not to say that she didn't have pain anymore and she didn't need the

[00:24:51] replacement. She still knew that she was going to get the replacement, but just to be able to go through her daily activities a little bit lighter without having that heaviness of that pain. And this is also where us giving specific recommendations can really be tough

[00:25:05] because core, anytime you improve that dynamic core stability, you can create from diaphragm to pelvic floor to all of the corset muscles, especially our transverse abdominis to be able to support the hips, the joints that are directly attached into that core can be huge.

[00:25:23] Balance can be huge, which again, especially as people are aging, balance can be a huge consideration. So is that something that you're struggling with? Maybe having a directed progressive balance routine that you work on could be a great

[00:25:39] place to start. And again, you mentioned the HIIT plan on GenHealth. We also have a core plan that is a great progressive way to reattach and reconnect back into that core for people who are looking for strength that might be wanting some sort

[00:25:53] of strength exercises. There's a plan, the full body low impact plan. I love that. It's my favorite plan. Best plan. And it's great for people who have knee and joint and knee hip, different joint pain that are looking to be able to strengthen without having as much pain.

[00:26:07] So all those plans can be great places to check in. We have a special discount for our podcast audience. If you want to go check out and start your free trial, you get a free week first.

[00:26:17] And then if you use code optimal, you'll get a discount on the first month so that you can check out some of these plans. See if it's something that helps you connect back into some of these areas in your body.

[00:26:28] And doing a plan for 20 bucks, following it for 30 days and really committing and seeing do I start to feel change? Do I start to notice something different? Thanks for tuning in for another PT Pearl all about hip arthritis.

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