Functional treatment for Hip Osteoarthritis
Osteoarthritis is the most common form of arthritis that affects millions of individuals every year. It happens when the cartilage starts wearing down and cause pain, swelling, crepitus, and limited range of motion in the joints that can lead to functional impairments. It is most commonly involving the following joints: hip, knee, hands, back, and neck. The prevalence of developing OA is increasing with the age of individuals. There are variety of different ways to treat and cope with hip OA that I will discuss them below:
This is also known as “hydrotherapy” or “pool therapy” where individuals start doing different range of motion, strengthening, dynamic, and aerobic exercises in a temperature that was set between 32-36 degrees. Out of the six RCT’s that were included in the systematic review, four studies were including both hip and knee OA patients, one study had hip OA patients only and one study focused on knee OA patients. All of these studies had less than 50 participants. Effectiveness of aqua therapy for hip OA resulted that there is lack of high evidence; however, aquatic exercise does appear to have some short term effects. It can slightly decrease pain level and slightly improve function over the period of 3 months.
Glucosamine can be found naturally in the body but can be also taken as supplements to build cartilage blocks. It can come in different forms such as sulphate, chondroitin, and hydrochloride. The usual dose that people in this study took was 1500mg a day for about 6 months. This study included 25 studies with 4963 patients that looked at efficacy of glucosamine and found that it is better than placebo for 22% decreasing pain level and increasing 11% in function. However, the result for WOMAC pain, function, and stiffness did not reach the statistical significance with non Rotta preparation. Study showed that glucosamine was better than placebo for pain reduction and functional improvement. People who took water pills had a score of 7 points on a 0 to 100 scale. However, pain may get better by 10 more points with Rotta brand of glucosamine when being compared with water pills. I believe Glocosamine is quite safe and has shown to have very rare and few side effects (stomach pain, and other joint pain). There are two RCTs that used Rotta preparation showed that glucosamine can slow down radiological progression of knee OA over a 3-year period. Hence, I would recommend taking Rotta glucosamine to my patients for at least period of 6 months (1500mg daily) who have hip/knee OA (relative risk ratio %99; 95% CI). However, if they happen to have side effects or did not report any benefit after taking it for 6 months’ period, I would ask them to stop taking it.
Manual, manipulative therapy and rehabilitation:
78 patients with symptomatic knee OA participated and they were randomly placed in three different groups: The purpose of this study was to compare manual manipulative therapy (MMT), rehabilitation program, and combination of MMT and rehabilitation program. There was statistically Significant change in all groups from baseline to week 5 and it showed benefit to all individuals with mild/moderate knee
OA. There were follow ups at 1-3- and 6 months follow up. Participants were between 38-80 years who has knee pain for more than 1 year. They excluded any severe knee OA, pathologies or psychiatric disorders. The participants went over 6 treatment sessions over 4 weeks and each treatment was about 20 minutes long. Treatment included joint manipulation, mobilization, soft tissue treatment. Rehabilitation included patient education, exercise prescription such as squats and step-ups, soft tissue therapy, and passive stretches.
The greatest change was reported in group 1 and 3 where the practitioner applied some treatment on 6 different sessions. I believe combination of manual therapy and exercise is an ideal approach for patients with mild/moderate hip/knee OA.
1.Bartels EM, Lund H, Hagen KB, Dagfinrud H, Christensen R, Danneskiold-Samsøe B. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews 2007, Issue 4
2.Towheed T, Maxwell L, Anastassiades TP, Shea B, Houpt JB, Welch V, Hochberg MC, Wells GA. Glucosamine therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2005, Issue 2
3.French HP, Brennan A, White B, Cusack T. Manual Therapy for Osteoarthritis of the Hip and Knee – A Systematic Review. Manual Therapy 2011. 16; 109-117