[Physio Discussed] Exercise as medicine: tackling hip pain and OA effectively with Dr Jo Kemp and Dr Josh Heerey
Aug 14, 2024
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In this engaging discussion, Dr. Jo Kemp, a Principal Research Fellow and expert in hip pain, joins Dr. Josh Heerey, a leading physiotherapist in hip osteoarthritis, to explore effective treatments for hip pain and osteoarthritis. They delve into the critical role of exercise as a primary intervention and how it can sometimes be more beneficial than surgery. The conversation also highlights the impact of hip morphology on treatment decisions and emphasizes the importance of managing patient expectations when it comes to imaging and personalized care.
Exercise is vital in managing hip osteoarthritis, significantly reducing surgery risks through structured programs and tailored approaches.
A comprehensive treatment strategy for hip pain should integrate education, exercise, weight management, and understand the nuances of hip morphology risk.
Deep dives
Importance of Exercise for Hip Osteoarthritis
Exercise plays a crucial role in managing hip osteoarthritis (OA), with evidence supporting both land-based and water-based exercises, particularly in advanced cases. A systematic review indicated that a structured three-month exercise program could reduce the risk of hip replacement by approximately 40% and delay the need for surgery by nearly two years. However, practitioners often encounter patients who present when their condition has become more severe, making exercise less effective. As a result, it is essential for clinicians to recognize that not all patients will respond similarly to exercise and to be open to incorporating other treatment modalities.
Multi-faceted Treatment Approaches
Treatment for hip OA should adopt a comprehensive approach that includes education, exercise, and weight management as first-line options. The clinical practice often deviates from these recommendations, with many patients receiving referrals for imaging or medication instead of exercise-based therapies. A pyramid model of treatment emphasizes that a significant portion of care should focus on lifestyle modifications alongside exercise. This discrepancy highlights the need for practitioners to align their treatment strategies with established guidelines to better address the needs of patients.
Understanding Hip Morphology and OA Risk
Hip morphology can increase the risk of developing osteoarthritis, but this does not guarantee that all individuals with such traits will experience the condition. It's crucial for clinicians to differentiate between relative risk—indicating a higher likelihood of OA development—and absolute risk, which represents a smaller portion of affected individuals. Communicating these distinctions to patients helps them manage expectations and reduces anxiety about their conditions. Emphasizing that not everyone with particular hip shapes will progress to OA is vital in encouraging informed decision-making about treatment options.
Holistic Assessment of Hip Pain Symptoms
The management of hip pain should encompass both intra-articular and extra-articular sources, as pain can stem from various factors beyond the joint itself. Clinicians should be thorough in considering potential referral pain from adjacent structures like the lumbar spine and pelvic areas. Effective evaluation includes recognizing contributing factors, whether mechanical, lifestyle-related, or psychological, and tailoring treatment accordingly. A comprehensive assessment strategy ensures a more effective treatment plan, aiming to address the full context of the patient’s symptoms and their underlying causes.
Introducing our new, longer form podcast, Physio Discussed, where 2 expert guests and our host explore everything you need to know about your favourite topics!
In this episode we dive deep into hip pain and hip osteoarthritis. We discuss:
When can you consider pharmacological treatments in a patent with early hip OA/OA.
What role does hip morphology play when considering treatment options
Will all patients with FAI syndrome and hip dysplasia develop hip osteoarthritis?
Does exercise have a role in treating hip pain in younger people, if pain is coming from structural things like labral or cartilage tears? How can exercise work in this scenario? Why would you choose exercise over surgery?
What is the evidence for exercise and does this type of exercise matter?
Are there other things alongside exercise that are important? - exercise different in younger people than older people with hip OA?
Want to learn more about hip osteoarthritis? Dr Jo Kemp has done a brilliant Masterclass with us called, “Hip Osteoarthritis: Optimising your Assessment and Treatment” where she goes into further depth on all things assessment and treatment of hip osteoarthritis.
Associate Professor Joanne Kemp is a Principal Research Fellow at the La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia.She is a titled APA Sports Physiotherapist with over 30 years of experience and has consulted to many National Sporting Organisations on the area of hip pain.
Dr Joshua Heerey is recognised internationally as an expert in the diagnosis and management of hip and groin conditions. Dr Heerey is a physiotherapist and Hip Osteoarthritis Research and Development Lead at La Trobe University's Sport and Exercise Medicine Research Centre.
If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!
Our host is @sarah.yule from Physio Network
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