So to say this months blog took me down a rabbit hole would be an understatement! It all started with our illustrious Editor and chief of the Voice, Gary Brindle. Gary has given his permission for me to tell his story and has the control to edit it anyway!
A short while ago Gary called and asked if we could help him with a few mechanical pains that he has been having. Now some were simpler than others and as we managed to improve his symptoms it quickly became clear that Gary had a hip problem.
With a combination of hip pain with reduced mobility and function we decided to X-ray Gary.
Luckily we have a high quality digital Xray facility on site at Cleve Chiropractic, which is the gold standard for diagnosis of hip Osteoarthrits (OA) otherwise known as wear and tear.
Sure enough Gary has some mild to moderate OA in his hip which is clearly leading to his symptoms. With this firm and quick diagnosis under our belt, I promptly referred Gary upstairs to see our Olympic Physio Keith. Keith is an all singing all dancing, prescribing physiotherapist who can also do ultrasound guided injections alongside his regular work.
Indeed this is the majority of Keith’s work these days. Keith injected Gary with a steroid to confirm that his symptoms were coming from the hip, if Garys symptoms reduced or disappeared then the hip is definitely the culprit, if not then we keep looking. As night follows day, Gary’s hip pain disappeared so we are now super confident of the diagnosis. At this junction, it is important to mention that we are now in the world of trying everything to at least delay or hopefully avoid a hip replacement. Whilst hip replacements are very successful, it is a major surgery with significant recovery that most people would rather not
rush into.
The window of opportunity with no pain after a steroid for Gary is often short lived, a few weeks to months until the steroids affects wear off, so we commence a good programme of rehabilitation. As Gary’s function starts to return alongside his exercises and treatment, so eventually does his pain, but don’t worry we still have a good plan. The first thing we do is to take advantage of our shiny brand new traction machine. We brought the traction machine into the clinic back in
January this year mainly for the purpose of decompressing spines for those painful neck and low back disc injuries that we treat nearly every day, and for the that the machine is an unsurpassed device in relieving disc injuries and helping the majority of patients avoid surgery.
Now I have only ever tractioned hips manually (using my hands) and its practically hard to do. It is hard to generate the force required and to be consistent, therefore we don’t really use it much as a treatment option. I dare to say that that traction is not in wide spread use for OA hips for this reason. Due to this new capability in the clinic I have embarked on a literature review of the evidence for traction of OA hips and what I found was enlightening!
The research goes back a long way and shows that traction of a stiff OA hip is more effective that rehab, however a combination approach is best. It finds that machine based traction provides a consistent outcome and is therefore better than the varying experiences of therapists. It can reduce pain and increase both mobility and function.
The more traction you have the better the effect and the more traction is combined with your treatment the less treatment that you need! An excellent study showed that 10 treatments of traction provided excellent outcomes in the majority of patients at 12 weeks, at least in the short to medium term. What’s more, none of the research that I found showed any negative side effects of hip or even knee traction and hip traction can also significantly reduce any referred knee pain.
Now we also know at the clinic that we get very good outcomes injecting Hyaluronic Acid (HA) into OA joints including hips and knees. HA acts as a long lasting lubricant and reportedly slows down the progression of OA whilst improving pain levels and function. So there is no reason that we cannot combine these approaches safely.
So in summary from my experience, working in an evidence based way, if you think that you may have wear and tear in your hip, at Cleve Chiropractic and Physiotherapy Centre in Mangotsfield, we are able to offer a personalised combination of care consisting of:
- · An X-ray of your hip for immediate diagnosis
- · Confirm with an ultrasound guided steroid if appropriate
- · Provide a rehab plan including hands on treatments and the anti gravity treadmill.
· Traction the hip
- · Inject HA to lubricate the joint which can last for many months to over a year
- · Some or all of these approaches may be appropriate for you. Speak to us for a tailored care programme.
So if you or somebody you know is worried about their hip and would like to talk to us about it, book in with any of our physio’s, chiros or sports therapists and we can help you find the right route for you. The treatment including traction for Gary is in it’s early stages but he can tell you that he is already getting some relief from the traction and fingers crossed if we continue down this path we will get him back to his old self in no time.
Photo by Ruben Ramirez on Unsplash
