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Managing an arthritic hip for young and old

By Lorraine Carroll
The hips, knees and ankles are the main weight bearing joints of the body. Though they are meant to last a lifetime, it is becoming more common to see younger people present with early signs of wear in one of these joints.

Through trauma, cumulative overloading such as road running over many years or genetics, articular cartilage covering the moving surface of the joint can begin to thin long before old age.
Articular cartilage is a shock absorbing layer which covers every moving part of the joint. It provides a friction-free surface to assist smooth, catch-free motion.

It also has shock absorbing properties, helping to protect the inside of the joint. Thinning is both the cause and effect of joint ‘wear and tear’. As the process worsens it gradually evolves into arthritis.

It used be thought that once the wear process started, arthritis was inevitable and that ultimately joint replacement by surgery would be necessary.

Thankfully, our understanding of how the wear process proceeds means we can positively affect the outcome. It is now possible to at least slow down the thinning process and in some cases actually reverse problems within a wearing joint.

The first thing is to recognise early symptoms of lower limb joint wear: local joint stiffness and difficulty in some movements. Symptoms often present a specific pattern with stiffness first thing in the morning. The middle of the day can feel quite good. Increasing aching pain (more than stiffness) comes on towards the end of the day.

Certain physical activities will repeatedly cause increased pain or stiffness. An acute bout of morning stiffness may occur after an exceptionally hard training session the day before.

This symptom pattern is being seen more commonly in 30+ year olds. Often this can be traced back either to excessive physical activity like significant road running over several years or a particular trauma such as a bad fall in the past.

So, if this all sounds familiar, what can you do? Looking after the sore joint is the first thing. If you are overweight, losing weight helps immediately by reducing the weight of loading on the joint.

Exercise is an essential component of a successful weight loss programme, but if you have a wearing hip or knee you need to modify your exercise to protect the thinning cartilage.

Weight bearing, high impact or high load exercises can wear the joint surface more quickly. Swap from walking or running to cycling or swimming. In the gym, choose the exercise bike and cross trainer instead of the treadmill and stepper. This reduces both shock to the joint and extra loading.

Even changing the time of the day at which you exercise can make a difference. First thing in the morning, when the joint feels stiff, is not the ideal time for heavy exercise. If possible it is optimal to take exercise in the middle of the day or early evening.

The floor surface where you exercise can be a help too. A sprung floor, grass or artificial turf is kinder than unyielding tarmac or concrete. If you are on your feet a lot, shock absorbing footwear makes good sense.

Simple over-the-counter medication is also useful when symptoms are present.
Your GP, pharmacist, podiatrist and local Chartered Physiotherapist can each be worth consulting for best advice earlier rather than when the cartilage wear becomes critical.

Essentially, the message is to deal with grumbling joint symptoms early to prevent arthritis later.

Copyright TherapyXperts

Lorraine Carroll is a Consultant Chartered Physiotherapist and practices at TherapyXperts Mount Merrion. Tel: 0818 333 611.
TherapyXperts: Registered business address: Kandoy House, 2 Fairview Strand, Fairview, Dublin 3, Ireland|Phone: +353 818 333 611|Email: info@therapyxperts.ie
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