September 2011
Although osteoarthritis commonly affects the knee, hands, and spine, the hip is the most commonly involved joint. When the cartilage is worn away, the hip socket begins to wear down and change shape. This change in shape causes limited range of motion and usually causes weakness in the muscles around the hip.
Physical Therapy can help relieve pain associated with hip osteoarthritis. When the hip joint is in the early stage of the disease, there is a great deal of pain and inflammation, but no significant structural change has occurred. It is important to address the restricted motion in the hip at this point, before permanent bony changes occur.
Your Physical Therapist has many tools to help relieve your pain and improve function. Although the treatment of this disease is similar across most patients, the stage of the disease determines the treatment plan.
In hip osteoarthritis there are generally three stages:
1) Early Stage: Thinning of cartilage that covers the bone, stiffness and intermittent pain that is relieved with rest.
1) Moderate Stage: Pain is more consistent when standing/walking and not relieved with rest. More significant stiffness.
2) Degenerative Stage: Complete loss of cartilage and “bone-on-bone” contact causes extreme discomfort. The bone becomes harder and more dense around the socket.
How Physical Therapy can help:
1. Improve mobility and decrease pain in the hip through joint mobilization (a specific technique to stretch the hip joint).
2. Improve range-of-motion through generalized stretching.
3. Improve function through gentle, progressive strengthening.
4. Improve soft-tissue extensibility through myofascial release of soft-tissue adhesions or restrictions.
5. Restore function through progressive home exercise program incorporating cardiovascular system.
Hip strengthening tips for osteoarthritis pain:
1. Each exercise should be pain-free. If there is pain or clunking then make the movement smaller.
2. Strengthening should be started in non-weight bearing (NOT STANDING) positioning. They should be progressed to weight-bearing (STANDING) positions at some point.
3. Using elastic bands and/or tubes is efficient and safe
4. Isometric strengthening helps build awareness and muscle coordination. These isometric contractions can be a good starting point if you are in the degenerative stage of the disease.
5. Aquatic exercise can be helpful to get started. Be careful: you still have to get out of the water. Many people wear themselves out in the water and then get out of the pool with more pain when trying to stand. This environment is safe and effective, but is not functional in the long-term.
6. Expect strengthening to help relieve pain. If it is not helping, you probably need guidance from a Physical Therapist.
Barefoot running has gained some popularity lately as an alternative to modern running shoes. With the release of the book “Born to run” in 2009 this movement has gained momentum. The book has helped popularize an idea that is truly nothing new and certainly not revolutionary.
It is true that societies exist around the world where people do not wear shoes and run a great deal without injury. It is true that our feet are engineering masterpieces of force distribution and shock absorption. Although these things are true they do not build an airtight case for an absolute transition to barefoot running.
Proponents of running only barefoot claim that this is a more “natural” form, causing us to strike our forefoot rather than our heel and thus propel ourselves more efficiently. They also propose that barefoot runners avoid injuries because of this natural pattern.
1) Is it a more Natural footstrike pattern: Some research has shown a difference in runners foot strike patterns when barefoot versus shoes. No research has shown any benefit to this foot strike pattern nor any reduction in injury. It seems that by striking with only the forefoot it shifts the forces makin us more susceptible to injury in a different part of the foot.
2) Are injuries less frequent: This fact has not been substantiated and only theoretical claims have been made by the barefoot running community. It would make sense that running on soft surfaces (i.e. trail running, grass or sand) would decrease the shock forces in the whole body, but running on asphalt and concrete has not been studied to show any differences between barefoot and shod running.
3) Is barefoot running for everyone?: Like any other form of exercise there will be people who truly benefit from barefoot running and those that will not. It has not been established that barefoot running will prevent injuries or rid you of chronic pain. There is no conclusive evidence to suggest that barefoot running will make you faster (are any elite long-distance runners going barefoot?) or more efficient in the long-term.
4) Is it safe to try barefoot running?: For most people it is perfectly safe to try. Like the proponents say, you will likely have sore feet and legs at first because you will use different muscles than you have before (especially if you run a significant distance). For some people with propensity towards stress fractures (i.e. osteoporosis) or who already have foot deformity (ie. Bunion) it is more of a risk.
5) In terms of development, should children run/play barefoot?: There is no conclusive evidence in this area. No researcher has shown any long-term benefit from restricting children from footwear.
*An article in the Journal of the American Podiatric Medical Association (May-June 2011) summed up the research to date regarding barefoot running: Barefoot running has been shown to be different but not better.