What is hip osteoarthritis?
Osteoarthritis of the hip is a degenerative joint disease that many dancers encounter in their late 40s, or older. It is a progressive disorder of the hip joint caused by gradual loss of the joint cartilage and deteriorating deformation. The main symptoms to look out for are pain, stiffness and progressive disability due to restricted joint movement.
How can it occur?
Osteoarthritis occurs when the cartilage that covers the ends of the bones in your joints gradually deteriorates. The role of the cartilage is to allow smooth joint movement, without friction, so when the slick surface progressively diminishes, as in osteoarthritis, this can cause significant pain and impaired movement.
Osteoarthritis of the hip can be brought on by intensive dance training over many years. Your risk is increased if you have hip joint bony abnormalities (hip dysplasia), or if you have previously had severe injuries or operations on the labrum or the joint cartilage (hip arthroscopy). Dancers should therefore take all possible precautions to avoid overuse and injury. Other contributing factors to osteoarthritis are poor core stability or balance, poor biomechanics or foot posture (flat feet) and poor nutrition or inappropriate diet.
Scoliosis is often associated with pelvic dysfunction (“blocked pelvis”) and muscle dysfunction of the core and leg muscles, a condition that can lead to excessive mechanical stress on the hip joint.
Dancers with anatomically limited turnout have an extremely high risk of developing hip osteoarthritis as they often compensate for their lack of hip external rotation by tilting their pelvis forwards. This puts a significant amount of stress on the labrum and the joint cartilage, especially when compensation for this malalignment fails and muscles around the hip get into dysfunction.
What are the typical symptoms of hip osteoarthritis?
Typical symptoms of hip osteoarthritis are pain and stiffness. The pain associated with it is typically felt in the groin, front of the hip or the buttock region. Occasionally pain may be radiating down to the thigh or knee. Pain may occur particularly with a lot of walking or dancing. It usually gets better when you reduce activity. Stiffness occurs especially after rest, but will get better after you start moving again.
You’ll probably find that your pain will vary and that you have good days and bad days, sometimes depending on how active you’ve been. Some people find that changes in the weather, especially damp weather and low pressure make their pain and stiffness worse.
With progressing osteoarthritis, your hip may show significant deformation. The femoral head may lose its shape and bony spurs called osteophytes may form along joint margins and limit joint movement.
How can hip osteoarthritis be diagnosed?
Your doctor will examine your hip and review your symptoms as well as your current daily life activities. He will especially check for pain in your groin or thigh that radiates to your buttocks or your knee. He will also put a focus on joint range of motion, leg alignment and knee stability. X-rays are the most useful tests to confirm an osteoarthritis. They may show present bone deformation such as osteophytes and narrowing of the space between bones. X-rays aren’t a good indicator of how much pain or disability you have. Some people have a lot of pain from minor joint damage but others only have little pain from severe damage. Your doctor may suggest to have an MRI-scan of your hip, which will show the soft tissues (e.g. cartilage and labrum) and changes in the bone (e.g. stress reactions) that can’t be seen on standard x-rays.
This MRI scan of the hip shows a severe hip arthritis. You can see a loss of joint space between the acetabulum and the femoral head due to cartilage degeneration as well as osteophytes that have formed on the femoral head. The joint is severely inflamed and shows bony stress reactions (bone bruises).
What treatment options are there?
Depending on the level of pain and damage suffered by a patient, there are different treatment options. Non-operative treatment is often limited by structural deformation of the joint due to the ongoing degenerative process. However, muscle dysfunction and dysbalance are important factors, influencing the function of an arthritic hip and can be addressed specifically to improve pain and function.
Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the treatment process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with these functional problems.
If pain is the limiting factor to an active rehabilitation approach, the use of anti-inflammatory drugs and steroid injections to the hip may be recommended. Also, aquatic training can be a good way to start training the hip in these situations.
Manual medicine and especially deep myofascial release treatment can be used to address present joint and myofascial dysfunction. Restriction of the fascia plays an important role with pain in osteoarthritis and can be addressed effectively with myofascial release techniques. Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
Surgery may be recommended if you have severe pain or mobility problems and non-operative treatment has failed to improve the situation. There are several kinds of replacement hip joints as well as different surgical methods. Your doctor and orthopedic surgeon will help you to choose the most suitable option, taking into account the condition of your hip and your general health.
Do you think that you might have hip osteoarthritis and want to have it sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.