Osteoarthritis of the Hip

What is Osteoarthritis of the Hip?

Osteoarthritis (OA) is an inflammatory joint disease that slowly affects the cartilage surface of the articulating bones. In severe cases, the bone tissue next to and under the cartilage can also be affected and bony spurs called osteophytes can form, further restricting the range of motion in the joint.

OA of the hip is the most common cause of pain in the hip. Symptoms may include:

• Pain & Stiffness particularly at night and first thing in the morning
• Difficulty getting in and out of a car
• Difficulty putting on socks / shoes
• Disturbed sleep
• Secondary low back and / or knee pain as a result of an altered gait pattern

What causes OA of the Hip?

There are several possible causes of hip OA so what follows is not definitive but is a list of the most common causes:

Previous hip fractures – almost always result in a long-term alignment issue which increases the stress and load on the hip joint.
Previous hip injuries – including labral tears (cartilage within the hip joint), severe dislocations and chronic soft tissue damage to the hip joint that again can alter the biomechanics of the joint and lead to OA.
Congenital malformations – when skeletal bones fail to develop properly in infancy and remain fragile, thereby leading to altered shape of the femoral head or acetabulum (ball and socket respectively).
Hip dysplasia – is similar to congenital malformations but is generically used to describe a hip joint (both the femoral head and acetabulum) that simply ‘does not fit’. Again, altered biomechanics can eventually lead to OA.

Management of Hip OA

Hip OA like all degenerative diseases is better treated proactively rather than reactively. The investigation of choice to determine the extent of OA is plain X-ray and the most common views requested are anterior-posterior (AP), lateral and occasionally weight-bearing. Once the extent of the OA is categorised as mild, moderate or severe and the severity of symptoms and affect on lifestyle considered, a management plan can be structured.
If the hip has severe OA and the lifestyle affected as a result, then the most common treatment would be surgery consisting of either a resurfacing of the femoral head and acetabulum (in younger populations) or a total hip replacement removing the femoral head and lining the acetabulum (older populations). These procedures are followed up with routine physiotherapy and exercises to strengthen around the hip. These should be prescribed for life in order to maintain a healthy, strong joint and reduce the onset of other problems.
In mild and moderate OA the client can be taught to manage the pain and stiffness with specific exercises. The most important areas to consider are strengthening of the deep stabilising muscles of the hip, mobility exercises of the hip and mobility and strengthening of the lumbar spine – perfect candidates for Pilates then!!

Pilates and Hip OA

As a Pilates teacher you will be more than aware of how important it is to maintain healthy joints and in particular the importance of keeping the pelvic area strong and supportive. When working with client’s suffering from hip OA it is important to consider their lifestyle, their goals and any contraindications to certain movements (if required and consented by the client, contact their GP, Consultant, Physiotherapist, etc, for more information).

Then consider everything that will help to maintain a healthy hip joint...

• The Hip joint itself
• The Spine (lumbar spine in particularly)
• The Knee, Foot and Ankle

By working around the joint as well as on it specifically, you will maximise the outcome of the conservative management of the OA. Particular attention should be paid to the pelvic floor musculature, the deep hip rotators, the small stabilisers of the spine and the mechanics / flexibility of the knees and feet.

As outlined above, most causes of OA in the hip are related to altered biomechanics. Therefore if you address and maintain alignment, as intended with Pilates, you can help to reduce symptoms, slow down the progression of existing OA and undoubtedly prevent the onset of hip OA.