This is a presentation Dr. Tanti provided about hip arthritis. While the presentation may of happened a while ago, the information is as relevant as the day it was given.
The Story
Sally woke up one day and she noticed that something was wrong. There was tremendous amount of soreness, and stabbing pains in the front of her hip.
She didn't think much of it. This wasn't the first time this has happened.
She got out of bed to start her normal routine...
...but this morning things WERE different.
When she went to stand up, she fell down onto her night stand. The clatter jolted her husband awake.
"Wha...whats going on? Are you ok?"
Sally wasn't ok..she needed help getting up. And Steve finally convinced her to see his doc...or he was going to drag her there in himself.
The Problem
Sally was dealing with a very arthritic hip. It had been developing slowly over the years.
However, lately it had becoming much worse. It had gotten to the point of causing her leg to give out, causing her to fall, jolt her husband awake and break the light on the night stand.
Something needed to be done!
The Solution
Surgery was out of the question!
Sally not only wanted to avoid it, but she also had health issues that increased the risks of surgery.
Luckily her husbands chiropractor was able to identify the problem, and provide a solution that would get Sally feeling good as new again!
These strategies are outlined in the video above.
We will also go through them down below.
So tighten your seatbelt, and lets get started.
**Sally and Steve are not real people. This scenario was fabricated by the author to illustrate the point. However, situations similar to that above do happen all the time**
We are going to cover several items.
1. Who am I?
2. What arthritis is, and what it isn't
3. Why does it matter
3. How to Solve it, without surgery
4. Case Study
Who is Dr. Joseph Tanti?
You could always ceck out the about page, but to be succinct, Dr. Joseph Tanti is a fellow, the Chiropractic College of Orthopaedic Specialist, and diplomate of the International Academy of Neuro Musculoskeletal Medicine.
There are not alot of Chiropractic Orthopaedic Specalsits in Canada, let alone Edmonton Alberta. At the time of this article, there's about two in Edmonton, and one of us in Sherwood Park.
Dr. Tanti also wrote the book on this very topic! You can check it out on amazon here.
What does an Orthopaedic Specialist do?
If you have some type of bodily pain or injury, they are able to diagnose and treat those problems. Not just spinal related issues. They treat everything from your toes to your nose and everything in between.
As long as it's not an organ problem. If you're having a heart attack, obviously go to the hospital. But if you're having any other problems, they are able to help with that
What Arthritis Is And What it Isn't
Many people think hip arthritis is a wear and tear type of problem. The reality is different. People say that it has to do with "just getting old". If that were the case, then why does everyone not get it?
And why is one side of your body typically more arthritic than the other side not?
Why does one area get arthritis and another area does not? Of course we are assuming that your whole body is the same age.
So it's not so much a wear and tear problem. It's more of a wear and disrepair.
Stresses, and strains go through our joints, through our body, and our body is able to heal itself. All these little microtraumas occur throughout a lifetime of living. And then the body is able to repair itself.
We are a self regenerating machine essentially.
But sometimes there's gonna be these functional deficits causing extra stress, extra strain on certain areas of our body, and then our body's not able to keep up with the repair.
It's not able to maintain that normal tissue. This is why certain areas become more arthritic than others. If there's trauma to a joint, for example, a motor vehicle collisions, the joints are possibly more likely to develop arthritis earlier than if they weren't in a collision.
People that have fallen on their hip, or fallen from a tall height and they've had some type of trauma to say their right leg or their right hip, they're more likely to have arthritic changes in that right side compared to the left. Because of that trauma, your body's not able to keep up with the repair as rapidly.
Other reasons is that we'll have certain postural habits. So for example, if you're standing, you might stand over on one side a lot more. You might kind of lean off to one side when you're sitting down, might cross one leg a lot more.
It's not that big of a deal in that moment, but over time seems to catch up with us. And those extra stresses and strains just puts a little bit extra stress through those joints, through those places, and our body can't keep up with that repair.
So then that arthritis starts to kick in.
The older we get, the slower our bodies repair
Just think of yourself in this example. When you were in your teens and twenties, if you got a paper cut, you'd probably pretty much be healed within a day or two,
I'm in my thirties and I noticed that they take a little longer, sometimes a couple days.
I have patients where they get a cut and sometimes it takes months for their skin to heal.
That's just the skin! But that healing also is happening everywhere in your body.
So the older we become, the slower we heal.
This is why that arthritis can be more present, and can develop so quickly the older we become.
So arthritis is not a wear and tear issue, it's more of a disrepair problem.
Why Does Arthritis Matter?
First, it reduces your mobility.
Why do we need mobility? Mobility is the ability of using your bodyto do things! To use your body. Getting dressed, walking, running, exercising, doing everything that it is you need to do or want to do.
The thing that all of these have in common is that you have to be able to move your body. When you can't move your body, you can't do the things you want.
Arthritis can also be very painful. Pain, as you know, can be draining. A lot of people say they have a high pain tolerance and a lot of people do. But acute pain is different than persistent pain. Many times hip arthritic pain is constant. And constant pain really drains on you. It drains your life, it drains your energy, affects your mood, which affects your relationships, can affect your identity. Let's pretend you're a runner and now you can't run. Well, now you're no longer a runner.
So sometimes people get an identity crisis.
They can't exercise anymore. They start putting on weight, they start developing other chronic problems, other health conditions. They start taking lots of medications, leading to polypharmacy.
Pain can also cause mood problems now because they can't do the things that they want to do. And have you ever been in a lot of pain? How was your mood? My guess is not very good to say the least.
Arthritic pain can be a really slippery slope and a downhill slide for people.
Hip Arthritis matters ,because it impacts your quality of life and the ability to do what it is you want to be able to do.
How does Hip Arthritis Develop?
The timeline for people having hip arthritis essentially starts first, with a little bit of stiffness in your hip. Maybe not all the time, maybe just when you wake up or after sitting for long periods of time.
Next you're gonna be getting some intermittent discomfort, maybe even some pain.This is typically gonna be in the front of your hip, sometimes like deep in the glutes, deep in the butt, and sometimes on the side your hip.
As it gets worse, it's gonna become more constant, maybe painful, maybe just stiff. Oftentimes, this is when people seek out care in our office. When they're having some discomfort and realize that something might be going on. Oftentimes they're going to be limping, but not realize it.
As things progress, it can get to the point where you can't walk too much at all without pain. And if even if you caan walk, if you can caall it that, there's a constant pain.
This progression can happen over weeks, or over years. It really is depends on the person, as everyone's a little different.
How do We Solve Arthritic Hip Pain Without Surgery?
Clearaly surgery is the only thing that we can do to change the structure of our bones. To "cut out' the arthritis.
However, there are many things we can do to help maintain the mobility, strength, and functionality of your hip! Often, providing immense pain relief, sometimes complete pain relief! So your arthritic hip has limited or impact on your quality of life!
So what are the steps?
1.Accurate diagnosis
2.Self-care strategies
3. Conservative care strategies
The Goal:Less pain (ideally zero), and to optimize your hip function to improve your quality of life.
Accurate Diagnosis
If you don't have an accurate diagnosis, your just guessing. If you don't know what the problem is, how can you treat it? An analogy is spinning on the teacups at Disneyland while blindfolded and trying to hit a dartboard.
Goodluck!
So we need to know what problem you havae in order to treat it. And one of the gold standards to diagnose hip arthritis is X-ray.
First however, you need to have a thorough examination as well.
Self Care Strategies for Arthritic Hip Pain
Stretching
You need to be doing some stretches. You should be stretching all the muscles, daily, that cross the hip.
Why?
When there is an arthritic hip, all the muscles that cross that hip joint are going to be affected. Your hamstrings on the back of your thigh. Your adductors the inside of your thigh, also known as your groin. Your hip flexors over the front of your thigh, which includes your iliopsoas and your quadriceps. Lastly lets not forget your glutes - your butt muscles essentially.
Your gait is also going to be altered by hip arthritis, so stretching your calves is important. Your lower leg is going get really stiff and tight as well.
Rather than showing you a bunch of stretches here, what you can do is simply go to YouTube.com, and then you just type in whatever body part it is, followed by 'stretch'.
For example....
Hamstring stretch
Adductor stretch
Hip flexor stretch
Thigh stretch
Glute stretch
You get the idea...
The good news is that there is no wrong stretch. Just ensure you are going gently, aand under control. You should feel a gentle pulling or, tight sensation in the area that you're actually trying to stretch.
If it is recreating the pain, that's probably not a great stretch for you right now.
Mobilizations for Arthritic Hip Pain
Mobility is the ability to move a joint within aa particular range of motion. And we all know, an arthritic joint typically looses its range of motion. Sometimes very fast!
As it becomes more stiff, often, the pain becomes worse. So we need to optimize the mobility of your hip!
As that arthritic process happens within your hip, what happens to the joint is the synovial fluid, (which is in a normal joint lubricates the joint, and keeps it smooth and moving) starts to get little more stiff. It turns more into like molasses.
So there is a stiffening of that joint.
This is why initially when you get up in the morning, it's really stiff sore.
But just like molasses, the more you move the joint around, the looser it becomes. And it starts to feel pretty good again.
There are essentially two different types of mobilizations you can do.
First, mobility drills with just your body. Second, mobility drills with some external help. For the second type I like to use bands.
Hip Mobility Drills Without Bands
Simply go to Youtube.com and search "hip mobility drills for arthritis", and a million videos will be found. Look through them and you will see some common themes. Give them a try ,and find which ones work best for you.
Often, a mobility drill that is terrible just needs a minor tweak and then it becomes the perfect fit for you. An example is the following video:
Hip Mobility Drills With A Band
Essentially what you're doing with this is you get like a strong exercise band. Not one of those flimsy ones that are really thin. You gotta get a strong exercise band. They typically have about 50 to 80 pounds of pull.
What you do is you strap it around your hip while you are doing the mobility drills or stretches.
Again, just go to YouTube and type "hip mobility drills with band", and a bunch will populate. Below is an example.
Pain Control For Hip Arthritis
Hip arthritis can be extremely painful.
And when things hurt, it is nearly impossible to do the stretches, mobility drills and exercises that you need to do!
So how do we reduce the pain? And reduce it naturally, so we don't suffer all the side effects?
Here are four simple strategies
1) Heat and/or Ice therapy.
2) Transcutaneous Electrical Neuromuscular Simulation aka. TENS.
While that is sure a mouthful, basically this is a device that cause uses electricity and pads. And the idea is that the electrical current blocks the pain signals from reaching your brain. If those signals don't reach your brain, they don't cause pain!
We sell some in the office, so feel free to give us a call if interested.
3) Topical cream
You can use Biofreeze, voltaren, A5/35, deep blue, etc. There's a million different types of topical creams. They all work to some degree. Some work better than others for different people.
So try a few and see what works best for you. These work in a similar manner to a TENS device.
4) Tissue therapies
These include self massage, foam rolling, Epsom salt bath, etc.
Each one of these strategies can be really helpful in reducing arthritic hip pain.
Its important to note, that these in themselves do not FIX the arthritis. They HELP with the pain, which allows you to do the stretches, exercises, mobilizations.
They all act in a similar manner. What they're trying to do is to block or reduce the pain signals from the hip, from the muscles in that area, from reaching your brain. They don't "fix" your hip, but they can help reduce the pain.
Benefits:The pros with all these self-care strategies is they're relatively low cost. While some are not FREE, theey are relatively inexpensive. They are also very accessible, and low risk of hurting yourself.
Draw Backs: The cons with these strategies is that it get a little bit messy sometimes. While low cost, it isn't free. And results vary. So if you are not getting results with these and you need other options as well.
Shifting gears now, I want to ask you ia question...
Are you fit enough not to exercise?
No.
You're not fit enough not to exercise. We all need to exercise, at least to some degree.
There are some guidelines for minimal amount of physical activity. The Canadian movement guidelines tell us that at bare minimum, you need to be getting at least 150 minutes a week of moderate to intense activity a week.
This includes any type of exercise, really brisk walk, getting that heart rate up.
That's about five times a week, for 30 minutes...bare MINIMUM!
You also want to be hitting the resistance training to hit all the major muscle groups at least twice a week. Especially working on strengthening the muscles and improving your balance.
The older we become, balance typically starts to decline.So really working on that can be extremely important.
In addition, the older you get, the, the more "you don't use it, you lose it" becomes a reality.
So you need to try to maintain your muscle mass by exercising your muscles and using them. If you don't things can go south really fast.
Those are the minimum guidelines. Okay? If you're hitting those, congratulations!
You can always do more, but try to get at least 30 minutes a day, five days a week, of some type of moderate exercise.
Specific Arthritic Hip Strengthening Exercises
The benefit of strengthening your body is that it will helpreduce these functional deficits that are oftenpresent. They are often a predisposition to the development of hip arthritis.
Remember I mentioned at the beginning, that arthritic hips are typically more dominant on one side. Both hips are the same age, so why is one arthritic and the other isn't?
So it doesn't necessarily have to do with your age.Often it is due to a trauma, or some functional deficit. Oftentimes it has to do to weakness within the glutes and within the core and your leg, especially on that more sore side or that arthritic hip side.
So improving the strength, but especially that side, is going to help reduce the stress and strain on your hip and knee joints.
I've also seen time and time again where someone may be extremely arthritic, but they have minimal pain or discomfort. The difference between someone with minimal pain and discomfort who's really arthritic, and someone who has a lot of pain and almost debilitated is often how strong they are.
The people who do really well are typically really strong. They have a lot of muscle. The people that don't, they have a lot of muscle wasting. They're quite weak.
One problem is that there's a million different types of exercises and sometimes people think if it hurts, it's making it worse.
That's not necessarily always the case... so that's why it can be difficult sometimes to know what you should be doing.
This is where having an expert help you can be useful...
Who should you see to help you with your arthritic hip pain?
There are a lot of options out there. This leads to confusion. Who should you choose?
Physiotherapy?
Acupuncture?
Medical doctor?
Massage Therapy?
Chiropractor?
Yoga?
Pilates?
Trainer at the gym?
Prayer?
Lets change our focus
Rather than thinking "who should I see", think "what do I need?"...and determine who can provide that for you.
So what do you need? Well you need to focus on a couple things...
1) Improved joint mechanics: You need help improving how the actual hip joints are moving.
2) Reduce the compensatory and functional changes in your body.
3) A Stretching Program
4) A Mobility Program
5) A strengthening Program
6) Reduce Inflammation and Pain
You need to address all six of these items to solve arthritic hip pain
If you don't, you'll simply be spinning your wheels with lacklustre results.
So it's not so much a "who should I see" question. Its a who is to address all of these different things.
If you just address one of them, for example, you take some NSAIDs, some anti-inflammatory medication that might reduce the inflammation or a mild to moderate amount for a period of time.
But if you're not addressing the joint mechanics, then the pain is going to come back. If you're not addressing how you move, the compensatory movements, and those functional deficits we talked about earlier, the pain's just going to come back.
If you're not stretching, if you're not strengthening, if you're not addressing your nutrition...
the pain's gonna keep coming back.
So you really need to be addressing all of these things to get lasting results. I
Who can help with arthritic hip pain?
So who's able to do that, I wonder?
A chiropractic orthopaedic specialist obviously!
There are multiple providers that can do all some of these things, but they really need to be all addressed. And this is why sometimes taking a multidisciplinary approach can be quite helpful.
Listen to Amanda's Story
My right leg was really giving me issues when I was getting standing up from sitting down. It was really stiff and it hurt. Um, sometimes it was a shooting pain through my leg when I put weight on it, and it usually took two or three steps, if not longer, before I was actually walking upright.So that wasn't great. I also had issues, even when I was just sitting down, it would be constantly aching. So, um, sometimes it was more achy than other times, but it seemed like it was aching most of the time. And sleeping was also difficult because my leg was constantly aching and turning over in bed was also very sore and painful.I couldn't lay on either side without my leg complaining and walking. I was limping quite a bit and especially, I was limping enough for friends and neighbors to start noticing that something was wrong. So were they making comments and stuff like that? Yes, they were one of them actually recommended I come and see you.What would you say are some of the activity limitations that you have? Even just walking the dog wasn't as enjoyable because I was concentrating more on how I was walking and how my leg was feeling than what the dog was doing. So our walks were shorter because I couldn't go the distance, which wasn't good.And also it was in the wintertime, I was really afraid of falling because if I fell I, I was concerned that I'd hurt myself some more or I wouldn't be able to get up. And that's the first time I've ever been leery about walking. In the wintertime, I also enjoy jogging, but that just wasn't an option with my leg aching and I'm being so painful.How'd that kind of make you feel frustrated? I really down helpless in a way because I, I was doing things to stay healthy and to stay mobile, and yet this, this ache in the leg, this pain in the leg just wasn't improving. Certainly not fast enough. How long were you dealing with it for? Since, I would say last September, and it probably stayed fairly, um, consistent in, in where it was at until about January where I had a few falls on the ice and the snow, and then it seemed to get worse and that was again, more painful, more, more constant pain.So then your neighbor suggested you come in here and you're kind of hesitant. Walk us through that kind of process for you and kind of what you were, uh, what you experienced and what you were thinking as things were happening. Well, I came in to see, to see you and, um, I. It's, it's worth a shot. I tried chiropractic for my arm many years before and it had worked well.So it seemed like the, the exercises that I was doing by myself were not getting my leg better. So I thought, let's give this a try. And then I guess to start off with, it was a couple of times a week, and I won't say that things got better immediately, but there was definitely the improvement that kept me coming back and now what, it's few months later, three, three months later, four months later.And I'm really happy with, with where I'm at. It's, that's great. I'm glad you're feeling so much better. So how, how is life kind of looking like now? Like what are the things you're able to do, you're having difficulty walking your dog, feeling confident, going out, exercising. So walking the dog, it's all good.We can go the longer distances because I know my leg is gonna hang in there. Jogging, I haven't tried yet and I think I'm gonna give that a little while. As far as sleeping goes, my leg isn't keeping me awake all night type thing. Um, I don't have. I aching and pain in my leg when I'm, I'm just at rest.There's maybe a little bit of an ache if I've been sitting for a while for the first step or so, but it's so much different than what it was before. It's, I would say, almost back to where it used to be before the the problem started. That's great. That's great to hear. What would you say to anyone who may be dealing with this kind of thing or similar issue and maybe a little hesitant to try out chiropractic come in or try different things that get it feeling better?What would you kind of say to that person? I would say to give it a try because there's not, it's the, the, the adjustments that you did were, were not painful. It, a lot of it is stretching or I don't know how to describe it, but it's not painful and, and it feels good afterwards. And to be able to move around without the pain, without using painkillers and to feel that it's all been done in a very natural way is the best, as far as I'm concerned.You know, like there's no invasive surgery, no pills that you're constantly taking. And from my perspective, no worries that my leg isn't gonna support me when I need it. I know you're really big on the natural route and really don't like taking medications. I think you were taking some medications before, right?And they were kind of moderately or mildly helpful, if anything at all. Yeah, basically. That'd be usual painkiller now and then, but it, it didn't really help. Okay. Anything else you wanna add? Anything you feel like I, I kind of omitted or didn't ask you about, I guess as well? One of the, the things that I liked was that the appointments very quickly went from two a week to one appointment every two weeks to once a month, and now we're up to one appointment every two months type thing.So just knowing that this isn't something that I have to work my schedule around every single week is awesome and, you know, to, to know that, okay, so arthritis can't be fixed and made to go away, but it can definitely be worked with. And, um, general regular maintenance. Helps keep me moving. Yeah. So, so true.I just wanna ask you actually one more thing, if you don't mind. What would you say some of the treatments, uh, that, that you are having done, what, how would you describe those? Like, a lot of times people will think the chiropractor will just kind of, you know, you're in there for 30 seconds, they'll kind of snap your back and then, uh, send you on your way.Um, and then you gotta go in, like you said, like once or twice a week, but indefinitely. And sometimes people are kind of concerned about that. Um, so sometimes people will not come in because they may feel like, well, if I go to, I go once, I gotta always go then. So I just don't wanna get started. What would you kind of say to that?Obviously it's not true, but, um, I mean, to start the, the session, it was always a case of you asking me, how are you doing, how are you feeling? Having a look at how I'm walking. And then it wasn't the same adjustments every single time, like you would, um, I think it was adjusting my hips or, or that lower back most of the time.And also, you know, doing some traction and some stretching exercises as well as some range of motion. I. Stuff with the, with the hip. So it's not just a case of me going in there and you saying, okay, we're gonna snap my back type thing. And, and going off. It's more personalized to what I'm dealing with rather than one size fits all.Well, I really appreciate your time, Amanda.
That was just Amanda. If you were listening you probably could identify with a lot of the things that she was dealing with.
She had the the progression of the stiffness, and then eventually it starts really catching up with you affecting how you're walking and all those types of things. You will notice that we're doing a lot of different types of therapies, not just one, but trying to address all those factors that need to be addressed for someone with hip arthritis.
And she's doing very well now.
There is clearly more to hip arthritis than just what is here. But this is a great primer to get you started.
If you'd like to see and hear other success stories for hip arthritis and other issues, you can check them out here.
The Next Step For Arthritic Hip Pain
First, use all the strategies that we talked about today
All those self-care strategies, the stretching, the mobilizations with and without external help with band, the strengthening exercises. All those are crucially important.
So definitely start there.
Make sure that you're meeting those minimum exercise guidelines.150 minutes a week or 30 minutes a day, five days a week.
Second, one-on-one treatment.
This allows you to get outta pain faster. Oftentimes, you get specific personalized treatment plan for you. Addressing the hip obviously, but any of those functional changes that have occurred to get better faster, get out of pain faster.
One benefit is that you will know how far along you are in that arthritic process. A lot of people don't know they. They have very mild or if anything at all, but they might be told that, oh, you have arthritis, and they think it's the end of the world and they need surgery. And a lot of times that's not true.
So by having the 1-on-1 treatment, you know you are getting everything you need, and you can eliminate all of the guesswork.
If you would like to schedule a 1-on-1 visit with me, you can book here.