Exercise and physical therapy fail to restore muscle strength in hip osteoarthritis patients
In this article we will discuss why exercise and physical therapy fail to restore muscle strength in hip osteoarthritis patients.
Four months of physiotherapist-supervised, progressive, moderate, and strength training was less effective than thought for improving muscle strength and power in patients with hip osteoarthritis
This is very typical of patients we see. They have been to physical therapy for months and nothing seems to have improved. How can this be?
Doctors at the University of Copenhagen published their study in the October 2017 edition of Physiotherapy research international in which they examined patients with hip osteoarthritis. Among the symptoms that these patients exhibited were noted impairments in muscle function (muscle strength and power) and hip range of motion.
So they set about to compare the short- and long-term effects of 4 months of physiotherapist-supervised strength training, physiotherapist-supervised Nordic Walking, or unsupervised home-based exercise on muscle function and hip range of motion in patients diagnosed with hip osteoarthritis.
There results were somewhat surprising, the treatments did not show any significant between-group differences for improvements in muscle strength and power or hip range of motion at any time points.
The researchers had to conclude:
- Four months of physiotherapist-supervised, progressive, moderate, and strength training was less effective than thought for improving muscle strength and power in patients with hip osteoarthritis who are not awaiting hip replacement. Our results may indicate that in these patients, improvements in disability are not necessarily dependent on improvements in strength and power or hip range of motion.(1)
What does all this mean? These are problems that clearly need to be addressed to reduce pain and disability.
- Loss of strength, muscle power and range of motion are clearly indicators of an impending hip replacement
- These are problems that clearly need to be addressed to reduce pain and disability.
In patients with degenerative hip disease, where connective tissue such as the tendons that attach hip muscles to the bones are damaged. It is very difficult to derive benefit from strength training where resistance is needed because the tendons that help provide that resistance are weak.
People were giving up on the exercise
This was not the only study to acknowledge that the benefits of exercise maybe limited in people with hip osteoarthritis.
A team of researchers from Oslo University in Norway evaluated the long-term effect of exercise therapy and patient education on range of motion, muscle strength, physical fitness, walking capacity, and pain during walking in people with hip osteoarthritis.
Published in the journal Physical Therapy, the key to this study was the focus on walking as the exercise. Six minutes of walking every day. What the researchers found was no improved range of motion, muscle strength, or how much distance during the 6 minute walk the patient could cover. Another factor the researchers noted was 53% rate of adherence to the exercise therapy program. People were giving up.(2)
Inability of benefit from strength training is a clear sign of total hip joint degeneration
It is difficult to isolate on one part of the pelvic-hip-spin complex when treating a patient with problems of Gluteus Medius tendinopathy.
- When the hip joint region becomes unstable, the muscles, including the Gluteus Medius, tries to create stability by tensing. As is the case with any joint of the body, ligament and tendon instability initiates muscle tension in an attempt to stabilize the joint.
- This compensatory mechanism to stabilize the hip joint eventually causes the gluteus medius, piriformis muscle, and iliotibial band/ tensor fascia lata muscles to tighten because of chronic contraction in an attempt to compensate for hip joint instability. The contracted gluteus medius can eventually irritate the trochanteric bursa, causing a trochanteric bursitis.
The constant strain on the muscles to produce strength and stability in the hip are actually causing more degenerative problems.
Repairing the tendons so physical therapy can work
In our article, Tendinopathy injections and treatments, you can read how a multi-national team of researchers including those from Rutgers University, Virginia College of Osteopathic Medicine, and the University Regensburg Medical Centre, in Germany tested the effects of Prolotherapy on tenocytes, tendon cells. What they were looking for was how did Prolotherapy heal tendons.
Do you have questions about loss of muscle strength in the hip as it relates to osteoarthritis? You can get help and information from our Caring Medical staff.
1 Bieler T, Siersma V, Magnusson SP, Kjaer M, Beyer N. Exercise induced effects on muscle function and range of motion in patients with hip osteoarthritis. Physiotherapy Research International. 2017 Oct 3. [Google Scholar]
2 Svege I, Fernandes L, Nordsletten L, Holm I, Risberg MA. Long-term effect of exercise therapy and patient education on impairments and activity limitations in people with hip osteoarthritis: Secondary outcome analysis of a randomized clinical trial. Physical therapy. 2016 Jun 1;96(6):818-27. [Google Scholar]