Case study – Bilateral hip osteoarthritis
A client from Injury Active who I was actively treating for shoulder pain, asked me to help with her squat. Client A was struggling to hit parallel and had an unusual movement pattern descending to the bottom. Client A had no symptoms in her hip and does not recall any previous injury.
I watched her squat and after trying to make a few tweaks, there wasn’t enough improvement. I decided to carry out a biomechanical screening so I could try and identify possible drivers for the problem.
Ankles, knees, spine – all seemed fine. However when I assessed the left hip in particular I found a discrepancy when testing the joint. Within the Crossfit world, we are always trying to work on our joint mobility and muscle length/tone to improve our movement patterns and attain better form. Unfortunately, joint shape, abnormality or degenerative problems are not often enough, taken into consideration. Why do people squat differently? You may find, especially when working with the back squat that specific mobility exercises can help. Equally, you may find that no matter how long you spend trying to get that hip to move more, it just doesn’t want to, or even worse symptoms arise / get worse.
Following on from the screening, we decided that a referral was necessary to check out the hip/s. It was also agreed that we would try and see how the hip would work with movement correction and mobilisations. As you can see from the image below, it certainly helped. This took a lot of work and a lot of concentration to move in this way.
Unfortunately for client A, the mobility and movement correction work caused symptoms to flare slightly for the first time accompanied with night pain. This put a huge wall in front of our progressions and decided we would wait for the investigations. Never before had client A experienced hip issues.
One x-ray later and bad news. Bilateral degeneration in the hips, osteoarthritis with obvious osteophytes giving rise to hip impingement. This is never easy to accept and understand. However I found myself searching for the positive side of the results for client A.
As you can see from the image above, this x ray taken for client A shows the issue in the femoral acetabulum joint. Bilateral degeneration = most likely osteoarthritis.
What is it? Symptoms?
The most important characteristic of hip osteoarthritis is that there’s damage to or loss of the articular cartilage. Pain with movement, which increases when they load the joint for too long or the wrong way. Later on, they will typically complain of a continuous pain and night pain.
Risk factors – Many, but one that we will focus on.
- Sedentary lifestyle
So activity helps?
Research has shown that weight training can help with bone density. Is it too late to manage this now though?
You are not going to reverse the osteoarthritis now. However, there is plenty of work that can be done. I would not advise taking a more sedentary lifestyle. Why become weaker, stiffer and less mobile?
How to manage hip OA:
Manage pain and swelling: Some times you may need to deload and look to medication. Once the pain has settled we move on to stage 2. Seeing your therapist can help you through massage, taping, movement correction or electrotherapy.
Restore normal joint range (as best as you can) and strength: Build strength and control around the joint to increase the joints efficiency and control. Crossfit and weight training will help you manage your weight. Weight gain/being overweight is only going to negatively effect your symptoms. We know that every day is leg day with crossfit. Perfect. The glutes are working hard and going through a periodised programme to get stronger. Stronger glutes normally mean more hip control and better distribution of forces.
OUTCOME
If you find you have limited range in hip movement then go and get screened. As I mentioned previously, my client had no symptoms in her hips. It was only through the proactive approach via screening which enabled us to find out the cause of the problem. Finding this early can help the individual. Go and see your therapist if mobility work is not helping or in fact causing symptoms to worsen.
If there is pain, adjust something. If pain is persistent and doesn’t improve after this adjustment then back off and seek help. Never train through pain.
Your body will benefit from stronger muscles and more mobile joints. Do not stop training. Keep improving.
Thanks for reading.
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Train hard, train safe as always.
Craig
