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Developed hip pain during your covid isolation? Avoid these 3 exercises!

Developed hip pain during your covid isolation? Avoid these 3 exercises!

Have you developed some new aches and pains or aggravated some old ones after following free online exercise classes? Or perhaps you have increased your normal activity level by doing more walking, running, stair or hill climbing to try and stay fit and healthy during the COVID-19 restrictions. At Physiotec, we have seen an increasing number of people who have developed or aggravated their hip pain during the covid-crisis. In fact, pain over the outer side of the hip is one of the most common problems we see. This is usually related to a condition called gluteal tendinopathy, also sometimes referred to as trochanteric bursitis.

There are some challenges with going it alone with a new exercise program. If you do have a pre-existing or new injury, how do you know:

  • which exercises or programs are the best options for you?
  • what are the correct techniques to use?
  • how do you make the exercise harder or easier if you need to?
  • how do you alter your program if you develop pain?

If you are struggling with any of these challenges, a physiotherapist can assist with either a telehealth or face-to-face consultation. For many painful conditions, good education and advice will help you stay active while minimising the risk of pain or injury.

For specific hip conditions such as gluteal tendinopathy or trochanteric bursitis, many factors influence the health of the tendons and bursae at the side of the hip. Either too much or too little stimulus may result in changes in tendon health and consequently, your ability to perform normal activities without pain. Too little load may be associated with a sedentary lifestyle where the muscles and tendons aren’t working enough. Too much load may be associated with a quick increase in activity (either a new or existing activity). Particular sustained positions or repetitive movements may also contribute to reduced tendon health or the development of pain over time.

3 Exercises to avoid when you have gluteal tendinopathy

 

So, who is most affected with this condition and why? 18% of the population aged over 50 suffers with this type of hip pain, and women are 3 times more likely to develop the condition than men. While the causes are often multifactorial, a change in hormones is thought to contribute to the development of tendon changes. A common story we hear from our patients is that there was an onset of pain associated with a combination of the following:
• Peri or post menopause and the associated hormonal changes
• Weight gain during this time, and
• A sudden increase in activity levels to counteract the weight gain

It should be said that changes in the health of tendons and bursae are not necessarily painful. Pain may develop if weakened tendons are unable to cope with their workload. Pain is often triggered by sudden increases in activity levels, where the tendons have not been given adequate time to adapt to the new loads. Examples include taking up a new sport or activity, or returning to activity after illness, injury or pregnancy. Going on holidays and walking lots of hills or stairs or for long distances along the beach may cause a problem. Sudden loads on the tendon during a slip or fall can also result in pain and injury, or a gain in weight may add more load to these tendons that support your bodyweight when standing on one leg.

How do you know if you have a gluteal tendinopathy or trochanteric bursitis?

Pain over the side of the hip due to gluteal tendinopathy or trochanteric bursitis

Do you have pain over the side of the hip with any of the following?
• Lying on your side
• Walking up hills or stairs
• Standing on one leg
• Sitting in low chairs especially with crossed legs
• Getting up from chairs and during the first steps

If you answered yes to most of these, you may have gluteal tendinopathy or trochanteric bursitis. The good news? Education and exercise provided by a physiotherapist provides an 80% success rate, with significantly better outcomes than a corticosteroid (cortisone) injection or a wait and see approach (i.e. basic advice and monitoring the condition)*. The even better news? Dr Alison Grimaldi was instrumental in the development of this successful program and all physiotherapists at Physiotec have been trained in the protocol.

We are now back in clinic for face to face consultations – if you have flared or developed hip pain (or any other pain), give us a call to book in! We are also still offering Telehealth consultations for those who are continuing to isolate or those who find it more convenient to attend an appointment ‘virtually’. You can read more about our Telehealth service here.

 

*Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B., 2018. Education plus exercise versus cortico- steroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. May 2;361:k1662. doi: 10.1136/bmj.k1662.

Osteoarthritis and Running

Osteoarthritis and Running

Does running accelerate the development of osteoarthritis?

There are so many misconceptions about running and how bad it can be for your joints. You may have

heard many friends and family members comment on this and they may have even tried to convince you to stop running and go swimming instead. Here is what the scientific research tells us so far:

Osteoarthritis (OA) is a musculoskeletal condition that involves degeneration of the joints and impact during weightbearing exercise such as running and may contribute to joint loads. There is very little evidence however, that running causes OA in the knees or hips. One study reported in 1985 by Sohn and Micheli compared incidence of hip and knee pain and surgery over 25 years in 504 former cross-country runners. Only 0.8% of the runners needed surgery for OA in this time and the researchers concluded that moderate running (25.4 miles/week on average) was not associated with increased incidence of OA.

In another smaller study of 35 older runners and 38 controls with a mean age of 63 years, researchers looked at progression of OA over 5 years in the hands, lumbar spine and knees (Lane et al. 1993) . They used questionnaires and x-rays as measurement tools. In a span of 5 years, both groups had some participants who developed OA- but found that running did not increase the rate of OA in the knees. They reported that the 12% risk of developing knee OA in their group could be attributed to aging and not to running. In 2008, a group of researchers reported results from a longitudinal study in which 45 long distance runners and 53 non-runners were followed for 21 years. Assessment of their knee X-Rays, revealed that runners did not have a higher risk of developing OA than the non-running control group. They did note however, that the subjects with worse OA on x-ray also had higher BMI (Body Mass Index) and some early arthritic change in their knees at the outset of the study.

Is it better to walk than to run?

It is a common belief that it must be better to walk than to run to protect your joints. In a recent study comparing the effects of running and walking on the development of OA and hip replacement risk, the incidence of hip OA was 2.6% in the running group, compared with 4.7% in the walking group (Williams et al 2013). The percentage of walkers who eventually required a hip replacement was 0.7%, while in the running group, it was lower at 0.3%. Although the incidence is small, the authors suggest the chance of runners developing OA of the hip is less than walkers.

In the same study, Williams and colleagues reinforced that running actually helped keep middle-age weight gain down. As excess weight may correlate with increased risk of developing OA, running may reduce the risks of OA. The relationship between bodyweight and knee OA has been well-established in scientific studies, so running for fitness and keeping your weight under control is much less likely to wear out your knees than being inactive and carrying excess weight. 

Is there a limit?

Recent studies have shown that we should be doing 30 minutes of moderate exercise daily to prevent cardiovascular disease and diabetes. But with running, researchers still have not established the exact dosage of runners that has optimal health effects. Hansen and colleagues’ review of the evidence to date reported that the current literature is inconclusive about the possible relationship about running volume and development of OA but suggested that physiotherapists can help runners by correcting gait abnormalities, treating injuries appropriately and encouraging them to keep the BMI down.

We still do not know how much is “too much” for our joints. However, we do know that with age, we expect degenerative changes to occur in the joints whether we run or not. Osteoarthritis is just as common as getting grey hair. The important thing is that we keep the joints as happy and healthy as possible.

How do you start running?

If you are not a runner and would

like to start running, walking would be a good way to start and then work your way up to short running intervals and then longer intervals as you improve your fitness and allow time for your body to adapt.

Therfore, running in general is not bad for the joints. It does not seem to increase our risk of developing OA in the hips and knees. But the way you run, the way you train and how fast you change your running frequency and distance may play a role in future injuries of the joints.

But that’s another story. Watch this space for more running gems….

Image by: Pixabay

References:

Cymet and Sinkov 2006. Does Long Distance running cause OA. The Journal of the American Osteopathic Association, June 2006, Vol. 106, 342-345.

Hansen et al 2012. Does Running cause osteoarthritis in the hip or knee?. Physical Medicine and Rehabilitation. 4 (5) 117-121.

Lane et al. 1993. The Risk of OA with Running and Ageing. Year Longitudinal Study. Journal of Rheumatology (20) 461-468

Sohn et al. 1985. The Effect of Running on pathogenesis of OA in hips and knees. Clin Orthop Res (9) 106-109

Williams 2013. Effects of Running and Walking on OA and Hip Replacement Risk. Med

Sci Sports Exerc. 45 (7) 1292-1297