358 | What To Do for Hip Osteoarthritis

[00:00:06] Welcome to The Optimal Body podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom and we are doctors of physical therapy, bringing you the body tips and physical

[00:00:13] therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] and restrictions, and answer your questions. Along with expert guests, our goal of The

[00:00:21] Optimal Body podcast is really to help you discover what optimal means within your own body.

[00:00:27] Let's dive in. Okay, so I know that this episode is about the hip and hip arthritis,

[00:00:32] but I don't think we can overstate how important our foot health, our foot strength and mobility

[00:00:37] is to our hip. How our feet operate is so important all the way up the chain and can impact knee,

[00:00:43] hip and low back health. And that's why we have partnered with Neboso because they have such an

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[00:01:36] code optimal to get 15% off your entire order. All right, now let's get into the PD Pro. So today

[00:01:43] we're going to jump in specifically on hip arthritis or hip osteoarthritis. We've done a

[00:01:48] couple other episodes on arthritic related pains, whether I think knee and back arthritis,

[00:01:54] spinal arthritis. We've done arthritis in general. Yeah, we've done a general episode on arthritis

[00:02:00] too. And honestly, hip arthritis, like this is so tough, like looking through all the research

[00:02:06] and we have someone on our team who does very thorough research for us. And there is so much,

[00:02:12] there's so much research on hip arthritis, the condition on hip arthritis with different therapies

[00:02:18] and exercise. And it's really tough to dice through because so many of the studies might

[00:02:23] have somewhat conflicting results and takeaways and conclusions, and it can be a real mind boggle.

[00:02:31] I mean, but that's the thing with research itself, right? And that's where I encourage you to listen

[00:02:37] to this with an open mindset of what you can do and what is the best practices for you as you

[00:02:42] continue to listen to this. Because at the end of the day, there is no, okay, you have hip

[00:02:48] arthritis, here are the three exercises you should be doing. Unfortunately, it doesn't work like that.

[00:02:53] We would love if the research pointed us to three exact exercises that everyone could do. It's just,

[00:02:59] I mean, that's the challenge, especially the more and more you research things in general,

[00:03:04] the more you start to come to the conclusion, like Jen just said, it's got to be specific to

[00:03:09] each individual person. And that's what a lot of the takeaways and discussion was surrounding

[00:03:15] these studies is that, okay, here's what we found, but based on all the research that is out there,

[00:03:20] here's kind of our takeaway.

[00:03:22] Yeah, exactly. So, in general, it's estimated that like one in four people will have hip osteoarthritis

[00:03:29] and obviously it's more prevalent as you increase in age and you get older. Our tissues change and

[00:03:36] that's just something that we've also talked about on other podcast episodes, how it's quite

[00:03:40] normal to see tissue changes. And with tissue changes are going to come some arthritic changes,

[00:03:46] because if we reduce the cartilage that is supporting that joint, we might have some more

[00:03:52] interaction between the joints causing potential bony growths and limitations in movement. So,

[00:04:01] that is some of the clinical signs and symptoms is that you're going to have

[00:04:05] limitation in your range of motion, tenderness around the groin. Typically, we're seeing it over

[00:04:11] the age of 60 and it's mostly predicted in the presence of radiographic hip osteoarthritis to be

[00:04:18] able to really see it in an x-ray.

[00:04:20] Yeah. So, like seeing it on an x-ray, you're going to see reduced space in the joint,

[00:04:24] meaning we probably have less cartilage and less cushion in that joint. You're going to see bony

[00:04:28] growth of some sort. And that can be a wide spectrum of what we're going to see on a radiograph.

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[00:07:09] let's get back into the episode. And I mean, we've pointed this out previously

[00:07:15] and in the research that we did, there were two massive studies that looked at it. I think it was,

[00:07:22] one of them was like the Farmingham study. So Farmingham study showed that 15.6% of patients

[00:07:30] with frequent hip pain showed radiographic evidence of osteoarthritis and 20.7% of hips

[00:07:38] with radiographic hip arthritis were frequently painful. So only one in five people who actually

[00:07:44] had it show up on their image actually had frequent pain and even a lower amount of people

[00:07:49] who were frequently painful had it show up on their image, which basically says that what

[00:07:55] is showing up on your image is not equivalent to the amount of pain you have. There was another

[00:07:59] study, the osteoarthritis index that had similar results. Less than 10% of people with frequent hip

[00:08:05] pain actually had radiographic arthritis and about 23% of people with radiographic hip arthritis had

[00:08:12] frequent pain. So that all just going to say that the level of deterioration or degeneration

[00:08:20] you see on the image doesn't have to be or may not be equal to the amount of pain you're feeling.

[00:08:25] Which is consistent with what we see across, you know, MRIs.

[00:08:29] All sorts of different joints, yeah.

[00:08:30] Yeah, and when we look at disc herniations and we can see people who have disc herniations and no

[00:08:36] pain and, you know, it goes far and that's why the image is one portion but don't let it,

[00:08:42] you know, determine everything in what you're going to feel in your outcomes

[00:08:46] moving forward in life. And I think that's what we want to continue to talk through today

[00:08:51] of what you can do when you start feeling these signs and symptoms kind of happening.

[00:08:56] And it's kind of interesting just to look at the prevalence of hip osteoarthritis when we're

[00:09:01] looking across countries and we actually see the lowest rate and prevalence happening in Africa

[00:09:07] and then followed by Asia, then North America and then the highest prevalence actually in Europe.

[00:09:13] And we can see, you know, if we kind of think even just at the lifestyle of some of these,

[00:09:19] we might already start to understand why this could be. It's genetic purposes, it could be

[00:09:25] lifestyle in terms of the food that is more prevalent in Western cultures and, you know,

[00:09:30] North America and Europe eating a little bit more, having a little bit more weight that we're

[00:09:35] putting on our body comparatively. But we also, what I thought was interesting was looking at the

[00:09:40] anatomical differences and what they, you know, kind of pointed out is that there is a lower rate

[00:09:46] of acetabular dysplasia in people in Asia countries. So essentially meaning that the joint

[00:09:52] isn't as predisposed for injury when we're looking in kind of other Asian cultures

[00:09:57] and there's a deeper size of the acetabulum. So that means, you know, it's kind of deeper into

[00:10:03] the socket. So there's going to be, you can have limited range of motion, you can have, you know,

[00:10:09] it could cause a bit more injury in terms of impingement and movement in European cultures.

[00:10:15] So it's kind of interesting to look at even anatomical, genetic and cultural differences

[00:10:21] and what we see prevalent with HIPAA.

[00:10:24] Yeah, I mean one last thing that we saw was that HIPAA can become more common in women

[00:10:31] after menopause than in men. And they think that this has something to do with the protective

[00:10:36] effect of estrogen. And then there, yeah, I mean there are just several different studies

[00:10:39] that support this hypothesis because of like the protective mechanism of estrogen with women.

[00:10:44] And that's where sometimes they might recommend estrogen replacement therapies, especially in

[00:10:48] people who are predisposed to having different arthritic conditions or other bone disorders.

[00:10:52] But I think one of the main things we want to get to is like, okay, what to do? What can I do to

[00:10:57] help this? And one of the questions that a lot of the studies were trying to answer was, okay, so

[00:11:03] some of the predictors of poor progression of HIPAA have to do with really poor range of motion,

[00:11:09] people who have a severe amount of pain and if there's any sort of cognitive decline or other

[00:11:13] significant comorbidities. So, essentially if you get HIPAA to the point where it's severe,

[00:11:19] it's debilitating, it's limiting your range of motion and your pain is severe, that puts you

[00:11:24] at a very poor prognosis for how it's going to progress. So, the question is how do we catch

[00:11:29] early? How do we catch people who might be starting to develop mild to moderate amounts of OA but not

[00:11:35] have significant symptoms yet so that they can start to be proactive about this? And that's the

[00:11:41] challenge because unless we're doing images on everybody to see like, okay, how's your hip look

[00:11:46] right after we talked about how your hip looks doesn't necessarily dictate your pain. But you

[00:11:51] know, there could be a mild correlation there and so if people knew, could they be more proactive

[00:11:57] about it? I think our message is just we should all be proactive about our joint health. We should

[00:12:01] all be focusing on how we can keep our joints strong and healthy regardless of how they look

[00:12:06] on the image. So, how do we prepare people to do that based on the information that we have?

[00:12:12] Well, you know, one study was looking particularly at trying to determine exactly what people could

[00:12:18] do. So, a panel of experts kind of agreed that a baseline assessment with a follow-up was an

[00:12:24] important component of delivering the best practices for this therapeutic exercise for knee and or hip

[00:12:30] OA. And really what they're looking at for this baseline assessment is taking in the whole

[00:12:37] biopsychosocial model. So, we're looking at the individual's report of difficulties. We're looking

[00:12:43] at their physical limitations, their functional restrictions, their impact on participation out

[00:12:49] in the world, relevant psychosocial factors, the individual's overall health, so including any core

[00:12:55] mobilities that might be happening, and any underlying serious pathology or contraindications

[00:13:01] that can affect therapeutic exercise. So, we're taking in the entire person. And I think that is

[00:13:10] what's so crucial and important to understand here. It's not just let me check your range of

[00:13:13] motion and let me see how strong you are. It's let me take in your life experiences, what's

[00:13:18] happening in the background, and all kinds of things within your life to really look at the

[00:13:23] bigger picture of what leads into pain as well. Yeah, we see it so consistently in different

[00:13:28] rehab protocols or especially something like this which is essentially a lifestyle change. Like if

[00:13:33] you're trying, if you're starting to have hip osteoarthritis symptoms, it's going to take a

[00:13:37] lifestyle change to consistently improve your quality of life, the pain numbers, your functionality.

[00:13:45] So, it needs to be something you enjoy and that's when people have the best success or compliance

[00:13:51] in those lifestyle behavior changes. It's not like, hey, I hate strength training, so I'm going

[00:13:55] to use strength training as my primary way to improve my hip osteoarthritis. No, like you need

[00:14:01] to choose something that you're going to enjoy whether that's bike riding, whether that's dance

[00:14:06] classes, whether that's yoga, like a variation of an exercise that you get fulfillment out of,

[00:14:13] that you take enjoyment away from, that also might include some components of strength,

[00:14:19] range of motion, balance, you know, all the things that are going to help us create a stronger

[00:14:25] and more resilient hip in the long term. Well, and that's where, you know, they also looked at

[00:14:30] and the reality of things is that there's no single type of exercise that's recommended over

[00:14:34] another. It's really important for the type of exercise to be selected directly based on the

[00:14:40] impairments or functional limitations of that particular individual and that's why again we

[00:14:45] can't just say, oh, you know, you have HIPAA or oh, you saw it on a radiograph, here's exactly

[00:14:51] what you should do. It really should be individualized and that's hard for people

[00:14:55] and it's also, you know, really important that it's reproducible for you. So if you do not have

[00:15:01] access, if you go to a physical therapy office and you're using, you know, some fancy equipment,

[00:15:05] but then you can't reproduce that at home, there's not really adherence to be able to maintain that

[00:15:12] exercise then. So what are we doing and what are we providing you that's making sure it's easy to

[00:15:18] achieve and it doesn't require some extensive equipment in order to maintain it, you know?

[00:15:24] The ability to perform it without supervision is also very important. And outside of that, I think

[00:15:29] that there's huge value to being with someone in person to start this. Like you said, it's important

[00:15:35] that you can do the exercises on your own or at home by yourself, but being with somebody who can

[00:15:41] do that assessment, talk with you, come up with the best plan that you're going to be able to

[00:15:47] enjoy doing, adhere to at home is so valuable having someone with that trained eye to know,

[00:15:53] okay, you're limited in these areas. Here's a few things that you can do to work on strength.

[00:15:57] What type of equipment do you have at home? And I think the research also supports that having

[00:16:02] someone to guide you through that process is much more successful than getting exercises and just

[00:16:07] trying to self-maintain a program at home. Well, and that's why I also hate like the little

[00:16:12] exercise papers that you get at a typical physical therapy clinic. If you're getting those,

[00:16:17] make sure you're saying, okay, if this is what I'm doing, how do I progress it if I'm feeling better?

[00:16:22] How do I modify it if I'm having a flare up? Because pain flare ups are going to happen,

[00:16:26] especially if you're going through times of stress or you're losing someone or whatever

[00:16:31] is happening in life that increases our pain thresholds or it decreases our pain threshold

[00:16:36] and actually increases pain sensitivity. So how are we modifying around so that we can continue

[00:16:41] to move and not feel defeated or fear that movement in exercise, but we're getting adequately

[00:16:47] guided? And I'm just going to toot my own horn real quick and say it's really awesome to see

[00:16:53] people going through our last challenge, our Strong Healthy Joints Challenge, and be able

[00:16:58] to hear the feedback of listening to your cues and getting your modifications allowed me to feel more

[00:17:04] confident in movement, allowed me to do exercises, allowed me to increase my strength and earn my

[00:17:10] load in exercises to a place that I didn't think I was able to do. And that's really cool. Again,

[00:17:15] that guidance that having someone expertly cue you and guide you modify as needed for your body is so

[00:17:23] huge so that you don't fear moving because exercise in the end is the only way that we're going to

[00:17:29] continue to improve. And we're also looking at like, you know, it's not always going to be what

[00:17:36] some of the, you know, studies have shown is that it's not always going to be the thing that's

[00:17:42] going to reduce the pain symptoms unfortunately, but it can help hugely improve your function.

[00:17:48] Yeah, which that's where are we measuring improvement? If we're solely like I need this

[00:17:53] pain to come down and that's the only thing that I'm going to see as a benefit, like Jen said,

[00:17:58] sometimes the exercise might not significantly reduce that pain or, you know, do so at all.

[00:18:04] But it might help you go up and down the stairs more effectively. It might help you be able to

[00:18:10] walk out to a field to watch your grandson or your son's baseball game or something like that.

[00:18:15] So, if there's improvement in function and the pain stays the same, a lot of the times we'll

[00:18:21] call that improvement, right? Because you can do more. Hopefully that increases your quality of

[00:18:24] life to some degree, even if the pain is not improving. And generally on our podcast like this

[00:18:31] isn't where we're going to tell you, oh go get a hip replacement or not. Hip replacements honestly,

[00:18:36] very high success rate, very, you know, good success rate at bringing pain levels down. You

[00:18:42] know, they do some amazing... And improving function. Yeah, and improving function. They

[00:18:45] do some amazing things with joint replacements, especially hip replacements these days.

[00:18:49] Mm-hmm.

[00:18:50] And that's where in the type of scenario where you already have significant reduction in,

[00:18:56] you know, range of motion, function, super high levels of pain, there might be some other

[00:19:01] comorbidities involved. That's when you might want to get with an orthopedic surgeon and say like,

[00:19:05] hey what are my options? Because my outlook doesn't look great as far as this improving,

[00:19:11] you know, with exercise. If you're somebody who... This is where we're talking to the people with,

[00:19:16] mild to moderate symptoms or joint degeneration, there is opportunity to improve the resilience

[00:19:24] and longevity of that joint in a way that we might be able to delay a replacement if we get one at

[00:19:30] all. But I just wanted to say there is, you know, a very good success rate of people who do decide

[00:19:38] to get hip joint replacements. Yeah, and I think that's really important to point out, especially,

[00:19:43] you know, we have one of our really good friends, Jill Miller. She actually had a hip replacement

[00:19:48] herself as well. She's not, you know, in her 60s, but she got it because genetics for her plays a

[00:19:56] role in her tissue laxity and she also, you know, put her joint in extreme ranges when she was

[00:20:02] doing a lot of different types of yoga where, you know, putting your leg behind your head and doing

[00:20:08] things that were beyond the normal range of motion that we're trying to achieve. And because she

[00:20:14] already has hypermobility and hyperlaxity within her joints, it causes a lot of stress to her

[00:20:18] joints. So in her case, getting the joint replacement really helped to now improve.

[00:20:24] So she's back to hip training. She's back to strength training. She's back to, you know,

[00:20:29] all the improving her range of motion, not having any pain or symptoms and being able to do all of

[00:20:34] these things. So it's not like you get a hip replacement and you're out for the count. You can

[00:20:40] get back to lifting heavy and being explosive and dynamic within your movement. So it depends on,

[00:20:47] you know, where you are along your journey. There's something that we've talked about at

[00:20:52] length on different podcasts is different modalities like electrotherapy or e-STEM,

[00:20:58] you know, joint mobilizations and manual therapy. What are some other ones?

[00:21:03] They looked at acupuncture as well.

[00:21:05] Acupuncture. And as far as hip osteoarthritis, especially for electrotherapy, acupuncture,

[00:21:11] they didn't find in studies that they were as effective for bringing down pain or improving

[00:21:16] function. There was some benefit to manual therapy as far as, you know, impacting or altering

[00:21:25] pain sensation for some people. But ultimately, that's not going to make the difference long term.

[00:21:30] It could provide, you know, some relief, different manual therapies to get people to be

[00:21:35] able to do more exercise, build up strength, build up the range of motion. But ultimately,

[00:21:40] they weren't seen as long term fix. There's some things in the research that discusses posture,

[00:21:46] sitting posture, shoes you should be wearing. And of course, all of these things that we do

[00:21:50] repetitively, if we're walking in certain types of shoes, that can put different pressures on our hips.

[00:21:55] If we're sitting in a way that is constantly putting our hips into extreme ranges of motion,

[00:21:59] that can impact the way that we feel or the, you know, the pressures that we're putting on our hips.

[00:22:04] So, of course, those are always things that we should be paying attention to and finding those

[00:22:08] times we might be putting repetitive undue stress on the hip joint.

[00:22:13] Yeah. So, essentially, try not to wear heels if you can. I mean, you know, because that's just

[00:22:19] going to put a lot more pressure into that hip. Crossing the leg, something that a lot of women do,

[00:22:23] you know, are we always sitting in that cross-legged position? How often are we sitting

[00:22:28] in that? Is it always one leg over the other? Are we strengthening in other directions? Are

[00:22:34] we moving in other directions? It's so important that it's not just about one thing or one thing

[00:22:40] you're cutting out, but what are you also including and adding that's helping with the

[00:22:44] overall range of motion and so that we're not getting stuck essentially in one range. And,

[00:22:49] you know, if you do need a little bit more support when you're sleeping, I mean, we have a whole

[00:22:53] sleep podcast where we talk about different positions that can be supportive for sleep

[00:22:57] to help reduce stress and pain. But if you're laying on your side, put a pillow either between

[00:23:03] your legs or I love to use a body pillow and put my leg on top of it because then that keeps my

[00:23:08] hips into a good alignment. Some people might need less flexion, so maybe you can't get your

[00:23:14] knee up as high, but you put a pillow between your legs and you kind of have your legs at

[00:23:18] less than a 90-degree angle and it can help to take off some stress. If you're laying on your back,

[00:23:23] put a pillow underneath your knees, you know. So how can you find support with those pillows to

[00:23:28] help take off some of the stress that you might be feeling? There were things about if you drive a lot

[00:23:33] and when you're in your car, your knees are higher like above your hip level, you could sit on a

[00:23:38] pillow especially if the seat kind of dumps back, sit on a pillow or a rolled up towel in a way that

[00:23:43] helps bring your knees a little bit lower than your hips. So again, activity modifications,

[00:23:49] finding the times that you can take a little bit of that undue stress off the hips. But ultimately,

[00:23:56] trying to summarize what we've been talking about is we need to find the plan that's best for you.

[00:24:01] We need to find the plan that you're going to enjoy the most, the exercise that specifically

[00:24:06] targets the areas that you might have deficiencies. That's why getting with somebody in person

[00:24:11] can be extremely beneficial to help start set this plan in motion and then finding some of the other

[00:24:17] things in life that we can alter. Maybe the way that we're sitting, maybe the way that we're

[00:24:22] sleeping, maybe the shoes that we're wearing. And everything in your life, right? Biopsychosocial, so

[00:24:29] are you getting emotional support? Do you have, are your finances kind of causing you stress? How

[00:24:35] can you get support in that area? Where in your life are you adding stress? Are we not getting

[00:24:42] enough water? Are we not getting enough sleep? All of these things really impact our pain

[00:24:47] threshold. So we have to look at the entire picture when it comes to reducing pain, and we

[00:24:53] have to keep moving when it comes to reducing function. And if we can take, you know, put those

[00:24:58] two in play together, I think we'll have a lot more success within our life. And of course, if you

[00:25:05] are feeling like you don't even want to get to that point, you're not sure, maybe you've had

[00:25:09] instances of feeling a little bit of hip discomfort and you're not wanting it to turn into hip

[00:25:13] osteoarthritis, we do have a hip plan on GenHealth. We have a full body low impact plan as well to help

[00:25:20] get you confident in lifting weights again and feeling good. Again, I hear over and over and

[00:25:26] over again how many people are helped and feel something different when they're moving weight

[00:25:32] in a different way and using the cues that I utilize to find how they can confidently move

[00:25:40] their body and load their body in a different way. And it's just so cool to see. We just talked

[00:25:45] to someone recently, I'll continue to kind of like toot Jen's horn and toot the horn of the

[00:25:50] GenHealth platform because like she mentioned, like so many people come into the platform

[00:25:54] with fear about going back into strength training or resistance training or loading their joints

[00:25:59] because they've had bad experiences in the past. And the person we just talked to recently said

[00:26:06] that Jen just says it and cues it in a way that makes sense. And she does it in a way that helps

[00:26:13] it click with my body. And we've heard that so many times from people. So if you feel like you're

[00:26:18] somebody who's like, yeah, I kind of avoid strength training, come on in. You can use code optimal,

[00:26:24] our podcast audience can always use code optimal to get a discount on any of the courses or

[00:26:29] the membership to hop into that hip plan or the full body low impact plan to start treating that

[00:26:34] hip right and maybe building some more strength back into that body in a way that you might not

[00:26:38] have felt before. Thanks so much for sticking around for another PT Pearl. Now remember, we are

[00:26:44] all going through the Barefoot Mini Course starting on June 3rd. It's going to be our little Barefoot

[00:26:49] Summer Challenge to get those feet ready to be barefoot outside in the grass or at the beach.

[00:26:54] This course takes you through two weeks of assessment and then addressing the restrictions

[00:26:58] that you find. It's still on discount but as our podcast audience, we're giving you a special

[00:27:03] discount on top of that you can get an extra $10 off if you use code optimal 10 at checkout. You

[00:27:09] can find the link down in the show notes but it's just Jen.health backslash barefoot and make sure

[00:27:14] you use code optimal 10 at checkout to get that extra discount. And of course, we'll see you on

[00:27:19] the next episode of the Optimal Body Podcast. Transcribed by https://otter.ai