Hip joint osteoarthritis is among the most common joint disorders with 87,733 hip replacements recorded by the national joint registry in 2016. Research studies suggest that the incidence of lower back pain accompanying hip arthritis is in the range of 20-40% of cases.
Arthritic changes to the cartilage surface lining the head of the femur (thigh bone) and the acetabulum (joint socket within the pelvis) cause gradual thickening and shortening of the hip joint capsule (ligament like tissue encasing the joint). The resulting reduction in flexibility at the hip joint impacts upon surrounding muscle tissue often causing shortening and decline in strength and control, thus accelerating the rate of damage to the cartilage surfaces.
The long term effect of reduced mobility at the hip joint is often over use of neighbouring joints, namely the knees and lower back. Hip rotation is often most affected by the hip joint soft tissue changes, and the movement that appears most limited when we assess hip arthritis. The consequence of this when turning one’s body is that the ball and socket joint of the hip will contribute only little towards the turn. Often unknown to the individual, the lumbar spine and knees will over contribute and experience additional torsion.
The same is true of bending forwards when the hinging motion of the hip is limited or poorly controlled. The effect of shortening or tightness in muscles over the front of the hip can cause lumbar lordosis, an exaggerated curvature of the lower spine, and compression of structures such as inter-vertebral discs of the spine, and neighbouring nerves.
Physiotherapy is recommended as a first-line of treatment for hip arthritis. Exercise and manual therapy can help restore length and flexibility to soft tissues and re-develop a range of muscular control.
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