Tips for Chiropractors and Care Providers to Avoid Arthroscopic Hip Surgery or Hip Replacement
In the United States, 3-7% of older adults will have some type of hip osteoarthritis during his lifetime. “Osteoarthritis” or “OA” is the appropriate term for overuse or age-related degenerative conditions. While there are other types of hip problems, such as fractures or soft tissue injuries, most people will be diagnosed and seek care for the degenerative type, eventually trying to avoid arthroscopic hip surgery.
Hip replacements and alternative methods
These degenerative hip problems result in nearly 200,000 hip replacements each year in our country. These surgeries are not only expensive, but involve intensive and time-consuming rehabilitation, as well as the potential for various post-surgical problems.
While some people may actually need arthroscopic hip surgery, many others are borderline surgical candidates or are not prepared to go under the knife without first exhausting other treatment options. In these cases, a combination of proper exercise and chiropractic care can significantly delay the need for surgery or even help prevent it altogether.
Exercise to support the muscles
Exercise and physical activity are known to have a positive effect on joint health and condition. When we look at the hip, we find a large “ball and socket” joint between the femur and pelvis that supports much of our weight when we do any “vertical” activity such as walking, running, or stopping.
Surrounding this joint and providing dynamic support is a complex arrangement of muscles, including the glutes, hip flexors, quads, hamstrings and adductors, to name just a few. Weakness in these muscle groups can cause unwanted additional load on the hips and cause excessive wear. By exercising regularly, especially in resistance exercise, we can make sure that the support muscles around the hip are strong and have the ability to support the hip during our daily activities.
Another added benefit of physical activity is that exercise can stimulate chondrocyte activity in the joints. Chondrocytes are the small cellular structures that hold and produce cushion-like connective tissue that surrounds and coats most of the joints in our body. If we can stimulate chondrocyte activity, we can aid in the physical process of repairing damaged tissue and creating new healthy tissue.
The good news is that if you don’t feel comfortable in a gym setting or your degeneration is too advanced to participate in “traditional” weight lifting, even the simplest bodyweight exercises can be extremely effective. Movements such as aerial positions, lunges, hip pushes / bridges, etc., are safe and efficient methods to improve endurance and muscle strength. If patients have the strength and ability to perform even more demanding exercises, encourage them to do so.
Strength exercises vs. cardio
If endurance exercise is good, what about cardio? Do you like walking or running? The answer is a bit complex.
Many studies show that, in the context of hip health, it is possible to overdo certain types of cardiovascular activity. A 2015 study, which measured the amount of load our hips experience when moving, showed that when walking, an average adult will experience hip contact forces approximately 4 to 5.5 times their body weight. This load can increase our body weight by up to 10 times when running 12 km / h (approximately the rate of one mile in 8 minutes).
For example, a 180-pound individual will experience hip contact forces of nearly 1,000 pounds when walking and more than 1,800 pounds when running. Does this mean that cardiovascular exercise is necessarily bad for the hip? No, but we must understand that these forces of contact with the hips create a cumulative effect over time. Several studies show a positive relationship between a runner’s age, running pace, total mileage, and degenerative hip disease, probably due to the increased hip contact forces that occur during the race. .
What does this mean for patients? While we can’t make specific recommendations for cardiovascular exercise, we know that extremely high mileage combined with a fast running pace can lead to an increased risk of degenerative hip problems, and the more degeneration there is, the more likely you are to encounter problems. . In the context of hip health, this means that a regular walking routine can greatly benefit patients, while running should be carefully monitored.
If you want to practice more vigorous cardiovascular exercise, try something like swimming or an elliptical shape that removes some of the load from the joints.
When adding exercise to a “surgical prevention routine,” the chiropractor or physiotherapist should determine what types of movements and loads are appropriate and make sure patients follow a proper and safe manner. When used correctly, exercise can play a valuable role in delaying the need for hip arthroscopic surgery or other surgery.
Research and the role of the chiropractor
Numerous studies have focused on the relationship between chiropractic / manual therapy and degenerative hip disease, but one highlights the benefits very well.
A 2004 study compared “manual therapy” with “exercise therapy” in 109 individuals who had previously been diagnosed with hip osteoarthritis. The exercise group focused on active exercises to improve muscle function and joint movement. Manual treatments (also known as chiropractic care) include: identification and stretching of short / tense muscles within the hip complex, traction of the hip joint, and manipulation of the joint in “each appropriate limited position.”
Participants were divided into two groups and treated for a period of five weeks, and the results were very impressive:
- Success rates of primary outcomes were 81% for manual therapy, compared with only 50% for exercise therapy;
- The manual therapy group had significantly better outcomes to improve range of motion, hip function, stiffness, and pain;
- The positive results experienced by the manual therapy group lasted after 29 weeks.
In addition to manipulating the hip joint, another consideration should be the difference in leg length (LLD), a sign of biomechanical problems with the pelvis, SI joints, and / or lumbar spine. Interestingly, research shows a potentially strong relationship between LLD and the onset of degenerative hip disorders, probably because weight alteration in a joint could be a contributing factor to osteoarthritis. Although there are other methods for analyzing pelvic / lower back function and alignment, research focuses on LLD because it is easily quantifiable and reliable.
LLD and stressful
The researchers propose that pelvic tilt or torsion, visible through the measured difference in leg length, puts uneven load and tension on the hips and can reduce the area of contact of cartilage in the joint.
The combination of these tensions can increase the pressure on the cartilage and bone of the joint, causing degenerative hip conditions. We see evidence of this in a survey of 100 patients who were diagnosed with hip osteoarthritis. The researchers measured each person’s LLD just before hip surgery and found that their hip osteoarthritis was next to the longest limb 84% of the time. Other studies have shown very similar findings regarding knee osteoarthritis.
For chiropractors treating patients with degenerative hip problems, the focus is on restoring normal movement of the joints to the hips, as well as eliminating or reducing the amount of measured difference in leg length. Regardless of what methods or techniques are used to achieve this, attending to these areas can significantly reduce the need for surgery and have a positive impact on patients ’overall function and pain levels.
Arthroscopic hip surgery and variable options
While some patients really need surgery or arthroscopic hip replacement to protect their quality of life, many others have options when it comes to degenerative hip problems.
Proper exercise scheduling, combined with specific chiropractic care, can dramatically improve an individual’s function and mobility, significantly reduce their pain levels, and delay or avoid the need for surgery.