By Cliff Collins
Article published in the Scribe Newspaper
Tony Rocklin, PT, DPT would like to help end the vicious cycle that patients with hip osteoarthritis experience and move them toward greater mobility and pain relief.
Rocklin, a certified orthopedic manual therapist and director of Therapeutic Associates’ downtown Portland clinic, said the traditional model of treating such patients – including giving pain medications and encouraging patients to exercise and, when applicable, to lose weight – has drawbacks as well as a low compliance rate.
Medications can be important in helping delay surgery, but they also have negatives, including cost, side effects and potential dependence. And when patients try to exercise, they often experience pain that leads them to cease trying. That can end up causing the patient to have more health problems. The solution is to interrupt that vicious cycle by applying a newer approach, he said.
That model incorporates manual therapy with therapeutic exercise and patient education. “In order to avoid loss of function and the plethora of co-morbidities that follow lack of exercise, we need to get patients moving,” he said.
Osteoarthritis is the most frequent cause of musculoskeletal disability and one of the most common causes of disability resulting in limited activities of daily living. According to research presented by the American College of Rheumatology, about 25 percent of Americans can expect to develop osteoarthritis of the hip during their lifetime.
Prevalence is rising dramatically and expected to continue to rise over the next few decades owing to an aging population and an increase in obesity rates. Nearly 32 percent of obese adults have arthritis, as do 22 percent of people who are overweight but not obese; that compares with 16 percent of those of normal weight.
The key to getting the patient moving again is to “mobilize the joint capsule,” Rocklin said. Joint mobilization has to precede therapeutic exercise in order for the latter to be effective. Some physicians will refer hip osteoarthritis patients to physical therapy, but many doctors may tell the patient, “Physical therapy will not help arthritis,” he said.
“But it absolutely will help the secondary effects of osteoarthritis, and that is what is disabling to people. You can get them moving. We can help them.”
Rocklin said not all physical therapists are experienced in administering manual therapy, but some have advanced training in the method.
The physical signs and symptoms of hip osteoarthritis occur as a result of the secondary changes to the joint, he pointed out. As the disease progresses, many individuals eventually will have intolerable pain and lose their overall functional ability, independence and quality of life.
Once all conservative measures have been exhausted and there are no contraindications, joint replacement surgery is appropriate and has been shown to be highly effective in improving pain and function, he said.
However, data indicate that only 12 percent of patients seeking help for hip pain end up having hip replacement with three years, and 22 percent within six years. Thus, the patients who are not yet candidates for surgery represent the majority of patients seeking primary care for hip pain, including patients with hip osteoarthritis.
“Therefore, there will be literally millions of individuals suffering with some form of personal disability, but not severe enough to warrant surgery,” he noted.
Many studies have shown that therapeutic exercise programs can be highly effecting without using painkilling drugs. When used alone, it has been found to help biomechanically unload intra-articular pressure from within the hip joint, leading to decrease pain, he said. This unloading occurs through improved flexibility, increased strength and decreased overall weight of the individual.
Newer studies investigating the combination of manual therapy techniques and therapeutic exercise have shown excellent results, said Rocklin, and the combination of those with patient education “shows the greatest promise for conservative treatment of hip osteoarthritis. By increasing the patients’ mobility and decreasing their pain, they are better able to perform their long-term exercise routine for decreased weight, increased flexibility and increased biomechanical strength.”
These conservative measures can lessen the need for medications, and improve patient morale and quality of life, he said. Consequently, the patient may more comfortably maintain functionality while waiting for or delaying total joint-replacement surgery.